bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional and psychological evaluation after exclusive chemoradiation therapy in oral and oropharyngeal cancer
Authors: Zanon C. , Airoldi M. , Garzaro M. , Raimondo L. 
Published: August 2020

e17012 Purpose: The treatment of head and neck tumours often negatively affects speech, swallowing, body image and quality of life (QoL). Aim of this study was the evaluation of the impact of exclusive chemoradiation therapy (CH-RT) on QoL and psychological functioning. Patients and Methods: Twenty-eight patients, affected by a carcinoma of the oral cavity and oropharynx received exclusive CH-RT. Late effects of CH-RT and psycho-oncological assessment included: Radiation Therapy Oncology Group (RTOG) - European Organisation for Research and Treatment of Cancer (EORTC) late radiation morbidity scoring system, DISCHE morbidity recording scheme, Hospital Anxiety and Depression Scale (HADS), Montgomery Asberg Depression Rating Scale (MADRS), Mini Mental Adjustment to Cancer (MINI MAC), and EORTC QoL Head and Neck 35. Results: After a median follow-up of 42 months (range 12–60 months) moderate-severe late toxicity was as follows: taste impairment (89.20%), salivary function (82.12%), subcutaneous tissue (7.08%). Concerning dysphagia 39% of patients complained some discomfort, 28% had a more severe toxicity whereas 7% could not have an oral feeding; patients with severe dysphagia showed higher levels of anxiety (p < 0.05): dysphagia influences the QoL, fatigue and physical-social functioning. Rates of depression and anxiety were generally low: 78.6% of our sample did not show clinical relevant anxious symptoms and 82.1% of patients did not reach the threshold of an overt depression. Just a fair concordance in rate of depression between self- and hetero-evaluated scale was observed, with higher rates relieved by MADRS compare to HADS depression subscale using 8 or 10 cut-off (Cohen's k test = 0.401) Conclusions: Our data suggest low rates of anxiety and depression, in patients treated with CH-RT, with a different evaluation between self-evaluative and hetero-evaluative scales. No significant financial relationships to disclose.
A six-panel PCR of both plasma and blood for EBV-DNA as tumor marker for nasopharyngeal carcinoma patients treated in the United States
Authors: Weiss J. , Xavier M. , Tsai D. , Arnoldi S. , Sherman E. 
Published: August 2020

e17014 Background: Studies of plasma from nasopharyngeal carcinoma (NPC) patients from endemic regions demonstrate that circulating DNA derived from EBV may be used as a tumor marker, but data from non-endemic regions or in whole blood are limited. Methods: ViraCor Laboratories (Lee's Summit, MO) performed PCR for EBNA, EBER, and LMP on both plasma and whole blood of 11 NPC patients undergoing therapy at the Hospital of the University of Pennsylvania. Results were correlated with disease status via review of chart records and imaging reports. Results: 7 of 11 patients tested were positive for circulating EBV derived DNA. 2 patients were treated with induction chemotherapy with suppression to 0 copies of circulating DNA for all plasma measures, but not whole blood measures (LMP 0, EBER 100 and EBNA 200 copies for one patient and LMP 100, EBNA 100 and EBER 300 copies for the other). The first of these patients remains free of disease but the other retains a large mass believed to be active disease, but which has not grown over 8 months following therapy. 5 patients, including the 2 patients treated with induction therapy, were treated with chemoradiotherapy. PCR following therapy was negative on all plasma measures for the 4 patients who remain free of disease (at intervals of 7, 12, 13 and 16 months). 2 of these patients retained low-level EBV on at least 1 whole-blood measure–1 for EBNA alone (100 copies) and the other for both EBER and EBNA (300 and 100 copies). 2 patients were treated for metastatic disease. 3 episodes of progression were all accompanied by increases in plasma EBV (EBNA from 13,700 to 21,100 with EBER 1600 to 9400 and EBNA 1800 to 2200 to 3000 with EBER 100 to 100 to 500). Conclusions: This pilot data on a population treated in the United States is consistent with larger data sets obtained in endemic regions demonstrating that EBV is an effective tumor marker for prognosis and to follow therapy. It is the first to demonstrate greater specificity of plasma measures over whole blood measures, and it raises the hypothesis that whole blood measures may be more sensitive. Further prospective study is warranted in non-endemic populations both to validate the measure and to facilitate translational research into biologic factors driving the behavior of these tumors. [Table: see text]
Use of tumor volume as measured on F18FDG-PET/CT scan as a predictive biomarker for head and neck cancer
Authors: Choi Y. , Song M. , Seol Y. , Kwon B. , Shin H. , Chung J. , Lee J. , Lee B. , Kim S. , Sohn C. , Cho G. 
Published: August 2020

e17019 Background: Functional imaging, PET and its fusion with anatomical modalities, PET/CT promise to improve detection and characteristic disease. The objective of this study was to evaluate metabolic tumor volume as measured on F-18 FDG-PET/CT and its association with treatment response and prognosis in patients with head and neck cancer. Methods: The study population consisted of patients received neoadjuvant chemotherapy for a maximum of three cycles followed by radiation therapy. Before treatment patients were taken FDG-PET/CT scan, SUVmax, tumor volume, metastasis were recorded. Results: We enrolled 59 patients with stage III ann IV head and neck cancer. The median age was 66 years (range 47–81). There were 32 patients with stage III and 27 with stage IV. The mean SUVmax was 8.8 (range, 1.478). The mean tumor volume was 21.3 cm3 (range, 0.2–170). There was no correlation between tumor volume and SUVmax (correlation coefficient 0.295). Higher SUVmax was not associated with an increased risk of lymph node and distant metastasis at diagnosis (p = 0.968). But higher tumor volume was associated with an increased risk of lymph node and distant metastasis at diagnosis (p = 0.063). The metabolic tumor volume as measured on PET/CT scans was predictor of treatment response and disease -free survival. The response rate were 84% (21/25) for an SUVmax <5.5, 55% (19/34) for an SUVmax > 5.5 (p = 0.038). The disease free survival were 31.1month for an SUVmax <5.5, 4.6months for an SUVmax > 5.5 (p = 0.025). Conclusions: The metabolic tumor volume as measured on F-18FDG-PET/CT is a predictive biomarker of treatment response and disease free survival for patients with head and neck cancer. No significant financial relationships to disclose.
Capecitabine and cisplatyl as neoadjuvant treatment of locally advanced nasopharyngeal carcinoma
Authors: Kerboua E. 
Published: August 2020

e17036 Background: The main objective of this study is to evaluate the activity and safety of capecitabine (X) and cisplatyl (C) in patients (pts) with locally advanced nasopharyngeal carcinoma(NPC). Capecitabine was reported to have single-agent activity in advanced/metastatic NPC. Combination of X and C should provide a convenient and active regimen. Methods: Pts with undifferentiated NPC type were enrolled from July 2007 to September 2008. They received X 1,000 mg/m2orally bid on days 1–14 + C 75/m2 IV day 1 q 3W, Three cycles were administered in a neoadjuvant setting before radiotherapy. The primary endpoint was overall response rate (ORR). Results: Forty-one (41) pts have been enrolled 28 male/13 female with locally advanced NPC: 15 pts (36,6% ) were stage III (UICC 1997) 26 pts (63,3%) stage IV (n = 6 IVA and n = 20 IVB). All pts were evaluated for safety and 36 pts for response. ORR was 86% with 63,8% (n = 23) complete response (CR), 22,2% (n = 8) partial response (PR), 2 progression disease (PD) and 2 stable disease (SD). The most common grade 3/4 adverse events were diarrhea 4,8% (n = 2), neutropenia 7,3% (n = 3), thrombocytopenia 7,3% (n = 3), vomiting 9,7% (n = 4) . Two pts died from sepsis that was probably treatment-related. A hand-foot syndrome was observed in 25% of pts (grade 1/2). Conclusions: Preliminary results show that X plus C provide an active regimen with an acceptable tolerability profile as neoadjuvant chemotherapy for locally advanced NPC. This regimen requires a shorter hospital stay and is more convenient for pts compared with the gold standard 5-FU plus cisplatyl. No significant financial relationships to disclose.
Weekly cetuximab and paclitaxel combination in metastatic/recurrent squamous cell cancer carcinoma of the head and neck (SCCHN): Clinical experience of a single institution
Authors: Diaz de Corcuera I. , Serrano C. , Pérez J. , Quispe I. , Arguis M. , Muñoz E. , Benavente S. , Martínez P. , Parera M. , del Campo J. M. 
Published: August 2020

e17043 Background: Results of a recent phase III randomized study with cetuximab and platin-5FU chemotherapy support its use in recurrent/metastatic SCCHN. However, many patients (pts) are not able to be treated with platin combinations. Paclitaxel (P) and cetuximab (C) have shown an encouraging activity in a similar patients subset. We review the data of the patients treated with this schedule in our centre. Methods: From our database, we conducted a retrospective study of 20 patients with recurrent SCCHN who did not meet criteria for platin therapy and were treated with weekly P (80 mg/m2) and C (initially 400 mg/m2 followed by 250 mg/m2) until progression or intolerable toxicity. We have collected data regarding previous treatments, response rate (RR), progression free survival (PFS), overall survival (OS) and toxicity. Results: From January 2007 to November 2008, 20 patients were included (18 male, 2 female) with a median age of 63 (50–81). Oral cavity (35%) and oropharynx (25%) were the most frequent locations. Most of the pts (13/20) had been treated with previous chemotherapy combinations (range 1–3 lines). All pts were evaluable for response and toxicity. Overall RR was 45% (1CR, 8 PR) and 35% of the pts (7/10) had SD. Response in radiated areas were 35% (6/17). With a median follow up of 10 months the median PFS and OS were 6.5 and 7 months respectively. Main related toxicities (Gr 2/3) were acne-like rash (30%), asthenia (15%), anemia (10%), and mucositis (10%). Conclusions: Our analysis confirms that weekly paclitaxel-cetuximab is an effective and safety combination in metastatic/recurrent SCCHN. Treatment is very well tolerated and could be a good alternative to platin-based chemotherapy in unfit patients for this therapy. No significant financial relationships to disclose.
Role of concurrent chemoradiotherapy in organ preservation for locally advanced head and neck cancer
Authors: Savaraj N. , Dinh V. , Chua L. , Bustillo P. , Nissim K. 
Published: August 2020

e17044 Background: Optimal management for head and neck cancer is controversial. Standard of care has been surgery followed by radiotherapy, but is done with the risk of organ resection. The VA larynx study, EORTC 24891, and 91–11 US Intergroup trial have shown that chemoradiotherapy is comparable to surgery with radiotherapy in laryngeal cancers while preserving organ function. It is unclear, though, whether this could be accomplished in other tumor sites without sacrificing locoregional control and/or survival. Methods: We performed a retrospective chart review of patients who were treated at the Miami VA Medical Center with chemoradiotherapy for advanced staged head and neck cancers from 1996 to 2008. The majority of patients (84%) received 5FU and cisplatin. The choice of chemoradiotherapy was either determined by patients’ choice or their comorbidities, such as pulmonary disease and cardiac disease, precluded them from undergoing major surgery. Primary endpoints included death, relapse rates, and disease-free survival; secondary endpoints were toxicities associated with treatment and diminished organ function. Results: A total of 62 patients were included. Out of these patients, 52% had stage III disease and 50% had primary sites in the oropharynx; the remaining included larynx and hypopharynx. 20% of patients required salvage neck dissection. Complications included severe mucositis (69%), dysphagia (19% short term, 34% long term), hoarseness (13%), and dry mouth (24%). 27% had relapse of disease and median time for disease-free survival was 26 months. A total of 35 patients had died with a 2-year survival rate of 59.6%. Overall survival was best for laryngeal and oropharyngeal cancer (63 and 46 months, respectively) compared to hypopharyngeal cancer (22 months). Conclusions: Concurrent chemoradiotherapy is a valid option for treatment of locally advanced head and neck cancers especially for laryngeal and possibly oropharyngeal primaries with significant but tolerable toxicities. Although organ preservation is possible for the majority of patients with locally advanced head and neck cancer, however, the poor survival seen in hypopharyngeal cancer needs further investigation. No significant financial relationships to disclose.
Function preservation with multimodality treatment in locally advanced oral tongue cancer
Authors: Hussain R. , Jamshed A. , Rehman K. , Iqbal H. , Azhar R. , Faruqui Z. , Ahmed Q. 
Published: August 2020

e17051 Background: Total or near total glossectomy with postoperative radiation is a standard treatment option for locally advanced squamous cell carcinoma oral tongue (LASCCOT). However, the procedure is controversial due to dismal cure rates and major functional deficits that impact on speech, deglutition and quality of life. We evaluated function preservation and survival outcome in LASCCOT treated with induction chemotherapy, limited surgery, and postoperative radiation/chemoradiation. Methods: We retrospectively identified 15 patients with LASCCOT treated with induction chemotherapy, limited surgery and postoperative radiation/chemoradiation at our institution between 04/07 - 04–08. M67%:F33% median age 50 years. Pretreatment AJCC stage as assessed on MRI was T2N+ (tumour crossing midline) 13%, T3N0 20%, T3N+ 47%, and T4N+ 20%. Prior to surgery induction chemotherapy, consisting of cisplatin 75 mg/m2 day 1 and gemcitabine 1 mg/m2 day 1 and 8 every three weeks for 2 cycles was given. Four to six weeks following second cycle of chemotherapy local excision of residual primary tumor with ipsilateral modified neck dissection was performed. Postoperative radiation dose was 60Gy/30 fractions. Post therapy pathological stage was ypT0N0 20%, ypT1N0 20%, ypT1N+ 40%, ypT2N+ 13%, and ypT3N+ 7%. Patients with ypN+ disease received concomitant 3 weekly cisplatin 75 mg/m2 with radiation. Results: Overall and disease free survival at 20 months was 60%. Twelve patients (80%) are alive and 3 patients (20%) have died of disease at 9, 14 and 14 months (locoregional failure 1 and distant metastasis 2 patients). In patients alive without disease assessment of deglutition and speech at the time of last follow up showed all patients on full oral diet with spontaneous intelligible speech. Conclusions: Multimodality treatment with induction chemotherapy, limited surgery and post operative radiation/chemoradiation may allow selected LASCCOT patients to avoid morbid surgery and preserve tongue function without compromising survival. This approach merits further investigation in clinical trials. No significant financial relationships to disclose.
Concurrent hypofractionated chemoradiation (CRT) for head and neck squamous cancer with weekly cisplatin: A Lancashire experience
Authors: Sivaramalingam M. , Mehta A. , Wong H. , Sidek N. 
Published: August 2020

e17052 Background: Concurrent chemoradiation with intravenous cisplatin is the standard treatment for locally advanced head and neck cancer. We evaluated the use of hypofractionated radiotherapy and weekly concomitant cisplatin in our center. Methods: We retrospectively analysed 37 patients treated at our centre from August 2005 to November 2007. They received weekly concurrent chemoradiation with cisplatin 30 mg/m2 with radiotherapy 65Gy in 30 fractions. We analysed tumour sites, changes in weight as an indirect measure of nutritional status, calculated creatinine clearance to assess nephrotoxicity, sites of recurrence, progression free survival and overall survival. The minimum follow up was 6 months. Results: Our study population comprised of 61% of T4 disease while 25% of our patients had T3 disease. Nearly a third of our patients underwent radical neck dissection prior to concurrent chemoradiation. We found that 80% of our patients had completed the full course of concurrent chemoradiation. More than 50% of patients had oropharyngeal cancer while 25% hypopharyngeal cancer. Majority of patients lost weight during treatment. The mean weight loss was 3.56 kilograms, despite 90% having had prophylactic enteral feeding tubes. Eleven patients maintained their weight while on treatment. There were 11 recurrences: 5 were at the primary site, 4 had distant metastasis, 1 had combination of primary site and nodal drainage and 1 patient had only nodal relapse. Lung was the most common site of distant metastasis amongst the 4 patients. While a proportion of patients had a fall in creatinine clearance, the values did not drop below the accepted 50 mL/min.Two-year progression free survival was 68% and overall survival at 24 months was 68.7%. Conclusions: Weekly intravenous cisplatin when combined with radiotherapy 65Gy in 30 fractions was effective in treating head and neck cancer. The nephrotoxicity was within acceptable limits. Many patients lost weight with this treatment despite having prophylactic enteral feeding tubes. Our survival figures were encouraging and similar to other reports in the literature. No significant financial relationships to disclose.
Impact of setup error on integral dose in head and neck cancer treated with intensity modulated radiation therapy
Authors: Prabhakar R. V. , Haresh K. P. , Laviraj M. A. , Rath G. K. , Julka P. K. 
Published: August 2020

e17056 Background: Intensity modulated radiation therapy (IMRT) has been widely used in the treatment of head and neck cancer and has the potential of escalating the dose with less morbidity. Integral dose is a concern in radiotherapy especially with IMRT as it may lead to an increase in second malignancies. Setup error is another important issue in radiotherapy which affects the final treatment outcome. In this study, the effect of setup error on non-target integral dose (NTID) for head and neck cancer treated with IMRT has been studied. Methods: Twelve patients of carcinoma of nasopharynx treated by IMRT with simultaneous integrated boost technique were included. The dose to the gross tumor volume (PTV70), CTV1 (PTV59.4) and CTV2 (PTV54) were planned for 70 Gy, 59.4 Gy and 54 Gy respectively in 33 fractions. All the patients were planned with nine equally spaced beams. The IMRT plan was generated in Eclipse treatment planning system using sliding window technique. Keeping it as the base plan, the patient setup error was simulated in the treatment planning system for 3 mm, 5 mm and 10 mm by shifting the isocenter in all three dimensions viz. anterior, posterior, superior, inferior, right lateral and left lateral. NTID was calculated from the following relation NTID = (non-target tissue volume X mean non-target tissue dose)/1000. Paired sample t-test was performed to compare NTID for different shifts with no shift (statistical significance: p < 0.05). Results: The mean NTID for no shift was 120.75 ± 22.85 (median: 116.59). The mean NTID with isocenter shift along the anterior direction were 119.87 ± 22.80, 119.24 ± 22.80, 117.97 ± 22.52 for 3 mm, 5 mm and 10 mm respectively. Similarly, the NTID for the posterior shifts were 121.59 ± 22.96, 122.08 ± 23.07 and 123.26 ± 23.34 for 3 mm, 5 mm and 10 mm respectively. The anterior and posterior setup error showed statistically significant difference (p < 0.0001) for NTID compared to no shift whereas lateral, superior and inferior setup errors were found to be statistically insignificant. Conclusions: Setup error is an important issue in radiotherapy. Our study shows that setup error along the posterior direction significantly increases NTID. Hence, the setup error along the posterior direction may increase the risk of second malignances in IMRT. No significant financial relationships to disclose.
Cost-effectiveness of capecitabine in combination with oxaliplatin (XELOX) compared with FOLFOX for the treatment of metastatic colorectal cancer: A Canadian evaluation
Authors: Belovich D. , Hux M. , Douglas P. , Maroun J. A. , Sommer N. 
Published: August 2020

e17502 Background: Capecitabine is an oral fluoropyrimidine used to treat patients with metastatic colorectal cancer (mCRC). Recent trials in 1st- and 2nd-line treatment have shown that capecitabine in combination with oxaliplatin (XELOX) is non-inferior to FOLFOX4 in terms of progression-free survival, overall survival and response rates. XELOX offers patients the advantage of treatment every 3 weeks rather than every 2 weeks without the need for lengthy infusions. This analysis evaluated the cost- effectiveness of replacing FOLFOX4 with XELOX for 1st- and 2nd-line treatment of mCRC from both Canadian healthcare system payor and societal perspectives. Methods: Based on evidence of non-inferiority of XELOX vs. FOLFOX4, cost-minimization analyses (CMA) were conducted using phase III clinical trial data. The CMA compared total cost associated with chemotherapy medications, administration of chemotherapy, and treatment related toxicities. For the societal perspective, patients’ costs and time were also included. The costs (or savings) were compared for 1st-line XELOX vs. FOLFOX4 and 2nd-line XELOX vs. FOLFOX4. Due to variation in Canadian clinical practice, sensitivity analyses using the FOLFOX6 regimen as a comparator were performed. Results: Cost savings per patient for XELOX vs. FOLFOX4 from a healthcare system payor perspective and a societal perspective are shown in the Table . XELOX was also associated with cost savings when compared with the simplified administration regimen of FOLFOX6. Reduced costs for chemotherapy administration and costs for patients’ time and travel primarily related to fewer clinic visits offset the increased drug acquisition cost of the XELOX regimen. Conclusions: Replacing FOLFOX with XELOX is associated with cost savings from the healthcare system payor and societal perspectives while preserving clinical efficacy. [Table: see text] [Table: see text]