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      Subsite‐specific trends in mid‐ and long‐term survival for head and neck cancer patients in Japan: A population‐based study

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          Abstract

          Advances in diagnostic techniques and treatment modalities have impacted head and neck cancer (HNC) prognosis, but their effects on subsite‐specific prognosis remain unclear. This study aimed to assess subsite‐specific trends in mid‐ and long‐term survival for HNC patients diagnosed from 1993 to 2011 using data from population‐based cancer registries in Japan. We estimated the net survival (NS) for HNC by subsite using data from 13 prefectural population‐based cancer registries in Japan. Changes in survival over time were assessed by multivariate excess hazard model of mortality. In total, 68,312 HNC patients were included in this analysis. We observed an overall improvement in 5‐year NS for HNC patients in Japan. However, survival varied among subsites of HNC, with some, such as naso‐, oro‐ and hypopharyngeal cancers, showing significant improvement in both 5‐ and 10‐year NS, whereas others such as laryngeal cancer showed only a slight improvement in 5‐year NS and no significant change in 10‐year NS after adjustment for age, sex and stage. In conclusion, the study provides insights into changing HNC survival by site at the population level in Japan. Although advances in diagnostic techniques and treatment modalities have improved survival, these improvements are not shared equally among subsites.

          Abstract

          We evaluated trends of head and neck cancer survival by subsite in Japan using population‐basedcancer registry data. During the observation periods, each pharyngeal cancer showed an upward trend, although laryngeal cancer showed no significant trend in long‐term survival. These findings may reflect the change in mainstream treatment.

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          Most cited references41

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          Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States

          Journal of Clinical Oncology, 29(32), 4294-4301
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            Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial

            Summary Background Xerostomia is the most common late side-effect of radiotherapy to the head and neck. Compared with conventional radiotherapy, intensity-modulated radiotherapy (IMRT) can reduce irradiation of the parotid glands. We assessed the hypothesis that parotid-sparing IMRT reduces the incidence of severe xerostomia. Methods We undertook a randomised controlled trial between Jan 21, 2003, and Dec 7, 2007, that compared conventional radiotherapy (control) with parotid-sparing IMRT. We randomly assigned patients with histologically confirmed pharyngeal squamous-cell carcinoma (T1–4, N0–3, M0) at six UK radiotherapy centres between the two radiotherapy techniques (1:1 ratio). A dose of 60 or 65 Gy was prescribed in 30 daily fractions given Monday to Friday. Treatment was not masked. Randomisation was by computer-generated permuted blocks and was stratified by centre and tumour site. Our primary endpoint was the proportion of patients with grade 2 or worse xerostomia at 12 months, as assessed by the Late Effects of Normal Tissue (LENT SOMA) scale. Analyses were done on an intention-to-treat basis, with all patients who had assessments included. Long-term follow-up of patients is ongoing. This study is registered with the International Standard Randomised Controlled Trial register, number ISRCTN48243537. Findings 47 patients were assigned to each treatment arm. Median follow-up was 44·0 months (IQR 30·0–59·7). Six patients from each group died before 12 months and seven patients from the conventional radiotherapy and two from the IMRT group were not assessed at 12 months. At 12 months xerostomia side-effects were reported in 73 of 82 alive patients; grade 2 or worse xerostomia at 12 months was significantly lower in the IMRT group than in the conventional radiotherapy group (25 [74%; 95% CI 56–87] of 34 patients given conventional radiotherapy vs 15 [38%; 23–55] of 39 given IMRT, p=0·0027). The only recorded acute adverse event of grade 2 or worse that differed significantly between the treatment groups was fatigue, which was more prevalent in the IMRT group (18 [41%; 99% CI 23–61] of 44 patients given conventional radiotherapy vs 35 [74%; 55–89] of 47 given IMRT, p=0·0015). At 24 months, grade 2 or worse xerostomia was significantly less common with IMRT than with conventional radiotherapy (20 [83%; 95% CI 63–95] of 24 patients given conventional radiotherapy vs nine [29%; 14–48] of 31 given IMRT; p<0·0001). At 12 and 24 months, significant benefits were seen in recovery of saliva secretion with IMRT compared with conventional radiotherapy, as were clinically significant improvements in dry-mouth-specific and global quality of life scores. At 24 months, no significant differences were seen between randomised groups in non-xerostomia late toxicities, locoregional control, or overall survival. Interpretation Sparing the parotid glands with IMRT significantly reduces the incidence of xerostomia and leads to recovery of saliva secretion and improvements in associated quality of life, and thus strongly supports a role for IMRT in squamous-cell carcinoma of the head and neck. Funding Cancer Research UK (CRUK/03/005).
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              Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients.

              Our previous individual patient data (IPD) meta-analysis showed that chemotherapy improved survival in patients curatively treated for non-metastatic head and neck squamous cell carcinoma (HNSCC), with a higher benefit with concomitant chemotherapy. However the heterogeneity of the results limited the conclusions and prompted us to confirm the results on a more complete database by adding the randomised trials conducted between 1994 and 2000. The updated IPD meta-analysis included trials comparing loco-regional treatment to loco-regional treatment+chemotherapy in HNSCC patients and conducted between 1965 and 2000. The log-rank-test, stratified by trial, was used to compare treatments. The hazard ratios of death were calculated. Twenty-four new trials, most of them of concomitant chemotherapy, were included with a total of 87 trials and 16,485 patients. The hazard ratio of death was 0.88 (p<0.0001) with an absolute benefit for chemotherapy of 4.5% at 5 years, and a significant interaction (p<0.0001) between chemotherapy timing (adjuvant, induction or concomitant) and treatment. Both direct (6 trials) and indirect comparisons showed a more pronounced benefit of the concomitant chemotherapy as compared to induction chemotherapy. For the 50 concomitant trials, the hazard ratio was 0.81 (p<0.0001) and the absolute benefit 6.5% at 5 years. There was a decreasing effect of chemotherapy with age (p=0.003, test for trend). The benefit of concomitant chemotherapy was confirmed and was greater than the benefit of induction chemotherapy.
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                Author and article information

                Contributors
                hidemi@aichi-cc.jp
                Journal
                Cancer Sci
                Cancer Sci
                10.1111/(ISSN)1349-7006
                CAS
                Cancer Science
                John Wiley and Sons Inc. (Hoboken )
                1347-9032
                1349-7006
                23 November 2023
                February 2024
                : 115
                : 2 ( doiID: 10.1111/cas.v115.2 )
                : 623-634
                Affiliations
                [ 1 ] Division of Cancer Information and Control, Department of Preventive Medicine Aichi Cancer Center Research Institute Nagoya Japan
                [ 2 ] Department of Otorhinolaryngology, Head and Neck Surgery Nagoya City University Graduate School of Medical Sciences Nagoya Japan
                [ 3 ] Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine Aichi Cancer Center Research Institute Nagoya Japan
                [ 4 ] School of Nursing University of Shizuoka Shizuoka Japan
                [ 5 ] Cancer Control Center Osaka International Cancer Institute Osaka Japan
                [ 6 ] Department of Epidemiology Radiation Effects Research Foundation Hiroshima Japan
                [ 7 ] Department of Health Sciences, School of Health and Social Services Saitama Prefectural University Saitama Japan
                [ 8 ] Department of Epidemiology and Public Health Kanazawa Medical University Ishikawa Japan
                [ 9 ] Division of Population Data Science National Cancer Center Institute for Cancer Control Tokyo Japan
                [ 10 ] Department of Medical Statistics, Research & Development Center Osaka Medical and Pharmaceutical University Osaka Japan
                [ 11 ] Department of Radiology, Division of Diagnostic Radiology Yamagata University Faculty of Medicine Yamagata Japan
                [ 12 ] Division of International Collaborative Research Center for Public Health Sciences, National Cancer Center Tokyo Japan
                [ 13 ] Department of Cancer Epidemiology Nagoya University Graduate School of Medicine Nagoya Japan
                [ 14 ] Division of Descriptive Cancer Epidemiology Nagoya University Graduate School of Medicine Nagoya Japan
                Author notes
                [*] [* ] Correspondence

                Hidemi Ito, Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Center Research Institute, 1‐1 Kanokoden, Chikusa‐ku, Nagoya, Aichi 464‐8681, Japan.

                Email: hidemi@ 123456aichi-cc.jp

                Author information
                https://orcid.org/0000-0001-9590-1693
                https://orcid.org/0000-0002-0762-1147
                https://orcid.org/0000-0002-5675-3429
                https://orcid.org/0000-0001-9782-8637
                https://orcid.org/0000-0002-1407-2393
                https://orcid.org/0000-0002-7311-1233
                https://orcid.org/0000-0003-1761-6314
                https://orcid.org/0000-0002-8023-4581
                Article
                CAS16028 CAS-OA-1530-2023.R1
                10.1111/cas.16028
                10859624
                37994633
                1bd66aa4-7c46-40eb-8cda-7cecaf242089
                © 2023 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 30 October 2023
                : 02 July 2023
                : 06 November 2023
                Page count
                Figures: 2, Tables: 2, Pages: 12, Words: 5153
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                February 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.6 mode:remove_FC converted:12.02.2024

                Oncology & Radiotherapy
                epidemiology,head and neck cancer,population‐based,survival,trend
                Oncology & Radiotherapy
                epidemiology, head and neck cancer, population‐based, survival, trend

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