This study aimed to examine the association between the use of H1-antihistamines(AHs)and head and neck cancer(HNC)risk in patients with type 2 diabetes mellitus(T2DM).Data from the National Health Insurance Research D...This study aimed to examine the association between the use of H1-antihistamines(AHs)and head and neck cancer(HNC)risk in patients with type 2 diabetes mellitus(T2DM).Data from the National Health Insurance Research Database of Taiwan were analyzed for the period from 2008 to 2018.A propensity-score-matched cohort of 54,384 patients each in the AH user and nonuser groups was created and analyzed using Kaplan-Meier method and Cox proportional hazards regression.The results showed that the risk of HNC was significantly lower in AH users(adjusted hazard ratio:0.55,95%CI:0.48 to 0.64)and the incidence rate was also lower(5.16 vs.8.10 per 100,000 person-years).The lower HNC incidence rate in AH users(95%CI:0.63;0.55 to 0.73)suggests that AH use may reduce the risk of HNC in T2DM patients.展开更多
Introduction: Oral health management is often difficult in patients after surgical tumor resection and/or radiotherapy due to defects, bulky flaps, limitation of tongue movement, and trismus. In addition, patients who...Introduction: Oral health management is often difficult in patients after surgical tumor resection and/or radiotherapy due to defects, bulky flaps, limitation of tongue movement, and trismus. In addition, patients who have undergone radiotherapy have serious disabilities such as oral mucositis, mucosal weakening, soft tissue fibrosis, salivary gland disorder, and osteoradionecrosis. Dental hygienists must understand the characteristics of patients after surgical tumor resection and/or radiotherapy. In this report, the oral health management of three patients after maxillectomy, mandibulectomy, and radiotherapy was shown. Case Description: Case 1: A 53-year-old male patient visited our clinic after chemotherapy, radiotherapy, and partial maxillectomy for cancer of the right maxillary gingiva. Case 2: A 65-year-old male patient visited our clinic after radiotherapy for a right-sided tongue cancer, partial mandibulectomy of the right tongue to the oropharynx, a right-sided segmental mandibulectomy and a speech aid and a mandibular prosthesis were provided. Case 3: A 36-year-old female visited our clinic for radiotherapy for left-sided tongue cancer. Dental hygienists provided oral health management to the patients. In oral health management, it was suggested that intervention before cancer treatment, oral hygiene instructions tailored to patients’ symptoms, and frequent professional care are important. Conclusion: Oral health management by dental hygienists is extremely important for patients undergoing maxillofacial cancer treatment to maintain their quality of life in the long term.展开更多
Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyng...Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.展开更多
Head and neck cancer and the approaches used to treat it can cause symptoms such as mucositis,alteration or loss of taste,dysphagia,and xerostomia,whichmakes the incidence of malnutrition in head and neck cancer patie...Head and neck cancer and the approaches used to treat it can cause symptoms such as mucositis,alteration or loss of taste,dysphagia,and xerostomia,whichmakes the incidence of malnutrition in head and neck cancer patients higher than in the general population of cancer patients.Malnutrition in patients with head and neck cancer is associated with the occurrence of treatment-related adverse events,an increase in overall economic cost,a decline in quality of life,and a poor prognosis.Therefore,rehabilitation interventions for malnutrition are necessary throughout the course of the disease.However,the importance of rehabilitation interventions for malnutrition in patients with head and neck cancer has not been fully recognized,and the optimal methods and timing of interventions are unclear.This article provides an overview of rehabilitation interventions for malnutrition,including nutritional supplementation,exercise-based interventions,nutritional counseling and cognitive improvement,and drug therapy,and discusses their advantages and disadvantages as well as potential future directions.展开更多
Head and neck cancer(HNC) is the sixth most common human malignancy worldwide. The main forms of treat ment for HNC are surgery, radiotherapy(RT) and che motherapy(CT). However, the choice of therapy de pends on the t...Head and neck cancer(HNC) is the sixth most common human malignancy worldwide. The main forms of treat ment for HNC are surgery, radiotherapy(RT) and che motherapy(CT). However, the choice of therapy de pends on the tumor staging and approaches, which are aimed at organ preservation. Because of systemic RT and CT genotoxicity, one of the important side effects is a secondary cancer that can result from the activity of radiation and antineoplastic drugs on healthy cells Ionizing radiation can affect the DNA, causing single and double-strand breaks, DNA-protein crosslinks and oxidative damage. The severity of radiotoxicity can be directly associated with the radiation dosimetry and the dose-volume differences. Regarding CT, cisplatin is stil the standard protocol for the treatment of squamous cell carcinoma, the most common cancer located in theoral cavity. However, simultaneous treatment with cisplatin, bleomycin and 5-fluorouracil or treatment with paclitaxel and cisplatin are also used. These drugs can interact with the DNA, causing DNA crosslinks, double and single-strand breaks and changes in gene expression. Currently, the late effects of therapy have become a recurring problem, mainly due to the increased survival of HNC patients. Herein, we present an update of the systemic activity of RT and CT for HNC, with a focus on their toxicogenetic and toxicogenomic effects.展开更多
Objective: This study aims to evaluate the impact and potential prognostic roles of the pre-and post-treatment Glasgow prognostic score(GPS) and the change thereof in patients with advanced head and neck cancer underg...Objective: This study aims to evaluate the impact and potential prognostic roles of the pre-and post-treatment Glasgow prognostic score(GPS) and the change thereof in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy(CCRT).Methods: We collected GPS and clinicopathological data of 139 stage III, IVA, and IVB head and neck cancer patients who underwent CCRT between 2008 and 2011. Their GPSs pre-and post-CCRT and the change thereof were analyzed for correlations with recurrence and survival.Results: The GPS changed in 72(51.8%) patients, with worse scores observed post-CCRT in 65(90.3%) of the GPS changed patients. Patients in the improved GPS group showed a tendency toward better survival. From the multivariate analysis, the post-CCRT GPS level was an independent prognostic factor in addition to tumor stage.Conclusions: After CCRT, a high GPS was revealed to be an important predictor of survival for advanced head and neck cancer.展开更多
BACKGROUND The targeted therapy cetuximab[directed at the epidermal growth factor receptor(EGFR)]in combination with 5-fluorouracil and platinum-based chemotherapy(the EXTREME regimen)has shown substantial efficacy fo...BACKGROUND The targeted therapy cetuximab[directed at the epidermal growth factor receptor(EGFR)]in combination with 5-fluorouracil and platinum-based chemotherapy(the EXTREME regimen)has shown substantial efficacy for patients with recurrent or metastatic squamous cell carcinoma of the head and neck(R/M SCCHN).Thus,this scheme has been established as the preferred first-line option for these patients.However,more recently,a new strategy combining platinum,taxanes,and cetuximab(the TPEx regimen)has demonstrated similar efficacy with a more favorable toxicity profile in clinical trials.AIM To evaluate the safety and efficacy of the TPEx scheme as first-line therapy in advanced SCCHN in a multicenter cohort study.METHODS This retrospective multicenter cohort study included patients with histologically confirmed recurrent or metastatic SCCHN treated with first-line TPEx at five medical centers in Argentina between January 1,2017 and April 31,2020.Chemotherapy consisted of four cycles of docetaxel,cisplatin,and cetuximab followed by cetuximab maintenance therapy.Clinical outcomes and toxicity profiles were collected from medical charts.Treatment response was assessed by the investigator in accordance with Response Evaluation Criteria in Solid Tumors(version 1.1).Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events(version 4.0).RESULTS Twenty-four patients were included.The median age at diagnosis was 58 years(range:36-77 years).The majority of patients(83.3%)received at least four chemotherapy cycles in the initial phase.In the included group,the overall response rate was 62.5%,and 3 patients achieved a complete response(12.5%).The median time to response was 2.4 mo[95% confidence interval(CI):1.3-3.5].With a median follow-up of 12.7 mo(95%CI:8.8-16.6),the median progression-free survival(PFS)was 6.9 mo(95%CI:6.5-7.3),and the overall survival rate at 12 mo was 82.4%.Patients with documented tumor response showed a better PFS than those with disease stabilization or progression[8.5 mo(95%CI:5.5-11.5)and 4.5 mo(95%CI:2.5-6.6),respectively;P=0.042].Regarding the safety analysis,two-thirds of patients reported at least one treatment-related adverse event,and 25% presented grade 3 toxicities.Of note,no patient experienced grade 4 adverse events.CONCLUSION TPEx was an adequately tolerated regimen in our population,with low incidence of grade 3-4 adverse events.The median PFS were consistent with those in recent reports of clinical trials evaluating this treatment combination.This regimen may be considered an attractive therapeutic strategy due to its simplified administration,decreased total number of chemotherapy cycles,and treatment tolerability.展开更多
Head and neck cancer (HNC) as a disease and its treatment have a disproportionate impact on all aspects of patients’ quality of life (QOL). QOL is a multidimensional construct of an individual’s subjective assessmen...Head and neck cancer (HNC) as a disease and its treatment have a disproportionate impact on all aspects of patients’ quality of life (QOL). QOL is a multidimensional construct of an individual’s subjective assessment of the impact of an illness or treatment on his/her physical, psychological, social and somatic functioning and general well-being [1]. Thus, QOL has become an important treatment outcome in HNC [2]. Objective: It is to evaluate the quality of life of patients dealing with squamous cell carcinoma of the head and neck treated in the radiotherapy department, National Cancer Institute, Cairo University. Material and methods: Starting from March 2012 to December 2013, 87 patients with histopathologically proven Head and Neck Squamous Cell Carcinoma (HNSCC) were taking part in our prospective study. The patients’ QOL answers to the questionnaire were collected for both the EORTC QLQ-C30 and the EORTC Head and Neck questionnaires (QLQ-H&N35) and then all points were transformed to a 0 - 100 scale according to the guidelines of the EORTC. Certain clinical factors were chosen to evaluate their effect on the QOL;site of primary tumor, clinical stage, and mode of therapy applied: radiotherapy versus chemo-radiotherapy (CRT). Moreover, age, gender and smoking were studied. Results: Majority of the items assessed in the QLQ-C30 and QLQ-H&N35 questionnaire showed that they were negatively impacted at the end of treatment. As for the factors that had a negative effect on the QOL, they comprised;female gender (p < 0.05), age < 60 years (p < 0.05), smoking (p < 0.01), clinical stage III and IV (p < 0.05), larynx and hypopharynx as a site of primary (p < 0.01), and CRT (p < 0.01). Conclusions: Results of our study showed that treatment options had a significant negative effect on the QOL by the end of the treatment course. Moreover, our results showed that age, gender, smoking habit, tumor site, and clinical stage of disease had a significant impact on the QOL of HNSCC patients.展开更多
Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubM...Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.展开更多
Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely...Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely malnourished patients. The assessment of nutritional status should be a priority when initiating medical nutrition therapy. We evaluated the agreement between Subjective and Objective evaluation of pre-operative nutrition status of head and neck cancer patients in a tertiary cancer centre. Methods: Two hundred and thirty seven head and neck cancer patients who underwent surgery were eligible. The patients included both males (147) and females (90) with age varying between 23 - 88 years. All patients were screened for pre-operative nutrition status objectively as well as subjectively. The association of pre-operative SGA scores (A, B and C) subjectively, and PNS score (0, 1, 2) objectively were tested for statistical significance. Results: The cancer sites included tongue in 82, buccal mucosa in 30, thyroid in 28, alveolus in 18, glottis in 10, RMT in 10, nasal cavity in 9, FOM in 8. The pre-operative nutrition status based on subjective scores are A in 156 (65.8%), B in 75 (32%) and C in 6 (2.5%). The objective parameters obtained on the basis of BMI, % weight loss, PNI and S. albumin values are PNS 0 in 161 (67.9%), PNS 1 in 71 (30%) and PNS 2 in 5 (2.1%) patients. As the kappa coefficient p-0.56, there is moderate agreement between the pre-operative nutrition status subjectively as well as objectively. Conclusion: Subjective global assessment is a simple and inexpensive way to screen the pre-operative nutrition status when compared to the other objective assessment tool. SGA has moderate agreement with expensive and complicated objective assessment tools. So it can be a reliable tool for assessing the pre-operative nutrition status.展开更多
Background: Radiation-induced gliomas of the spinal cord are rare late complications of spinal cord irradiation that typically occur in patients treated at younger ages. Aim: Raise awareness of radiation induced high ...Background: Radiation-induced gliomas of the spinal cord are rare late complications of spinal cord irradiation that typically occur in patients treated at younger ages. Aim: Raise awareness of radiation induced high grade gliomas with a case presentation and a review of the literature. Case Presentation: A 50-year-old male with Stage IVA squamous cell carcinoma of the oropharynx was treated with external beam radiotherapy with a complete response. Seven years later, he presented with a cervical spinal cord mass on MRI. An open biopsy was performed. Pathology revealed an intramedullary WHO grade IV astrocytoma, (i.e., glioblastoma multiforme) of the cervical spine that fulfilled the criteria for a radiation-induced malignancy. Conclusions : Review of the literature suggests that radiation-induced gliomas tend to be high grade and may occur at the periphery of an irradiated field. Radiation-induced gliomas of the spinal cord are a serious complication of radiotherapy that may occur in older patients with head and neck cancers, but are so rare that it should not affect treatment decisions.展开更多
Introduction: The incidence of head and neck cancers has increased markedly over the last decade. A Danish study of the costs of head and neck cancers has not been undertaken. Such studies have again become relevant d...Introduction: The incidence of head and neck cancers has increased markedly over the last decade. A Danish study of the costs of head and neck cancers has not been undertaken. Such studies have again become relevant due to the development of the HPV vaccines, as some cases are attributable to high-risk HPV 16 or 18. The objective of study was to estimate the incidence of head and neck cancers and their health care costs. Methods: Data on incidence and health care use related to head and neck cancer were obtained from Danish health care registers. New cancer patients were identified in the Danish National Cancer Register. Resource use per year in the hospital sector was estimated using data from the National Patient Register applying charges as cost estimates. Health care consumption by cancer patients was compared with that by an age- and sex-matched cohort without cancer. Results: We found that nearly 1000 new cases of oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancer are diagnosed annually. In total the cost of these cancers to the Danish hospital sector constituted 31.6 million Euros per year, with the majority of costs (74%) occurring in men. The total costs associated with HPV16/18-related head and neck cancers were estimated to be 6.1 million Euros per year. Conclusion: This study provides the first Danish estimates of the costs associated with non-cervical and non-genital HPV-related cancers based on very reliable, individual-based data. It is expected that the current HPV vaccination programme will reduce this burden.展开更多
Objective: To obtain detailed understanding on the gene regulation of natural compounds in altering prognosis of head and neck squamous cell carcinomas(HNSC). Methods: Gene expression data of HNSC samples and peripher...Objective: To obtain detailed understanding on the gene regulation of natural compounds in altering prognosis of head and neck squamous cell carcinomas(HNSC). Methods: Gene expression data of HNSC samples and peripheral blood mononuclear cells(PBMCs) of HNSC patients were collected from Gene Expression Omnibus(GEO). Differential gene expression analysis of GEO datasets were achieved by the GEO2R tool. Common differentially expressed gerres(DEGs) were screened by comparing DEGs of HNSC with those of PBMCs. The combination was further analyzed for regulating pathways and biological processes that were affected. Results: Totally 110 DEGs were retrieved and identified to be involved in biological processes related to tumor regulation. Then 102 natural compounds were screened for a combination such that the expressions of all 110 commonly DEGs were altered. A combination of salidroside, ginsenoside Rd, oridonin, britanin, and scutellarein was chosen. A multifaceted, multi-dimensional tumor regression was showed by altering autophagy, apoptosis, inhibiting cell proliferation, angiogenesis, metastasis and inflammatory cytokines production. Conclusions: This study has helped develop a unique combination of natural compounds that will markedly reduce the propensity of development of drug resistance in tumors and immune evasion by tumors. The result is crucial to developing a combinatorial natural therapeutic cocktail with accentuated immunotherapeutic potential.展开更多
Nanomaterials(NMs)have increasingly been used for the diagnosis and treatment of head and neck cancers(HNCs)over the past decade.HNCs can easily infiltrate surrounding tissues and form distant metastases,meaning that ...Nanomaterials(NMs)have increasingly been used for the diagnosis and treatment of head and neck cancers(HNCs)over the past decade.HNCs can easily infiltrate surrounding tissues and form distant metastases,meaning that most patients with HNC are diagnosed at an advanced stage and often have a poor prognosis.Since NMs can be used to deliver various agents,including imaging agents,drugs,genes,vaccines,radiosensitisers,and photosensitisers,they play a crucial role in the development of novel technologies for the diagnosis and treatment of HNCs.Indeed,NMs have been reported to enhance delivery efficiency and improve the prognosis of patients with HNC by allowing targeted delivery,controlled release,responses to stimuli,and the delivery of multiple agents.In this review,we consider recent advances in NMs that could be used to improve the diagnosis,treatment,and prognosis of patients with HNC and the potential for future research.展开更多
Objective:Patients with head and neck cancer often undergo extensive ablative and reconstructive surgery.Many risk factors are unalterable,but some operative variables are possible to adjust.The goal of this study was...Objective:Patients with head and neck cancer often undergo extensive ablative and reconstructive surgery.Many risk factors are unalterable,but some operative variables are possible to adjust.The goal of this study was to estimate the association between operative variables and the incidence of perioperative complications in a contemporary tertiary care university‐based head and neck patient population and a Veteran Administration hospital head and neck patient population from an earlier time period.Methods:We retrospectively reviewed all patients who underwent major head and neck surgery.Results:Two‐hundred‐two university patients and 122 veteran patients were reviewed.On multivariable analysis,the total amount of intravenous(IV)fluid received during the procedure was associated with postoperative complications as were patients’weight,American Society of Anesthesiologists(ASA)score,and adult comorbidity evaluation‐27(ACE‐27)score.These associations did not depend on whether the patient was treated at the university or veteran hospital.Conclusion:Our study suggests that the odds of a postoperative complication increase as the total amount of IV fluid increases.展开更多
Despite intensive efforts and refined techniques,overall survival in HPV-negative head and neck cancer remains poor.Robust immune priming is required to elicit a strong and durable antitumor immune response in immunol...Despite intensive efforts and refined techniques,overall survival in HPV-negative head and neck cancer remains poor.Robust immune priming is required to elicit a strong and durable antitumor immune response in immunologically cold and excluded tumors like HPV-negative head and neck cancer.This review highlights how the tumor microenvironment could be affected by different immune and stromal cell types,weighs the need to integrate metabolic regulation of the tumor microenvironment into cancer treatment strategies and summarizes the emerging clinical applicability of personalized immunotherapeutic strategies in HPV-negative head and neck cancer.展开更多
Modern medicine is reliant on various medical imaging technologies for non-invasively observing patients’anatomy.However,the interpretation of medical images can be highly subjective and dependent on the expertise of...Modern medicine is reliant on various medical imaging technologies for non-invasively observing patients’anatomy.However,the interpretation of medical images can be highly subjective and dependent on the expertise of clinicians.Moreover,some potentially useful quantitative information in medical images,especially that which is not visible to the naked eye,is often ignored during clinical practice.In contrast,radiomics performs high-throughput feature extraction from medical images,which enables quantitative analysis of medical images and prediction of various clinical endpoints.Studies have reported that radiomics exhibits promising performance in diagnosis and predicting treatment responses and prognosis,demonstrating its potential to be a non-invasive auxiliary tool for personalized medicine.However,radiomics remains in a developmental phase as numerous technical challenges have yet to be solved,especially in feature engineering and statistical modeling.In this review,we introduce the current utility of radiomics by summarizing research on its application in the diagnosis,prognosis,and prediction of treatment responses in patients with cancer.We focus on machine learning approaches,for feature extraction and selection during feature engineering and for imbalanced datasets and multi-modality fusion during statistical modeling.Furthermore,we introduce the stability,reproducibility,and interpretability of features,and the generalizability and interpretability of models.Finally,we offer possible solutions to current challenges in radiomics research.展开更多
Head and neck(HN)cancer is an endemic disease in Taiwan,China.Locally recurrent HN cancer after full-dose irradia-tion poses a therapeutic challenge,and boron neutron capture therapy(BNCT)may be a solution that could ...Head and neck(HN)cancer is an endemic disease in Taiwan,China.Locally recurrent HN cancer after full-dose irradia-tion poses a therapeutic challenge,and boron neutron capture therapy(BNCT)may be a solution that could provide durable local control with tolerable toxicity.The Tsing-Hua Open Pool Reactor(THOR)at National Tsing-Hua University in Hsin-Chu,provides a high-quality epithermal neutron source for basic and clinical BNCT research.Our first clinical trial,entitled“A phase I/II trial of boron neutron capture therapy for recurrent head and neck cancer at THOR”,was carried out between 2010 and 2013.A total of 17 patients with 23 recurrent HN tumors who had received high-dose photon irradiation were enrolled in the study.The fructose complex of l-boronophenylalanine was used as a boron carrier,and a two-fraction BNCT treatment regimen at 28-day intervals was used for each patient.Toxicity was acceptable,and although the response rate was high(12/17),re-recurrence within or near the radiation site was common.To obtain better local control,another clinical trial entitled“A phase I/II trial of boron neutron capture therapy combined with image-guided intensity-modulated radiotherapy(IG-IMRT)for locally recurrent HN cancer”was initiated in 2014.The first administration of BNCT was performed according to our previous protocol,and IG-IMRT was initiated 28 days after BNCT.As of May 2017,seven patients have been treated with this combination.The treatment-related toxicity was similar to that previously observed with two BNCT applications.Three patients had a complete response,but locoregional recurrence was the major cause of failure despite initially good responses.Future clinical trials combining BNCT with other local or systemic treatments will be carried out for recurrent HN cancer patients at THOR.展开更多
Background: Head and neck cancers (HNCs) are a heterogeneous group of tumors that progress owing to varied enviromental and genetic risk factors. Viral infections are threatening and adept at altering the expression o...Background: Head and neck cancers (HNCs) are a heterogeneous group of tumors that progress owing to varied enviromental and genetic risk factors. Viral infections are threatening and adept at altering the expression of cellular transcription factors such as nuclear factor kappa B (NF-κB) and deregulation of other cellular proteins like NF kappa B inhibitor alpha (IκBα). The present study was conducted to detect high-risk genotypes of human papillomavirus (HPV) and protein expression of NF-κB signaling pathway in HNC patients with HPV infection.Methods: For HPV detection, genomic DNA from 152 HNC tumors was extracted formalin-fixed paraffin-embedded tissue DNA kit. For genotyping, polymerase chain reaction (PCR) using a general primer, HPV type-specific primers and agarose gel electrophoresis were performed. Immunohistochemistry (IHC) was also performed on 4-μm thick tissue sections using HPV E6 monoclonal antibody. Protein expression analysis of NF-κB signaling pathway including p50, p65, and IκBα was performed using IHC.Results: PCR analysis showed that 24.3% (37/152) of HNC cases were HPV positive. Among HPV positive, 86.5% (32/37) were tobacco users, while among HPV negative, 66.9% (77/115) were tobacco users. A significant association of HPV positivity and tobacco user was observed by univariate analysis [P < 0.01;odds ratio (OR): 0.310, 95% confidence interval (CI): 0.110 to 0.870]. More HPV positive patients were with poor oral hygiene (78.3%) when compared with patients with good oral hygiene (21.6%) [P < 0.03, OR: 2.440, 95% CI: 1.650 to 3.600]. The results of the logistic regression analysis showed that age, tobacco use and oral hygiene are significant predictors (P < 0.02). PCR and IHC staining results confirmed that HPV16 was predominant among HNC cases (64.8%) when compared with HPV18 (35.2%). Expression of NF-κB proteins (p50, p65, and IκBα inhibitor) were also observed in HPV and non-HPV infected HNC tissues. IHC expression of p50, and p65 showed nuclear staining, while IκBα inhibitor showed cytoplasmic staining. Protein expression in HPV cases was higher as compared to HPV naive cases (P < 0.05).Conclusions: From the study, it can be established that the use of tobacco, oral hygiene, and HPV infection may be synergistically involved in modulating the expression of NF-κB signaling pathway for the development and progression of HNC in the Pakistani population.展开更多
基金Lo-Hsu Medical Foundation,LotungPoh-Ai Hospital,supports Szu-Yuan Wu’s work(Funding Numbers:10908,10909,11001,11002,11003,11006,and 11013).
文摘This study aimed to examine the association between the use of H1-antihistamines(AHs)and head and neck cancer(HNC)risk in patients with type 2 diabetes mellitus(T2DM).Data from the National Health Insurance Research Database of Taiwan were analyzed for the period from 2008 to 2018.A propensity-score-matched cohort of 54,384 patients each in the AH user and nonuser groups was created and analyzed using Kaplan-Meier method and Cox proportional hazards regression.The results showed that the risk of HNC was significantly lower in AH users(adjusted hazard ratio:0.55,95%CI:0.48 to 0.64)and the incidence rate was also lower(5.16 vs.8.10 per 100,000 person-years).The lower HNC incidence rate in AH users(95%CI:0.63;0.55 to 0.73)suggests that AH use may reduce the risk of HNC in T2DM patients.
文摘Introduction: Oral health management is often difficult in patients after surgical tumor resection and/or radiotherapy due to defects, bulky flaps, limitation of tongue movement, and trismus. In addition, patients who have undergone radiotherapy have serious disabilities such as oral mucositis, mucosal weakening, soft tissue fibrosis, salivary gland disorder, and osteoradionecrosis. Dental hygienists must understand the characteristics of patients after surgical tumor resection and/or radiotherapy. In this report, the oral health management of three patients after maxillectomy, mandibulectomy, and radiotherapy was shown. Case Description: Case 1: A 53-year-old male patient visited our clinic after chemotherapy, radiotherapy, and partial maxillectomy for cancer of the right maxillary gingiva. Case 2: A 65-year-old male patient visited our clinic after radiotherapy for a right-sided tongue cancer, partial mandibulectomy of the right tongue to the oropharynx, a right-sided segmental mandibulectomy and a speech aid and a mandibular prosthesis were provided. Case 3: A 36-year-old female visited our clinic for radiotherapy for left-sided tongue cancer. Dental hygienists provided oral health management to the patients. In oral health management, it was suggested that intervention before cancer treatment, oral hygiene instructions tailored to patients’ symptoms, and frequent professional care are important. Conclusion: Oral health management by dental hygienists is extremely important for patients undergoing maxillofacial cancer treatment to maintain their quality of life in the long term.
基金This research was supported by the National Key Research and Development Project of China(No.2017YFC1309204)the Medical Nutrition Clinical Research Project of China International Medical Foundation(No.Z-2017-24-2110).
文摘Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.
文摘Head and neck cancer and the approaches used to treat it can cause symptoms such as mucositis,alteration or loss of taste,dysphagia,and xerostomia,whichmakes the incidence of malnutrition in head and neck cancer patients higher than in the general population of cancer patients.Malnutrition in patients with head and neck cancer is associated with the occurrence of treatment-related adverse events,an increase in overall economic cost,a decline in quality of life,and a poor prognosis.Therefore,rehabilitation interventions for malnutrition are necessary throughout the course of the disease.However,the importance of rehabilitation interventions for malnutrition in patients with head and neck cancer has not been fully recognized,and the optimal methods and timing of interventions are unclear.This article provides an overview of rehabilitation interventions for malnutrition,including nutritional supplementation,exercise-based interventions,nutritional counseling and cognitive improvement,and drug therapy,and discusses their advantages and disadvantages as well as potential future directions.
文摘Head and neck cancer(HNC) is the sixth most common human malignancy worldwide. The main forms of treat ment for HNC are surgery, radiotherapy(RT) and che motherapy(CT). However, the choice of therapy de pends on the tumor staging and approaches, which are aimed at organ preservation. Because of systemic RT and CT genotoxicity, one of the important side effects is a secondary cancer that can result from the activity of radiation and antineoplastic drugs on healthy cells Ionizing radiation can affect the DNA, causing single and double-strand breaks, DNA-protein crosslinks and oxidative damage. The severity of radiotoxicity can be directly associated with the radiation dosimetry and the dose-volume differences. Regarding CT, cisplatin is stil the standard protocol for the treatment of squamous cell carcinoma, the most common cancer located in theoral cavity. However, simultaneous treatment with cisplatin, bleomycin and 5-fluorouracil or treatment with paclitaxel and cisplatin are also used. These drugs can interact with the DNA, causing DNA crosslinks, double and single-strand breaks and changes in gene expression. Currently, the late effects of therapy have become a recurring problem, mainly due to the increased survival of HNC patients. Herein, we present an update of the systemic activity of RT and CT for HNC, with a focus on their toxicogenetic and toxicogenomic effects.
文摘Objective: This study aims to evaluate the impact and potential prognostic roles of the pre-and post-treatment Glasgow prognostic score(GPS) and the change thereof in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy(CCRT).Methods: We collected GPS and clinicopathological data of 139 stage III, IVA, and IVB head and neck cancer patients who underwent CCRT between 2008 and 2011. Their GPSs pre-and post-CCRT and the change thereof were analyzed for correlations with recurrence and survival.Results: The GPS changed in 72(51.8%) patients, with worse scores observed post-CCRT in 65(90.3%) of the GPS changed patients. Patients in the improved GPS group showed a tendency toward better survival. From the multivariate analysis, the post-CCRT GPS level was an independent prognostic factor in addition to tumor stage.Conclusions: After CCRT, a high GPS was revealed to be an important predictor of survival for advanced head and neck cancer.
基金financially supported by Merck KGaA,Darmstadt,German。
文摘BACKGROUND The targeted therapy cetuximab[directed at the epidermal growth factor receptor(EGFR)]in combination with 5-fluorouracil and platinum-based chemotherapy(the EXTREME regimen)has shown substantial efficacy for patients with recurrent or metastatic squamous cell carcinoma of the head and neck(R/M SCCHN).Thus,this scheme has been established as the preferred first-line option for these patients.However,more recently,a new strategy combining platinum,taxanes,and cetuximab(the TPEx regimen)has demonstrated similar efficacy with a more favorable toxicity profile in clinical trials.AIM To evaluate the safety and efficacy of the TPEx scheme as first-line therapy in advanced SCCHN in a multicenter cohort study.METHODS This retrospective multicenter cohort study included patients with histologically confirmed recurrent or metastatic SCCHN treated with first-line TPEx at five medical centers in Argentina between January 1,2017 and April 31,2020.Chemotherapy consisted of four cycles of docetaxel,cisplatin,and cetuximab followed by cetuximab maintenance therapy.Clinical outcomes and toxicity profiles were collected from medical charts.Treatment response was assessed by the investigator in accordance with Response Evaluation Criteria in Solid Tumors(version 1.1).Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events(version 4.0).RESULTS Twenty-four patients were included.The median age at diagnosis was 58 years(range:36-77 years).The majority of patients(83.3%)received at least four chemotherapy cycles in the initial phase.In the included group,the overall response rate was 62.5%,and 3 patients achieved a complete response(12.5%).The median time to response was 2.4 mo[95% confidence interval(CI):1.3-3.5].With a median follow-up of 12.7 mo(95%CI:8.8-16.6),the median progression-free survival(PFS)was 6.9 mo(95%CI:6.5-7.3),and the overall survival rate at 12 mo was 82.4%.Patients with documented tumor response showed a better PFS than those with disease stabilization or progression[8.5 mo(95%CI:5.5-11.5)and 4.5 mo(95%CI:2.5-6.6),respectively;P=0.042].Regarding the safety analysis,two-thirds of patients reported at least one treatment-related adverse event,and 25% presented grade 3 toxicities.Of note,no patient experienced grade 4 adverse events.CONCLUSION TPEx was an adequately tolerated regimen in our population,with low incidence of grade 3-4 adverse events.The median PFS were consistent with those in recent reports of clinical trials evaluating this treatment combination.This regimen may be considered an attractive therapeutic strategy due to its simplified administration,decreased total number of chemotherapy cycles,and treatment tolerability.
文摘Head and neck cancer (HNC) as a disease and its treatment have a disproportionate impact on all aspects of patients’ quality of life (QOL). QOL is a multidimensional construct of an individual’s subjective assessment of the impact of an illness or treatment on his/her physical, psychological, social and somatic functioning and general well-being [1]. Thus, QOL has become an important treatment outcome in HNC [2]. Objective: It is to evaluate the quality of life of patients dealing with squamous cell carcinoma of the head and neck treated in the radiotherapy department, National Cancer Institute, Cairo University. Material and methods: Starting from March 2012 to December 2013, 87 patients with histopathologically proven Head and Neck Squamous Cell Carcinoma (HNSCC) were taking part in our prospective study. The patients’ QOL answers to the questionnaire were collected for both the EORTC QLQ-C30 and the EORTC Head and Neck questionnaires (QLQ-H&N35) and then all points were transformed to a 0 - 100 scale according to the guidelines of the EORTC. Certain clinical factors were chosen to evaluate their effect on the QOL;site of primary tumor, clinical stage, and mode of therapy applied: radiotherapy versus chemo-radiotherapy (CRT). Moreover, age, gender and smoking were studied. Results: Majority of the items assessed in the QLQ-C30 and QLQ-H&N35 questionnaire showed that they were negatively impacted at the end of treatment. As for the factors that had a negative effect on the QOL, they comprised;female gender (p < 0.05), age < 60 years (p < 0.05), smoking (p < 0.01), clinical stage III and IV (p < 0.05), larynx and hypopharynx as a site of primary (p < 0.01), and CRT (p < 0.01). Conclusions: Results of our study showed that treatment options had a significant negative effect on the QOL by the end of the treatment course. Moreover, our results showed that age, gender, smoking habit, tumor site, and clinical stage of disease had a significant impact on the QOL of HNSCC patients.
文摘Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.Purpose: The aim of the study was to evaluate the association between clinicopathological and prognostic significance and circulating tumor cells (CTCs) in patients with head and neck cancer. Methods: We searched PubMed, MEDLINE, BioMed, and EMbase databases for studies that assessed the association between clinicopathological and prognostic significance and CTCs in patients with head and neck cancer. Studies obtained from search strategy were screened using pre-specified criteria, and necessary data were retrieved for meta-analysis. Results: Seventeen studies with 816 patients were eligible for combined analysis. Presence of CTCs in peripheral blood was significantly associated with N stage (OR 0.50, 95%CI [0.30, 0.81], n = 10, P = 0.005). Patients in the high-CTC group were significantly associated with poorer disease-free survival (DFS;HR = 1.73, 95%CI [1.01 - 2.96], P = 0.050) and poorer overall survival (OS;HR = 2.53, 95%CI [1.37 - 4.69] P = 0.003). Further analyses indicated strong prognostic powers of CTCs in non-RT-PCR group and pre-treatment group. Conclusion: Our meta-analysis indicates that presence of CTCs is associated with higher N stage and poorer prognosis in patients with head and neck cancer. The potential for further clinical application may be needed for further investigation.
文摘Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely malnourished patients. The assessment of nutritional status should be a priority when initiating medical nutrition therapy. We evaluated the agreement between Subjective and Objective evaluation of pre-operative nutrition status of head and neck cancer patients in a tertiary cancer centre. Methods: Two hundred and thirty seven head and neck cancer patients who underwent surgery were eligible. The patients included both males (147) and females (90) with age varying between 23 - 88 years. All patients were screened for pre-operative nutrition status objectively as well as subjectively. The association of pre-operative SGA scores (A, B and C) subjectively, and PNS score (0, 1, 2) objectively were tested for statistical significance. Results: The cancer sites included tongue in 82, buccal mucosa in 30, thyroid in 28, alveolus in 18, glottis in 10, RMT in 10, nasal cavity in 9, FOM in 8. The pre-operative nutrition status based on subjective scores are A in 156 (65.8%), B in 75 (32%) and C in 6 (2.5%). The objective parameters obtained on the basis of BMI, % weight loss, PNI and S. albumin values are PNS 0 in 161 (67.9%), PNS 1 in 71 (30%) and PNS 2 in 5 (2.1%) patients. As the kappa coefficient p-0.56, there is moderate agreement between the pre-operative nutrition status subjectively as well as objectively. Conclusion: Subjective global assessment is a simple and inexpensive way to screen the pre-operative nutrition status when compared to the other objective assessment tool. SGA has moderate agreement with expensive and complicated objective assessment tools. So it can be a reliable tool for assessing the pre-operative nutrition status.
文摘Background: Radiation-induced gliomas of the spinal cord are rare late complications of spinal cord irradiation that typically occur in patients treated at younger ages. Aim: Raise awareness of radiation induced high grade gliomas with a case presentation and a review of the literature. Case Presentation: A 50-year-old male with Stage IVA squamous cell carcinoma of the oropharynx was treated with external beam radiotherapy with a complete response. Seven years later, he presented with a cervical spinal cord mass on MRI. An open biopsy was performed. Pathology revealed an intramedullary WHO grade IV astrocytoma, (i.e., glioblastoma multiforme) of the cervical spine that fulfilled the criteria for a radiation-induced malignancy. Conclusions : Review of the literature suggests that radiation-induced gliomas tend to be high grade and may occur at the periphery of an irradiated field. Radiation-induced gliomas of the spinal cord are a serious complication of radiotherapy that may occur in older patients with head and neck cancers, but are so rare that it should not affect treatment decisions.
基金supported by an unrestricted research grant to CAST,University of Southern Denmark,from Sanofi Pasteur MSD.
文摘Introduction: The incidence of head and neck cancers has increased markedly over the last decade. A Danish study of the costs of head and neck cancers has not been undertaken. Such studies have again become relevant due to the development of the HPV vaccines, as some cases are attributable to high-risk HPV 16 or 18. The objective of study was to estimate the incidence of head and neck cancers and their health care costs. Methods: Data on incidence and health care use related to head and neck cancer were obtained from Danish health care registers. New cancer patients were identified in the Danish National Cancer Register. Resource use per year in the hospital sector was estimated using data from the National Patient Register applying charges as cost estimates. Health care consumption by cancer patients was compared with that by an age- and sex-matched cohort without cancer. Results: We found that nearly 1000 new cases of oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancer are diagnosed annually. In total the cost of these cancers to the Danish hospital sector constituted 31.6 million Euros per year, with the majority of costs (74%) occurring in men. The total costs associated with HPV16/18-related head and neck cancers were estimated to be 6.1 million Euros per year. Conclusion: This study provides the first Danish estimates of the costs associated with non-cervical and non-genital HPV-related cancers based on very reliable, individual-based data. It is expected that the current HPV vaccination programme will reduce this burden.
文摘Objective: To obtain detailed understanding on the gene regulation of natural compounds in altering prognosis of head and neck squamous cell carcinomas(HNSC). Methods: Gene expression data of HNSC samples and peripheral blood mononuclear cells(PBMCs) of HNSC patients were collected from Gene Expression Omnibus(GEO). Differential gene expression analysis of GEO datasets were achieved by the GEO2R tool. Common differentially expressed gerres(DEGs) were screened by comparing DEGs of HNSC with those of PBMCs. The combination was further analyzed for regulating pathways and biological processes that were affected. Results: Totally 110 DEGs were retrieved and identified to be involved in biological processes related to tumor regulation. Then 102 natural compounds were screened for a combination such that the expressions of all 110 commonly DEGs were altered. A combination of salidroside, ginsenoside Rd, oridonin, britanin, and scutellarein was chosen. A multifaceted, multi-dimensional tumor regression was showed by altering autophagy, apoptosis, inhibiting cell proliferation, angiogenesis, metastasis and inflammatory cytokines production. Conclusions: This study has helped develop a unique combination of natural compounds that will markedly reduce the propensity of development of drug resistance in tumors and immune evasion by tumors. The result is crucial to developing a combinatorial natural therapeutic cocktail with accentuated immunotherapeutic potential.
基金This work was supported by the National Natural Science Foundation of China(grant numbers 62171193,81802710).
文摘Nanomaterials(NMs)have increasingly been used for the diagnosis and treatment of head and neck cancers(HNCs)over the past decade.HNCs can easily infiltrate surrounding tissues and form distant metastases,meaning that most patients with HNC are diagnosed at an advanced stage and often have a poor prognosis.Since NMs can be used to deliver various agents,including imaging agents,drugs,genes,vaccines,radiosensitisers,and photosensitisers,they play a crucial role in the development of novel technologies for the diagnosis and treatment of HNCs.Indeed,NMs have been reported to enhance delivery efficiency and improve the prognosis of patients with HNC by allowing targeted delivery,controlled release,responses to stimuli,and the delivery of multiple agents.In this review,we consider recent advances in NMs that could be used to improve the diagnosis,treatment,and prognosis of patients with HNC and the potential for future research.
文摘Objective:Patients with head and neck cancer often undergo extensive ablative and reconstructive surgery.Many risk factors are unalterable,but some operative variables are possible to adjust.The goal of this study was to estimate the association between operative variables and the incidence of perioperative complications in a contemporary tertiary care university‐based head and neck patient population and a Veteran Administration hospital head and neck patient population from an earlier time period.Methods:We retrospectively reviewed all patients who underwent major head and neck surgery.Results:Two‐hundred‐two university patients and 122 veteran patients were reviewed.On multivariable analysis,the total amount of intravenous(IV)fluid received during the procedure was associated with postoperative complications as were patients’weight,American Society of Anesthesiologists(ASA)score,and adult comorbidity evaluation‐27(ACE‐27)score.These associations did not depend on whether the patient was treated at the university or veteran hospital.Conclusion:Our study suggests that the odds of a postoperative complication increase as the total amount of IV fluid increases.
文摘Despite intensive efforts and refined techniques,overall survival in HPV-negative head and neck cancer remains poor.Robust immune priming is required to elicit a strong and durable antitumor immune response in immunologically cold and excluded tumors like HPV-negative head and neck cancer.This review highlights how the tumor microenvironment could be affected by different immune and stromal cell types,weighs the need to integrate metabolic regulation of the tumor microenvironment into cancer treatment strategies and summarizes the emerging clinical applicability of personalized immunotherapeutic strategies in HPV-negative head and neck cancer.
基金supported in part by the National Natural Science Foundation of China(82072019)the Shenzhen Basic Research Program(JCYJ20210324130209023)+5 种基金the Shenzhen-Hong Kong-Macao S&T Program(Category C)(SGDX20201103095002019)the Mainland-Hong Kong Joint Funding Scheme(MHKJFS)(MHP/005/20),the Project of Strategic Importance Fund(P0035421)the Projects of RISA(P0043001)from the Hong Kong Polytechnic University,the Natural Science Foundation of Jiangsu Province(BK20201441)the Provincial and Ministry Co-constructed Project of Henan Province Medical Science and Technology Research(SBGJ202103038,SBGJ202102056)the Henan Province Key R&D and Promotion Project(Science and Technology Research)(222102310015)the Natural Science Foundation of Henan Province(222300420575),and the Henan Province Science and Technology Research(222102310322).
文摘Modern medicine is reliant on various medical imaging technologies for non-invasively observing patients’anatomy.However,the interpretation of medical images can be highly subjective and dependent on the expertise of clinicians.Moreover,some potentially useful quantitative information in medical images,especially that which is not visible to the naked eye,is often ignored during clinical practice.In contrast,radiomics performs high-throughput feature extraction from medical images,which enables quantitative analysis of medical images and prediction of various clinical endpoints.Studies have reported that radiomics exhibits promising performance in diagnosis and predicting treatment responses and prognosis,demonstrating its potential to be a non-invasive auxiliary tool for personalized medicine.However,radiomics remains in a developmental phase as numerous technical challenges have yet to be solved,especially in feature engineering and statistical modeling.In this review,we introduce the current utility of radiomics by summarizing research on its application in the diagnosis,prognosis,and prediction of treatment responses in patients with cancer.We focus on machine learning approaches,for feature extraction and selection during feature engineering and for imbalanced datasets and multi-modality fusion during statistical modeling.Furthermore,we introduce the stability,reproducibility,and interpretability of features,and the generalizability and interpretability of models.Finally,we offer possible solutions to current challenges in radiomics research.
基金supported by“Ministry of science and technology of Taiwan”,China.
文摘Head and neck(HN)cancer is an endemic disease in Taiwan,China.Locally recurrent HN cancer after full-dose irradia-tion poses a therapeutic challenge,and boron neutron capture therapy(BNCT)may be a solution that could provide durable local control with tolerable toxicity.The Tsing-Hua Open Pool Reactor(THOR)at National Tsing-Hua University in Hsin-Chu,provides a high-quality epithermal neutron source for basic and clinical BNCT research.Our first clinical trial,entitled“A phase I/II trial of boron neutron capture therapy for recurrent head and neck cancer at THOR”,was carried out between 2010 and 2013.A total of 17 patients with 23 recurrent HN tumors who had received high-dose photon irradiation were enrolled in the study.The fructose complex of l-boronophenylalanine was used as a boron carrier,and a two-fraction BNCT treatment regimen at 28-day intervals was used for each patient.Toxicity was acceptable,and although the response rate was high(12/17),re-recurrence within or near the radiation site was common.To obtain better local control,another clinical trial entitled“A phase I/II trial of boron neutron capture therapy combined with image-guided intensity-modulated radiotherapy(IG-IMRT)for locally recurrent HN cancer”was initiated in 2014.The first administration of BNCT was performed according to our previous protocol,and IG-IMRT was initiated 28 days after BNCT.As of May 2017,seven patients have been treated with this combination.The treatment-related toxicity was similar to that previously observed with two BNCT applications.Three patients had a complete response,but locoregional recurrence was the major cause of failure despite initially good responses.Future clinical trials combining BNCT with other local or systemic treatments will be carried out for recurrent HN cancer patients at THOR.
基金Higher Education Commission of Pakistan (HEC) in the form of Indigenous PhD fellowship(2MB1-487)。
文摘Background: Head and neck cancers (HNCs) are a heterogeneous group of tumors that progress owing to varied enviromental and genetic risk factors. Viral infections are threatening and adept at altering the expression of cellular transcription factors such as nuclear factor kappa B (NF-κB) and deregulation of other cellular proteins like NF kappa B inhibitor alpha (IκBα). The present study was conducted to detect high-risk genotypes of human papillomavirus (HPV) and protein expression of NF-κB signaling pathway in HNC patients with HPV infection.Methods: For HPV detection, genomic DNA from 152 HNC tumors was extracted formalin-fixed paraffin-embedded tissue DNA kit. For genotyping, polymerase chain reaction (PCR) using a general primer, HPV type-specific primers and agarose gel electrophoresis were performed. Immunohistochemistry (IHC) was also performed on 4-μm thick tissue sections using HPV E6 monoclonal antibody. Protein expression analysis of NF-κB signaling pathway including p50, p65, and IκBα was performed using IHC.Results: PCR analysis showed that 24.3% (37/152) of HNC cases were HPV positive. Among HPV positive, 86.5% (32/37) were tobacco users, while among HPV negative, 66.9% (77/115) were tobacco users. A significant association of HPV positivity and tobacco user was observed by univariate analysis [P < 0.01;odds ratio (OR): 0.310, 95% confidence interval (CI): 0.110 to 0.870]. More HPV positive patients were with poor oral hygiene (78.3%) when compared with patients with good oral hygiene (21.6%) [P < 0.03, OR: 2.440, 95% CI: 1.650 to 3.600]. The results of the logistic regression analysis showed that age, tobacco use and oral hygiene are significant predictors (P < 0.02). PCR and IHC staining results confirmed that HPV16 was predominant among HNC cases (64.8%) when compared with HPV18 (35.2%). Expression of NF-κB proteins (p50, p65, and IκBα inhibitor) were also observed in HPV and non-HPV infected HNC tissues. IHC expression of p50, and p65 showed nuclear staining, while IκBα inhibitor showed cytoplasmic staining. Protein expression in HPV cases was higher as compared to HPV naive cases (P < 0.05).Conclusions: From the study, it can be established that the use of tobacco, oral hygiene, and HPV infection may be synergistically involved in modulating the expression of NF-κB signaling pathway for the development and progression of HNC in the Pakistani population.
