Purpose:
To evaluate the role of upper-neck irradiation versus standard whole-neck irradiation in patients with N0-1 nasopharyngeal carcinoma.
Methods:
We conducted a PRISMA guideline based ...systematic review and meta-analysis. Randomized clinical trials assessing upper-neck irradiation versus whole-neck irradiation with or without chemotherapy in non-metastatic N0-1 nasopharyngeal carcinoma patients were identified. The studies were searched on the PubMed, Embase and Cochrane library up to March 2022. Survival outcomes, including overall survival, distant metastasis-free survival and relapse-free survival, and toxicities rate were evaluated.
Results:
There were two randomized clinical trials with 747 samples finally included. Upper-neck irradiation had similar overall survival (hazard ratio = 0.69, 95% confidence interval = 0.37-1.30), distant metastasis-free survival (hazard ratio = 0.92, 95% confidence interval = 0.53-1.60) and relapse-free survival (risk ratio = 1.03, 95% confidence interval = 0.69-1.55) compared to whole-neck irradiation. No differences in both acute and late toxicities were recorded between upper-neck irradiation and whole-neck irradiation.
Conclusion:
This meta-analysis supports the potential role of upper-neck irradiation in this population of patients. Further research is needed to confirm results.
•CIRT in Head and Neck Mucosal Melanoma (HNMM) is safe and locally effective.•CIRT for HNMM is safe both in unresected and postoperative setting.•Multidisciplinary management of HNMM in high ...expertise referral centers is crucial.•Immunotherapy after CIRT may provide potential survival advantage.•Prospective studies are needed to investigate the role of immunotherapy after CIRT.
To evaluate efficacy and toxicity of carbon ion radiotherapy (CIRT) in locally advanced head and neck mucosal melanoma (HNMM) patients treated at our Institute.
Between June 2013 and June 2020, 40 HNMM patients were treated with CIRT. Prescription dose was 65.6-68.8 Gy relative biological effectiveness RBE in 16 fractions. Twelve (30%) patients received only biopsy, 28 (70%) surgical resection before CIRT. Immunotherapy was administered before and/or after CIRT in 45% of patients, mainly for distant progression (89%).
Median follow-up was 18 months. 2-year Local Relapse Free Survival (LRFS), Overall Survival (OS), Progression Free Survival (PFS) and Distant Metastasis Free Survival (DMFS) were 84.5%, 58.6%, 33.2% and 37.3%, respectively. At univariate analysis, LRFS was significantly better for non-recurrent status, < 2 surgeries before CIRT and treatment started < 9 months from the initial diagnosis, with no significant differences for operated versus unresected patients. After relapse, immunotherapy provided longer median OS (17 months vs 3.6, p-value<0.001). Late toxicity ≥ G3 (graded with CTCAE 5.0 scale) was reported in 10% of patients.
CIRT in advanced HNMM patients is safe and locally effective. Prospective trials are warranted to assess the role of targeted/immune- systemic therapy to improve OS.
•Recent literature reported NLR as a prognostic factor in various neoplasms treated with photon beam radiotherapy.•There is no report about the role of NLR in adenoid cystic carcinomas (ACCs) treated ...with carbon ion radiotherapy (CIRT)•ACC patients with higher pre-CIRT levels of NLR and hemoglobin > 14 g/dl had a predictable decrease in DFS.•hemoglobin > 14 g/dL was a negative independent prognostic predictor for MFS.
In recent years, there is an emerging interest in the prognostic role of chemistry blood biomarkers in oncological patients but their role in adenoid cystic carcinomas (ACCs) is still unknown. This study aims to assess the prognostic significance of baseline neutrophil-to-lymphocyte ratio (NLR) and blood chemistry in a series of head and neck ACC patients treated with carbon ion radiotherapy (CIRT).
We retrospectively retrieved the data of 49 consecutive head and neck ACC patients treated with CIRT. Univariable and multivariable Cox proportional hazard regression (Cox-ph) analyses were performed to look for a potential association of NLR, and other blood biomarker values, with disease-free survival (DFS), Local Control (LC), Metastasis Free Survival (MFS) and overall survival (OS).
No significant association between NLR > 2,5 and DFS, LC, MFS and OS was found with univariable analysis although a trend was reported for DFS (Hazard ratio HR: 2,10, 95 % CI: 0,85 – 5,08, p-value = 0,11). Patients with hemoglobin (hb) ≤ 14 g/dL showed significantly better DFS, MFS and OS. Multivariable regression Cox-ph analysis for DFS, adjusted for margin status, clinical target volume and Absolute Number of Monocytes, reported the following statistically significant HRs, for both NLR > 2,5 and hb > 14 g/dL respectively: 4,850 (95 % CI = 1,408 – 16,701, p = 0,012) and 3,032 (95 % CI = 1,095 – 8,393, p = 0,033). Moreover, hb > 14 with HR = 3,69 (95 % CI: 1,23 – 11,07, p-value = 0,02), was a negative independent prognostic predictor for MFS.
Pre-treatment NLR and hb values seem to be independent prognostic predictor for clinical outcomes in head and neck ACC patients. If their role will be validated in a larger prospective cohort, they might be worthwhile for a pre-treatment risk stratification in patients treated with CIRT.
At present, there is uncertainty on the best systemic treatment in first-line setting for RAS wild-type (WT) metastatic colorectal cancer (mCRC) patients. Indeed, several chemotherapy and biologics ...combinations showed an improvement on survival. We performed a systematic review with a pair-wise and bayesan meta-analysis to rank the best strategy for these patients.
A systematic literature search through March 2017 was performed to evaluate the association between several treatment combinations and overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and toxicity rate (TR) in RAS WT mCRC patients. Data were extracted from studies and pooled using the random-effect model for pair-wise meta-analyses and bayesan model for network meta-analysis (NMA).
Eight studies with a total of 2518 individuals were included in the meta-analyses. Pooled analyses for subgroups stratified by type of schedule and tumor location demonstrated that anti-EGFR + doublet had the best OS when compared to doublet ± bevacizumab (0.767; 95%CI, 0.695–0.846; P < 0.0001). This benefit is limited to LSCC when compared to a doublet-based schedule and doublet + bevacizumab (HRs, 0.692; 95%CI, 0.596–0.804; P < 0.001; 0.706; 95%CI, 0.584–0.854; P < 0.001; respectively). No significant differences are detected in PFS, whereas the cetuximab-based regimens showed the highest ORR and TR. In NMA our ranking showed the best performance for FOLFOX + panitumumab.
Our study indicates that FOLFOX + panitumumab has the major probability to provide an improvement of survival with a good safety profile in patients with RAS WT mCRC with an added value from selection based on sidedness.
Objectives
The role of radiotherapy (RT) for oligometastases is currently established in different oncological settings but data on salivary gland cancer (SGC) are lacking. We evaluated the role of ...RT in oligometastatic SGC patients, focusing on stereotactic body radiation therapy (SBRT).
Materials and methods
We performed a retrospective, multicentric study of oligometastatic SGC treated with palliative RT or SBRT. Endpoints included response evaluation and local control (LC).
Results
Between 2006 and 2016, 64 patients were collected from 9 Italian Cancer Centers, on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Head and Neck Working Group. 37 patients (57.8%) were suffering from adenoid cystic carcinoma (ACC) and 27 patients (42.2%) had non‐ACC. Thirty‐four patients underwent palliative RT (53,1%), and 30 received SBRT (46,9%). Most common metastatic sites were bone for palliative RT and lung for SBRT. Among patients treated with SBRT, an objective response or a stability was observed in all treated lesions. After a median follow‐up of 29.2 months (range 2.3–117.1), LC at 12 months was 57.5% for patients treated with SBRT and was higher in ACC subgroup.
Conclusion
We confirmed the potential role of SBRT in the management of oligometastatic SGC patients to control limited burden of disease considering the absence of effective systemic therapies.
Purpose/Objective:
To perform a dosimetric and a normal tissue complication probability (NTCP) comparison between intensity modulated proton therapy and photon volumetric modulated arc therapy in a ...cohort of patients with parotid gland cancers in a post-operative or radical setting.
Materials and methods:
From May 2011 to September 2021, 37 parotid gland cancers patients treated at two institutions were eligible. Inclusion criteria were as follows: patients aged ⩾ 18 years, diagnosis of parotid gland cancers candidate for postoperative radiotherapy or definitive radiotherapy, presence of written informed consent for the use of anonymous data for research purposes. Organs at risk (OARs) were retrospectively contoured. Target coverage goal was defined as D95 > 98%. Six NTCP models were selected. NTCP profiles were calculated for each patient using an internally-developed Python script in RayStation TPS. Average differences in NTCP between photon and proton plans were tested for significance with a two-sided Wilcoxon signed-rank test.
Results:
Seventy-four plans were generated. A lower Dmean to the majority of organs at risk (inner ear, cochlea, oral cavity, pharyngeal constrictor muscles, contralateral parotid and submandibular gland) was obtained with intensity modulated proton therapy vs volumetric modulated arc therapy with statistical significance (p < .05). Ten (27%) patients had a difference in NTCP (photon vs proton plans) greater than 10% for hearing loss and tinnitus: among them, seven qualified for both endpoints, two patients for hearing loss only, and one for tinnitus.
Conclusions:
In the current study, nearly one-third of patients resulted eligible for proton therapy and they were the most likely to benefit in terms of prevention of hearing loss and tinnitus.
Purpose
To review experience and indications for head and neck (HN) tumors at our center in relation to the published literature.
Methods
HN cancer patients treated at our center either with protons ...(PT) or carbon ions (CIRT) were extracted from our institutional retrospective and longitudinal Registry (NCT05203250 REGAL), including all the patients treated since the beginning of our clinical activity. A literature search was conducted with selection of most representative published studies for adenoid cystic carcinoma (ACC), mucosal melanoma (MM), sinonasal cancers (SNCs) and reirradiations.
Results
Since the beginning of the clinical activity in 2011, 1311 HN tumors have been treated a tour center. Majority of treated patients were ACC (52%), non-ACC salivary gland tumors (18%), paranasal sinuses tumors (9%), MM (7%), and reirradiation of recurrent tumors after previous RT (14%). Oncological outcome in terms of safety and efficacy has been published on the series of 184 ACC and 40 MM, both treated with CIRT in the years 2013–2020. Reviewed reirradiation published series included a cohort of 52 recurrent salivary gland tumors retreated with CIRT from 2013 to 2016, and the experience of 2013–2020 of retreatment of 15 SNCs (13 with CIRT and 2 with PT).
Conclusion
HN tumors are major indications for particle treatment around the world and at our center. Particle treatment might be personalized for each patient, with CIRT indicated for radioresistant tumors such as ACC and MM. Data on oncologic outcomes of CIRT at our center are consistent with published series.
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