Management of the neck after definitive chemoradiation in patients with HPV-associated oropharyngeal cancer: An institutional experience

Wotman, Michael; Ghaly, Maged; Massaro, Luke; Tham, Tristan; Seetharamu, Nagashree; Kamdar, Dev; Frank, Douglas K.; Kraus, Dennis H.; Teckie, Sewit

doi:10.1016/j.amjoto.2019.06.003

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…24 Additionally, when formal consolidated guidelines are lacking, a multisectoral approach might guide health-care professionals in the decision-making process, as advocated by Wotman et al in papillomavirus-positive oropharyngeal squamous-cell carcinoma with incomplete postchemoradiation node response. 48 A multimodal and interdiscipline-centered approach might similarly compensate, as underlined by Herlemann et al, the absence of consolidated recommendations on timing and best-treatment sequence in metastatic hormonesensitive prostate cancer. 49 To corroborate this, Fazio et al suggested that an integrated multispecialty strategy might be helpful also to optimize the management of lung neuroendocrine tumors, since the wider armamentarium available for this subgroup compared to the poorly differentiated counterpart.…”

Section: Improvements In Clinical Decision-making and Patient Managementmentioning

confidence: 99%

<p>Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management</p>

Berardi¹,

Morgese²,

Rinaldi³

et al. 2020

CMAR

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Over the years, a growing body of literature has confirmed as beneficial the implementation of a multidisciplinary approach in the so-often-intricate scenario of cancer patients' management. Together with the consolidation of tumor-board experience in clinical practice, certain aspects have emerged as controversial and a source of current debate. In this systematic literature review, we focused our attention on the impact of multidisciplinary tumor boards, assessing benefits and limitations as a result of the dissemination of such approaches. On the bright side, adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes have been recognized as advantages. On the other side, our analysis highlights a few limitations that should be taken into account to optimize cancer patients' management. Of note, some issues, such as costs, legal responsibility, geographic barriers, and treatment delays, have yet to be resolved. In order partly to address this matter, software platforms and novel methods of computational analysis may provide the needed support. Therefore, the aim of our analysis was to describe the multidisciplinary approach in cancer care in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes through a systematic review of the literature.

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Section: Improvements In Clinical Decision-making and Patient Managementmentioning

confidence: 99%

<p>Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management</p>

Berardi¹,

Morgese²,

Rinaldi³

et al. 2020

CMAR

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“…Our institution uses PET/CT frequently after completion of chemoradiation, as is recommended by National Comprehensive Cancer Network guidelines for head and neck cancer [17], and indeterminate results are common. The modality is known to have a high NPV but a relatively poor PPV [2][3][4][5][6][7][8][9][10][11], and we thus were hoping to determine where the tradeoffs existed.…”

Section: Discussionmentioning

confidence: 99%

“…One meta-analysis shows lower sensitivity and specificity for treatment response assessment for HPV+ tumors, 75 and 87% versus 89 and 95% in HPV− tumors [9]. Conversely, later studies have suggested a trade-off with positive predictive value (PPV) higher in HPV− patients and NPV higher in HPV+ patients [10,11]. At least one study showed metabolic tumor volume was only a useful prognostic indicator in HPV− patients [12], whereas another showed total lesion glycolysis was only useful in HPV+ patients [13].…”

Section: Introductionmentioning

confidence: 99%

Qualitative and quantitative methods in post-chemoradiation PET for head and neck cancer

Oldan¹,

Beaty

Jewells³

et al. 2022

Nuclear Medicine Communications

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Objective The aim of this study was to determine whether quantitative methods could aid in the evaluation of post-treatment head and neck scans, particularly taking human papillomavirus status into account.Methods Clinical readings of positron emission tomography/computed tomography scans as well as standardized uptake value (SUV) max (and other metrics) of nodes visible on PET conducted on a total of 172 patients with head and neck squamous cell cancer were examined. Locoregional recurrence at 2 years was assessed. In total 88 of these patients had close enough follow-up to determine whether individual nodes were positive or negative, and 233 nodes on these patients were compared to surgical pathology notes or follow-up (if no path was available). ResultsGeneral negative predictive value (NPV) of complete response was 93% and an equivocal response was 89%; focusing on nodal recurrence, NPV was found to be 97% and positive predictive value (PPV) 46% if equivocal reads were treated as negative and NPV 98% and PPV 16% if equivocal reads were treated as positive.Using SUV max of the hottest node with a cutoff of 3.4 gave NPV 97% and PPV 26%; a direct re-read (using 2 observers) gave NPV 98% and PPV 32% if equivocal reads were treated as negative, and NPV 99% and PPV 18% if equivocal reads were treated as positive. Using other firstorder radiomics data such as SD and skewness did not improve this.Conclusions Quantitative data such as SUV max does not show additional value over qualitative evaluation of response to chemoradiation in head and neck tumors.

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“…14 Nonetheless, the positive predictive value of PET-CT in HPV-associated HNSCC is particularly low (0%-30%), 15,37 and even in association with other imaging examinations, the evidence of persistence or relapse of disease can be challenging, particularly after chemoradiation. 38,39 Consequently, patients with HPV-associated HNSCC are prone to experience unnecessary diagnostic or therapeutic procedures, such as ND. The rate of unnecessary ND in case of clinical partial nodal response is high, and almost 60% of ND specimens did not include cancer tissues.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

Cell‐Free Human Papillomavirus‐DNA for Monitoring Treatment Response of Head and Neck Squamous Cell Carcinoma: Systematic Review and Meta‐Analysis

et al. 2021

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Objectives/Hypothesis: The aim of this study was to assess the value of cell-free human papillomavirus-DNA (cfHPV-DNA) as a diagnostic test for the post-treatment surveillance of patients with HPV-positive head and neck squamous cell carcinoma (HNSCC) through a systematic review and meta-analysis.Study Design: Systematic review and meta-analysis. Methods: A literature search was conducted in three databases (MEDLINE, Embase, and Scopus) in January 2021. The population included patients with HPV-positive HNSCC. The intervention was the use of the repeated liquid biopsy with circulating HPV-DNA detection during follow-up. The outcome was to establish the value of cfHPV-DNA as a diagnostic test for the post-treatment surveillance of patients with HPV-positive HNSCC.Results: Ten studies included in the meta-analysis provided a total of 457 patients with HPV-positive HNSCC. The metaanalytic study estimated the diagnostic performance of cfHPV-DNA as follows: pooled sensitivity and specificity of 0.65 (95% confidence interval [CI]: 0.40-0.84) and 0.99 (99% CI: 0.96-0.99), respectively; positive and negative likelihood ratios of 62.5 (99% CI: 22.9-170.2) and 0.05 (99% CI: 0.013-0.24), respectively; and pooled diagnostic odds ratio of 371.66 (99% CI: 60.4-2286.7).Conclusion: Currently, the follow-up protocol for HNSCC patients includes routine clinical evaluation and radiological imaging. Biomarkers to monitor this disease are not established. Considering its high specificity, cfHPV-DNA represents a potential confirmatory test in the case of positive positron emission tomography and computed tomography. In the near future, cfHPV-DNA could be used as a biomarker for monitoring the treatment response during the clinical trials of de-escalation therapy or immunotherapy. Larger sample sizes and the homologation of study protocols and methodology are needed to better establish its utility in the clinical practice.

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Management of the neck after definitive chemoradiation in patients with HPV-associated oropharyngeal cancer: An institutional experience

Cited by 6 publications

References 16 publications

<p>Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management</p>

<p>Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management</p>

Qualitative and quantitative methods in post-chemoradiation PET for head and neck cancer

Cell‐Free Human Papillomavirus‐DNA for Monitoring Treatment Response of Head and Neck Squamous Cell Carcinoma: Systematic Review and Meta‐Analysis

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