Journal of Clinical Oncology, Год журнала: 2024, Номер unknown
Опубликована: Окт. 3, 2024
Язык: Английский
International Journal of Radiation Oncology*Biology*Physics, Год журнала: 2025, Номер unknown
Опубликована: Янв. 1, 2025
Язык: Английский
Процитировано
2
Journal of Clinical Oncology, Год журнала: 2025, Номер unknown
Опубликована: Фев. 11, 2025
ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following guideline development process as outlined in Methodology Manual . follow Conflict Interest Policy Clinical Practice other guidance (“Guidance”) provided by is not a or definitive guide to treatment options. It intended voluntary use clinicians should be used conjunction independent professional judgment. Guidance may applicable all patients, interventions, diseases stages diseases. based on analysis statement standard care. does endorse third-party drugs, devices, services, therapies assumes no responsibility any harm arising from related this information. See complete disclaimer Appendix 1 2 (online only) more PURPOSE To evidence-based transoral robotic surgery (TORS) multidisciplinary management oropharyngeal squamous cell cancer (OPC). METHODS convened Expert Panel evaluate evidence formulate recommendations. The search included studies published between January 1, 2002, August 31, 2024, comprised systematic reviews, meta-analyses, randomized controlled trials, observational studies. Outcomes interest include overall disease-free survival, functional outcomes, quality life. members available informal consensus develop RESULTS A total 58 publications were identified inform base guideline. RECOMMENDATIONS Evidence-based address evaluation workup patients human papillomavirus (HPV)–positive OPC, role TORS, patient selection, adjuvant therapy, HPV-negative TORS salvage recurrent setting. Additional information at www.asco.org/head-neck-cancer-guidelines
Язык: Английский
Процитировано
1
JAMA Otolaryngology–Head & Neck Surgery, Год журнала: 2024, Номер 150(9), С. 811 - 811
Опубликована: Авг. 1, 2024
Importance Patients undergoing treatment for head and neck cancer (HNC) experience oral complications requiring substantial dental treatment. This is commonly not reimbursed by medical insurers, presenting a potential financial burden patients. Objective To characterize the care needs associated cost patients with HNC. Design, Setting, Participants survey study included Head Neck Cancer Alliance (HNCA) members who were surveyed from March 23 to October 27, 2023, using Qualtrics. The was promoted HNCA’s social media email list. Data analysis performed between 2023 May 2024. Main Outcomes Measures outcomes of among HNC, association use, costs Results Of 100 individuals administered survey, 85 (85%) completed all required questions in analysis. 84 participants age sex data, 51 (61%) aged 65 years or older 45 (54%) female. respondents, 59 (70%) indicated that their current health worse than before Most respondents (73 [86%]) endorsed treatment, including xerostomia (66 73 [90%]), caries (35 [48%]), mucositis (29 [40%]); 64 (88%) follow-up Overall, 4 28 (14%) HNC 17 53 (32%) after reported finances as reason recommended received. A total 33 (39%) said postcancer had caused them hardship. Individuals less likely endorse hardship more have greater educational attainment (odds ratio [OR], 0.20; 95% CI, 0.06-0.58), higher income (OR, 0.33; 0.11-0.94), increased pre-HNC visit frequency 0.30; 0.10-0.86), same better 0.13; 0.02-0.50), lower out-of-pocket expenses 0.09; 0.03-0.29). Conclusions Relevance In this study, most extensive throughout treatment; presented 39% limiting barrier care. Since private insurers do reimburse comprehensive coverage deserves policy attention.
Язык: Английский
Процитировано
4
Journal of Dental Research, Год журнала: 2024, Номер 103(12), С. 1185 - 1196
Опубликована: Окт. 6, 2024
The introduction of immune checkpoint inhibitors (ICIs) to oncological care has transformed the management various malignancies, including head and neck squamous cell carcinoma (HNSCC), offering improved outcomes. first-line treatment recurrent malignant HNSCC for many years was combined platinum, 5-fluorouracil, cetuximab. Recently, ICI pembrolizumab approved as a treatment, with or without chemotherapy, based on tumor percentage programmed-death ligand 1 (PD-L1). Multiple (HN) cancer trials have subsequently explored immunotherapies in combination surgery, and/or radiation. Immunotherapy regimens may be personalized by biomarker, PD-L1 content, mutational burden, microsatellite instability. However, further clinical are needed refine biomarker-driven protocols standardize pathological methods guide regimen timing, sequencing, deescalation. Gaps remain using immunotherapy reverse oral premalignant lesions, particularly high-risk leukoplakias. A phase II nonrandomized controlled trial, nivolumab, showed 2-y cancer-free survival 73%, although larger needed. Guidelines also role dental evaluation before, during, after immunotherapy, specifically regard immune-related adverse events their impact recurrence. Standardized diagnostic coordination strategies close these gaps ensure continued success HN immunotherapy.
Язык: Английский
Процитировано
4
medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2025, Номер unknown
Опубликована: Фев. 5, 2025
Abstract Objective Osteoradionecrosis of the jaw (ORNJ) is a chronic radiation-associated toxicity that lacks standardized classification criteria and treatment guidelines. Understanding early signs tissue injury could help us better predict, prevent, conservatively manage ORN. Our primary aims were to identify initial clinically-detected ORN, determine frequency imaging-detected ORNJ, validate ability classify cases using novel system, ClinRad. Study Design A retrospective electronic health record review 91 patients treated for head neck cancer at The University Texas MD Anderson Cancer Center with suspected ORN was performed by an Oral Medicine specialist Patients who received reirradiation or did not have enough evidence excluded. descriptive analysis performed. Results 51 met inclusion criteria. Half (53%) presented imaging findings exposed bone. Imaging in absence bone exposure identified 37%, which disease progression observed 26%. All classifiable Conclusion Subclinical bony changes consistent may be evident on without bone, supporting use surveillance. ClinRad provided mechanism all onset. Data availability statement Anonymized data reported analyses made publicly available figshare 10.6084/m9.figshare.28292186. Reporting guideline compliance In accordance EQUATOR Network (Enhancing QUAlity Transparency Of Research) guidance, we utilized RECORD checklist, “REporting studies Conducted Observational Routinely-collected data” (Benchimool El al., 2015) checklist as Supplementary file via 10.6084/m9.figshare.28292219. anonymized “Preparing raw clinical publication: guidance journal editors, authors, peer reviewers” (Hrynaszkiewicz I et 2010).
Язык: Английский
Процитировано
0
medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2025, Номер unknown
Опубликована: Фев. 14, 2025
Osteoradionecrosis of the jaw (ORNJ) is a debilitating complication that affects up to 15% head and neck cancer patients who undergo radiotherapy. The ASCO/ISOO/MASCC-endorsed ClinRad severity classification system was recently proposed (and recommended in latest ASCO guidelines) incorporate radiographic findings for determining ORNJ based on vertical extent bone necrosis. However, variability imaging modalities specialty-specific knowledge may contribute disparities diagnosing classifying ORNJ. This study aims evaluate benchmark multi-specialty physician performance using different imaging. A single institution retrospective diagnostic validation conducted at University Texas MD Anderson Cancer Center involving 20 healthcare providers across varying specialties including oral oncology, radiation surgery, neuroradiology. Participants reviewed 85 de-identified sets computed tomography (CT) orthopantomogram (OPG) images from 30 with confirmed ORN, blinded replicates (n=10) assessment intra-observer asked diagnose stage system. Diagnostic assessed ROC curves; intra- inter-observer agreement were measured Cohen's Fleiss kappa, respectively. Sub-analyses considered specialty, years clinical experience level confidence. Paired CT-OPG improved all specialties, AUC values ranging 0.79 (residents) 0.98 (surgeons). Inter- intra-rater agreements detection limited, median (IQR) kappa 0.38 (0.22) 0.08 (0.17), Slight fair inter-rater observed 0.22, 0.13, 0.05 stages 0/1, 2, 3, most commonly reported features cases staged as grade 1 or 2 "bone necrosis confined alveolar bone" (22.7%), basilar maxillary sinus" (14.8%), lysis/sclerosis" (20.0%). establishes an essential significant emphasizes need standardized protocols specialist training well highlights value multimodality
Язык: Английский
Процитировано
0
The Laryngoscope, Год журнала: 2025, Номер unknown
Опубликована: Фев. 17, 2025
ABSTRACT Objective The management of head and neck squamous cell carcinoma (HNSCC) has substantially changed over the past two centuries. This review explores historical progression HNSCC focusing on multidisciplinary treatment paradigm. Data Sources synthesizes data from current clinical trials, books, scientific reports, public documents, other written material relevant to management. Review Methods Historical review. Results Although surgery was initially only available, radiation, chemotherapy, immunotherapy have expanded landscape for HNSCC. Despite continuous evolution, modern remains rooted in a multidisciplinary, personalized approach. highlights pioneers who established standards care landmark trials that progressed it. optimal timing, application, extent different treatments, including role neoadjuvant therapy, remain under study. Immunotherapy improved outcomes recurrent/metastatic mucosal cutaneous malignancies, although its curative is still materializing. Conclusions Surgery radiotherapy made continued gains reducing morbidity sequala. Platinum‐based chemotherapy mainstay systemic therapy HNSCC, but there been accelerated growth application targeted therapy. Comprehensive cancer depends management, usually requiring multiple modalities while individualizing both therapies goals. Additional phase III are needed further define treatments
Язык: Английский
Процитировано
0
Опубликована: Янв. 1, 2025
Язык: Английский
Процитировано
0
Journal of Clinical Medicine, Год журнала: 2025, Номер 14(5), С. 1661 - 1661
Опубликована: Фев. 28, 2025
Background/Objectives: This retrospective study examined the relationship between prophylactic tooth extraction (PTE) and occurrence of jaw osteoradionecrosis (JORN) in patients undergoing head neck radiotherapy (HNR). The primary objective was to determine whether PTE resulted a JORN rate comparable that who did not require or undergo PTE. Methods: A total 497 were included. predictor variable PTE, outcome occurrence. Statistical analyses included univariate, bivariate, multivariate regression, as well Cox regression. significance threshold set at p ≤ 0.005. Results: more frequent group than (17.1% vs. 13.0%; hazard ratio [HR] 1.71, 95% CI: 1.08–2.71, = 0.021). However, significant association could be confirmed using multiple logistic regression (odds [OR] 1.36, 0.82–2.26, 0.236). Suggestive associations observed for HNR dose (HR 1.03 per Gy, 0.007) tumor location (pharyngeal HR 0.52, 0.03; laryngeal 0.51, 0.02). Conclusions: Patients with showed higher but findings only marginally significant, no causal established. differing results suggest time-dependent effect an increased early risk JORN. Further studies are needed greater emphasis should placed on tooth-preserving measures, limiting extractions before strictly non-preservable teeth.
Язык: Английский
Процитировано
0
Journal of Radiation Research, Год журнала: 2025, Номер unknown
Опубликована: Март 5, 2025
Postoperative chemoradiotherapy (POCRT) is the standard treatment for patients with head and neck squamous cell carcinoma (HNSCC) high-risk features (positive microscopic margins and/or extranodal extensions). We hypothesized that dose escalation using hyperfractionation in intensity-modulated radiotherapy (HF-IMRT) improves POCRT outcomes; however, no prospective trial has assessed feasibility of HF. Therefore, we evaluated HF-IMRT. HNSCC positive extension following surgery were included. HF-IMRT (73.6 Gy 64 fractions twice daily) was administered along cisplatin at 40 mg/m2 once a week seven cycles during radiotherapy. The primary endpoint proportion who completed treatment, which included planned administration ≥200 cisplatin. Feasibility defined as >60% one-sided binomial test. Ten registered between October 2021 April 2023. One patient excluded because tumor recurrence before POCRT. median follow-up time 18.2 months, 88.9%. total 240 mg/m2. percentage grade 3 acute non-hematological adverse events 77.8%. No experienced 4 or higher late events. feasible achieving adequate doses safe HNSCC.
Язык: Английский
Процитировано
0