Impact of initial FDG PET/CT in the management plan of patients with locally advanced head and neck cancer

Objective. To determine the impact of initial FDG PET/CT staging on clinical stage and the management plan in patients with locally advanced head and neck cancer (LAHNC). Materials and methods. We retrospectively reviewed the records of 72 consecutive patients (2007–2010) staged with PET/CT and conventional CT with tumours of hypopharynx/larynx (26 patients, 36 %), oral cavity (17 patients, 24 %), oropharynx (16 patients, 22 %), nasopharynx (12 patients, 17 %), and others (2 %). The impact of PET/CT on management plans was considered high when PET/CT changed the planned treatment modality or treatment intent, and intramodality changes were considered as minor changes with low impact. Results. FDG PET/CT changed the stage in 27 patients and had high impact on the management plan in 12 % of patients (detection of distant metastases in 6 patients and stage II in 2 patients). Intramodality changes were more frequent: FDG PET/CT altered the TNM stage in 18/72 (25 %) of patients, upstaging N stage in 90 % of patients with low impact. Conclusions. Initial FDG PET/CT staging not only improves stage but also affects the management plan in LAHNC patients (AU)

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Impact of initial FDG PET/CT in the management plan of patients with locally advanced head and neck cancer.

OBJECTIVE: To determine the impact of initial FDG PET/CT staging on clinical stage and the management plan in patients with locally advanced head and neck cancer (LAHNC). MATERIALS AND METHODS: We retrospectively reviewed the records of 72 consecutive patients (2007-2010) staged with PET/CT and conventional CT with tumours of hypopharynx/larynx (26 patients, 36 %), oral cavity (17 patients, 24 %), oropharynx (16 patients, 22 %), nasopharynx (12 patients, 17 %), and others (2 %). The impact of PET/CT on management plans was considered high when PET/CT changed the planned treatment modality or treatment intent, and intramodality changes were considered as minor changes with low impact. RESULTS: FDG PET/CT changed the stage in 27 patients and had high impact on the management plan in 12 % of patients (detection of distant metastases in 6 patients and stage II in 2 patients). Intramodality changes were more frequent: FDG PET/CT altered the TNM stage in 18/72 (25 %) of patients, upstaging N stage in 90 % of patients with low impact. CONCLUSIONS: Initial FDG PET/CT staging not only improves stage but also affects the management plan in LAHNC patients.

Final results of a phase II single-institutional trial with hyperfractionated radiation therapy (HFX) and four-weekly continuous cisplatin in locally advanced head and neck carcinoma

BACKGROUND: To evaluate the efficacy and toxicity of hyperfractionated radiation therapy and continuous infusion of cisplatin on weeks 1 and 5 in locally advanced head and neck carcinoma. METHODS: There were 53 patients: 3 (5.7 %) T2 patients, 31 T3 patients (58.4 %), and 19 T4 patients (35.8 %). Forty-one patients (77.4 %) were N-positive. According to the AJCC, 40 (75.4 %) patients had stage IV and the rest stage III. Treatment consisted of hyperfractionated radiation therapy, 120 cGy bid to a dose of 76.8-81.6 Gy, and cisplatin 20 mg/m(2)/day administered by continuous infusion over 120 h during days 1-5 and 21-25 of radiation therapy. RESULTS: Tumor response and toxicity There were 40 (75.5 %) complete responses, 6 partial responses (11.3 %), and 5 (9.4 %) non-responses or progression. Two patients were non-evaluable for response due to toxic death. All patients had some acute toxicity grade, the most frequent being mucositis (grade 3-4 in 33 patients) and epithelitis (grade 3-4 in 30 patients). Regarding late toxicity, only 2/24 long-term survivors had tracheostomy, and none of them needed enteral nutrition. Survival and local control With a median follow-up of 66 months, the 5-year overall survival rate for all the series was 49.1 % (95 % CI 58.9-39.3 %) with a median survival duration of 32.83 months. Five-year local control was 68.4 % (95 % CI 81.3-55.5 %). CONCLUSIONS: Hyperfractionated radiation therapy and continuous infusion of cisplatin during weeks 1 and 5 are an active treatment in patients with LAHNC. Nevertheless, new strategies are necessary to increase the local control rates and reduce the incidence of distant metastasis and second tumors (AU)

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Final results of a phase II single-institutional trial with hyperfractionated radiation therapy (HFX) and four-weekly continuous cisplatin in locally advanced head and neck carcinoma.

BACKGROUND: To evaluate the efficacy and toxicity of hyperfractionated radiation therapy and continuous infusion of cisplatin on weeks 1 and 5 in locally advanced head and neck carcinoma. METHODS: There were 53 patients: 3 (5.7 %) T2 patients, 31 T3 patients (58.4 %), and 19 T4 patients (35.8 %). Forty-one patients (77.4 %) were N-positive. According to the AJCC, 40 (75.4 %) patients had stage IV and the rest stage III. Treatment consisted of hyperfractionated radiation therapy, 120 cGy bid to a dose of 76.8-81.6 Gy, and cisplatin 20 mg/m(2)/day administered by continuous infusion over 120 h during days 1-5 and 21-25 of radiation therapy. RESULTS: Tumor response and toxicity There were 40 (75.5 %) complete responses, 6 partial responses (11.3 %), and 5 (9.4 %) non-responses or progression. Two patients were non-evaluable for response due to toxic death. All patients had some acute toxicity grade, the most frequent being mucositis (grade 3-4 in 33 patients) and epithelitis (grade 3-4 in 30 patients). Regarding late toxicity, only 2/24 long-term survivors had tracheostomy, and none of them needed enteral nutrition. Survival and local control With a median follow-up of 66 months, the 5-year overall survival rate for all the series was 49.1 % (95 % CI 58.9-39.3 %) with a median survival duration of 32.83 months. Five-year local control was 68.4 % (95 % CI 81.3-55.5 %). CONCLUSIONS: Hyperfractionated radiation therapy and continuous infusion of cisplatin during weeks 1 and 5 are an active treatment in patients with LAHNC. Nevertheless, new strategies are necessary to increase the local control rates and reduce the incidence of distant metastasis and second tumors.

Hemorragia digestiva en paciente con cáncer de orofaringe. A propósito de un caso / Digestive haemorrhage in a patient with oropharyngeal cancer. A case study

Las metástasis gástricas de tumores sólidos sonmuy infrecuentes y en la mayoría de los casos aparecensimultáneamente con otras metástasis. Los tumoresprimarios que más frecuentemente metastatizan a estenivel son los de pulmón y mama. Los síntomas y datosclínicos que presentan son inespecíficos y pueden abarcardesde la dispepsia hasta una hemorragia gastrointestinalmasiva. Para el diagnóstico la gastroscopia es laherramienta fundamental. En esta nota clínica presentamosun caso inusual de hemorragia digestiva masiva enun paciente con un carcinoma de orofaringe(AU)

Gastric metastases from solid tumours are veryinfrequent and in most cases appear simultaneouslywith other metastases. The most frequent primary tumorsare lung and breast. Clinical data and symptomsare non-specific, and can range from abdominal discomfortto massive gastrointestinal bleeding. The diagnosesmust be established by gastroscopy and biopsy.We present an unusual case of digestive haemorrhagesecondary to gastric metastases from oropharyngealcarcinoma(AU)

[Current state of PET in head and neck tumours: impact on the planning of radiotherapy treatment]. / Estado actual del PET en los tumores de cabeza y cuello: impacto en la planificación del tratamiento radioterápico.

The use of positron emission tomography (PET) in head and neck tumours is increasingly widespread. To its clinical indications--especially in the staging of patients but also in evaluating response to treatment and in detecting or confirming relapses--is now added its possible therapeutic impact through its contribution to the planning of radiotherapy treatment. The integration of PET images in the radiotherapy process seems promising, although important doubts remain about it, which means that it is still under research. This article reviews the current state of PET in the area of head and neck tumours, as well as its impact on radiotherapy treatment planning.

[Interaction of radiotherapy and new agents with molecular targets]. / Interacción de la radioterapia con los nuevos agentes con dianas moleculares.

Radiochemotherapy represents one of the greatest achievements in cancer treatment in recent decades, although it involves significant toxicity for patients. Research developed recently in the molecular biology of cancer has enabled understanding of the genetic and molecular changes that determine malign cellular transformation, which has led to the identification of key molecules, converting them into molecular targets that have led to a revolution in radiobiological concepts of cellular response to radiations and radioresistance. The new agents against molecular targets possess greater specificity and less adverse effects, making them more attractive than chemotherapy for combination with radiotherapy. They can act by inhibiting intracellular transduction signals, modulating the cellular cycle, apoptosis or inhibiting angiogenesis. The effect of radiotherapy can be strengthened through inhibition of cellular repopulation, improvement of tumour oxygenation, redistribution of the cellular cycle, inhibition of invasion and metastasis, and increase of radiosensitivity. The available data support its efficacy and applicability in preclinical and clinical studies in different tumour models and open up a promising path in cancer treatment.

Estado actual del PET en los tumores de cabeza y cuello: impacto en la planificación del tratamiento radioterápico / Current state of PET in head and neck tumours: impact on the planning of radiotherapy treatment

El uso de la tomografía de emisión de positrones(PET) en los tumores de cabeza y cuello está cada vezmás extendido. A sus indicaciones clínicas –especialmenteen el estadiaje de los pacientes pero tambiénen la valoración de la respuesta al tratamiento y en ladetección o confirmación de recidivas–, se une ahorael posible impacto terapéutico a través de su aportaciónen la planificación del tratamiento radioterápico.La integración de las imágenes del PET en el procesoradioterápico parece prometedora, aunque persistenimportantes dudas acerca del mismo que hacen que demomento se reserve al campo de la investigación. Eneste trabajo se revisa el estado actual del PET en el áreade los tumores de cabeza y cuello, así como su impactoen la planificación del tratamiento radioterápico(AU)

The use of positron emission tomography (PET)in head and neck tumours is increasingly widespread.To its clinical indications –especially in the staging ofpatients but also in evaluating response to treatmentand in detecting or confirming relapses– is now addedits possible therapeutic impact through its contributionto the planning of radiotherapy treatment. The integrationof PET images in the radiotherapy process seemspromising, although important doubts remain about it,which means that it is still under research. This articlereviews the current state of PET in the area of head andneck tumours, as well as its impact on radiotherapytreatment planning(AU)

Interacción de la radioterapia con los nuevos agentes con dianas moleculares / Interaction of radiotherapy and new agents with molecular targets

La radioquimioterapia supuso uno de los mayoreslogros en el tratamiento del cáncer en las últimas décadas,aunque con una importante toxicidad para los enfermos.La investigación desarrollada recientemente enla biología molecular del cáncer ha permitido conocerlos cambios genéticos y moleculares que determinan latransformación maligna celular, lo que ha conducido aidentificar moléculas claves convirtiéndolas en dianasmoleculares además de revolucionar los conceptos radiobiológicosde respuesta celular a las radiaciones yde radiorresistencia.Los nuevos agentes contra dianas moleculares poseenmayor especificidad y menos efectos adversos, loque les hace más atractivos que la quimioterapia paraser combinados con radioterapia. Pueden actuar inhibiendolas señales de transducción intracelular, modulandoel ciclo celular, la apoptosis o inhibiendo la angiogénesis.El efecto de la radioterapia puede potenciarsea través de una inhibición de la repoblación celular, mejoríade la oxigenación tumoral, redistribución duranteel ciclo celular, inhibición de la invasión y metástasis, yaumento de la radiosensibilidad. Los datos disponiblesapoyan su eficacia y aplicabilidad en estudios preclínicosy clínicos en diversos modelos tumorales y abrenuna vía esperanzadora de cambio en el tratamiento del cáncer(AU)

Radiochemotherapy represents one of the greatestachievements in cancer treatment in recent decades,although it involves significant toxicity for patients.Research developed recently in the molecular biologyof cancer has enabled understanding of the geneticand molecular changes that determine malign cellulartransformation, which has led to the identification ofkey molecules, converting them into molecular targetsthat have led to a revolution in radiobiological conceptsof cellular response to radiations and radioresistance.The new agents against molecular targets possessgreater specificity and less adverse effects, makingthem more attractive than chemotherapy for combinationwith radiotherapy. They can act by inhibitingintracellular transduction signals, modulating the cellularcycle, apoptosis or inhibiting angiogenesis. Theeffect of radiotherapy can be strengthened throughinhibition of cellular repopulation, improvement of tumouroxygenation, redistribution of the cellular cycle,inhibition of invasion and metastasis, and increase ofradiosensitivity. The available data support its efficacyand applicability in preclinical and clinical studies in differenttumour models and open up a promising path in cancer treatment(AU)

The EORTC cancer in-patient satisfaction with care questionnaire: EORTC IN-PATSAT32 Validation study for Spanish patients

OBJECTIVES: The EORTC Quality of Life (QL) Group has developed a questionnaire (the EORTC IN-PATSAT32) to assess the satisfaction of cancer inpatients with hospitalbased care. In this study we assess the psychometric properties of the EORTC IN-PATSAT32 applied to a sample of Spanish patients. MATERIALS AND METHODS: Eighty cancer patients with different tumour sites completed the EORTC QLQ-C30 and EORTC IN-PATSAT32 questionnaires. Psychometric evaluation of the structure, reliability and validity was conducted. RESULTS: Multitrait scaling analysis showed that most itemscale correlation coefficients met the standards of convergent and discriminant validity. Cronbach's coefficients were good (0.77-0.97) for all scales except hospital access. Correlations between the scales and single items of the QLQ-C30 and EORTC IN-PATSAT32 were generally low. Correlations between the Oberst scales and an item on intention to recommend the hospital or ward to others with the EORTC IN-PATSAT32 were moderate. Patients with higher scores on the Oberst scales and the item on intention to recommend the hospital or ward showed higher satisfaction with care levels in all EORTC IN-PATSAT32 areas but one. CONCLUSIONS: The EORTC IN-PATSAT32 appears to be a reliable and valid instrument when applied to a sample of Spanish cancer patients. These results are in line with those of the EORTC validation study (AU)

The EORTC Quality of Life Questionnaire for patients with prostate cancer: EORTC QLQ-PR25. Validation study for Spanish patients.

OBJECTIVES: The EORTC Quality of Life (QL) Group has developed a questionnaire, the EORTC QLQ-PR25, for evaluating QL in prostate cancer. The aim of this study is to assess the psychometric properties of the EORTC QLQPR25 when applied to a sample of Spanish patients. MATERIALS AND METHODS: One hundred and thirty-seven prostate cancer patients with localised disease who started radiotherapy with radical intention combined with or without hormonotherapy prospectively completed the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires three times: on the first and last day of radiotherapy and in the follow-up period. Psychometric evaluation of the questionnaires' structure, reliability and validity was conducted. RESULTS: Multitrait scaling analysis showed that many of the item-scale correlation coefficients met the standards of convergent and discriminant validity. Exceptions appeared mainly in the scales for bowel symptoms and for hormonal- treatment-related symptoms. Cronbach's coefficients of the scales were good (0.72-0.86) for the urinary symptoms and sexual function scales but they were lower (<0.70) for the bowel and hormonal treatment scales. Most scales of the EORTC QLQ-PR25 had low to moderate intercorrelations. Correlations between the scales of the QLQ-C30 and the module were generally low. Group comparison analyses showed better QL in patients with higher Performance Status. Changes in QL appeared throughout the measurements. These were in line with the treatment process. CONCLUSIONS: The EORTC QLQ-PR25 was a reliable and valid instrument when applied to a sample of Spanish prostate cancer patients. These results are in line with those of the EORTC validation study.

The EORTC Quality of Life Questionnaire for patients with prostate cancer: EORTC QLQ-PR25. Validation study for Spanish patients

OBJECTIVES: The EORTC Quality of Life (QL) Group has developed a questionnaire, the EORTC QLQ-PR25, for evaluating QL in prostate cancer. The aim of this study is to assess the psychometric properties of the EORTC QLQPR25 when applied to a sample of Spanish patients. MATERIALS AND METHODS: One hundred and thirty-seven prostate cancer patients with localised disease who started radiotherapy with radical intention combined with or without hormonotherapy prospectively completed the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires three times: on the first and last day of radiotherapy and in the follow-up period. Psychometric evaluation of the questionnaires' structure, reliability and validity was conducted. RESULTS: Multitrait scaling analysis showed that many of the item-scale correlation coefficients met the standards of convergent and discriminant validity. Exceptions appeared mainly in the scales for bowel symptoms and for hormonal- treatment-related symptoms. Cronbach's coefficients of the scales were good (0.72-0.86) for the urinary symptoms and sexual function scales but they were lower (<0.70) for the bowel and hormonal treatment scales. Most scales of the EORTC QLQ-PR25 had low to moderate intercorrelations. Correlations between the scales of the QLQ-C30 and the module were generally low. Group comparison analyses showed better QL in patients with higher Performance Status. Changes in QL appeared throughout the measurements. These were in line with the treatment process. CONCLUSIONS: The EORTC QLQ-PR25 was a reliable and valid instrument when applied to a sample of Spanish prostate cancer patients. These results are in line with those of the EORTC validation study (AU)

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[Digestive haemorrhage in a patient with oropharyngeal cancer. A case study]. / Hemorragia digestiva en paciente con cáncer de orofaringe. A propósito de un caso.

Gastric metastases from solid tumours are very infrequent and in most cases appear simultaneously with other metastases. The most frequent primary tumors are lung and breast. Clinical data and symptoms are non-specific, and can range from abdominal discomfort to massive gastrointestinal bleeding. The diagnoses must be established by gastroscopy and biopsy. We present an unusual case of digestive haemorrhage secondary to gastric metastases from oropharyngeal carcinoma.