Successes and Failures of Combined Modality Therapies in Head and Neck Cancer

Bowles, Daniel W.; Deutsch, Éric; Raben, David

doi:10.1016/j.semradonc.2016.05.004

Cited by 4 publications

(2 citation statements)

References 83 publications

(83 reference statements)

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“…In the absence of randomised data though, it remains contentious whether any perceived benefits justify the high capital investment protons require, particularly in the current environment of stringent healthcare budgets. Strategies involving deescalation of chemotherapy and radiotherapy [56], improving management of acute toxicities [57,58], using functional imaging to adapt radiotherapy [59], strengthening collaboration with speech and language therapists and dietetics to facilitate timely swallowing interventions and evaluating novel drugeradiotherapy combinations are some of the key measures that need to be incorporated to ultimately devise a successful personalised toxicitymitigating approach in pharyngeal cancer.…”

Section: Resultsmentioning

confidence: 99%

Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it?

et al. 2017

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Dysphagia after primary chemoradiotherapy or radiation alone in pharyngeal cancers can have a devastating impact on a patient's physical, social and emotional state. Establishing and validating efficient dysphagia-optimised radiotherapy techniques is, therefore, of paramount importance in an era where health-related quality of life measures are increasingly influential determinants of curative management strategies, particularly as the incidence of good prognosis, human papillomavirus-driven pharyngeal cancer in younger patients continues to rise. The preferential sparing achievable with intensity-modulated radiotherapy (IMRT) of key swallowing structures implicated in post-radiation dysfunction, such as the pharyngeal constrictor muscles (PCM), has generated significant research into toxicity-mitigating strategies. The lack of randomised evidence, however, means that there remains uncertainty about the true clinical benefits of the dosimetric gains offered by technological advances in radiotherapy. As a result, we feel that IMRT techniques that spare PCM cannot be incorporated into routine practice. In this review, we discuss the swallowing structures responsible for functional impairment, analyse the studies that have explored the dose-response relationship between these critical structures and late dysphagia, and consider the merits of reported dysphagia-optimised IMRT (Do-IMRT) approaches, thus far. Finally, we discuss the dysphagia/aspiration-related structures (DARS) study (ISRCTN 25458988), which is the first phase III randomised controlled trial designed to investigate the impact of swallow-sparing strategies on improving long-term function. To maximise patient benefits, improvements in radiation delivery will need to integrate with novel treatment paradigms and comprehensive rehabilitation strategies to eventually provide a patient-centric, personalised treatment plan.

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Section: Resultsmentioning

confidence: 99%

Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it?

et al. 2017

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“…Leveraging information from elucidating the genomic landscape of HNSCC may also guide the development of more effective therapies to enhance radiation therapy for the treatment of HNSCC 3 . Although there have been significant advances in radiation technologies, such as the introduction of intensity modulated radiation therapy (IMRT), the impact of specific genetic alterations in HNSCC on response to radiotherapy has not been intensively investigated.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Implications of the Genetic Landscape of Head and Neck Cancer

Cho

Johnson

Grandis

2018

Seminars in Radiation Oncology

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Large-scale sequencing studies of head and neck squamous cell carcinoma (HNSCC) have elucidated the genetic changes that characterize HNSCC. These findings have supported the development of therapeutic strategies that target key components of aberrant signaling pathways and immune dysregulation. Cumulative evidence suggests that these agents in combination with radiotherapy may have synergistic effects. This review highlights the predictive biomarkers that have been identified from HNSCC genomic studies and implications on the development of molecular-targeting agents that may effectively treat patients with HNSCC, especially when used in combination with radiation.

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