Seminars in Radiation Oncology最新文献

Hypofractionated Radiation Therapy in the Definitive Management of Head and Neck Cancer

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.01.002

Dominic H. Moon M.D. , Musaddiq J. Awan M.D.

引用次数: 0

Managing Patients with Head and Neck Cancer and Advanced Age or Comorbidities

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.001

James M. Price , Loren K. Mell

{"title":"Managing Patients with Head and Neck Cancer and Advanced Age or Comorbidities","authors":"James M. Price , Loren K. Mell","doi":"10.1016/j.semradonc.2025.02.001","DOIUrl":"10.1016/j.semradonc.2025.02.001","url":null,"abstract":"<div><div>The dominant treatment paradigm for locoregionally advanced head and neck squamous cell carcinoma (HNSCC) involves postoperative or definitive radiotherapy with concurrent cisplatin chemotherapy. Despite years of research investigating de-intensified treatment, cisplatin-based chemoradiotherapy remains the standard, yet it is associated with significant acute and chronic toxicity. However, due to shared risk factors, such as advanced age, and tobacco and alcohol use, patients with HNSCC frequently have comorbid illnesses that impact treatment tolerability, adding complexity to treatment-related decision-making. In addition, many patients have medical contraindications to cisplatin, requiring alternative treatment strategies. It is thus important to consider how well patients are likely to tolerate treatment, and how to adapt treatment in response to a patient's condition, when weighing treatment options. In this review, we aim to offer readers guidance in managing the elderly or comorbid patient with HNSCC, with particular attention to (i) approaching comorbidity and fragility assessment to make determinations on intensity of treatment, (ii) considering primary treatment modality (eg, surgery <em>vs</em> radiotherapy, chemo-radiotherapy <em>vs</em> radiotherapy alone) and (iii) choice of concurrent systemic therapy agent.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 197-206"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Radiation-Therapy Related Salivary Dysfunction

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.006

Grace C. Blitzer , Cristina Paz , Sara S. McCoy , Randall J. Kimple

{"title":"Radiation-Therapy Related Salivary Dysfunction","authors":"Grace C. Blitzer , Cristina Paz , Sara S. McCoy , Randall J. Kimple","doi":"10.1016/j.semradonc.2025.02.006","DOIUrl":"10.1016/j.semradonc.2025.02.006","url":null,"abstract":"<div><div>Radiation-induced xerostomia (RIX) is a common and debilitating side effect of head and neck cancer radiotherapy, significantly impacting patients' quality of life. This review comprehensively summarizes the current understanding of RIX, encompassing its clinical quantification, underlying pathophysiology, and established and emerging treatment modalities. We explore various objective and subjective measures used to quantify salivary flow and assess the severity of xerostomia in clinical settings. The pathophysiological mechanisms leading to RIX are elucidated, including radiation damage to salivary glands, alterations in saliva composition, and the role of inflammatory processes. Current treatment strategies, such as saliva substitutes and stimulants, are discussed alongside their limitations. Furthermore, we delve into novel investigational approaches, including gene therapy, stem cell transplantation, and pharmacologic interventions, offering promising avenues for future RIX management. This review provides clinicians and researchers with a comprehensive overview of RIX, highlighting the need for continued research to develop more effective preventative and therapeutic strategies to alleviate this burdensome condition.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 278-284"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Principles and Paradigms of De-Escalated Elective Nodal Irradiation: Boldly Going Towards an Inflection Point in Head and Neck Radiotherapy

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.01.001

Amir H. Safavi MD, MSc , Nancy Y. Lee MD , C. Jillian Tsai MD, PhD

{"title":"Principles and Paradigms of De-Escalated Elective Nodal Irradiation: Boldly Going Towards an Inflection Point in Head and Neck Radiotherapy","authors":"Amir H. Safavi MD, MSc , Nancy Y. Lee MD , C. Jillian Tsai MD, PhD","doi":"10.1016/j.semradonc.2025.01.001","DOIUrl":"10.1016/j.semradonc.2025.01.001","url":null,"abstract":"<div><div>Fundamental axioms of elective nodal irradiation (ENI) for head and neck cancers merit re-examination in contemporary practice. Standard ENI doses to volumes bordering critical organs-at-risk increased during the transition from two-dimensional radiation planning to intensity-modulated radiotherapy, despite improvements in detection of occult nodal metastases with modern imaging, use of concurrent chemotherapy, and identification of human papillomavirus (HPV)-related radiosensitivity. Historical large ENI volumes covering low-risk nodal regions continue to be commonly used even as awareness grows regarding the predominant pattern-of-failure within existing gross disease. In this review, we outline principles for de-escalating head and neck ENI dose and volume and highlight the emerging paradigm of ENI omission. We also propose a three-part approach to ENI de-escalation, the rationale for early adoption of de-escalated ENI in the absence of level-one evidence, and strategies to promote early adoption in light of modest equipoise and an inflection point towards changing the status quo.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 143-156"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Immunotherapy With Curative Intent Radiotherapy for Patients With Cancers of the Head and Neck

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.005

Jordan Hill , Jonathan D. Schoenfeld

引用次数: 0

Reirradiation for Locally Recurrent Head and Neck Cancer: State-of-the-Art and Future Directions

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.009

Jack Phan , Michael T. Spiotto , Christopher D. Goodman , Jay Reddy , Phillip Newcomm , Adam S. Garden , Anna Lee

{"title":"Reirradiation for Locally Recurrent Head and Neck Cancer: State-of-the-Art and Future Directions","authors":"Jack Phan , Michael T. Spiotto , Christopher D. Goodman , Jay Reddy , Phillip Newcomm , Adam S. Garden , Anna Lee","doi":"10.1016/j.semradonc.2025.02.009","DOIUrl":"10.1016/j.semradonc.2025.02.009","url":null,"abstract":"<div><div>Reirradiation of the head and neck presents one of the most complex and challenging scenarios faced by (for) clinicians due to the narrow therapeutic window. Its use is increasing in clinical practice, often guided by empirical and pragmatic approaches due to the limited availability of high-level evidence from randomized clinical trials. Successful reirradiation requires a precise balance between tumor control probability (TCP) and normal tissue complication probability (NTCP). Advances in radiation technologies, including intensity-modulated radiation therapy (IMRT), proton beam therapy (PBT), and stereotactic body radiation therapy (SBRT), have enabled more precise high-dose delivery, potentially improving dose distribution and reducing severe toxicity. This review explores current state-of-the-art approaches to reirradiating recurrent head and neck cancer, focusing on modern reirradiation techniques and critically assessing the literature on their clinical application, integration with systemic therapy, and future directions. It also addresses key practical challenges related to patient selection and toxicity/risk management, offering a comprehensive overview of the evolving treatment landscape and highlighting some of the most complex issues clinicians face in reirradiation.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 243-258"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

De-escalated Management of HPV-positive Oropharyngeal Carcinoma: Improving Outcomes with Personalized Approaches

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.01.004

Irini Yacoub , Achraf Shamseddine , Joshua Qian , Mary Youssef , Amir H. Safavi , Nancy Y. Lee

引用次数: 0

Oral Mucositis in Head and Neck Cancer Patients

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.011

Carryn Anderson , Deborah Saunders

{"title":"Oral Mucositis in Head and Neck Cancer Patients","authors":"Carryn Anderson , Deborah Saunders","doi":"10.1016/j.semradonc.2025.02.011","DOIUrl":"10.1016/j.semradonc.2025.02.011","url":null,"abstract":"<div><div>Oral mucositis (OM) is a common side effect of radiation therapy for head and neck cancer (HNC). Despite the medical advances in cancer therapy, OM is still virtually inevitable in patients being irradiated for neoplasms of the head and neck. The initial signs of oral mucositis typically manifest after cumulative doses between 15 and 20 Gy, with ulceration formation by 30 Gy and reaching peak severity in the week after radiation treatment completion (generally 60-72 Gy in management of HNC), then resolving over the 3-4 weeks following treatment completion. Severe oral mucositis (SOM), defined as WHO grade 3 and grade 4, occurs in 65-70% of patients receiving concurrent cisplatin and radiation therapy for locoregionally advanced HNC. WHO grade 3 or 4 oral mucositis leads to risk of systemic infection, severe pain, reduced oral intake which can lead to dehydration, significant weight loss and malnutrition, need for feeding tube placement and hospitalization. The clinical and economic impact, not to mention the impact on patient quality of life from oral mucositis has been well studied. As mucositis is commonly the dose-limiting factor leading to disruption or delay in cancer therapy, establishment of evidence-based guidelines has been paramount in supportive care management of these patients. Improvements in the prevention and treatment of oral mucositis remain essential to better patient outcomes. Here we review the current standard of care, recent successes and failures in development of therapies to mitigate OM, share patient and provider educational resources, and describe on-going and future directions of research in this area.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 271-277"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

De-escalation of Adjuvant Therapy in Operatively Managed HPV Associated Oropharyngeal Carcinoma: Current Status and Future Directions

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.002

Daniel Ma MD, David M. Routman MD

引用次数: 0

Personalising Nasopharyngeal Cancer: Systemic Therapy and Radiotherapy Treatment Volumes

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.01.003

Benjamin X.Z. Huang MD , Xin Zhang PhD , Megan P. Kang MBBS , Melvin L.K. Chua PhD

{"title":"Personalising Nasopharyngeal Cancer: Systemic Therapy and Radiotherapy Treatment Volumes","authors":"Benjamin X.Z. Huang MD , Xin Zhang PhD , Megan P. Kang MBBS , Melvin L.K. Chua PhD","doi":"10.1016/j.semradonc.2025.01.003","DOIUrl":"10.1016/j.semradonc.2025.01.003","url":null,"abstract":"<div><div>Nasopharyngeal carcinoma (NPC) is sensitive to chemotherapy and radiotherapy, with current treatment recommendations largely based on TNM-stage. Radiotherapy remains the backbone of treatment for NPC. Over the past decades, the addition of concurrent chemotherapy to radiotherapy for early-stage disease, and the combination of induction chemotherapy (IC) or adjuvant chemotherapy (AC) with chemoradiotherapy vs chemoradiotherapy alone for advanced disease have led to substantial improvements in survival of patients with NPC. Nonetheless, in the era of precision oncology, there is growing recognition that patients with NPC are clinically heterogeneous even within the same stage-group, and future advances must focus on individualisation of systemic therapy and radiotherapy. In this review, we summarised the published evidence on EBV DNA as a biomarker for clinical stratification and treatment response in NPC, and discussed some of the ongoing clinical trials of EBV DNA-directed personalisation of systemic therapy in locoregionally-advanced disease. Next, we assessed the evidence concerning individualised radiotherapy strategies for target volume delineation of the primary tumour and cervical nodes that ought to be based on individual tumour extent and IC response (for locoregionally-advanced NPC) as opposed to the historical one-size fits all approach. In the same vein, radiotherapy dose de-escalation may be considered in good responders to IC, whereas for the poor responders, altered fractionation or dose escalation may be required to target resistant disease. These concepts are particularly relevant in the era of combinatorial immune checkpoint blockade therapy with radiotherapy, where preservation of circulating immune cells is crucial to evoke immune-mediated antitumour cytotoxicity.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 173-189"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0