The Indian scenario of head and neck oncology – Challenging the dogmas

Vidisha Tuljapurkar; Harsh Dhar; Aseem Mishra; Swagnik Chakraborti; Pankaj Chaturvedi; Prathamesh S. Pai

doi:10.4103/2278-330X.187573

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05 (

); 105-110

doi:

10.4103/2278-330X.187573

The Indian scenario of head and neck oncology – Challenging the dogmas

Vidisha Tuljapurkar¹, Harsh Dhar¹, Aseem Mishra¹, Swagnik Chakraborti¹, Pankaj Chaturvedi¹, Prathamesh S. Pai^1,

1 Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra

*Corresponding author: Dr. Prathamesh S. Pai. drpspai@gmail.com

Published: 2020-12-28

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Head and neck cancers (HNCs) are the most common malignancies worldwide. Asian populations bear major burden of this disease, with certain unique characteristics. Although significant research in HNCs is ongoing globally, many clinical issues still remain unanswered. We performed a literature search to find noteworthy Indian studies that changed practice of HNC as well as to look for areas for further research in this field. Many randomized controlled trials as well as large patient series are reported in the field of radiotherapy, chemotherapy, and surgical management of HNC. Still, many areas such as palliative therapy, targeted agents, and newer chemotherapeutic agents remain unexplored. Planned collaborative research is need of the hour to provide more evidenced based.

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References

Grégoire V, Lefebvre JL, Licitra L, Felip E; EHNS-ESMO-ESTRO Guidelines Working Group. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v184-6.
GLOBOCAN 2012 (IARC) Section of Cancer Surveillance. Available from: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx. [Last accessed on 2016 Jun 23].
Mayne ST, Morse DE, Winn DM. Cancers of the oral cavity and pharynx. In: Schottenfeld D, Fraumeni FJ, editors. Cancer Epidemiology and Prevention. 3rd ed. New York, NY, USA: Oxford University Press; 2006. p. 674-96.
Amit M, Yen TC, Liao CT, Chaturvedi P, Agarwal JP, Kowalski LP, et al. Improvement in survival of patients with oral cavity squamous cell carcinoma: An international collaborative study. Cancer 2013;119:4242-8.
Kane SV, Gupta M, Kakade AC, D′ Cruz A. Depth of invasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity. Eur J Surg Oncol 2006;32:795-803.
Huang SH, Hwang D, Lockwood G, Goldstein DP, O′Sullivan B. Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: A meta-analysis of reported studies. Cancer 2009;115:1489-97.
Chaturvedi P, Datta S, Nair S, Nair D, Pawar P, Vaishampayan S, et al. Gross examination by the surgeon as an alternative to frozen section for assessment of adequacy of surgical margin in head and neck squamous cell carcinoma. Head Neck 2014;36:557-63.
Pantvaidya GH, Agarwal JP, Deshpande MS, Rangarajan V, Singh V, Kakade A, et al. PET-CT in recurrent head neck cancers: A study to evaluate impact on patient management. J Surg Oncol 2009;100:401-3.
Dandekar MR, Kannan S, Rangarajan V, Purandare NC, Chaukar DA, Deshmukh A, et al. Utility of PET in unknown primary with cervical metastasis: A retrospective study. Indian J Cancer 2011;48:181-6.
Arya S, Rane P, Deshmukh A. Oral cavity squamous cell carcinoma: Role of pretreatment imaging and its influence on management. Clin Radiol 2014;69:916-30.
de Bondt RB, Nelemans PJ, Hofman PA, Casselman JW, Kremer B, van Engelshoven JM, et al. Detection of lymph node metastases in head and neck cancer: A meta-analysis comparing US, USGFNAC, CT and MR imaging. Eur J Radiol 2007;64:266-72.
Chaturvedi P, Datta S, Arya S, Rangarajan V, Kane SV, Nair D, et al. Prospective study of ultrasound-guided fine-needle aspiration cytology and sentinel node biopsy in the staging of clinically negative T1 and T2 oral cancer. Head Neck 2015;37:1504-8.
D′Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 2015;373:521-9.
Pantvaidya GH, Pal P, Vaidya AD, Pai PS, D′Cruz AK. Prospective study of 583 neck dissections in oral cancers: Implications for clinical practice. Head Neck 2014;36:1503-7.
Singh B, Nair S, Nair D, Patil A, Chaturvedi P, D′Cruz AK. Ipsilateral neck nodal status as predictor of contralateral nodal metastasis in carcinoma of tongue crossing the midline. Head Neck 2013;35:649-52.
Pathak KA, Shah BC. Marginal mandibulectomy: 11 years of institutional experience. J Oral Maxillofac Surg 2009;67:962-7.
Sebastian P, Thomas S, Varghese BT, Iype EM, Balagopal PG, Mathew PC. The submental island flap for reconstruction of intraoral defects in oral cancer patients. Oral Oncol 2008;44:1014-8.
Kim JJ, Tannock IF. Repopulation of cancer cells during therapy: an important cause of treatment failure. Nat Rev Cancer 2005;5:516-25.
Overgaard J, Hansen HS, Specht L, Overgaard M, Grau C, Andersen E, et al. Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomised controlled trial. Lancet 2003;362:933-40.
Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, et al. A radiation therapy oncology group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48:7-16.
Bourhis J, Overgaard J, Audry H, Ang KK, Saunders M, Bernier J, et al. Hyperfractionated or accelerated radiotherapy in head and neck cancer: A meta-analysis. Lancet 2006;368:843-54.
Peters LJ, Ang KK, Thames HD Jr. Accelerated fractionation in the radiation treatment of head and neck cancer. A critical comparison of different strategies. Acta Oncol 1988;27:185-94.
Bernier J, Bentzen SM. Altered fractionation and combined radio-chemotherapy approaches: Pioneering new opportunities in head and neck oncology. Eur J Cancer 2003;39:560-71.
Overgaard J, Mohanti BK, Begum N, Ali R, Agarwal JP, Kuddu M, et al. Five versus six fractions of radiotherapy per week for squamous-cell carcinoma of the head and neck (IAEA-ACC study): A randomised, multicentre trial. Lancet Oncol 2010;11:553-60.
Pignon JP, le Maître A, Maillard E, Bourhis J; MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:4-14.
Ghosh-Laskar S, Kalyani N, Gupta T, Budrukkar A, Murthy V, Sengar M, et al. Conventional radiotherapy versus concurrent chemoradiotherapy versus accelerated radiotherapy in locoregionally advanced carcinoma of head and neck: Results of a prospective randomized trial. Head Neck 2016;38:202-7.
Jensen SB, Pedersen AM, Vissink A, Andersen E, Brown CG, Davies AN, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: Prevalence, severity and impact on quality of life. Support Care Cancer 2010;18:1039-60.
Tejpal G, Jaiprakash A, Susovan B, Ghosh-Laskar S, Murthy V, Budrukkar A. IMRT and IGRT in head and neck cancer: Have we delivered what we promised? Indian J Surg Oncol 2010;1:166-85.
Gupta T, Agarwal J, Jain S, Phurailatpam R, Kannan S, Ghosh-Laskar S, et al. Three-dimensional conformal radiotherapy (3D-CTRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: A randomized controlled trial. Radiother Oncol 2012;104:343-8.
Kumar A, Sharma A, Mohanti BK, Thakar A, Shukla NK, Thulkar SP, et al. A phase 2 randomized study to compare short course palliative radiotherapy with short course concurrent palliative chemotherapy plus radiotherapy in advanced and unresectable head and neck cancer. Radiother Oncol 2015;117:145-51.
Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091-8.
Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27:843-50.
Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: Preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst 1996;88:890-9.
Patil VM, Prabhash K, Noronha V, Joshi A, Muddu V, Dhumal S, et al. Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers. Oral Oncol 2014;50:1000-4.
Gupta T, Agarwal JP, Ghosh-Laskar S, Parikh PM, D′Cruz AK, Dinshaw KA. Radical radiotherapy with concurrent weekly cisplatin in loco-regionally advanced squamous cell carcinoma of the head and neck: A single-institution experience. Head Neck Oncol 2009;1:17.
Dimri K, Pandey AK, Trehan R, Rai B, Kumar A. Conventional radiotherapy with concurrent weekly Cisplatin in locally advanced head and neck cancers of squamous cell origin - A single institution experience. Asian Pac J Cancer Prev 2013;14:6883-8.
Pai PS, Vaidya AD, Prabhash K, Banavali SD. Oral metronomic scheduling of anticancer therapy-based treatment compared to existing standard of care in locally advanced oral squamous cell cancers: A matched-pair analysis. Indian J Cancer 2013;50:135-41.
Patil VM, Noronha V, Joshi A, Muddu VK, Dhumal S, Bhosale B, et al. A prospective randomized phase II study comparing metronomic chemotherapy with chemotherapy (single agent cisplatin), in patients with metastatic, relapsed or inoperable squamous cell carcinoma of head and neck. Oral Oncol 2015;51:279-86.
Reddy BK, Lokesh V, Vidyasagar MS, Shenoy K, Babu KG, Shenoy A, et al. Nimotuzumab provides survival benefit to patients with inoperable advanced squamous cell carcinoma of the head and neck: A randomized, open-label, phase IIb, 5-year study in Indian patients. Oral Oncol 2014;50:498-505.

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[1] Grégoire V, Lefebvre JL, Licitra L, Felip E; EHNS-ESMO-ESTRO Guidelines Working Group. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v184-6.

[2] GLOBOCAN 2012 (IARC) Section of Cancer Surveillance. Available from: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx. [Last accessed on 2016 Jun 23].

[3] Mayne ST, Morse DE, Winn DM. Cancers of the oral cavity and pharynx. In: Schottenfeld D, Fraumeni FJ, editors. Cancer Epidemiology and Prevention. 3rd ed. New York, NY, USA: Oxford University Press; 2006. p. 674-96.

[4] Amit M, Yen TC, Liao CT, Chaturvedi P, Agarwal JP, Kowalski LP, et al. Improvement in survival of patients with oral cavity squamous cell carcinoma: An international collaborative study. Cancer 2013;119:4242-8.

[5] Kane SV, Gupta M, Kakade AC, D′ Cruz A. Depth of invasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity. Eur J Surg Oncol 2006;32:795-803.

[6] Huang SH, Hwang D, Lockwood G, Goldstein DP, O′Sullivan B. Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: A meta-analysis of reported studies. Cancer 2009;115:1489-97.

[7] Chaturvedi P, Datta S, Nair S, Nair D, Pawar P, Vaishampayan S, et al. Gross examination by the surgeon as an alternative to frozen section for assessment of adequacy of surgical margin in head and neck squamous cell carcinoma. Head Neck 2014;36:557-63.

[8] Pantvaidya GH, Agarwal JP, Deshpande MS, Rangarajan V, Singh V, Kakade A, et al. PET-CT in recurrent head neck cancers: A study to evaluate impact on patient management. J Surg Oncol 2009;100:401-3.

[9] Dandekar MR, Kannan S, Rangarajan V, Purandare NC, Chaukar DA, Deshmukh A, et al. Utility of PET in unknown primary with cervical metastasis: A retrospective study. Indian J Cancer 2011;48:181-6.

[10] Arya S, Rane P, Deshmukh A. Oral cavity squamous cell carcinoma: Role of pretreatment imaging and its influence on management. Clin Radiol 2014;69:916-30.

[11] de Bondt RB, Nelemans PJ, Hofman PA, Casselman JW, Kremer B, van Engelshoven JM, et al. Detection of lymph node metastases in head and neck cancer: A meta-analysis comparing US, USGFNAC, CT and MR imaging. Eur J Radiol 2007;64:266-72.

[12] Chaturvedi P, Datta S, Arya S, Rangarajan V, Kane SV, Nair D, et al. Prospective study of ultrasound-guided fine-needle aspiration cytology and sentinel node biopsy in the staging of clinically negative T1 and T2 oral cancer. Head Neck 2015;37:1504-8.

[13] D′Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 2015;373:521-9.

[14] Pantvaidya GH, Pal P, Vaidya AD, Pai PS, D′Cruz AK. Prospective study of 583 neck dissections in oral cancers: Implications for clinical practice. Head Neck 2014;36:1503-7.

[15] Singh B, Nair S, Nair D, Patil A, Chaturvedi P, D′Cruz AK. Ipsilateral neck nodal status as predictor of contralateral nodal metastasis in carcinoma of tongue crossing the midline. Head Neck 2013;35:649-52.

[16] Pathak KA, Shah BC. Marginal mandibulectomy: 11 years of institutional experience. J Oral Maxillofac Surg 2009;67:962-7.

[17] Sebastian P, Thomas S, Varghese BT, Iype EM, Balagopal PG, Mathew PC. The submental island flap for reconstruction of intraoral defects in oral cancer patients. Oral Oncol 2008;44:1014-8.

[18] Kim JJ, Tannock IF. Repopulation of cancer cells during therapy: an important cause of treatment failure. Nat Rev Cancer 2005;5:516-25.

[19] Overgaard J, Hansen HS, Specht L, Overgaard M, Grau C, Andersen E, et al. Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomised controlled trial. Lancet 2003;362:933-40.

[20] Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, et al. A radiation therapy oncology group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48:7-16.

[21] Bourhis J, Overgaard J, Audry H, Ang KK, Saunders M, Bernier J, et al. Hyperfractionated or accelerated radiotherapy in head and neck cancer: A meta-analysis. Lancet 2006;368:843-54.

[22] Peters LJ, Ang KK, Thames HD Jr. Accelerated fractionation in the radiation treatment of head and neck cancer. A critical comparison of different strategies. Acta Oncol 1988;27:185-94.

[23] Bernier J, Bentzen SM. Altered fractionation and combined radio-chemotherapy approaches: Pioneering new opportunities in head and neck oncology. Eur J Cancer 2003;39:560-71.

[24] Overgaard J, Mohanti BK, Begum N, Ali R, Agarwal JP, Kuddu M, et al. Five versus six fractions of radiotherapy per week for squamous-cell carcinoma of the head and neck (IAEA-ACC study): A randomised, multicentre trial. Lancet Oncol 2010;11:553-60.

[25] Pignon JP, le Maître A, Maillard E, Bourhis J; MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:4-14.

[26] Ghosh-Laskar S, Kalyani N, Gupta T, Budrukkar A, Murthy V, Sengar M, et al. Conventional radiotherapy versus concurrent chemoradiotherapy versus accelerated radiotherapy in locoregionally advanced carcinoma of head and neck: Results of a prospective randomized trial. Head Neck 2016;38:202-7.

[27] Jensen SB, Pedersen AM, Vissink A, Andersen E, Brown CG, Davies AN, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: Prevalence, severity and impact on quality of life. Support Care Cancer 2010;18:1039-60.

[28] Tejpal G, Jaiprakash A, Susovan B, Ghosh-Laskar S, Murthy V, Budrukkar A. IMRT and IGRT in head and neck cancer: Have we delivered what we promised? Indian J Surg Oncol 2010;1:166-85.

[29] Gupta T, Agarwal J, Jain S, Phurailatpam R, Kannan S, Ghosh-Laskar S, et al. Three-dimensional conformal radiotherapy (3D-CTRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: A randomized controlled trial. Radiother Oncol 2012;104:343-8.

[30] Kumar A, Sharma A, Mohanti BK, Thakar A, Shukla NK, Thulkar SP, et al. A phase 2 randomized study to compare short course palliative radiotherapy with short course concurrent palliative chemotherapy plus radiotherapy in advanced and unresectable head and neck cancer. Radiother Oncol 2015;117:145-51.

[31] Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091-8.

[32] Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27:843-50.

[33] Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: Preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst 1996;88:890-9.

[34] Patil VM, Prabhash K, Noronha V, Joshi A, Muddu V, Dhumal S, et al. Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers. Oral Oncol 2014;50:1000-4.

[35] Gupta T, Agarwal JP, Ghosh-Laskar S, Parikh PM, D′Cruz AK, Dinshaw KA. Radical radiotherapy with concurrent weekly cisplatin in loco-regionally advanced squamous cell carcinoma of the head and neck: A single-institution experience. Head Neck Oncol 2009;1:17.

[36] Dimri K, Pandey AK, Trehan R, Rai B, Kumar A. Conventional radiotherapy with concurrent weekly Cisplatin in locally advanced head and neck cancers of squamous cell origin - A single institution experience. Asian Pac J Cancer Prev 2013;14:6883-8.

[37] Pai PS, Vaidya AD, Prabhash K, Banavali SD. Oral metronomic scheduling of anticancer therapy-based treatment compared to existing standard of care in locally advanced oral squamous cell cancers: A matched-pair analysis. Indian J Cancer 2013;50:135-41.

[38] Patil VM, Noronha V, Joshi A, Muddu VK, Dhumal S, Bhosale B, et al. A prospective randomized phase II study comparing metronomic chemotherapy with chemotherapy (single agent cisplatin), in patients with metastatic, relapsed or inoperable squamous cell carcinoma of head and neck. Oral Oncol 2015;51:279-86.

[39] Reddy BK, Lokesh V, Vidyasagar MS, Shenoy K, Babu KG, Shenoy A, et al. Nimotuzumab provides survival benefit to patients with inoperable advanced squamous cell carcinoma of the head and neck: A randomized, open-label, phase IIb, 5-year study in Indian patients. Oral Oncol 2014;50:498-505.

The Indian scenario of head and neck oncology – Challenging the dogmas

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Abstract

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References

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