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Adjuvant Radiotherapy in Moderately Advanced (T3) Oral Cavity Cancers

Wang, Ronald S; Chow, Michael S; Gordon, Alex J; Santacatterina, Michele; Vaezi, Alec E; Tam, Moses M; Givi, Babak
OBJECTIVE:To investigate the impact of adjuvant radiotherapy in isolated locally advanced oral cavity cancers (pT3N0M0) without adverse features. METHODS:We selected all patients from the National Cancer Database (2004-2019) who underwent surgical treatment where the final pathology was T3N0M0 with negative margins. Demographics, details of treatment, and outcomes were abstracted. The impact of radiotherapy on survival was assessed with univariable, multivariable, and propensity score-matched analyses. RESULTS:We identified 571 patients in our survival cohort. Most were male (348, 60.9%), and median age was 65. Less than one-third (176, 30.8%) received adjuvant radiotherapy. The median length of follow-up was 29 months. Overall, adjuvant radiotherapy was associated with improved survival (87.2% vs. 77.7%, at 2 years, p < 0.01). On multivariable analysis controlling for age and comorbidities, this survival difference persisted (HR: 0.62, 95% CI: 0.43-0.90, p = 0.01). In a propensity score-matched population of 278 patients matched on age and comorbidities, adjuvant radiotherapy was still associated with longer survival (87.4% vs. 78.5%, p = 0.014). CONCLUSION/CONCLUSIONS:In our study, adjuvant radiotherapy was associated with improved survival in completely excised locally advanced oral cavity tumors (T3N0M0). However, a significant proportion of patients do not receive adjuvant radiotherapy. These findings highlight the need for continued efforts to promote guideline-recommended care. LEVEL OF EVIDENCE/METHODS:3 Laryngoscope, 134:2236-2242, 2024.
PMID: 37937735
ISSN: 1531-4995
CID: 5725482

Surgical Treatment in Very Advanced (T4b) Adenoid Cystic Carcinoma of the Head and Neck

Papazian, Michael R; Chow, Michael; Oliver, Jamie; Gordon, Alex J; Jacobson, Adam; Vaezi, Alec; Tam, Moses; Givi, Babak
OBJECTIVE:To compare treatment outcomes for T4b head and neck adenoid cystic carcinoma (ACC). STUDY DESIGN/METHODS:Historical cohort study. SETTING/METHODS:National Cancer Database (NCDB). METHODS:Identified all T4b ACC of head and neck origin diagnosed 2004 to 2019 in the NCDB. Demographics, clinical characteristics, treatment details, and survival were analyzed. Treatment outcomes were analyzed using univariable and multivariable Cox regression. RESULTS:We identified 606 cases of T4b ACC. Less than half (284, 47.0%) underwent curative-intent treatment. Among these, most were treated with primary surgery: surgery + radiotherapy (RT) (122, 43.0%) or surgery + chemoradiotherapy (CRT) (42, 14.8%). The positive margin rate was 78.7%, and 90-day postoperative mortality was zero. Nonsurgical patients were treated with definitive RT (60, 21.1%) or definitive CRT (60, 21.1%). The median follow-up was 51.5 months. Overall survival was 77.8% at 3 years. Three-year survival was higher for patients treated with surgery compared to those treated nonsurgically (84% vs 70%; p = .005). Surgical treatment remained associated with higher survival on multivariable analysis (hazard ratio [HR]: 0.47, p = .005). This effect was most pronounced for oral cavity tumors (HR: 0.17, p = .01). Among matched cohorts of surgically treated patients, there was no difference in 3-year survival between clinical T4a and T4b tumors (83.3% vs 83.0%, p = .99). CONCLUSION/CONCLUSIONS:Long-term survival for T4b ACC of the head and neck could be expected. Primary surgical treatments can be performed safely and are associated with longer survival. A carefully selected subset of patients with very advanced ACC might benefit from the consideration of surgical treatments.
PMID: 36892056
ISSN: 1097-6817
CID: 5432862

Novel VMAT planning technique improves dosimetry for head and neck cancer patients undergoing definitive chemoradiotherapy

DiBartolo, David; Carpenter, Todd; Santoro, Joseph P; Lischalk, Jonathan W; Ebling, David; Haas, Jonathan A; Witten, Matthew; Rybstein, Marissa; Vaezi, Alec; Repka, Michael C
PMID: 36790072
ISSN: 1651-226x
CID: 5427152

Head and Neck

Chapter by: Morris, Matthew; Vaezi, Alec
in: The ABSITE Blueprints by
[S.l.] : Springer International Publishing, 2023
pp. 659-675
ISBN: 9783031326424
CID: 5717762

Adoption of adjuvant chemotherapy in high-risk salivary gland malignancies

Gordon, Alex J; Chow, Michael S; Patel, Aneek; Hu, Kenneth S; Li, Zujun; Jacobson, Adam S; Vaezi, Alec E; Tam, Moses M; Givi, Babak
BACKGROUND:The present study characterizes national trends in the utilization of adjuvant chemotherapy to treat salivary gland malignancies. METHODS:The National Cancer Database was queried for salivary gland malignancies treated by surgery with radiation in 2004-2019. Proportions of patients receiving adjuvant chemotherapy over the study period were analyzed by linear regression. The impact of chemotherapy on overall survival was assessed using Kaplan-Meier and Cox proportional hazards analyses. RESULTS:Among 15 965 patients meeting inclusion criteria, 2355 (14.8%) received adjuvant chemotherapy. Chemotherapy utilization significantly increased from 4.9% to 16.5% over the study period (p < 0.001). No survival benefit was observed with adjuvant chemotherapy on propensity score-matched Kaplan-Meier analysis (HR: 0.98; 95% CI: 0.86-1.11; p = 0.72) or multivariable Cox regression (HR: 0.92; 95% CI: 0.78-1.09; p = 0.34). CONCLUSIONS:Adjuvant chemotherapy has been increasingly utilized to treat salivary gland malignancies in recent years. Our findings highlight the importance of obtaining high-quality prospective data regarding the benefit of chemotherapy.
PMID: 36245302
ISSN: 1097-0347
CID: 5360072

Repeat re-irradiation with interstitial HDR-brachytherapy for an in-field isolated nodal recurrence in a patient with HPV-positive squamous cell carcinoma of the head and neck [Case Report]

Kim, Joseph K; Hardy-Abeloos, Camille; Purswani, Juhi M; Kamen, Emily; Concert, Catherine M; Duckworth, Tamara; Tam, Moses; Haas, Jonathan; Rybstein, Marissa; Vaezi, Alec; Jacobson, Adam; Hu, Kenneth S
PURPOSE/OBJECTIVE:Locoregionally recurrent head and neck cancer is a complex clinical scenario that often requires multimodality treatment. These patients have often previously received definitive treatment with a combination of surgery, radiation therapy, and systemic therapy, which can make further management difficult. A second isolated locoregional failure is rare and clinicians are faced with a challenge to optimize disease control while minimizing treatment-related toxicity. METHODS AND MATERIALS/METHODS:In this report, we present the diagnosis, management, and outcomes of a patient with an isolated locoregional recurrence who was previously treated with two courses of radiation. The patient was treated with a second course of reirradiation using interstitial brachytherapy as well as a discussion regarding patient selection and optimal management for recurrent head and neck cancer. RESULTS:Repeat reirradiation using interstitial HDR-brachytherapy with the use of an alloderm spacer was successfully delivered to the patient for an in-field right neck nodal recurrence. He received a total EQD2/BED dose of 127.70/153.24 Gy. At 1-year followup, the patient was without evidence of recurrent disease or new significant side effects. CONCLUSION/CONCLUSIONS:Recurrent head and neck cancer should be managed with a multidisciplinary approach given the complex clinical scenario. Reirradiation is a commonly used salvage measure for recurrent head and neck cancer that requires careful planning and patient selection due to prior treatment-related effects and dose constraints. We reported a case of a second course of reirradiation using interstitial HDR-brachytherapy for locoregionally recurrent head and neck cancer and showed no recurrence of disease or worsening long term side effects at 1 year.
PMID: 36593130
ISSN: 1873-1449
CID: 5409832

A Phase II Trial Evaluating Rapid Mid-Treatment Nodal Shrinkage to Select for Adaptive Deescalation in p16+Oropharyngeal Cancer Patients Undergoing Definitive Chemoradiation [Meeting Abstract]

Kim, J. K.; Tam, M.; Karp, J. M.; Oh, C.; Kim, G.; Solomon, E.; Concert, C. M.; Vaezi, A. E.; Li, Z.; Tran, T.; Zan, E.; Corby, P.; Feron-Rigodon, M.; Fitz, C. Del Vecchio; Goldberg, J. D.; Hochman, T.; Givi, B.; Jacobson, A.; Persky, M.; Hu, K. S.
ISI:001079706803134
ISSN: 0360-3016
CID: 5591182

Disease Characteristics, Patterns of Care and Survival Outcomes in Patients with Synovial Cell Sarcoma of the Head and Neck (HNSCS) [Meeting Abstract]

Kim, J K; Karp, J M; Hu, K S; Vaezi, A E; Liu, C Z; Rybstein, M; Li, Z; Jacobson, A; Persky, M; Givi, B; Tam, M
Purpose/Objective(s): HNSCS is a rare diagnosis with an overall poor prognosis. Due to its rarity, our understanding of HNSCS and its optimal management is mainly derived from retrospective and single-institution studies. We aimed to evaluate the disease characteristics, patterns of care, and survival outcomes in patients with HNSCS. Materials/Methods: Using the National Cancer Database (NC
EMBASE:2020264161
ISSN: 1879-355x
CID: 5366292

Non-Squamous Cell Malignancies of the Larynx

Rotsides, Janine M; Patel, Evan; Oliver, Jamie R; Moses, Lindsey E; Jacobson, Adam S; Hu, Kenneth S; Vaezi, Alec; Tam, Moses; Givi, Babak
OBJECTIVES/HYPOTHESIS/OBJECTIVE:Non-squamous cell carcinoma (SCC) malignancies are rare, but well described laryngeal pathologies. However, the epidemiology and clinical behavior of these tumors is not well studied. STUDY DESIGN/METHODS:Retrospective cohort study. METHODS:Patients diagnosed with non-squamous cell larynx cancer from 2004 to 2017 in the National Cancer Database were selected. Demographic, clinicopathologic factors, treatments, and survival were analyzed. Univariable and multivariable cox regression were performed. Survival was compared with a propensity score-matched (PSM) population of laryngeal SCC patients. RESULTS:A total of 136,235 cases of larynx cancer were identified. After excluding SCC variants, 2,172 (1.6%) patients met inclusion criteria. The most common histology was chondrosarcoma (374, 17.2%), followed by small cell (345, 15.9%), and spindle cell carcinoma (268, 12.3%). The most common treatment was surgery (683, 31.4%) followed by chemoradiation (409, 18.8%) and surgery and adjuvant radiation (288, 13.3%). Overall, 3- and 5-year survival was 67.9% and 59.4%, respectively. In multivariate analysis controlling for age, stage, comorbidity, histology, and treatment modality; chondrosarcoma had the best survival (hazard ratio [HR] 0.11, confidence interval [CI] 0.07-0.19, P < .001). In a PSM population, matched for age, stage, comorbidity, and treatments; non-SCC patients had significantly lower survival (51.5% vs. 59.9%, P < .001). CONCLUSION/CONCLUSIONS:A diverse range of non-squamous cell malignancies occur in the larynx. In general, these tumors have poor survival, with few exceptions such as chondrosarcoma. While the majority of these histologies undergo surgical-based treatments in other sites, only 53% of patients underwent surgical-based treatment in the larynx. These data could guide clinicians in determining the outcome of treatment in these patients. LEVEL OF EVIDENCE/METHODS:4 Laryngoscope, 2022.
PMID: 34994977
ISSN: 1531-4995
CID: 5107502

Patterns of Care and Outcomes of Carcinosarcoma of the Major Salivary Glands

Talwar, Abhinav; Patel, Evan; Tam, Moses; Zhou, Fang; Hu, Kenneth; Persky, Michael; Vaezi, Alec; Jacobson, Adam; Givi, Babak
OBJECTIVE:Carcinosarcoma of the salivary gland is a rare malignant biphasic tumor. The present study investigates the epidemiology and clinical behavior of carcinosarcoma of the major salivary glands using the National Cancer Database (NCDB). STUDY DESIGN/METHODS:Historical cohort study. SETTING/METHODS:NCDB. METHODS:All tumors were selected between 2004 and 2018. Patient demographics, tumor characteristics, treatments, and survival were analyzed. Cox regression analysis was performed in surgically treated patients. RESULTS:= .008) remained significant. CONCLUSION/CONCLUSIONS:Carcinosarcoma is a rare salivary gland tumor that frequently presents at a locally advanced stage. Despite multimodality treatments, the outcomes are poor. In the absence of clinical trial data, these data from the NCDB could guide clinicians in the management of this rare disease.
PMID: 35998038
ISSN: 1097-6817
CID: 5331582