Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 100 randomized trials and 19,248 patients, on behalf of MACH-NC group

Blanchard, Pierre; Landais, C.; Petit, Claire; Zhang, Q.; Grégoire, Vincent; Tobias, Jeffrey; Burtness, Barbara; Ghi, Maria Grazia; Janot, F.; Overgaard, Jens; Wolf, Gregory T.; Lewin, Freddi; Hitt, Ricardo; Corvò, Renzo; Budach, Volker; Trotti, Andy; Fortpied, Catherine; Hackshaw, Allan; Bourhis, Jean; Pignon, J.-P.

doi:10.1093/annonc/mdw376.02

Cited by 50 publications

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“…guidelines, since some elderly and frail patients were not intended to be able to tolerate simultaneous chemotherapy according to the data of "Meta-analysis of chemotherapy in head and neck cancer (MACH-NC)". (Blanchard et al 2016). In accordance to the data of the MACH-NC meta-analysis elderly patients in our collective who had risk factors (ECS, more than 3 lymph nodes affected, less than 5 mm margin), comorbidities or a low Karnofsky performance status received radiotherapy alone although -according to oncological guidelines -simultaneous chemoradiation should also be conducted -at least theoretically.…”

Section: Discussionsupporting

confidence: 69%

Adjuvant Radiotherapy and Chemoradiation in Elderly Patients with Squamous Cell Carcinoma of the Head and Neck

Süß

Ratzisberger

Hipp³

et al. 2020

Preprint

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Abstract Background:Radiotherapy and chemoradiation are well-established therapies for patients with squamous cell carcinoma of the head and neck (SCCHN). In aging societies, also the incidence of SCCHN in elderly patients is rising. Because of the underrepresentation of elderly patients in scientific trials, we evaluated the feasibility of adjuvant radiotherapy and chemoradiation in patients with SCCHN aged >70 years. Methods:All patients had been >70 years at the time of diagnosis and received adjuvant radiotherapy or, if feasible, chemoradiation at the University Medical Centre Regensburg between 2004 and 2018.71 patients -most with SCCHN UICC stage IVa- with a median age of 75 years were included; 9 patients received concomitant chemoradiation. Median follow-up was 27 months (IQR 18 – 62 months).Results:Radiotherapy and chemoradiation was well tolerated. 62 patients (87.3%) underwent treatment without interruption, and 65 patients (91.5%) completed radiotherapy with 95% of the initially prescribed dose. Median dose for all patients was 64 Gy (IQR: 60 – 66 Gy). 6/9 patients received at least 75 % of the planned chemotherapy dose. 37 patients (52.1%) developed acute toxicity CTC grade III or IV.Overall survival was 87 % after 12 months, 67 % after 24 months and 41 % after 60 months. Median overall survival was 51 months (IQR: 19 - 99 months). Local tumour control was 99 % after 12 months, 88 % after 24 months and 76 % after 5 years.Conclusion:Feasibility of adjuvant radiotherapy and chemoradiation in our collective of elderly patients with SCCHN was good. Particularly local tumour control was satisfactory. Overall survival does not seem to differ between elderly and younger patients or patients unselected for age. De-intensification of treatment because of age does not seem justified.

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Section: Discussionsupporting

confidence: 69%

Adjuvant Radiotherapy and Chemoradiation in Elderly Patients with Squamous Cell Carcinoma of the Head and Neck

Süß

Ratzisberger

Hipp³

et al. 2020

Preprint

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“…These were mainly by febrile neutropenia before G-CSF use was implemented. A high quality metaanalysis failed to define a clear benefit of induction chemotherapy and supported CRT as the primary nonsurgical treatment modality [6,7].…”

Section: Induction Chemotherapy In Non-surgical Managementmentioning

confidence: 99%

The neoadjuvant paradigm reinvigorated: a review of pre-surgical immunotherapy in HNSCC

Stafford

Kaczmar

2020

Cancers Head Neck

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Background: There remains up to a 50% recurrence rate in advanced p16-head and neck squamous cell carcinoma with current standard of care treatment. In an attempt to improve survival, multiple trials administering induction or neoadjuvant chemotherapy have been conducted but none demonstrated improved overall survival. The established efficacy of immune checkpoint inhibitors in the recurrent and metastatic setting has produced widespread interest in their neoadjuvant use. Purpose: To survey the landscape of active neoadjuvant immunotherapy trials in head and neck squamous cell carcinoma and summarize and synthesize currently available outcomes from these trials. Conclusions: Neoadjuvant immunotherapy has proven safe and well tolerated in head and neck squamous cell carcinoma with encouraging efficacy results, including relatively high rates of pathologic response. Ongoing studies offer an opportunity to study immune responses in vivo. PD-L1 positivity, high tumor mutational burden and infiltration of NK cells, CD8, CD26 and Tim3 positive lymphocytes at time of surgery have been correlated with pathologic responses. We await updated reports of disease free survival and overall survival data and results of ongoing phase III studies utilizing neoadjuvant immunotherapy to determine if this treatment paradigm will have a place in the standard of care treatment in head and neck squamous cell carcinoma.

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“…Seeing as full surgical resection was not possible, and given the N3 staging, isolated radiotherapy was the safest option. Cisplatin radiosensitization was not performed because studies have shown no benefit in patients over 70 years [17,18].…”

Section: Discussionmentioning

confidence: 99%

Carotid Sinus Syndrome in a Patient with Head and Neck Cancer: A Case Report

Toscano¹,

Cristina²,

Alves³

2020

Cureus

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Syncope is a common complaint among patients presenting to the emergency department. Its differential diagnosis is broad and its management varies significantly depending on the underlying etiology. This is especially complex in patients with head and neck cancer since it may appear as an initial manifestation of the disease, as a side effect of surgery or radiotherapy, or as an indicator of local recurrence. Carotid sinus syndrome is a rare disease, whose pathophysiology is not yet fully understood. Here, we present the rare case of a 79-year-old male patient with a left cervical lymph node metastasis from an occult primary malignancy, who was admitted due to recurrent syncope. Paroxysms of extreme bradycardia were detected and a definitive dual chamber pacemaker was placed; however, the patient remained symptomatic. Cervical CT-scan revealed incarceration and compression of the left carotid sinus. The patient underwent radiotherapy, with favourable response, and remains asymptomatic to date.

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Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 100 randomized trials and 19,248 patients, on behalf of MACH-NC group

Cited by 50 publications

References 0 publications

Adjuvant Radiotherapy and Chemoradiation in Elderly Patients with Squamous Cell Carcinoma of the Head and Neck

Adjuvant Radiotherapy and Chemoradiation in Elderly Patients with Squamous Cell Carcinoma of the Head and Neck

The neoadjuvant paradigm reinvigorated: a review of pre-surgical immunotherapy in HNSCC

Carotid Sinus Syndrome in a Patient with Head and Neck Cancer: A Case Report

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