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9th International Conference on Head and Neck Cancer
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9th International Conference on Head and Neck Cancer The use of transoral robotic surgery (TORS) for surgical resection of oropharyngeal cancer is increasing rapidly in the USA; is associated with reduced length of hospital stay; and has less treatment-related morbidity and overall cost, according to researchers at the Johns Hopkins School of Medicine (Baltimore, MD, USA). By doing a crosssectional analysis of 4940 patients who underwent a surgical procedure for malignant oropharyngeal cancer between 2010 and 2012 using the MarketScan Commercial Claim and Encounters database, Kevin Motz and colleagues found the use of TORS increased from 2·8% of surgical cases in 2010 to 10·3% of surgical cases in 2012. Using a multivariate analysis, TORS was associated with significantly decreased odds of post-treatment gastrostomy (odds ratio [OR] 0·54 [0·32–0·92]) and tracheostomy (OR 0·28 [0·09–0·83]) at 1 year and significantly decreased overall treatment-related costs of care (mean incremental cost –US$22 356). Considering the uptake of TORS in the USA in more detail, Jennifer R Cracchiolo (Memorial Sloan Kettering Cancer Center, New York, NY, USA) and colleagues presenting data from 3071 patients with oropharyngeal squamous cell carcinoma included in the National Cancer Database showed that low tumour stage (T1 vs T2: OR 1·33 [CI 1·09–1·64], p=0·007; T1 vs T3: 2·44 [1·69–3·45], p<0·0001), receiving treatment at an academic centre (community vs academic: 2·24 [1·2–3·9], p=0·004), and being treated at a high volume hospital (<4 cases vs >34 cases: 2·23 [1·29–3·88]) were associated with an increased use of TORS. Use of TORS in a high volume academic hospital was also associated with a significantly better chance of negative margins on pathological specimens. Finally, William Albergotti and colleagues (University of Pittsburgh Medical Center, Pittsburgh, PA, USA)
showed that although patients who undergo TORS typically have dysphagia during the first month post-operatively, normal swallowing function is restored by 3 months for patients who do not have adjuvant therapy. The prospective study investigated the effect of a new dysphagia management protocol for 45 patients undergoing TORS for oropharyngeal squamous cell carcinoma. The primary objective was to measure short-term swallowing outcomes before and after implementation of the protocol. There was a significant decrease in the rate of dysphagia-associated readmissions after initiation of the protocol compared with before (12 [8·8%] of 125 vs none of 45, p=0·04). Using a ten-item validated questionnaire to measure swallowing dysfunction, the Eating Assessment Tool 10 (EAT-10), dysphagia was significantly worse at 3 months in patients undergoing any adjuvant therapy compared with those who did not have adjuvant therapy (mean EAT-10 score 21·5 vs 0·5; p=0·028).
Brachytherapy for tongue cancer A phase 2 trial has shown that brachytherapy is feasible for management of cancer of the oral tongue. Recruiting 36 patients, Rami Shoukrun and colleagues (Jewish General Hospital, Montreal, QC, Canada) inserted high dose rate brachytherapy catheters peroperatively to deliver a total dose of 34·0–40·8 Gy in 10–12 fractions. For patients with an involved neck, external beam radiotherapy was delivered to a total dose of 55 Gy in 25 daily fractions, and concommitant chemotherapy was used for patients with positive margins or extracapsular extension. With a median follow-up of 23 months, four patients experienced local failure, one patient had regional failure, one had systemic failure, and six patients died. 3-year locoregional control, disease-free survival, and overall survival were 80·0%, 77·5%, and 83·0%,
www.thelancet.com/oncology Vol 17 September 2016
respectively. Toxicity was manageable with no (RTOG) grade 3 or 4 long-term side-effects.
Trastuzumab for salivary gland cancer Interim results from a phase 2 single-institution, open-label, singlegroup study of trastuzumab (loading dose 8 mg/kg, then 6 mg/kg) and docetaxel (70 mg/m² for patients aged <75 years, 55 mg/m² for patients aged ≥75 years) administered every 3 weeks in patients with unresected HER2+ salivary gland cancer showed 76% of patients achieved an objective response and a median progression-free survival of 9·8 months. Hideaki Takahashi (Mita Hospital, Tokyo, Japan) and colleagues also showed that among the 48 enrolled patients, grade 3–4 toxicities were seen in 94% of patients, but no treatment-related deaths occurred. The trial is ongoing.
John Mead/Science Photo Library
TORS use increasing
Published Online July 21, 2016 http://dx.doi.org/10.1016/ S1470-2045(16)30373-4 The 9th International Conference on Head and Neck Cancer was held on July 16–20, 2016, in Seattle, WA, USA
Stain improves tumour resection A large, British, multicentre, randomised controlled trial investigating the use of Lugol’s iodine vital staining to reduce resection margin dysplasia (a known cause of disease failure after surgery) in patients with oral and oropharyngeal squamous cell carcinoma found to be beneficial in assisting surgeons to excise tumours with clearer margins. Presenting on behalf of the study group, James McCaul (The Royal Marsden, London, UK) showed that among the 419 patients enrolled and randomised 50:50 to stain or control, a reduced number of patients in the Lugol’s iodine group underwent additional excision of surgical margins for close or involved tumour or residual dysplasia (p<0·005). Surgeons in the trial reported that the stain was helpful in 69·1% of cases and that the residual tissue exposed by the stain could be resected in 96·9% of cases.
David Collingridge 1195
9th International Conference on Head and Neck Cancer The use of transoral robotic surgery (TORS) for surgical resection of oropharyngeal cancer is increasing rapidly in the USA; is associated with reduced length of hospital stay; and has less treatment-related morbidity and overall cost, according to researchers at the Johns Hopkins School of Medicine (Baltimore, MD, USA). By doing a crosssectional analysis of 4940 patients who underwent a surgical procedure for malignant oropharyngeal cancer between 2010 and 2012 using the MarketScan Commercial Claim and Encounters database, Kevin Motz and colleagues found the use of TORS increased from 2·8% of surgical cases in 2010 to 10·3% of surgical cases in 2012. Using a multivariate analysis, TORS was associated with significantly decreased odds of post-treatment gastrostomy (odds ratio [OR] 0·54 [0·32–0·92]) and tracheostomy (OR 0·28 [0·09–0·83]) at 1 year and significantly decreased overall treatment-related costs of care (mean incremental cost –US$22 356). Considering the uptake of TORS in the USA in more detail, Jennifer R Cracchiolo (Memorial Sloan Kettering Cancer Center, New York, NY, USA) and colleagues presenting data from 3071 patients with oropharyngeal squamous cell carcinoma included in the National Cancer Database showed that low tumour stage (T1 vs T2: OR 1·33 [CI 1·09–1·64], p=0·007; T1 vs T3: 2·44 [1·69–3·45], p<0·0001), receiving treatment at an academic centre (community vs academic: 2·24 [1·2–3·9], p=0·004), and being treated at a high volume hospital (<4 cases vs >34 cases: 2·23 [1·29–3·88]) were associated with an increased use of TORS. Use of TORS in a high volume academic hospital was also associated with a significantly better chance of negative margins on pathological specimens. Finally, William Albergotti and colleagues (University of Pittsburgh Medical Center, Pittsburgh, PA, USA)
showed that although patients who undergo TORS typically have dysphagia during the first month post-operatively, normal swallowing function is restored by 3 months for patients who do not have adjuvant therapy. The prospective study investigated the effect of a new dysphagia management protocol for 45 patients undergoing TORS for oropharyngeal squamous cell carcinoma. The primary objective was to measure short-term swallowing outcomes before and after implementation of the protocol. There was a significant decrease in the rate of dysphagia-associated readmissions after initiation of the protocol compared with before (12 [8·8%] of 125 vs none of 45, p=0·04). Using a ten-item validated questionnaire to measure swallowing dysfunction, the Eating Assessment Tool 10 (EAT-10), dysphagia was significantly worse at 3 months in patients undergoing any adjuvant therapy compared with those who did not have adjuvant therapy (mean EAT-10 score 21·5 vs 0·5; p=0·028).
Brachytherapy for tongue cancer A phase 2 trial has shown that brachytherapy is feasible for management of cancer of the oral tongue. Recruiting 36 patients, Rami Shoukrun and colleagues (Jewish General Hospital, Montreal, QC, Canada) inserted high dose rate brachytherapy catheters peroperatively to deliver a total dose of 34·0–40·8 Gy in 10–12 fractions. For patients with an involved neck, external beam radiotherapy was delivered to a total dose of 55 Gy in 25 daily fractions, and concommitant chemotherapy was used for patients with positive margins or extracapsular extension. With a median follow-up of 23 months, four patients experienced local failure, one patient had regional failure, one had systemic failure, and six patients died. 3-year locoregional control, disease-free survival, and overall survival were 80·0%, 77·5%, and 83·0%,
www.thelancet.com/oncology Vol 17 September 2016
respectively. Toxicity was manageable with no (RTOG) grade 3 or 4 long-term side-effects.
Trastuzumab for salivary gland cancer Interim results from a phase 2 single-institution, open-label, singlegroup study of trastuzumab (loading dose 8 mg/kg, then 6 mg/kg) and docetaxel (70 mg/m² for patients aged <75 years, 55 mg/m² for patients aged ≥75 years) administered every 3 weeks in patients with unresected HER2+ salivary gland cancer showed 76% of patients achieved an objective response and a median progression-free survival of 9·8 months. Hideaki Takahashi (Mita Hospital, Tokyo, Japan) and colleagues also showed that among the 48 enrolled patients, grade 3–4 toxicities were seen in 94% of patients, but no treatment-related deaths occurred. The trial is ongoing.
John Mead/Science Photo Library
TORS use increasing
Published Online July 21, 2016 http://dx.doi.org/10.1016/ S1470-2045(16)30373-4 The 9th International Conference on Head and Neck Cancer was held on July 16–20, 2016, in Seattle, WA, USA
Stain improves tumour resection A large, British, multicentre, randomised controlled trial investigating the use of Lugol’s iodine vital staining to reduce resection margin dysplasia (a known cause of disease failure after surgery) in patients with oral and oropharyngeal squamous cell carcinoma found to be beneficial in assisting surgeons to excise tumours with clearer margins. Presenting on behalf of the study group, James McCaul (The Royal Marsden, London, UK) showed that among the 419 patients enrolled and randomised 50:50 to stain or control, a reduced number of patients in the Lugol’s iodine group underwent additional excision of surgical margins for close or involved tumour or residual dysplasia (p<0·005). Surgeons in the trial reported that the stain was helpful in 69·1% of cases and that the residual tissue exposed by the stain could be resected in 96·9% of cases.
David Collingridge 1195