Seminars in Radiation Oncology, Год журнала: 2025, Номер 35(2), С. 285 - 300
Опубликована: Март 14, 2025
Язык: Английский
Опубликована: Янв. 14, 2025
IMPORTANCE: Early detection of Head and Neck Squamous Cell Carcinoma (HNSCC) recurrence in HPV-positive patients is crucial for improving survival rates reducing treatment costs. Integrating circulating tumor DNA (ctDNA) testing as part post-treatment surveillance may enhance timely cancer detection, reduce false-positive rates, lower overall OBJECTIVE: To develop evaluate personalized, cost-effective strategies that integrate ctDNA with established, computed tomography (CT) scans, the goal minimizing costs delays HNSCC patients. METHODS: We constructed a microsimulation model optimizes timing tests generates schedules designed to achieve below specified thresholds at minimum cost. The was fit using n= 840 training data validated 447 external data. Six sub-populations were created based on combination stage (AJCC 8th edition 1, 2, 3) smoking status (non-smoker ever-smoker). study compared proposed ctDNA-based strategy established clinical guidelines, well from literature. RESULTS: Our optimization generated cost-effecive scheduling range delay tolerances (i.e., 3, 6, 9 months) across six subpopulations. optimal demonstrated substantial cost savings, potentially annual USA by least $200 million imaging-based while matching an equal patient outcome delay. Additionally, hypothetical scenario monthly testing, incurring comparable total existing guidelines’, offers 32% reduction also highlighted growing importance surveillance, incidence projected rise, further emphasizing cost-saving potential integration. CONCLUSION: traditional imaging methods minimizes delays. As population grows, significance savings will increase. Future research should focus applicability developed their impact quality life.
Язык: Английский
Процитировано
0
Therapeutic Advances in Medical Oncology, Год журнала: 2025, Номер 17
Опубликована: Янв. 1, 2025
Oropharyngeal carcinoma, a type of head and neck cancer (HNC), is an emerging malignancy associated with low survival rates. It typically affects older males correlates smoking, drinking, lower socioeconomic conditions. Traditional treatments such as surgery have often yielded limited outcomes. However, recent insights, particularly those emphasized by Dr Teknos in his Keynote Conference at MedNews Week, sparked deeper exploration into alternative more promising treatment methods. A comprehensive literature review was conducted to explore this subject further. One approach, demonstrated the UMCC 9921 trial, involves protocol starting induction chemotherapy. This initial phase aims reduce tumor burden assess response treatment. Based on individual outcomes, patients then undergo concurrent chemoradiation or salvage surgery. strategy has significantly improved rates, especially human papillomavirus (HPV)-positive patients, showcasing potential tailored treatments. While these advancements are promising, long-term complications dysphagia osteoradionecrosis remain cause concern. The rise HPV-related squamous cell carcinoma further changed how risk factors outcomes viewed. HPV-positive cancers unique characteristics respond well modern therapies. Researchers investigating biomarkers circulating HPV DNA immunoglobulin J polypeptide expression, which could provide valuable insights disease progression pave way for targeted effective strategies. In addition, use existing medications, fenofibrate, combat infections illustrates resourcefulness repurposing specific Challenges persist, need reliable early detection monitoring. Deeper viral-host interactions shape immunotherapy strategies that revolutionize approaches. Collaborative efforts between researchers, healthcare providers, policymakers play vital role translating substantial clinical benefits, improving quality life individuals affected diseases. HPV-associated HNCs present significant challenges, continuous research innovative offer hope brighter future combating growing epidemic patient care.
Язык: Английский
Процитировано
0
Neurosurgery, Год журнала: 2025, Номер unknown
Опубликована: Март 5, 2025
Glioblastoma (GBM) recurrence after surgery remains a significant clinical challenge because of limited early detection methods and effective molecular markers. This study investigates the potential dynamic tumor in situ fluid circulating DNA (TISF-ctDNA) as tool for monitoring residual disease evaluating treatment efficacy postsurgical patients with GBM. In this prospective cohort study, 75 resectable glioma were enrolled between October 2019 to June 2023. Primary tissues TISF samples collected, along cranial imaging. TISF-ctDNA was identified through targeted next-generation sequencing, positivity defined by presence one or more variants matching those primary tumors an increase ≥10 single-nucleotide across consecutive assessments. 62.2% period, indicating high prevalence disease. Patients positive showed significantly higher risk (hazard ratio 2.512, 95% CI 1.264-4.993, P = .0054). Conversion negativity post-treatment associated improved overall survival, highlighting its role response. Multivariate analysis revealed that independent predictor progression-free survival during adjuvant therapy, predictive accuracy (sensitivity 86.2%, specificity 100%). Importantly, preceded imaging signs median 71 days. no impact specific markers each subcohort (EGFR, TP53, PTEN, NF1) on observed. is promising biomarker GBM benefit. It provides insight into genomic evolution identifies who may benefit from chemotherapy. robust prognostic indicator patient outcomes marker frontline therapy.
Язык: Английский
Процитировано
0
JAMA Otolaryngology–Head & Neck Surgery, Год журнала: 2025, Номер unknown
Опубликована: Март 13, 2025
Importance Despite the favorable prognosis for HPV−positive oropharyngeal squamous cell carcinoma (HPV + OPSCC), efforts to de-escalate treatment intensity, while maintaining low recurrence and mortality rates, have proven challenging. Identifying appropriate prognostic factors remains elusive; however, association of pretreatment circulating tumor tissue viral−modified HPV (TTMV-HPV) DNA level with known characteristics disease burden—clinical staging, imaging, aggressive histopathologic features surgical specimen—may offer insights that could shift paradigms OPSCC. Objective To investigate TTMV-HPV levels clinical, radiologic, histopathologic, outcome metrics in patients Design, Setting, Participants This cohort study OPSCC positive test results fragment used data from a single tertiary center April 2020 September 2023. fragments were categorized into 3 cohorts: (≤99 fragments/mL), moderate (100-999/mL), high (≥1000/mL). Main Outcomes Measures Association clinical (cT) nodal (cN) staging level. Secondary outcomes included between emission tomography−computed tomography (PET-CT) as well specimen. The receiving adjuvant therapy was also analyzed. Recurrence-free survival disease-specific assessed. Results population 203 (mean [SD] age, 62 [10] years; 24 [12%] females 179 males [88%]), 58 (29%) whom low, 73 (36%) moderate, 72 (35%) fragment-level cohort. Compared cT0/1 stage, those cT2 stage cT3/4 had increased odds higher levels, adjusted ratios (aORs) 2.33 (95% CI, 1.24-4.46) 2.51 1.17-5.46), respectively. cN0 cN1 cN2/3 aORs 4.26 1.82-10.34) 3.64 1.46-9.36), In analysis PET-CT characteristics, total primary plus volume associated an aOR 1.04 1.02-1.07). Among 94 patients, no significant found lymphovascular invasion, perineural pathologic T number nodes, or extranodal extension on pathological No differences recurrence-free found. Conclusion Relevance more advanced aggregate cervical results. Future studies are needed explore how may influence decisions.
Язык: Английский
Процитировано
0
Seminars in Radiation Oncology, Год журнала: 2025, Номер 35(2), С. 285 - 300
Опубликована: Март 14, 2025
Язык: Английский
Процитировано
0