Head and Neck Cancers, Version 2.2014

Pfister, David G.; Spencer, Sharon A.; Brizel, David M.; Burtness, Barbara; Busse, Paul M.; Caudell, Jimmy J.; Cmelak, Anthony J.; Colevas, A. Dimitrios; Dunphy, Frank; Eisele, David W.; Gilbert, Jill; Gillison, Maura L.; Haddad, Robert I.; Haughey, Bruce H.; Hicks, Wesley L.; Hitchcock, Ying J.; Jimeno, Antonio; Kies, Merrill S.; Lydiatt, William M.; Maghami, Ellie; Martins, Renato; McCaffrey, Thomas V.; Mell, Loren K.; Mittal, Bharat B.; Pinto, Harlan A.; Ridge, John A.; Rodriguez, Cristina P.; Samant, Sandeep; Schuller, David E.; Shah, Jatin P.; Weber, Randal S.; Wolf, Gregory T.; Worden, Frank; Yom, Sue S.; McMillian, Nicole R.; Hughes, Miranda

doi:10.6004/jnccn.2014.0142

Cited by 194 publications

(70 citation statements)

References 157 publications

(199 reference statements)

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“…The metrics encompassed the longitudinal care of the patient with head and neck cancer (pretreatment evaluation, treatment, and post treatment surveillance) and were modeled on metrics suggested by the American Headand Neck Society, 11 National Comprehensive Cancer Network guidelines for oral cavity cancer, 21 or other publications. 12,22,23 The metrics were chosen because they possessed the following characteristics: usability (the information is actionable and understandable), feasibility (the data are easily measurable and collectable), reproducibility, meaningfulness (the metrics are agreed on by stakeholders), promotion of quality improvement (compliance with the metrics can be tracked over time), and possession of face validity (a priori suspicion of association with improved outcomes).…”

Section: Methodsmentioning

confidence: 99%

Association of Compliance With Process-Related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma

Graboyes

Gross

Kallogjeri

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Quality metrics for patients with head and neck cancer are available, but it is unknown whether compliance with these metrics is associated with improved patient survival. OBJECTIVE To identify whether compliance with various process-related quality metrics is associated with improved survival in patients with oral cavity squamous cell carcinoma who receive definitive surgery with or without adjuvant therapy. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at a tertiary academic medical center among 192 patients with previously untreated oral cavity squamous cell carcinoma who underwent definitive surgery with or without adjuvant therapy between January 1, 2003, and December 31, 2010. Data analysis was performed from January 26 to August 7, 2015. INTERVENTIONS Surgery with or without adjuvant therapy. MAIN OUTCOMES AND MEASURES Compliance with a collection of process-related quality metrics possessing face validity that covered pretreatment evaluation, treatment, and posttreatment surveillance was evaluated. Association between compliance with these quality metrics and overall survival, disease-specific survival, and disease-free survival was calculated using univariable and multivariable Cox proportional hazards analysis. RESULTS Among 192 patients, compliance with the individual quality metrics ranged from 19.7% to 93.6% (median, 82.8%). No pretreatment or surveillance metrics were associated with improved survival. Compliance with the following treatment-related quality metrics was associated with improved survival: elective neck dissection with lymph node yield of 18 or more, no unplanned surgery within 14 days of the index surgery, no unplanned 30-day readmissions, and referral for adjuvant radiotherapy for pathologic stage III or IV disease. Increased compliance with a “clinical care signature” composed of these 4 metrics was associated with improved overall survival, disease-specific survival, and disease-free survival on univariable analysis (log-rank test; P < .05 for each). On multivariable analysis controlling for pT stage, pN stage, extracapsular spread, margin status, and comorbidity, increased compliance with these 4 metrics was associated with improved overall survival (100% vs ≤50% compliance: adjusted hazard ratio [aHR], 4.2; 95% CI, 2.1-8.5; 100% vs 51%-99% compliance: aHR, 1.7; 95% CI, 1.0-3.1), improved disease-specific survival (100% vs ≤50% compliance: aHR, 3.9; 95% CI, 1.7-9.0; 100% vs 51%-99%: aHR, 1.3; 95% CI, 0.6-2.9), and improved disease-free survival (100% vs ≤50% compliance: aHR, 3.0; 95% CI, 1.5-5.8; 100% vs 51%-99% compliance: aHR, 1.6; 95% CI, 0.9-2.7). CONCLUSIONS AND RELEVANCE Compliance with a core set of process-related quality metrics was associated with improved survival for patients with surgically managed oral cavity squamous cell carcinoma. Multi-institutional validation of these metrics is warranted.

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Section: Methodsmentioning

confidence: 99%

Association of Compliance With Process-Related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma

Graboyes

Gross

Kallogjeri

et al. 2016

JAMA Otolaryngol Head Neck Surg

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“…The survival of these patients is better than for those whose tumors are un-associated with HPV (6, 15). Laryngeal SCC is declining in incidence and, unlike HNSCC at other sites, is generally associated with limited regional metastasis due to anatomic barriers (16). The hypopharynx is the least common site for HNSCC and has decreasing incidence but relatively poor prognosis (17, 18).…”

Section: Introductionmentioning

confidence: 99%

Detection of somatic mutations and HPV in the saliva and plasma of patients with head and neck squamous cell carcinomas

et al. 2015

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To explore the potential of tumor-specific DNA as a biomarker for head and neck squamous cell carcinomas (HNSCC), we queried DNA from saliva or plasma of 93 HNSCC patients. We searched for somatic mutations or human papillomavirus genes, collectively referred to as tumor DNA. When both plasma and saliva were tested, tumor DNA was detected in 96% of 47 patients. The fractions of patients with detectable tumor DNA in early- and late-stage disease were 100% (n = 10) and 95% (n = 37), respectively. When segregated by site, tumor DNA was detected in 100% (n = 15), 91% (n = 22), 100% (n = 7), and 100% (n = 3) of patients with tumors of the oral cavity, oropharynx, larynx, and hypopharynx, respectively. In saliva, tumor DNA was found in 100% of patients with oral cavity cancers and in 47 to 70% of patients with cancers of the other sites. In plasma, tumor DNA was found in 80% of patients with oral cavity cancers, and in 86 to 100% of patients with cancers of the other sites. Thus, saliva is preferentially enriched for tumor DNA from the oral cavity, whereas plasma is preferentially enriched for tumor DNA from the other sites. Tumor DNA in saliva was found postsurgically in three patients before clinical diagnosis of recurrence, but in none of the five patients without recurrence. Tumor DNA in the saliva and plasma appears to be a potentially valuable biomarker for detection of HNSCC.

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“…However more recent randomized trials fail to show improvements in survival comparing various intensive neoadjuvant versus sequential or concurrent chemoradiation approaches 20–22 . Based on these cumulative experiences, a standard treatment approach of concurrent chemoradiation has been widely adopted as the preferred alternative to total laryngectomy for patients with advanced laryngeal cancer who are seeking larynx preservation 23 . Unfortunately, 5 year overall survival rates remain less than 50% 4,24 .…”

Section: Introductionmentioning

confidence: 99%

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Wolf

Bellile

Eisbruch

et al. 2017

JAMA Otolaryngol Head Neck Surg

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The introduction of chemoradiation for advanced laryngeal cancer led to a major paradigm shift in treatment as an alternative to laryngectomy. Despite widespread adoption, survival rates have not improved and the original premise of matching neoadjuvant chemotherapy tumor response to determine subsequent treatment has not been followed. A unique approach incorporating a single cycle of neoadjuvant chemotherapy to select patients with advanced disease for either laryngectomy or concurrent chemoradiation was studied to determine if improved survival could be achieved. Design From 2002–2012, we treated an unselected cohort of 247 patients with laryngeal cancer in an academic institution. Interventions Limited disease patients (n=94) underwent endoscopic resection (n=33; 35%), radiation (n=50; 53%) or chemoradiation for deeply invasive T2 lesions (n=11; 12%). For advanced disease (n=153), neoadjuvant chemotherapy for treatment selection (n=71; 46%), concurrent chemoradiation (n=50; 33%) or primary surgery (n=32; 21%) was recommended. Outcomes Propensity for treatment selection in advanced patients was modeled using logistic regression. Overall (OS) and disease specific survival (DSS) were analyzed with Cox proportional hazards models stratified by propensity score. Median follow was 48 months. Results Five-year OS and DSS was 75% (95% C.I. 68–81%) and 83% (77–88%), respectively for the entire cohort. DSS was 92% (83–97%) for patients with Stage I, II and 78% (69–84%) for patients with Stage III, IV disease. For advanced disease patients, 5-year OS (and DSS) ranged from 78% (91%) for surgery to 76% (79%) for neoadjuvant bioselection and 61% (66%) for primary chemoradiation. Propensity-adjusted multivariable Cox models controlling for known prognostic factors showed DSS was significantly improved in the neoadjuvant group compared to definitive chemoradiation [Hazard ratio 0.48, 95%CI: (0.29, 0.80), p=0.005]. DSS for the definitive surgery group was significantly better compared to the neoadjuvant bioselection group, [Hazard ratio 0.34, 95%CI: (0.14, 0.82), p=0.02]. Larynx preservation was achieved in 65% of advanced patients. Conclusions Exceptional survival rates were achieved with a bioselective treatment approach utilizing a single cycle of neoadjuvant chemotherapy. Excellent survival rates were also achieved in patients selected for primary surgery and both were better than with concurrent chemoradiation suggesting that the optimal individualized treatment approach for patients with advanced laryngeal cancer has not yet been defined.

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Head and Neck Cancers, Version 2.2014

Cited by 194 publications

References 157 publications

Association of Compliance With Process-Related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma

Association of Compliance With Process-Related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma

Detection of somatic mutations and HPV in the saliva and plasma of patients with head and neck squamous cell carcinomas

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

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