The chemoradiation paradigm in head and neck cancer

In this article, we use the example of head and neck cancer to show how concurrent chemoradiotherapy is used to treat a cancer where locoregional control is central for treatment success. The advent of concurrent chemoradiation has significantly contributed to the curability of head and neck cancer, including locoregionally advanced disease. Preserving organ function and reducing toxic effects are increasingly the focus of clinical trials. We review the available chemoradiotherapy platforms used for head and neck cancer, with initial discussions focused on single-agent cytotoxic-based regimens. We then assess the literature on multiagent-based regimens and include a discussion of the integration of novel agents, such as EGFR inhibitors, and antiangiogenic drugs into treatment platforms. Although single-agent cisplatin-based chemoradiotherapy is still widely used as a standard therapy, we propose that evidence increasingly shows that multiagent-based chemoradiotherapy, and EGFR-inhibitor-based treatments, offer distinct advantages. We provide guidance for clinicians based on current clinical trial evidence on how to choose appropriate treatment platforms for their patients. [1]


Randomized Phase III Trial of Neoadjuvant Chemotherapy in Head and Neck Cancer: 10-Year Follow-Up

In 1986, we initiated a multicenter, randomized trial to compare induction chemotherapy with cisplatin and 5-fluorouracil followed by locoregional treatment (surgery and radiotherapy or radiotherapy alone) with locoregional treatment alone in patients with head and neck squamous cell carcinoma. Here we report the long-term results of the trial. A total of 237 patients with nonmetastatic stage III or IV head and neck carcinoma were randomly assigned to receive four cycles of neoadjuvant chemotherapy followed by locoregional treatment (group A) or locoregional treatment alone (group B). Among all patients, overall survival at 5 and 10 years was 23% (95% confidence interval [CI] = 15.3% to 30.9%) and 19% (95% CI = 11.6% to 26.4%), respectively, for those in group A and 16% (95% CI = 9.6% to 23.4%) and 9% (95% CI = 3.5% to 14.7%), respectively, for those in group B ( P = .13). Among operable patients, we observed no difference between group A and group B in overall survival at 5 and 10 years (group A, 31% [95% CI = 14.9% to 47.3%] and 22.7% [95% CI = 7.1% to 38.3%], respectively; group B, 43.3% [95% CI = 25.6% to 61.0%] and 14.2% [95% CI = 0.1% to 28.3%], respectively; P = .73). Among inoperable patients, overall survival at 5 and 10 years was 21% (95% CI = 12.3% to 30.1%) and 16% (95% CI = 7.7% to 23.9%), respectively, for group A and 8% (95% CI = 1.5% to 12.3%) and 6% (95% CI = 0.1% to 9.1%), respectively, for group B (log-rank P = .04). Four cycles of neoadjuvant chemotherapy is a promising approach for treating patients with inoperable advanced head and neck cancer but not for treating patients with operable disease. [2]


Head and neck cancer: a global perspective on epidemiology and prognosis

Head and neck cancers (ICD-9 categories 140-149 and 161) are common in several regions of the world where tobacco use and alcohol consumption is high. The age standardized incidence rate of head and neck cancer (around 1990) in males exceeds 30/100, 000 in regions of France, Hong Kong, the Indian sub-continent, Central and Eastern Europe, Spain, Italy, Brazil, and among US blacks. High rates (> 10/100,000) in females are found in the Indian sub-continent, Hong Kong and Philippines. The highest incidence rate reported in males is 63.58 (France, Bas-Rhin) and in females 15.97 (India, Madras). The variation in incidence of cancers by subsite of head and neck is mostly related to the relative distribution of major risk factors such as tobacco or betel quid chewing, cigarette or bidi smoking, and alcohol consumption. Some degree of misclassification by subsites is a clear possibility in view of the close proximity of the anatomical subsites. While mouth and tongue cancers are more common in the Indian sub-continent, nasopharyngeal cancer is more common in Hong Kong; pharyngeal and/or laryngeal cancers are more common in other populations. While the overall incidence rates show a declining trend in both sexes in India, Hong Kong, Brazil and US whites, an increasing trend is observed in most other populations, particularly in Central and Eastern Europe, Scandinavia, Canada, Japan and Australia. The overall trends are a reflection of underlying trends in cancers of major subsites which seem to be related to the changing prevalence of risk factors. The five year relative survival varies from 20-90% depending upon the subsite of origin and the clinical extent of disease. While primary prevention is the potential strategy for long term disease control, early detection and treatment may have limited potential to improve mortality in the short term. [3]

Epidemiology of Head and Neck Cancers in Maiduguri-Northeastern Nigeria

Head and neck cancers is one of the common health problems in our environment affecting relatively the youth. The paucity of literature on community based studies in Nigeria to determine the incidence of the disease obscure its burden, pattern and magnitude. This study presents epidemiological characteristics of head and neck cancers in Maiduguri as seen during the period of insurgency.

A 5 year retrospective review of patients seen from January, 2010 to December, 2014 with histologically diagnosed head and neck cancers. Data extracted from the records of histopathology department of University of Maiduguri Teaching Hospital was analyzed using SPSS version 16.0.

Of the 7655 patients, 1312 (17.14%) were cancers and 217 (16.54%) of this was head and neck malignancies. Average age was 35.5years with SD±20.07. About 69% of cases were epithelial in origin and 60.83% of patients were less than 41 years of age. The age group worse affected by carcinoma is older than those with sarcoma and lymphoma.

Head and neck is not uncommon in Maiduguri even in the face of insurgency, it is also among one of the common health problems of the relatively young. This therefore call for in-depth research on aetiological factors. Relevant authorities shall also establish oncology centers which will promote education, screening programmes, early detection, prevention and control of head and neck cancers. [4]

The Relationship between Single Nucleotide Polymorphisms of Gene XRCC1 and Toxicity Induced Radiation in Patients with Head and Neck Cancer

Aims: The head and neck cancer is one of the most common types and their treatment brings complications such as dermatitis, mucositis and dysphagia. Studies of genetic variations of patients are those that enable the identification of prognostic factors for treatment, generally based on greater risk of injury to healthy tissue.

Study Design: This study examined the association between single nucleotide polymorphisms (SNPs) of XRCC1 gene in patients with head and neck cancer with adverse reactions presented in normal tissues as result of radiotherapy.

Place and Duration of Study: The study was conduct at Pontifícia Universidade Católica de Goiás, and the patients were recruited at Hospital Araújo Jorge, Associação de Combate ao Câncer em Goiás, Radiotherapy Service.

Methodology: We evaluated 54 patients, through a retrospective study, based on data contained in records and teletherapy records of patients with this cancer who underwent radiotherapy for at least 5 years.

Results: The mean age of patients was 58.43±13.79 years and the mean dose was applied 64,02Gy. Regarding the acute and late toxicities, patients analyzed showed a higher frequency of low-grade morbidities when compared to high grade. For acute toxicity, patients presenting polymorphism rs1799782 had an increased risk for developing mucositis, but the other polymorphisms were not statistically significant for the development of these changes (dermatitis, xerostomia and mucositis) acute. Patients who have studied polymorphisms have no increased risk of developing chronic changes of the larynx and esophagus (P>.05). In relation to the suspension of radiotherapy, patients with polymorphism rs25487 had reduced risk to have treatment discontinued, while patients with polymorphism rs25489 have an increased risk. Conclusion: Studies of genetic variants XRCC1 gene family should continue, to develop mechanisms to determine the degree of radiosensitivity in risk organs in patients with head and neck tumor. Thus, the personalized treatment with ionizing radiation can be prescribed for patients decreasing complications and improving the effectiveness of treatment and quality of life of patients. [5]



[1] Seiwert, T.Y., Salama, J.K. and Vokes, E.E., 2007. The chemoradiation paradigm in head and neck cancer. Nature clinical practice Oncology, 4(3), pp.156-171.

[2] Zorat, P.L., Paccagnella, A., Cavaniglia, G., Loreggian, L., Gava, A., Mione, C.A., Boldrin, F., Marchiori, C., Lunghi, F., Fede, A. and Bordin, A., 2004. Randomized phase III trial of neoadjuvant chemotherapy in head and neck cancer: 10-year follow-up. Journal of the National Cancer Institute, 96(22), pp.1714-1717.

[3] Sankaranarayanan, R., Masuyer, E., Swaminathan, R., Ferlay, J. and Whelan, S., 1998. Head and neck cancer: a global perspective on epidemiology and prognosis. Anticancer research, 18(6B), pp.4779-4786.

[4] Kodiya, A. M., Adamu, A. I., Nggada, H. A., Garandawa, H. I., Ngamdu, Y. B., Sandabe, M. B. and Isa, A. (2015) “Epidemiology of Head and Neck Cancers in Maiduguri-Northeastern Nigeria”, Journal of Advances in Medicine and Medical Research, 11(5), pp. 1-7. doi: 10.9734/BJMMR/2016/20344.

[5] Augusto de Oliveira Neto, O., Lázaro de Carvalho Vasconcelos, G., de Abreu Mendonça, Y., Castro Dourado Pinezi, J. and de Bastos Ascenço Soares, R. (2016) “The Relationship between Single Nucleotide Polymorphisms of Gene XRCC1 and Toxicity Induced Radiation in Patients with Head and Neck Cancer”, Journal of Cancer and Tumor International, 4(1), pp. 1-17. doi: 10.9734/JCTI/2016/27419.

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