A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study—Part 2 (Radiation Oncology)

Eliçin, Olgun; Putora, Paul Martin; Siano, Marco; Broglie, Martina A.; Simon, Christian; Zwahlen, Daniel R.; Huber, Gerhard; Ballerini, Giorgio; Beffa, Lorenza; Giger, Roland; Rothschild, Sacha I.; Negri, Sandro; Dulguerov, Pavel; Henke, Guido

doi:10.3389/fonc.2019.01126

Cited by 3 publications

(2 citation statements)

References 85 publications

(97 reference statements)

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“…They reported an overall rate of occult metastasis of 23%. Similarly, we evaluated the incidence of occult additional metastasis in the rcN+ neck by compartmentalization of the neck in its levels, which is especially useful for the planning of adjuvant salvage radiotherapy 14 . Occult additional metastases in radiologically uninvolved neck levels were observed in 25% of the patients treated with salvage neck dissection.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Salvage Therapy in Isolated Regional Recurrence in Head and Neck Squamous Cell Carcinoma

et al. 2020

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Objectives/Hypothesis Head and neck squamous cell carcinoma (HNSCC) has a high tendency for regional lymphatic spreading. Nevertheless, isolated regional lymph node recurrences are rare, and only limited data regarding its management are available. The aim of this study was to describe treatment modalities and outcomes, and to identify prognostic factors. Study Design Retrospective cohort study. Methods The records of all patients (n = 498) with tumor persistence or recurrence after curatively intended treatment for HNSCC were retrospectively reviewed. Patients with synchronous secondary tumors at initial presentation, tumor persistence, local or locoregional recurrence, and systemic metastases were excluded. Results A total of 76 patients were included. The rate of occult additional metastasis in radiologically uninvolved neck compartments during salvage neck dissection was 25%. The salvaged patients showed a 37.5% 5‐year recurrence‐free survival (RFS). Multivariate analysis revealed initial stage IVA‐B (hazard ratio [HR]: 4.16, P < .01), extracapsular spread (HR: 3.71, P = .04), higher involved/total lymph node ratio (HR: 6.79, P < .01), and soft‐tissue infiltration (HR: 3.27, P < .01) as independent adverse prognostic factors for RFS. Moreover, univariate data analysis identified recurrent stage rcN2‐3; clinical involvement of the neck levels IV, V and/or VI; and smoking as adverse risk factors for RFS. Conclusions This study identifies initial stage IVA‐B, extracapsular spread, higher involved/total lymph node ratio, and soft‐tissue infiltration as independent adverse prognostic factors for RFS following isolated regional recurrences. The incidence of occult additional metastasis of radiologically uninvolved levels during salvage neck dissections was high (25%). Therefore, superselective or selective neck dissection would not have been the adequate type of salvage surgery. Level of Evidence 4 Laryngoscope, 131:67–72, 2021

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Section: Discussionmentioning

confidence: 99%

Outcome of Salvage Therapy in Isolated Regional Recurrence in Head and Neck Squamous Cell Carcinoma

et al. 2020

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“…Another compartmentalization strategy for HNSCC is the omission of the primary tumor bed for patients with a favorable local risk profile that receive PORT to the at-risk areas in the involved neck. Why the postoperative primary tumor bed should be irradiated in the presence of multiple nodal positivity and/or ECE, whereas the same tumor bed would not receive any radiation if the neck is pN0-1 lacks a logical rationale ( 27 ). A national patterns of care study revealed no consensus on this issue with 70% of the centers not separating the tumor bed from the dissected nodal levels, and 30% allowing for this type of de-escalation ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Oncologic outcome with versus without target volume compartmentalization in postoperative radiotherapy for oral cavity squamous cell carcinoma

Riggenbach,

Waser,

Mueller

et al. 2024

Front. Oncol.

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Background and purposeThe volume treated with postoperative radiation therapy (PORT) in patients with oral cavity squamous cell carcinoma (OCSCC) is a mediator of toxicity affecting quality of life. Current guidelines only allow for very limited reduction of PORT volumes. This study investigated the safety and efficacy of de-intensified PORT for patients with OCSCC by refined compartmentalization of the treatment volume.Materials and methodsThis retrospective cohort study identified 103 OCSCC patients treated surgically from 2014 to 2019 with a loco-regional risk profile qualifying for PORT according to guidelines. PORT was administered only to the at-risk compartment and according to a refined compartmentalization concept (CC). Oncological outcome of this CC cohort was compared to a historical cohort (HC) of 98 patients treated before the CC was implemented.ResultsMedian follow-up time was 4.5 and 4.8 years in the CC and HC cohorts, respectively. In the CC cohort, a total of 72 of 103 patients (70%) had a pathological risk profile that allowed for further compartmentalization and, hence, received a reduced treatment volume or omission of PORT altogether. Loco-regional control at 3 and 5 years was 77% and 73% in the CC cohort versus 78% and 73% in the HC (p = 0.93), progression-free survival was 72% and 64% versus75% and 68% (p = 0.58), respectively. Similarly, no statistically significant difference was seen in other outcome measures.ConclusionsDe-intensified PORT limiting the treatment volume to the at-risk compartment or avoiding PORT altogether for low-risk patients with OCSCC does not seem to compromise disease control in this retrospective comparison. Based on these hypothesis-generating findings, a prospective study is being planned.

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Radiation ulcer treatment with hyperbaric oxygen therapy and haemoglobin spray: case report and literature review

et al. 2020

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Objective: To explore the effectiveness of a combination of hyperbaric oxygen therapy and haemoglobin spray in radiation ulcer treatment. Method: We reviewed the available literature and present a case report in which radiation ulcer was treated with a combination of hyperbaric oxygen therapy and haemoglobin spray. Results: After 30 sessions of hyperbaric oxygen therapy (2.4 ATA; 90 minutes each session) and administration of haemoglobin spray, the wounds showed gradual progress towards healing and a good granulating base was achieved. The wounds were closed after two months using a small split thickness skin graft. Conclusion: A combination of hyperbaric oxygen therapy and haemoglobin spray was effective as a short course of treatment for radiation ulcers.

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A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study—Part 2 (Radiation Oncology)

Cited by 3 publications

References 85 publications

Outcome of Salvage Therapy in Isolated Regional Recurrence in Head and Neck Squamous Cell Carcinoma

Outcome of Salvage Therapy in Isolated Regional Recurrence in Head and Neck Squamous Cell Carcinoma

Oncologic outcome with versus without target volume compartmentalization in postoperative radiotherapy for oral cavity squamous cell carcinoma

Radiation ulcer treatment with hyperbaric oxygen therapy and haemoglobin spray: case report and literature review

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