Imagining Our Lives Post-Pandemic Yom, Sue S; Zietman, Anthony L
International journal of radiation oncology, biology, physics,
10/2020, Letnik:
108, Številka:
2
Journal Article
Despite convincing evidence that the principles of accelerated repopulation would open up additional therapeutic opportunities in the treatment of advanced-stage non–small cell lung cancer, this ...strategy has been generally underexplored. The implementation of accelerated radiotherapy schedules has been hampered by logistical barriers, concerns about acute toxicity, and the prioritization of integrating concurrent chemotherapy into the standard treatment platform. At present, it is unclear to what extent accelerated fractionation will influence future treatment paradigms in non–small cell lung cancer, although technical advances in radiotherapy, allowing higher dose delivery with reduced toxicity, could permit the development of more convenient and tolerable forms of accelerated schedules.
Objectives
To demonstrate adequacy of radiation therapy alone to the neck in patients with maxillary sinus squamous cell carcinoma (MS‐SCC) without clinical evidence of regional metastasis.
Methods
...Retrospective review between 2000 and 2018 from a single high‐volume tertiary academic head and neck cancer center of all patients with MS‐SCC.
Results
A total of 55 patients were treated for MS‐SCC at our center. A clinically uninvolved neck on presentation was found in 46 patients (83.6%) in the initial dataset. Of the 39 patients with radiologic N0 disease who were treated with primary surgical resection, 15.4% (6 patients) did not undergo any treatment of the neck, 2.6% (1 patient) underwent a neck dissection only, 69.2% (27 patients) received RT only, and 12.8% (5 patients) were treated with both a neck dissection followed by RT. Median follow‐up was 26 months (mean 48 months, interquartile range 9–76 months). Five‐year overall survival of all patients with N0 necks treated with upfront surgical resection was 46.5% (95% CI, 32.3%–66.9%). No patients with N0 necks had isolated regional recurrence regardless of neck management.
Conclusions
Regional recurrence is rare for patients with radiologic N0 MS‐SCC. Single‐modality elective neck radiation provides excellent regional disease control in these patients.
Purpose
This study suggests a lifelong learning‐based convolutional neural network (LL‐CNN) algorithm as a superior alternative to single‐task learning approaches for automatic segmentation of head ...and neck (OARs) organs at risk.
Methods and materials
Lifelong learning‐based convolutional neural network was trained on twelve head and neck OARs simultaneously using a multitask learning framework. Once the weights of the shared network were established, the final multitask convolutional layer was replaced by a single‐task convolutional layer. The single‐task transfer learning network was trained on each OAR separately with early stoppage. The accuracy of LL‐CNN was assessed based on Dice score and root‐mean‐square error (RMSE) compared to manually delineated contours set as the gold standard. LL‐CNN was compared with 2D‐UNet, 3D‐UNet, a single‐task CNN (ST‐CNN), and a pure multitask CNN (MT‐CNN). Training, validation, and testing followed Kaggle competition rules, where 160 patients were used for training, 20 were used for internal validation, and 20 in a separate test set were used to report final prediction accuracies.
Results
On average contours generated with LL‐CNN had higher Dice coefficients and lower RMSE than 2D‐UNet, 3D‐Unet, ST‐ CNN, and MT‐CNN. LL‐CNN required ~72 hrs to train using a distributed learning framework on 2 Nvidia 1080Ti graphics processing units. LL‐CNN required 20 s to predict all 12 OARs, which was approximately as fast as the fastest alternative methods with the exception of MT‐CNN.
Conclusions
This study demonstrated that for head and neck organs at risk, LL‐CNN achieves a prediction accuracy superior to all alternative algorithms.
Fluorine-18 (18F)-fluorodeoxyglucose (FDG) positron emission tomography fused with computed tomography (PET/CT) is a valuable tool in surgical planning for head and neck squamous cell carcinoma ...(HNSCC). If performed prior to biopsy or other surgical intervention, FDG-PET/CT has high sensitivity for the detection of the primary site in patients with cervical lymph node metastases from unknown primary origin and can be used to direct the surgical workup. FDG-PET/CT is superior to CT alone for detection of nodal metastases outside the expected pattern or distant metastases or second primary cancers and can greatly affect determination of appropriate management including surgical eligibility. Prior to the advent of PET/CT, many patients undergoing (chemo)radiation-based therapy had planned post-treatment neck dissection; FDG-PET/CT now has a proven role in the evaluation of recurrent or persistent disease amenable to salvage surgery and enables safe avoidance of planned postradiation neck dissection with a high negative predictive value. Specifically for this important application, two standardized reporting metrics may be used in the head and neck anatomic region: the “Hopkins criteria” and the “Neck Imaging Reporting and Data System”; both systems produce a formalized evaluation and recommendation based on PET/CT findings. The role of PET/CT as a replacement for elective neck dissection or examination under anesthesia remains controversial but deserves further study. FDG-PET/CT has a wide-ranging impact on the surgical management of patients with HNSCC and should be used routinely in patients with unknown primary nodal disease and those presenting with advanced-stage cancers at initial staging and to assess treatment response.
Background
Neighborhood socioeconomic deprivation impacts outcomes in various cancers. We examined this association in nasopharyngeal carcinoma (NPC) patients using the area deprivation index (ADI).
...Methods
We conducted a single‐institution retrospective cohort study on NPC patients treated with definitive radiotherapy from 1980 to 2023. ADI was used as the primary exposure measure. Higher ADI indicates higher levels of socioeconomic deprivation.
Results
Of 561 patients, those with higher ADI (6–10 vs. 1–5) presented more commonly with AJCC stage III/IV compared to I/II (87% vs. 76%, p = 0.03). Increasing ADI decile score correlated with poorer overall survival (HR 1.14, 95% CI 1.01–1.28, p = 0.04). Local control was worse in patients from the most deprived quartile in the cohort ADI 5–10 (HR 2.11, 95% CI 1.01–4.41, p = 0.05).
Conclusions
NPC patients from more disadvantaged neighborhoods undergoing radiotherapy had worse local control and survival outcomes. Interventions to address structural determinants of health and neighborhood disparities may improve these outcomes.
In Reply to Gupta et al Thomson, David J; Yom, Sue S
International journal of radiation oncology, biology, physics,
07/2020, Letnik:
107, Številka:
4
Journal Article
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