Dr. Loren Scott Michel on HPV-Associated Oropharyngeal Cancer hrvatski padezi vjezbe
ENT cancer treatment has raised hpv positive head and neck cancer cetuximab questions, the present therapeutic standard being simultaneous radio-chemotherapy with cisplatin, a quality regional control being obtained by hyper-fractionated radiotherapy, targeted on the tumour volume.
The technical inconveniences that, in some cases, make impossible the accomplishment of a correct treatment, have determined us to make a retrospective analysis of the studies published in medical journals, with the aim of discerning a therapeutic method that has a role in increasing the loco-regional control of the disease.
The studies speak about intra-arterial chemoinfusion with cisplatin, alongside radiotherapy, demonstrating with certainty the superiority of this method versus administrating the drug intravenously, in terms of local tumour control and tolerability. Because the benefits regarding the survival rate and the disease-free period have not reached the statistically significant level, intra-arterial chemoinfusion of cisplatin, alongside radiotherapy, remains a subject that is open to further studies.
Keywords ENT cancers, advanced loco-regional stages, treatment, intra-arterial chemoinfusion Rezumat Elementul-cheie care ne-a determinat să inițiem un studiu privind evaluarea beneficiilor chimioterapiei intraarteriale este faptul că, în ciuda progreselor terapeutice, prognosticul cancerelor sferei ORL este rezervat, cu precădere în stadiile avansate locoregional cu risc crescut de a dezvolta eșecuri terapeutice.
Tratamentul cancerelor sferei ORL a ridicat numeroase controverse, actual fiind stabilit ca standard terapeutic radio-chimioterapia concomitentă cu cisplatin, un control locoregional de calitate fiind obținut în cazul iradierii hiperfracționate, țintit pe volumul tumoral.
Inconvenientele tehnice care, în anumite situații, fac imposibilă realizarea unui tratament corect ne-au determinat să realizăm o analiză retrospectivă a studiilor publicate în revistele de specialitate, cu scopul decelării unei metode terapeutice cu rol în creșterea controlului locoregional al bolii.
Human Papillomavirus and Head and Neck Cancer depistarea ovulelor de helmint
Studiile fac referire la chimioinfuzia intraarterială cu cisplatin, concomitent cu radioterapia, demonstrându-se cu certitudine superioritatea acesteia comparativ cu administrarea intravenoasă în termenii controlului local tumoral și al tolerabilității. Întrucât beneficiile în termenii ratei de supraviețuire și ai intervalului liber de boală nu au atins pragul semnificației statistice, administrarea chimioinfuziei intraarteriale cu cisplatin concomitent cu radioterapia rămâne un subiect deschis evaluării studiilor viitoare.
În boala recidivantă, eficacitatea chimioinfuziei intraarteriale cu cisplatin nu a fost studiată, însă rămâne un subiect demn de a fi abordat întrucât s-a demonstrat că metoda prezintă eficacitate din punct de vedere al profilului de siguranță, având o tolerabilitate bună, precum și al profilului de activitate, realizând o ameliorare a calității vieții și o prelungire a supraviețuirii prin controlul local tumoral superior administrării intravenoase.
Cuvinte cheie ENT cancers advanced loco-regional stages treatment intra-arterial chemoinfusion Introduction Cancers in the head and throat area are a heterogeneous group of tumours that include tumours which have an origin point in the oral cavity, the oropharynx, the rhino-pharynx, the hypo pharynx, the larynx, the salivary glands, the thyroid and the sinuses.
The essential evolutionary particularity is backed up by a concept that implies that prolonged exposure of the oral and pharynx mucosa to carcinogens is what favours the onset and development of multifocal mucosal anomalies.
HPV-related Oropharynx Cancer Discoveries - Mayo Clinic tratament cu paraziti ababaca
In the European Union, the incidence is Also, annually, worldwide, approximately patients are diagnosed with head and neck cancer and patients die because of this disease Because of this increasing incidence and mortality of malign tumours of the head and neck, it entails the necessity of knowing the cause of the growth of these parameters, focusing our attention on the ENT controversial cancer treatment.
Despite therapeutic progress, even in the molecular and immunotherapy treatment era, ENT cancers have a poor prognosis, especially those that are in stages with loco-regional invasion, with a higher risk of therapeutic failure, the correct staging of the disease and a proper treatment for that stage being important.
MACH-NC meta-analysis Meta-Analysis of Chemotherapy in Head and Neck Cancerwhich was updated incomprising 93 trials which included patients, showed that only radio-chemotherapy done at the same time had a statistically significant benefit, regarding the 5-year survival rate of 6. The maximum benefit was obtained in the case of radio-chemotherapy concomitant with cisplatin 0.
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Neoadjuvant polychemotherapy has showed a minimal benefit regarding the 5-year survival rate of only 2. On a patients lot with resectable disease vs. Controversies regarding neoadjuvant polychemotherapy are tied to the minimal benefits in terms of the survival rate and of the inherent toxicity, so that the natural question is if administering is justified or not, the answer being found in the results of the second phase-three randomized trial. DECIDE, the first trial, included patients with head and neck cancers and carcinoma of the oral cavity, hypopharinx and larynx, but especially oropharynx carcinomas Also, hematologic toxicity, and neutropenia respectively, were decreased in the radio-chemotherapy concomitant with cisplatin group.
The lack of therapeutic benefits and the high toxicity are clear arguments that do not justify neoadjuvant poly-chemotherapy usage.
Controversies regarding concomitant chemotherapy and radiotherapy are tied to the benefits that erbitux brings relative to cisplatin. The benefits of erbitux concomitant with radiotherapy are controversial in the results of two retrospective studies, MSKCC Koucher et al.
The survival rate and disease-free interval benefits have reached the statistically significant level regarding concomitant radio-chemotherapy and cisplatin, results that clearly demonstrate the cisplatin superiority versus erbitux concomitant with radiotherapy. As such, the standard treatment of ENT carcinomas is concomitant radio-chemotherapy with cisplatin, a quality loco-regional control being obtained by using tumoral volume targeted hyper-fractionated radiation.
But radiotherapy ward overcrowding makes doing a hyper-fractionated radiation in all hpv positive head and neck cancer cetuximab cases impossible, and using standard fractionated radiation will lead to a decrease of the loco-regional control rate of the disease.
But conventional radiation using wide radiation areas will certainly lead to a severe toxicity that imposes the ending of the treatment, and the prolonged display represents a loco-regional control rate decreasing factor.
These technical inconveniences have determined the authors of the study to make a retrospective analysis of the studies that were published in specialty journals with the aim of finding a therapeutic method with a role in increasing the disease loco-regional control.
Intra-arterial administration is made with the help of the angiograph and it presumes a femoral artery approach with carotid artery catheterization, the external carotid selectively and progressively the artery that vascularizes the tumour, where a catheter is fixed, that has been inserted with a guidewire through the femoral artery approach, catheter through which the cytostatic will be administered with the help of a chemotherapy injector that has been fixed in the arterial sheath.
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The first study that evaluated the benefits of cisplatin intra-arterial chemoinfusion concomitant with radiotherapy was that of Robbins, inthat included patients with ENT cancers in loco-regional advanced stages stages III-IVA, IVB. Also, toxicity was decreased in the initiated study aas well as in the multicentre study bconsisting especially in mucositis, without reporting cisplatin-specific intravenous administration renal toxicity.
The conclusion of the studies was that cisplatin intra-arterial chemoinfusion concomitant with radiotherapy was superior to intravenous administration in terms of tumour local control and of tolerability In the interval, three studies were undergone that enrolled a large number of patients with ENT carcinomas with a poor prognosis in different clinic-imagistic states.
Ina study led by Samant enrolled patients who presented or not imagistic cartilage and bone invasion, the patients being homogenously assigned. None of the three studies reported data regarding benefits in terms of the survival rate and of the disease free interval, the only certain data being those tied to the loco-regional control of the disease.
Hpv induced throat cancer HPV-related Oropharynx Cancer Discoveries - Mayo Clinic tratament cu paraziti ababaca Înțelesul "papillomavirus" în dicționarul Engleză Traducerea «papillomavirus» în 25 de limbi Traducerea «HPV» în 25 de limbi The epidemiology of hypopharynx and cervical esophagus cancer Sinonimele și antonimele papillomavirus în dicționarul de sinonime Engleză Introduction Human papillomavirus 52 positive squamous cell carcinoma of the conjunctiva Symptoms of head and neck cancer caused by hpv In addition to tobacco and alcohol abuse, certain viruses have been associated with squamous cell carcinoma SCC of the head and neck, causing alterations in DNA. It has been demonstrated that the human papillomavirus HPV type 16, a subtype of the human papillomavirus, is present in the oropharyngeal carcinomas of non-smokers patients inclusive. HPV-infected cells express some viral enterobius vermicularis source of infection hpv induced throat cancer by genes called E6 and E7, hpv induced throat cancer can inactivate p53 protein and the retinoblastoma-type protein RBP involved in the regulation of proliferation and cell death.
Also, toxicity was decreased, consisting in every situation of mucositis and hematologic toxicity, cisplatin specific intravenous administration renal toxicity not being reported. The conclusion of the studies was that intra-arterial chemoinfusion concomitant with radiotherapy was superior to intravenous administration in terms of tumoral local control and of tolerability The objective was to evaluate the efficacy of cisplatin intra-arterial chemoinfusion compared with intravenous administration concomitant with radiotherapy, the patients being assigned homogenously into two lots.
Taking into account the renal toxicity of cisplatin when administered intravenously, a fact that imposes carboplatin administration, inBertino made a antiparazitare complexe pentru om which enrolled 46 patients with ENT carcinomas, loco-regionally advanced cases, stages III-IVA and IVB, respectively.
After the studies that evaluated benefits of intra-arterial chemoinfusion concomitant with radiotherapy, we can affirm that intra-arterial administered cisplatin is superior to intravenous administration in terms of the local control and of the tolerability.
Positive results for palbociclib/cetuximab therapy in head and neck cancer
Another justifying element is the results of the published studies that show with certainty the benefits of intra-arterial chemotherapy with regards to the tumoral local control and to tolerability. As a primordial element in case of relapse remains the local tumoral control taking into account that the presence of a tumour that is voluminous and compressive on vital structures can lead to complications with a vital risk.
Also, in the relapsing disease, the tumour can bleed spontaneously leading to the possibility of recidivating epistaxis, of oral cavity bleeding, as well as of large vessel erosion of the neck region, leading to lethal haemorrhage through large vessel perforation carotid artery, jugular vein.
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In these conditions, at the same time with the chemoinfusion embolization of the artery that vascularizes the tumour can be performed with the aim of interrupting the vascularization and stopping the haemorrhaging risk, as well as stopping hpv positive head and neck cancer cetuximab tumour evolution through hypoxia and necrosis secondary to vascularization interruption.
We can say that in case of relapse it is important to apply intra-arterial chemoinfusion as it leads to far greater benefits compared to intravenous palliative chemotherapy administration. The obtained benefits concern quality of life improvement severe and with a vital risk symptomatology improvement through epistaxis and haemorrhage stoppage and decrease of the complications secondary to the compression phenomenon due to the tumour and prolonging survival because post embolization tumoral vascularization will be interrupted, leading to hypoxia and secondary necrosis with tumour evolution stoppage Conclusions 1.
Standard treatment of ENT cancers in loco-regional advanced stages is represented by concomitant radio-chemotherapy which has proven a statistically significant benefit in terms of survival rate and of disease-free interval, the maximum benefit being attained in the case of cisplatin.
Neo-adjuvant intra-arterial chemoinfusion is superior to intravenous administration in terms of local tumour control and of tolerability.
Chimioterapia intraarterială a cancerelor sferei ORL
Intra-arterial chemoinfusion concomitant with radiotherapy is superior to intravenous administration in terms of local tumour control and of tolerability. Intra-arterial chemoinfusion is a safe method from a secure profile point of view, being simple, painless and easily tolerated.
Intra-arterial chemoinfusion is a safe method from an activity profile point of view, through quality of life improvement and prolonging survival through tumour evolution interruption. Initiating an individualized study regarding therapeutic evaluation of intra-arterial chemotherapy benefits in case of loco-regional relapsed disease, in which therapeutic resources are exhausted, through mutilating surgery and limited radiotherapy, is important.
The major role of intra-arterial chemoinfusion in case of relapse is eliminating a vital risk stopping epistaxis and haemorrhageimproving the symptomatology reducing complications secondary to compression phenomenon and prolonging survival stopping the tumour evolution through hypoxia and necrosis, happening after the tumour vascularizing artery embolization. Bibliografie 1. Concurrent chemotherapyradiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial, J Clin Oncol ; — Pignon JP, 6.
Chemotherapy added to locoregional treatment for head and neck squamous condilom pe testicul carcinoma: three meta-analyses of updated individual data.
Metaanalysis of chemotherapy on head and neck cancer, Lancet ; — Final results of the French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma, J Clin Oncol ; Epub Dec Chemoradiotherapy, as compared to radiotherapy alone, significantly increases disease-free and overall survival in head and neck patients after surgery: results of EORTC phase III trial [abstract].
Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: A prospective randomized trial, J Clin Oncol ; Chemotherapy added to locoregional treatment for head and neck squamous cell carcinoma: three meta-analysis of updated individual data, Lancet ; —55 The role of inction chemotherapy in the curative treatment of squamous cell cancer of the head and neck, Semin Oncol ; — Neoadjuvant docetaxel, cisplatin, 5-fluorouracil before concurrent chemoradiotherapy in locally advanced squamous cell carcinoma of the head and neck versus concomitant chemoradiotherapy: a phase II feasibility study, Antihelmintic pentru copii J RadiatOncolBiol Phys.
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Randomized phase III evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and neck cancer E : an intergroup trial of the Eastern Cooperative Oncology Group, J ClinOncol ; Induction chemotherapy followed by concurrent chemoradiation in advanced squamous cell carcinoma of the head and neck: final results from a phase II study with docetaxel, cisplatin and 5-fluorouracil with a four-year follow-up, Oral Oncol.
Epub May Cetuximab prolongs survival in patients with locoregionally advanced squamous cell carcinoma of head andneck: A phase III study of high dose radiation therapy with or without cetuximab [abstract], J ClinOncol, ; 22 14S : Hpv positive head and neck cancer cetuximab plus cetuximab for squamous-cell carcinoma of the head and neck, N Engl J Med.
Vogl, Franco Orsi, Alberto Sobrero.
Genetic progression model for head and neck cancer: implications for field cancerizatio, Cancer Res— Smith E. Cancer incidence, mortality and prevalence wordwide, version 1. Alegerea protocolului de tratament pentru pacienții cu carcinoame ale sferei ORL stadii avansate locoregional, rămâne o discuție desc Laurenţiu Simion, Alexandru C.