Radiotherapy for locally advanced head and neck cancer in elderly patients: results and prognostic factors a single cohort

Viani, Gustavo Arruda; Faustino, Alexandre Ciufi; Danelichen, Anielle Freitas Bendo; Matsuura, Fernando Kojo; Neves, Lucio Pereira; Fernandes, Marco Henrique; Fernandes, Juliana Pavoni

doi:10.5603/rpor.a2021.0002

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…It has to be noted that, HPV positive patients are demographically and biologically different from older patients who are mostly HPV negative. The estimated 5-year OS in our study was 34.3% which is comparable to 30% as quoted by National Cancer Data Base of US [11] and other similar retrospective Institutional studies [15,16,17] where all patients were older.…”

Section: Discussionsupporting

confidence: 85%

Outcomes With Optimal Treatment in Geriatric Head and Neck Cancers – Tertiary Cancer Centre Experience

Ahmed¹

2022

IJCMO

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Aim: Older patients with locally advanced head and neck cancers (LA-HNC) are under-represented in clinical trials and denied standard treatment with concurrent Chemo-radiation. Most are treated with Radiotherapy (RT) alone. However, with the use of Intensity Modulated Radiation Therapy (IMRT) and good supportive care, even this cohort of patients can be considered for chemo-radiation. Methods and Materials: 69 patients with age >65 years with LA-HNC treated between April 2015 and December 2019 in our Institute were prospectively evaluated for treatment compliance and outcomes. All patients were planned to receive 70Gy in 33-35 fractions with IMRT and weekly Cisplatin at a dose of 40mg/m2 (or Carboplatin-AUC-2). Loco-regional Control (LRC), Overall survival (OS) and prognostic factors were evaluated. Results: Median age at presentation was 67 years (65-81). 54 were male. 64% had Karnofsky Performance Status of >90. 42% had Oropharyngeal Primary. 17% had co-morbidities. 66% had T3 disease, 77% had Node positive disease. 54% had stage III disease. All patients completed 70Gy. 81% patients received at least 5 (>200mg/m2) chemotherapy cycles. Acute Grade3 toxicity was seen in 20% of patients. 64% had complete response. With a median follow up of 23.6 months (3-71), OS was 53.5%. Estimated 2-year LRC was 60%; estimated 2- and 5-year OS was 53.5% and 34.3% respectively. On Univariate analysis, age <70 years, Cisplatin use, limited nodal disease, Stage III and complete response to treatment showed good OS (p<0.05). Conclusion: Definitive chemo-IMRT approach in older LA-HNC is well tolerated with good clinical outcomes. Hence older age should not be a barrier for standard treatment.

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Section: Discussionsupporting

confidence: 85%

Outcomes With Optimal Treatment in Geriatric Head and Neck Cancers – Tertiary Cancer Centre Experience

Ahmed¹

2022

IJCMO

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“…Early-stage head and neck cancer are typically treated with surgery, locally advanced cancer is treated with chemotherapy and radiotherapy, and recurrence or metastasis is treated with chemotherapy as a symptomatic treatment [4]. In general, even for locally advanced head and neck cancer, chemotherapy and radiotherapy are more than 50% effective [5].…”

Section: Introductionmentioning

confidence: 99%

Targeting of FSP1 regulates iron homeostasis in drug-tolerant persister head and neck cancer cells via lipid-metabolism-driven ferroptosis

Wu,

Huang,

Hsieh

et al. 2024

Aging

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Background: Research has demonstrated that some tumor cells can transform into drug-tolerant persisters (DTPs), which serve as a reservoir for the recurrence of the disease. The persister state in cancer cells arises due to temporary molecular reprogramming, and exploring the genetic composition and microenvironment during the development of head and neck squamous cell carcinoma (HNSCC) can enhance our comprehension of the types of cell death that HNSCC, thus identifying potential targets for innovative therapies. This project investigated lipid-metabolism-driven ferroptosis and its role in drug resistance and DTP generation in HNSCC. Methods: High levels of FSP1 were discovered in the tissues of patients who experienced relapse after cisplatin treatment. RNA sequencing indicated that a series of genes related to lipid metabolism were also highly expressed in tissues from these patients. Consistent results were obtained in primary DTP cells isolated from patients who experienced relapse. The Cancer Genome Atlas database confirmed this finding. This revealed that the activation of drug resistance in cancer cells is influenced by FSP1, intracellular iron homeostasis, and lipid metabolism. The regulatory roles of ferroptosis suppressor protein 1 (FSP1) in HNSCC metabolic regulation were investigated.

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“…They originate from epithelial cells of the aerodigestive tract [ 2 , 3 , 4 ] and may be classified according to their localization: nasopharyngeal, tongue, oral, and laryngeal squamous cell carcinoma (NSCC, TSCC, OSCC, and LSCC, respectively) [ 2 , 3 , 5 , 6 ]. The most common risk factors are alcohol consumption, tobacco smoking, and human papilloma virus (HPV) infection [ 7 , 8 ]. Interestingly, among younger patients, HPV infection is the most important risk factor, often associated with better treatment outcomes and recovery [ 1 , 2 , 3 , 4 , 6 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of YRNAs on HNSCC and HPV Infection

et al. 2023

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HPV infection is one of the most important risk factors for head and neck squamous cell carcinoma among younger patients. YRNAs are short non-coding RNAs involved in DNA replication. YRNAs have been found to be dysregulated in many cancers, including head and neck squamous cell carcinoma (HNSCC). In this study, we investigated the role of YRNAs in HPV-positive HNSCC using publicly available gene expression datasets from HNSCC tissue, where expression patterns of YRNAs in HPV(+) and HPV(−) HNSCC samples significantly differed. Additionally, HNSCC cell lines were treated with YRNA1-overexpressing plasmid and RNA derived from these cell lines was used to perform a NGS analysis. Additionally, a deconvolution analysis was performed to determine YRNA1’s impact on immune cells. YRNA expression levels varied according to cancer pathological and clinical stages, and correlated with more aggressive subtypes. YRNAs were mostly associated with more advanced cancer stages in the HPV(+) group, and YRNA3 and YRNA1 expression levels were found to be correlated with more advanced clinical stages despite HPV infection status, showing that they may function as potential biomarkers of more advanced stages of the disease. YRNA5 was associated with less-advanced cancer stages in the HPV(−) group. Overall survival and progression-free survival analyses showed opposite results between the HPV groups. The expression of YRNAs, especially YRNA1, correlated with a vast number of proteins and cellular processes associated with viral infections and immunologic responses to viruses. HNSCC-derived cell lines overexpressing YRNA1 were then used to determine the correlation of YRNA1 and the expression of genes associated with HPV infections. Taken together, our results highlight the potential of YRNAs as possible HNSCC biomarkers and new molecular targets.

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Radiotherapy for locally advanced head and neck cancer in elderly patients: results and prognostic factors a single cohort

Cited by 7 publications

References 19 publications

Outcomes With Optimal Treatment in Geriatric Head and Neck Cancers – Tertiary Cancer Centre Experience

Outcomes With Optimal Treatment in Geriatric Head and Neck Cancers – Tertiary Cancer Centre Experience

Targeting of FSP1 regulates iron homeostasis in drug-tolerant persister head and neck cancer cells via lipid-metabolism-driven ferroptosis

The Impact of YRNAs on HNSCC and HPV Infection

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