Background
In a considerable subgroup of glioma patients treated with (chemo) radiation new lesions develop either representing tumor progression (TP) or treatment-related abnormalities (TRA). ...Quantitative diffusion imaging metrics such as the Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) have been reported as potential metrics to noninvasively differentiate between these two phenomena. Variability in performance scores of these metrics and absence of a critical overview of the literature contribute to the lack of clinical implementation. This meta-analysis therefore critically reviewed the literature and meta-analyzed the performance scores.
Methods
Systematic searching was carried out in PubMed, EMBASE and The Cochrane Library. Using predefined criteria, papers were reviewed. Diagnostic accuracy values of suitable papers were meta-analyzed quantitatively.
Results
Of 1252 identified papers, 10 ADC papers, totaling 414 patients, and 4 FA papers, with 154 patients were eligible for meta-analysis. Mean ADC values of the patients in the TP/TRA groups were 1.13 × 10
−3
mm
2
/s (95% CI 0.912 × 10
–3
–1.32 × 10
−3
mm
2
/s) and 1.38 × 10
−3
mm
2
/s (95% CI 1.33 × 10
–3
–1.45 × 10
−3
mm
2
/s, respectively. Mean FA values of TP/TRA was 0.19 (95% CI 0.189–0.194) and 0.14 (95% CI 0.137–0.143) respectively. A significant mean difference between ADC and FA values in TP versus TRA was observed (
p
= 0.005).
Conclusions
Quantitative ADC and FA values could be useful for distinguishing TP from TRA on a meta-level. Further studies using serial imaging of individual patients are warranted to determine the role of diffusion imaging in glioma patients.
•Circulating tumour DNA can be detected in advanced SDC.•Longitudinal ctDNA analysis can be informative to understand disease dynamics in SDC.•ctDNA levels seem to correlate with radiological ...response in SDC.
Glioblastoma (GBM), the most common glial primary brain tumour, is without exception lethal. Every year approximately 600 patients are diagnosed with this heterogeneous disease in The Netherlands. ...Despite neurosurgery, chemo -and radiation therapy, these tumours inevitably recur. Currently, there is no gold standard at time of recurrence and treatment options are limited. Unfortunately, the results of dedicated trials with new drugs have been very disappointing. The goal of the project is to obtain the evidence for changing standard of care (SOC) procedures to include whole genome sequencing (WGS) and consequently adapt care guidelines for this specific patient group with very poor prognosis by offering optimal and timely benefit from novel therapies, even in the absence of traditional registration trials for this small volume cancer indication. The GLOW study is a prospective diagnostic cohort study executed through collaboration of the Hartwig Medical Foundation (Hartwig, a non-profit organisation) and twelve Dutch centers that perform neurosurgery and/or treat GBM patients. A total of 200 patients with a first recurrence of a glioblastoma will be included. Dual primary endpoint is the percentage of patients who receive targeted therapy based on the WGS report and overall survival. Secondary endpoints include WGS report success rate and number of targeted treatments available based on WGS reports and number of patients starting a treatment in presence of an actionable variant. At recurrence, study participants will undergo SOC neurosurgical resection. Tumour material will then, together with a blood sample, be sent to Hartwig where it will be analysed by WGS. A diagnostic report with therapy guidance, including potential matching off-label drugs and available clinical trials will then be sent back to the treating physician for discussing of the results in molecular tumour boards and targeted treatment decision making. The GLOW study aims to provide the scientific evidence for changing the SOC diagnostics for patients with a recurrent glioblastoma by investigating complete genome diagnostics to maximize treatment options for this patient group.
Patients who receive chemoradiotherapy or bioradiotherapy (CRT/BRT) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) often experience high toxicity rates interfering with oral ...intake, causing tube feeding (TF) dependency. International guidelines recommend gastrostomy insertion when the expected use of TF exceeds 4 weeks. We aimed to develop and externally validate a prediction model to identify patients who need TF ≥ 4 weeks and would benefit from prophylactic gastrostomy insertion.
A retrospective multicenter cohort study was performed in four tertiary head and neck cancer centers in the Netherlands. The prediction model was developed using data from University Medical Center Utrecht and the Netherlands Cancer Institute and externally validated using data from Maastricht University Medical Center and Radboud University Medical Center. The primary endpoint was TF dependency ≥4 weeks initiated during CRT/BRT or within 30 days after CRT/BRT completion. Potential predictors were extracted from electronic health records and radiotherapy dose–volume parameters were calculated.
The developmental and validation cohort included 409 and 334 patients respectively. Multivariable analysis showed predictive value for pretreatment weight change, texture modified diet at baseline, ECOG performance status, tumor site, N classification, mean radiation dose to the contralateral parotid gland and oral cavity. The area under the receiver operating characteristics curve for this model was 0.73 and after external validation 0.62. Positive and negative predictive value for a risk of 90% or higher for TF dependency ≥4 weeks were 81.8% and 42.3% respectively.
We developed and externally validated a prediction model to estimate TF-dependency ≥4 weeks in LAHNSCC patients treated with CRT/BRT. This model can be used to guide personalized decision-making on prophylactic gastrostomy insertion in clinical practice.
Purpose
The CONDOR study showed that docetaxel/cisplatin/5-fluorouracil (TPF) followed by conventional radiotherapy with cisplatin 100 mg/m
2
on days 1, 22, and 43 (cis100 + RT;
n
= 27)) versus ...accelerated radiotherapy with cisplatin weekly 40 mg/m
2
(cis40 + ART;
n
= 29) in locally advanced head and neck cancer (LAHNC) patients was not feasible. Here, we report the analysis of health-related quality of life (HRQOL) of the patients entered in this study.
Methods
HRQOL was assessed at baseline, after two TPF, before start of chemoradiotherapy, and 1, 4, 8, 12, and 24 months after completion of chemoradiotherapy using the EORTC-QLQ-C30 and QLQ-H&N35 in 62 patients.
Results
Compliance with the QOL questionnaires was 94% (59/62) at baseline and 61% (30/49) at 12 months, respectively. HRQOL decreased after TPF and further decreased during chemoradiohteray in both arms equally. Pain and swallowing dysfunction improved significantly during TPF but deteriorated below baseline levels during chemoradiotherapy, cis40 + ART > cis100 + RT (
p
< 0.05). HRQOL and symptoms restored to baseline within 12 months in both arms and remained at that level until 24 months.
Conclusions
After TPF, cis40 + ART had a larger negative impact on symptoms than cis100 + RT, probably due to the ART. HRQOL and symptoms restored to baseline levels within 12 months after end of treatment in both arms, which is an important perspective for patients during the phase of most serious acute side effects of treatment.
Trial registration:
NCT00774319.
Salivary duct carcinoma (SDC), one subtype of the 22 different salivary gland cancers, is a rare malignancy. Risk factors for the development of salivary gland cancer and SDC are largely unknown, ...although pollution has been described as one of the risk factors. In other cancers, especially in lung cancer, the carcinogenicity of chromium VI Cr(VI) is well-known. Here we report on two SDC patients who were occupationally exposed to Cr(VI) and discuss a potential relation between their Cr(VI) exposure and the occurrence of SDC.
The work history of two SDC patients was analyzed for chemical exposures. Both patients had a history of Cr(VI) exposure, with maintenance of military equipment considered as the source for this exposure. Inhalation of Cr(VI) containing particles from the removal of old paint by mechanical abrasion was identified as a probable source of exposure for both patients, and one of these patients also applied new paint. Both patients reported not to have used any respiratory protection which may have resulted in substantial inhalation of Cr(VI)-containing chromates. Furthermore, in one patient inhalation of fumes from soldering may have resulted in relevant co-exposure.
A causal relation between Cr(VI) exposure and SDC, a rare cancer, cannot be demonstrated on an individual basis but detection in a population-based study is also unlikely because of the extremely low prevalence. Nevertheless, the work history is considered a relevant risk factor in the onset of SDC as occupational exposures to Cr(VI) occurred in poorly ventilated working environment and without using appropriate respiratory protective equipment.
Background
This study evaluated ototoxicity in locally advanced head and neck cancer patients treated in the CONDOR study with docetaxel/cisplatin/5‐fluorouracil (TPF) followed by conventional ...radiotherapy with concomitant cisplatin 100 mg/m2 on days 1, 22, and 43 (cis100+RT) versus accelerated radiotherapy with concomitant cisplatin weekly 40 mg/m2 (cis40+ART).
Methods
Sixty‐two patients were treated in this study. Audiometry was performed at baseline, during TPF, before start of chemoradiotherapy, and 1, 4, 8, and 12 months after treatment.
Results
A complete dataset of audiometric data was available of 12 patients treated with high‐dose cisplatin and of 11 patients treated with intermediate‐dose cisplatin. Patients in the high‐dose group showed significant more hearing loss than in the intermediate group at 4 kHz (z = 1.98; P = .04 and 8 kHz z = 2.07; P < .03). Interindividual variation was high in both groups.
Conclusion
After induction TPF, more ototoxicity was observed in chemoradiotherapy with cis100+RT than after chemoradiotherapy with cis40+ART.
•Head and neck cancer and its treatment affect health-related quality of life (HRQoL).•HRQoL and clinical outcomes together determine the net clinical benefit of treatment.•Patients with propylactic ...antibiotics during chemoradiotherapy reported better HRQoL.
The recent PANTAP trial showed that administration of prophylactic antibiotics in locally advanced head and neck carcinoma (LAHNC) patients treated with chemoradiotherapy reduced fever, hospitalization and costs. The current study describes the effect of prophylactic antibiotics on health-related quality of life (HRQoL), another secondary endpoint of the trial.
In this multicenter randomized trial, LAHNC patients treated with chemoradiotherapy received prophylactic antibiotics or standard care. HRQoL was assessed at baseline (before chemoradiotherapy), day 28 of chemoradiotherapy (one day before starting prophylactic antibiotics), the final day of radiotherapy, and 3.5 months after the end of chemoradiotherapy, using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC H&N35 module, and the Performance Status Scale for Head & Neck cancer patients (PSS-HN).
Ninety-five patients were randomized: 48 patients were allocated to the standard group and 47 patients to the prophylaxis group. Thirty-four patients in the standard group (70.8%) and 28 patients in the prophylaxis group (59.6%) completed the questionnaires at baseline and at follow-up. No significant differences in HRQoL were found at baseline and at day 28. At the end of radiotherapy, the prophylaxis group performed better on almost all functional subscales of the EORTC QLQ-C30 and reported less symptoms. At the end of follow up, almost no differences were seen between the two treatment groups.
Prophylactic antibiotics during chemoradiotherapy for LAHNC patients improved HRQoL at the end of the radiotherapy, however no differences were found 3.5 months after the end of chemoradiotherapy.
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