Late toxicity after radical treatment for locally advanced head and neck cancer

Cequier, Ángel; Rullan, Antonio; Hierro, Cinta; Navarro, V.; Vázquez, Silvia; Lozano, A.; Vilajosana, E.; Mañós, M.; Roig, Antonio Marí; Viñals, J.; Mesı́a, Ricard

doi:10.1016/j.oraloncology.2015.05.002

Cited by 35 publications

(28 citation statements)

References 13 publications

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“…The highest rates of HNC ORN have been documented in the oral cavity (15%), documented incidence of ORN in HNC of the laryngopharynx is about 4.1%. Rates are significantly influenced by primary tumor stage (T4 or not), RT treatment technique (intensity modulated radiation therapy/volumetric modulated arc radiotherapy or not), radiation dose (70 Gy or less), and age (greater than years or not) findings that are seen consistently across multiple studies . Our study reflected similar risk factors in that all of the patients, except one presented with or progressed to T4 disease, were exposed to 70 Gy, and 83% of patients or greater at time of ORN diagnosis.…”

Section: Discussionsupporting

confidence: 65%

“…Incidence varies based on volume of exposure, which is determined by both target size, dose administered, and technique of radiation administration. HNC patients are at increased risk for ORN given the typical radiation regimen of 60 to 70 Gy and the close proximity of adjacent critical structures . The highest rates of HNC ORN have been documented in the oral cavity (15%), documented incidence of ORN in HNC of the laryngopharynx is about 4.1%.…”

Section: Discussionmentioning

confidence: 99%

“…Manifestations of these toxicities vary in both onset and severity. Intolerance of toxicity can limit the delivery of effective radiation doses and result in long‐term morbidity impairing laryngopharyngeal function and quality of life . Despite the large population of HNC patients experiencing these complications, insufficient data exists to accurately characterize patient specific toxicity risk and subsequent progression.…”

Section: Introductionmentioning

confidence: 99%

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Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation

Irizarry

Shatzkes

Teng³

et al. 2018

The Laryngoscope

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Objectives Adequate treatment of laryngopharyngeal malignancy often incorporates radiation therapy. Structures surrounding laryngopharynx exposed to traditional radiation doses are susceptible to posttreatment toxicity. Among poorly understood sequelae is the rare manifestation of sternoclavicular joint (SCJ) osteoradionecrosis (ORN). Methods Three institutional encounters prompted a comprehensive literature search, generating three published case reports. Systematic extraction and analysis (n = 6) of demographics, cancer history, comorbidities, ORN presentation, imaging, and management established the largest series to investigate this pathology. Results Patients were males (6), 54 to 70 years old, smokers (4), with Hypertension/dyslipidemia, myocardial infarction/coronary artery disease, second primary (2), diabetes mellitus (1), and myelofibrosis(1). Four underwent total laryngectomy, one primary, three as salvage. Five patients had concurrent chemoradiation (≥70 Gy). All patients presented with swollen, tender neck wounds concerning for persistent/recurrent malignancy. Computed tomography (CT) demonstrated bone erosion (5 of 5) and increased bone scan uptake (2 of 2). All responded to surgical exploration with drainage alone (1), sequestrectomy (2), or bone resection with synovectomy (3). Complete healing took 2 months to 3 years. One unrelated patient death occurred before control of ORN was achieved. Discussion Given varied patient characteristics, synergistic risk factors exist that alter bone radiation threshold, resulting in irreversible ischemic damage and osteoradionecrosis. Vascular susceptibility and inability to repair may regulate that threshold. Understanding this relationship will facilitate early detection and intervention. Conclusion Integrating cases of sternoclavicular joint ORN promotes awareness of atypical laryngopharyngeal radiation complications, elucidates contributing factors, educates physicians on presentation and management, and provides a platform for prospective investigation. Level of Evidence 4 Laryngoscope, 129:865–870, 2019

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation

Irizarry

Shatzkes

Teng³

et al. 2018

The Laryngoscope

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“…This study was limited to data available in the SEER database, which is of high quality but does not include all factors with the potential to impact other‐cause survival. Toxicities of head and neck cancer treatment can cause late mortality . For example, stroke risk is increased after carotid radiation and patients receiving radiotherapy had lower other‐cause survival; however, individual deaths cannot be attributed to treatment toxicities with these data and this association may reflect the selection of sicker patients for nonsurgical therapy.…”

Section: Discussionmentioning

confidence: 95%

Decreased cancer-independent life expectancy in the head and neck cancer population

et al. 2017

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“…With regard to late toxicity (at least six months after treatment completion), CTRT led to more renal dysfunction (22.4 vs. 0%). Taberna, et al 45 identified CTRT as a risk factor for moderate (odds-ratio …”

Section: Questionmentioning

confidence: 99%

Multidisciplinary, Multi-Institutional Consensus on Cetuximab Usefulness in the Treatment of Patients with Head and Neck Squamous Cell Carcinoma

Barrera-Franco¹,

Bautista-Aragón²,

Gallegos-Hernández³

et al. 2022

GAMO

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Epidermal growth factor receptor is preferably expressed in head and neck squamous cell carcinomas and is a promising therapeutic target. Cetuximab is the only epidermal growth factor receptor-targeted agent that has been approved for the treatment of squamous cell carcinoma. The 2006 FDA-approved indication refers to the use of cetuximab in combination with radiotherapy for the treatment of locoregional, advanced, unresectable head and neck squamous cell carcinoma, except for nasopharyngeal carcinoma. In 2011, the use of cetuximab in combination with platinum and 5-fluorouracil was approved as first-line treatment for recurrent and/or metastatic head and neck squamous cell carcinoma. In order to homogenize and arrive at a multidisciplinary, multi-institutional consensus based on scientific evidence, a meeting was held where the existing literature was reviewed and the role of cetuximab in the treatment of patients with head and neck squamous cell carcinoma was discussed. This work reviews current evidence-based indications for the use of cetuximab in the treatment of patients with head and neck squamous cell carcinoma. (creativecommons.org/ licenses/by-nc-nd/4.0/).

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Late toxicity after radical treatment for locally advanced head and neck cancer

Cited by 35 publications

References 13 publications

Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation

Osteoradionecrosis of the sternoclavicular joint after laryngopharyngeal radiation

Decreased cancer-independent life expectancy in the head and neck cancer population

Multidisciplinary, Multi-Institutional Consensus on Cetuximab Usefulness in the Treatment of Patients with Head and Neck Squamous Cell Carcinoma

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