Consensus and clinical recommendations for nutritional intervention for head and neck cancer patients undergoing chemoradiotherapy in Taiwan

Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): Mei-Chun Lin, Pei-Wei Shueng, Wei-Kuo Chang, Peter Mu-Hsin Chang, Hsin-Chun Feng, Muh-Hwa Yang, Pei-Jen Lou
Because of the anatomical location, patients with head and neck cancer (HNC) frequently experience dysphagia and malnutrition at the time of diagnosis and these conditions are often exacerbated after chemoradiotherapy. There is an emerging medical need to establish a consensus on nutritional intervention for these patients. A panel of 30 senior physicians and experts from multidisciplinary teams drafted clinical recommendations to improve the management of nutritional interventions in Taiwan and to provide updated treatment strategy recommendations in hope of improving the nutritional status of patients with HNC. This clinical review describes the resulting consensus document, including the impact of malnutrition on clinical outcomes, the role of prophylactic tube feeding, the choice of tube feeding, and the benefit of oral nutritional supplements in patients with HNC undergoing chemoradiotherapy. The outcomes of this review will support clinicians in their efforts to improve the nutritional status of patients with HNC.



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Multi-modality 3D mandibular resection planning in head and neck cancer using CT and MRI data fusion: A clinical series

Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): J. Kraeima, B. Dorgelo, H.A. Gulbitti, R.J.H.M. Steenbakkers, K.P. Schepman, J.L.N. Roodenburg, F.K.L. Spijkervet, R.H. Schepers, M.J.H. Witjes
Objectives3D virtual surgical planning (VSP) and guided surgery has been proven to be an effective tool for resection and reconstruction of the mandible. Currently, most widely used 3D VSP approaches to mandibular resection do not include detailed tumour information in the VSP. This manuscript presents a strategy where the aim was to incorporate tumour visualisation into the 3D virtual plan. Three-dimensional VSP of the mandibular resections was based on the fusion of CT and MRI data which was subsequently applied in clinical practice.MethodsAll patients diagnosed with oral squamous cell carcinoma between 2014 and 2017 at the University Medical Centre Groningen were included. The tumour was delineated on the MRI data, after which this dataset was fused with the CT bone data in order to construct a 3D bone and tumour model for virtual resection planning. Guided resections were performed and post-operative evaluation quantified the accuracy of the resection. The histopathological findings and patient and tumour characteristics were compared to those of a historical cohort (2009–2014) of conventional mandibular continuity resections.ResultsTwenty-four patients were included in the cohort. The average deviation from planned resection was found to be 2.2 mm. Histopathologic analysis confirmed all resection planes (bone) were tumour free, compared to 96.4% in the historic cohort.ConclusionMRI-CT base tumour visualisation and 3D resection planning is a safe and accurate method for oncologic resection of the mandible. It is an improvement on the current methods reported for 3D resection planning based solely on CT data.



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Integrated genomic characterization of oral carcinomas in post-hematopoietic stem cell transplantation survivors

Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): Glenn J. Hanna, Eric R. Kofman, Muhammad Ali Shazib, Sook-bin Woo, Brendan Reardon, Nathaniel S. Treister, Robert I. Haddad, Corey S. Cutler, Joseph H. Antin, Eliezer M. Van Allen, Ravindra Uppaluri, Robert J. Soiffer
ObjectivesSecondary oral squamous cell carcinoma (OSCC) is a late complication in allogeneic hematopoietic stem cell transplantation (HSCT) patients, but little is known about long-term outcomes and prognostication. Additionally, molecular alterations and immunologic insights unique to this disease remain largely unexplored.MethodsWe present a cohort of 31 patients with post-HSCT OSCC and reported on clinicopathologic predictors of survival. Whole-exome sequencing was performed on 6 (19%) matched pairs of peripheral blood (post-conditioning, pre-HSCT) and tumor samples. The entire cohort had archival tumor available for immunoprofiling with PD-1/L1 immunohistochemistry.ResultsFive-year overall survival (OS) was 57% (95% CI: 46.1–69.8) with a median disease-free survival (DFS) of 13.3 months. Advanced initial staging, a buccal or oral tongue subsite, chronic oral graft-versus-host disease (GVHD) and smoking all negatively impacted survival. High tumor mutational burden (TMB) (median 11.3 vs. 5.0) and unique mutational signatures were noted between unrelated and related donor groups – with a strong correlation between infiltrating PD-1+ lymphocytes and TMB (R = 0.98, p < 0.01). Some differences were observed when comparing commonly mutated genes among our cohort and TCGA, with a predominance of TP53 events.ConclusionSurvival outcomes appear similar in HSCT survivors with OSCC compared with non-HSCT OSCC populations. We identified somatic alterations in genes with therapeutic potential unique to this subpopulation of oral cancers.



https://ift.tt/2Jyeweh

Consensus and clinical recommendations for nutritional intervention for head and neck cancer patients undergoing chemoradiotherapy in Taiwan

Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): Mei-Chun Lin, Pei-Wei Shueng, Wei-Kuo Chang, Peter Mu-Hsin Chang, Hsin-Chun Feng, Muh-Hwa Yang, Pei-Jen Lou
Because of the anatomical location, patients with head and neck cancer (HNC) frequently experience dysphagia and malnutrition at the time of diagnosis and these conditions are often exacerbated after chemoradiotherapy. There is an emerging medical need to establish a consensus on nutritional intervention for these patients. A panel of 30 senior physicians and experts from multidisciplinary teams drafted clinical recommendations to improve the management of nutritional interventions in Taiwan and to provide updated treatment strategy recommendations in hope of improving the nutritional status of patients with HNC. This clinical review describes the resulting consensus document, including the impact of malnutrition on clinical outcomes, the role of prophylactic tube feeding, the choice of tube feeding, and the benefit of oral nutritional supplements in patients with HNC undergoing chemoradiotherapy. The outcomes of this review will support clinicians in their efforts to improve the nutritional status of patients with HNC.



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A Nomogram based prognostic score that is superior to conventional TNM staging in predicting outcome of surgically treated T4 buccal mucosa cancer: Time to think beyond TNM

Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): Saurabh Bobdey, Manish Mair, Sudhir Nair, Deepa Nair, Ganesh Balasubramaniam, Pankaj Chaturvedi
Background and objectivesT4 squamous cell carcinomas of the buccal mucosa is known to have ominous outcome. The aim of this study was to develop a nomogram for T4 buccal mucosa cancer patients and demonstrate the difference in survival based on prognosticators beyond those covered by the traditional TNM staging system.MethodsWe examined medical records of treatment naïve 205 T4 buccal mucosa cancer patients operated between January 1, 2009, and December 31, 2014. A nomogram was developed using multivariate cox-regression. The nomogram was validated internally by bootstrapping and externally in an independent validation set.ResultsThe nomogram for predicting 3-year overall survival was built using Tumor differentiation, Pathological Lymph node involvement, Bone and Perineural invasion. Based on nomogram, a score was assigned to each patient and they were divided into two groups based on Youden derived cut-off value (13.5). These two groups in training and validation set showed significant difference in survival.ConclusionWe developed a high performance, accurate and efficient nomogram to predict the probability of 3-year survival in T4 buccal mucosa cancer patients. Intensification of adjuvant treatment in these advanced cancer patients with poorer score might improve their survival.



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Multi-modality 3D mandibular resection planning in head and neck cancer using CT and MRI data fusion: A clinical series

Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): J. Kraeima, B. Dorgelo, H.A. Gulbitti, R.J.H.M. Steenbakkers, K.P. Schepman, J.L.N. Roodenburg, F.K.L. Spijkervet, R.H. Schepers, M.J.H. Witjes
Objectives3D virtual surgical planning (VSP) and guided surgery has been proven to be an effective tool for resection and reconstruction of the mandible. Currently, most widely used 3D VSP approaches to mandibular resection do not include detailed tumour information in the VSP. This manuscript presents a strategy where the aim was to incorporate tumour visualisation into the 3D virtual plan. Three-dimensional VSP of the mandibular resections was based on the fusion of CT and MRI data which was subsequently applied in clinical practice.MethodsAll patients diagnosed with oral squamous cell carcinoma between 2014 and 2017 at the University Medical Centre Groningen were included. The tumour was delineated on the MRI data, after which this dataset was fused with the CT bone data in order to construct a 3D bone and tumour model for virtual resection planning. Guided resections were performed and post-operative evaluation quantified the accuracy of the resection. The histopathological findings and patient and tumour characteristics were compared to those of a historical cohort (2009–2014) of conventional mandibular continuity resections.ResultsTwenty-four patients were included in the cohort. The average deviation from planned resection was found to be 2.2 mm. Histopathologic analysis confirmed all resection planes (bone) were tumour free, compared to 96.4% in the historic cohort.ConclusionMRI-CT base tumour visualisation and 3D resection planning is a safe and accurate method for oncologic resection of the mandible. It is an improvement on the current methods reported for 3D resection planning based solely on CT data.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader https://ift.tt/2IGhFHC
via IFTTT

Integrated genomic characterization of oral carcinomas in post-hematopoietic stem cell transplantation survivors

Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): Glenn J. Hanna, Eric R. Kofman, Muhammad Ali Shazib, Sook-bin Woo, Brendan Reardon, Nathaniel S. Treister, Robert I. Haddad, Corey S. Cutler, Joseph H. Antin, Eliezer M. Van Allen, Ravindra Uppaluri, Robert J. Soiffer
ObjectivesSecondary oral squamous cell carcinoma (OSCC) is a late complication in allogeneic hematopoietic stem cell transplantation (HSCT) patients, but little is known about long-term outcomes and prognostication. Additionally, molecular alterations and immunologic insights unique to this disease remain largely unexplored.MethodsWe present a cohort of 31 patients with post-HSCT OSCC and reported on clinicopathologic predictors of survival. Whole-exome sequencing was performed on 6 (19%) matched pairs of peripheral blood (post-conditioning, pre-HSCT) and tumor samples. The entire cohort had archival tumor available for immunoprofiling with PD-1/L1 immunohistochemistry.ResultsFive-year overall survival (OS) was 57% (95% CI: 46.1–69.8) with a median disease-free survival (DFS) of 13.3 months. Advanced initial staging, a buccal or oral tongue subsite, chronic oral graft-versus-host disease (GVHD) and smoking all negatively impacted survival. High tumor mutational burden (TMB) (median 11.3 vs. 5.0) and unique mutational signatures were noted between unrelated and related donor groups – with a strong correlation between infiltrating PD-1+ lymphocytes and TMB (R = 0.98, p < 0.01). Some differences were observed when comparing commonly mutated genes among our cohort and TCGA, with a predominance of TP53 events.ConclusionSurvival outcomes appear similar in HSCT survivors with OSCC compared with non-HSCT OSCC populations. We identified somatic alterations in genes with therapeutic potential unique to this subpopulation of oral cancers.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader https://ift.tt/2Jyeweh
via IFTTT