Albert Tiong

Weekly cisplatin and radiotherapy for low risk, locoregionally advanced human papillomavirus–positive oropharyngeal squamous cell carcinoma

There is interest in different treatment strategies, including deintensification in good prognosis human papillomavirus‐positive (HPV(+)) oropharyngeal squamous cell carcinoma (SCC). We reviewed our experience with weekly cisplatin in low‐risk, locoregionally advanced HPV(+) oropharyngeal SCC since late 2009.Background There is interest in different treatment strategies, including deintensification in good prognosis human papillomavirus-positive (HPV(+)) oropharyngeal squamous cell carcinoma (SCC). We reviewed our experience with weekly cisplatin in low-risk, locoregionally advanced HPV(+) oropharyngeal SCC since late 2009. Methods Data from patients with low-risk HPV(+) oropharyngeal SCC treated with weekly cisplatin (40 mg/m2) and 70 Gy radiotherapy were collected. Low risk was defined as stage III to IV oropharyngeal SCC excluding T1-2N1, T4 or N3 disease, or N2b to N2c disease in patients with >10 pack-year smoking history. Results Of 31 patients, the median age was 56 years (range, 41–69 years). All patients completed 70 Gy radiotherapy within 51 days and 84% completed at least 5 cycles of cisplatin. Grade 3 mucositis occurred in 22 patients (71%) and grade 3 febrile neutropenia in 6 patients (19%). No patients required enteral feeding at 12 months. The median follow-up was 30 months (range, 21–57 months) with no recurrences or deaths. Conclusion Concurrent weekly cisplatin is relatively well-tolerated and associated with excellent disease control in low-risk, locoregionally advanced HPV(+) oropharyngeal SCC.

Prognostic markers in metastatic cutaneous squamous cell carcinoma of the head and neck

The minority of head and neck cutaneous squamous cell carcinomas (SCC) metastasize to regional lymph nodes. The purpose of this study was to describe the clinical outcomes and prognostic factors for patients with node‐positive head and neck cutaneous SCC who underwent lymphadenectomy.

Faculty of Radiation Oncology Position Paper on the use of Image-Guided Radiation Therapy.

The development of technology such as intensity‐modulated radiotherapy (IMRT), volumetric arc therapy (VMAT) and stereotactic ablative body radiotherapy (SABR) has resulted in highly conformal radiotherapy treatments. While such technology has allowed for improved dose delivery, it has also meant that improved accuracy in the treatment room is required. Image‐guided radiotherapy (IGRT), the use of imaging prior to or during treatment delivery, has been shown to improve the accuracy of treatment delivery and in some circumstances, clinical outcomes. Allied with the adoption of highly conformal treatments, there is a need for stringent quality assurance processes in a multidisciplinary environment. In 2015, the Royal Australian and New Zealand College of Radiologist (RANZCR) updated its position paper on IGRT. The draft document was distributed through the membership of the Faculty of Radiation Oncology (FRO) for review and the final version was endorsed by the board of FRO. This article describes issues that radiotherapy departments throughout Australia and New Zealand should consider. It outlines the role of IGRT and reviews current clinical evidence supporting the benefit of IGRT in genitourinary, head and neck, and lung cancers. It also highlights important international publications which provide guidance on implementation and quality assurances for IGRT. A set of key recommendations are provided to guide safe and effective IGRT implementation and practice in the Australian and New Zealander context.

Unilateral radiotherapy treatment for p16/human papillomavirus-positive squamous cell carcinoma of unknown primary in the head and neck: Radiotherapy for p16 + Unknown Primary

The outcomes of unilateral radiotherapy treatment for patients with p16/HPV‐positive squamous cell carcinomas of unknown primary (SCCUP) affecting cervical lymph nodes are under‐reported. Compared to radiating large volumes of the pharyngeal axis (the more common approach), this is potentially a much less toxic treatment for a good prognosis group.

National survey on image-guided radiotherapy practice in New Zealand.

INTRODUCTION This survey aimed to assess the use of image-guided radiotherapy (IGRT) within New Zealand (NZ) and evaluate the quality of IGRT delivery. METHOD All nine centres in NZ were invited to participate in an online survey in November 2015. Questions were asked on type of IGRT technologies available, IGRT use by tumour site and frequency of imaging. In addition, questions were asked in reference to the American Society for Radiation Oncology (ASTRO) White Paper recommendations on safe practice of IGRT. RESULTS Seven of the nine centres (78%) responded. Kilovoltage cone-beam CT (CBCT), kilovoltage planar imaging and megavoltage electronic portal imaging were the most commonly used IGRT technologies. CBCT was most frequently used in gynaecology (100%), genitourinary (86%) and head and neck (86%) sites. Despite the availability of similar IGRT technologies, there was significant variation in their application between centres. All centres used online IGRT; however, the frequency of imaging varied across the tumour sites and individual centres. Daily online IGRT use ranged from 43% to 86% across the tumour sites. Overall, there was good compliance by the NZ centres to the White Paper recommendations, with at least 71% reached for each element. However, the compliance rates for the individual centres ranged between 50% and 100%. The most commonly identified barrier to IGRT use was lack of guidelines/education (43%). CONCLUSION Image-guided radiotherapy is widely used in NZ; however, there is a wide variation in its application between centres. Detailed tumour site-specific, imaging modality-specific national guidelines will allow standardization of IGRT practices.

Retrospective audit of patients referred for further treatment following Mohs surgery for non-melanoma skin cancer.

To describe the characteristics, subsequent management and outcomes of patients referred for further management following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Weekly cisplatin and radiotherapy for low risk, locoregionally advanced human papillomavirus-positive oropharyngeal squamous cell carcinoma: Weekly Cisplatin and RT in HPV(+) OP SCC

There is interest in different treatment strategies, including deintensification in good prognosis human papillomavirus‐positive (HPV(+)) oropharyngeal squamous cell carcinoma (SCC). We reviewed our experience with weekly cisplatin in low‐risk, locoregionally advanced HPV(+) oropharyngeal SCC since late 2009.Background There is interest in different treatment strategies, including deintensification in good prognosis human papillomavirus-positive (HPV(+)) oropharyngeal squamous cell carcinoma (SCC). We reviewed our experience with weekly cisplatin in low-risk, locoregionally advanced HPV(+) oropharyngeal SCC since late 2009. Methods Data from patients with low-risk HPV(+) oropharyngeal SCC treated with weekly cisplatin (40 mg/m2) and 70 Gy radiotherapy were collected. Low risk was defined as stage III to IV oropharyngeal SCC excluding T1-2N1, T4 or N3 disease, or N2b to N2c disease in patients with >10 pack-year smoking history. Results Of 31 patients, the median age was 56 years (range, 41–69 years). All patients completed 70 Gy radiotherapy within 51 days and 84% completed at least 5 cycles of cisplatin. Grade 3 mucositis occurred in 22 patients (71%) and grade 3 febrile neutropenia in 6 patients (19%). No patients required enteral feeding at 12 months. The median follow-up was 30 months (range, 21–57 months) with no recurrences or deaths. Conclusion Concurrent weekly cisplatin is relatively well-tolerated and associated with excellent disease control in low-risk, locoregionally advanced HPV(+) oropharyngeal SCC.