Pub Date : 2026-01-31DOI: 10.1016/j.oraloncology.2026.107877
Sholem Hack , Ron J. Karni , Antonino Maniaci , Christopher E. Fundakowski , Luca Castellani , Fabiola Incandela , Remo Accorona , Miguel Mayo-Yanez , Martina Violati , Lorenzo Giannini , Niccolo’ Mevio , Alberto Maria Saibene
Background
The management of head and neck cancer relies on multidisciplinary expertise; however, access to tumor boards remains variable. Large language models (LLMs) may support guideline-based decision-making, although performance in complex oncologic scenarios is not well defined.
Methods
Fourteen synthetic cases based on real tumor board encounters were evaluated. Five blinded comparator arms produced recommendations: a human expert, Non-RAG-GPT-4, Non-RAG-GPT-5, RAG-GPT-4, and RAG-GPT-5. Eight head and neck oncologic surgeons scored each recommendation for appropriateness, clarity, specificity, and feasibility using 5-point Likert scales. Paired permutation testing and inter-rater reliability were assessed.
Results
LLM outputs showed close alignment with expert recommendations. RAG-based models achieved the highest mean scores across domains, with some statistically significant differences versus the expert comparator in appropriateness and clarity; however, absolute differences were modest. Inter-rater reliability was strong (ICC 0.73–0.87).
Conclusions
Advanced LLMs can generate guideline-concordant management recommendations in simulated head and neck cancer cases, supporting potential utility for decision support and education; prospective validation and expert oversight remain essential.
{"title":"Evaluation of large language models as decision support tools for head and neck cancer management: A blinded multidisciplinary simulation study","authors":"Sholem Hack , Ron J. Karni , Antonino Maniaci , Christopher E. Fundakowski , Luca Castellani , Fabiola Incandela , Remo Accorona , Miguel Mayo-Yanez , Martina Violati , Lorenzo Giannini , Niccolo’ Mevio , Alberto Maria Saibene","doi":"10.1016/j.oraloncology.2026.107877","DOIUrl":"10.1016/j.oraloncology.2026.107877","url":null,"abstract":"<div><h3>Background</h3><div>The management of head and neck cancer relies on multidisciplinary expertise; however, access to tumor boards remains variable. Large language models (LLMs) may support guideline-based decision-making, although performance in complex oncologic scenarios is not well defined.</div></div><div><h3>Methods</h3><div>Fourteen synthetic cases based on real tumor board encounters were evaluated. Five blinded comparator arms produced recommendations: a human expert, Non-RAG-GPT-4, Non-RAG-GPT-5, RAG-GPT-4, and RAG-GPT-5. Eight head and neck oncologic surgeons scored each recommendation for appropriateness, clarity, specificity, and feasibility using 5-point Likert scales. Paired permutation testing and inter-rater reliability were assessed.</div></div><div><h3>Results</h3><div>LLM outputs showed close alignment with expert recommendations. RAG-based models achieved the highest mean scores across domains, with some statistically significant differences versus the expert comparator in appropriateness and clarity; however, absolute differences were modest. Inter-rater reliability was strong (ICC 0.73–0.87).</div></div><div><h3>Conclusions</h3><div>Advanced LLMs can generate guideline-concordant management recommendations in simulated head and neck cancer cases, supporting potential utility for decision support and education; prospective validation and expert oversight remain essential.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"Article 107877"},"PeriodicalIF":3.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 10.1016/j.oraloncology.2026.107864
Katelyn Steele , Catherine Barnett , Rahul Ladwa , Meg L Donovan , Clara Lawler , Arutha Kulasinghe
Head and neck squamous cell carcinoma (HNSCC) represents a biologically diverse group of malignancies within the upper aerodigestive tract and oral cavity and remains a significant cause of global morbidity and mortality. Increasing evidence highlights that the tumour microenvironment (TME) plays a central role in disease progression and therapeutic response. Distinct immune and stromal profiles have been observed between HPV positive (HPV+) and HPV negative (HPV-) HNSCC, underpinning their differing natural history and responses to immunotherapy. Despite advances, only 15–20% of patients with recurrent or metastatic HNSCC (RMHNSCC) respond to immunotherapy, with no difference in response being seen between HPV+ and HPV- disease. This may reflect the complexity and heterogeneity of the TME. This review explores how emerging spatial omics technologies, combining molecular, and spatial context, are reshaping our understanding of the HNSCC microenvironment, with emphasis on recurrent and/or metastatic disease. By delineating the spatial organisation of immune, stromal, and metabolic features, these approaches provide new insights into mechanisms of treatment resistance, prognostic biomarkers, and therapeutic vulnerabilities. Understanding spatial TME dynamics across HPV-related subtypes may ultimately guide more precise and effective treatment strategies for HNSCC.
{"title":"Tumour microenvironment diversity of HNSCC and the molecular landscape of recurrent disease","authors":"Katelyn Steele , Catherine Barnett , Rahul Ladwa , Meg L Donovan , Clara Lawler , Arutha Kulasinghe","doi":"10.1016/j.oraloncology.2026.107864","DOIUrl":"10.1016/j.oraloncology.2026.107864","url":null,"abstract":"<div><div>Head and neck squamous cell carcinoma (HNSCC) represents a biologically diverse group of malignancies within the upper aerodigestive tract and oral cavity and remains a significant cause of global morbidity and mortality. Increasing evidence highlights that the tumour microenvironment (TME) plays a central role in disease progression and therapeutic response. Distinct immune and stromal profiles have been observed between HPV positive (HPV+) and HPV negative (HPV-) HNSCC, underpinning their differing natural history and responses to immunotherapy. Despite advances, only 15–20% of patients with recurrent or metastatic HNSCC (RMHNSCC) respond to immunotherapy, with no difference in response being seen between HPV+ and HPV- disease. This may reflect the complexity and heterogeneity of the TME. This review explores how emerging spatial omics technologies, combining molecular, and spatial context, are reshaping our understanding of the HNSCC microenvironment, with emphasis on recurrent and/or metastatic disease. By delineating the spatial organisation of immune, stromal, and metabolic features, these approaches provide new insights into mechanisms of treatment resistance, prognostic biomarkers, and therapeutic vulnerabilities. Understanding spatial TME dynamics across HPV-related subtypes may ultimately guide more precise and effective treatment strategies for HNSCC.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"Article 107864"},"PeriodicalIF":3.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 10.1016/j.oraloncology.2026.107876
Bartosz P Wojtera, Avinash Beharry, Victoria Salati, Karma Lambercy, Nina Wahler, Edouard Romano, Wojciech Golusinski, Christian Simon
Objective: Transoral robotic surgery (TORS), either used alone or combined with radiotherapy, is a common treatment for operable T-stage oropharyngeal squamous cell carcinoma (OPSCC). Due to high survival rates, maintaining quality of life-especially swallowing function-is an important long-term consideration. This study aimed to assess swallowing outcomes five years and beyond following TORS in patients with primary OPSCC.
Methods: "Functional outcome swallowing scale" (FOSS) was used to retrospectively assess long-term dysphagia in 47 OPSCC patients, with a median follow-up of 6.8 years. All patients had a minimum follow-up of five years.
Results: The FOSS scores remained stable at five years compared to 1-4 years post-TORS (all p > 0.99). Furthermore, there were no significant differences in FOSS from 1 to 10 years post-TORS compared to preoperative score. Adjuvant therapy was a univariate predictor of worse swallowing outcomes (OR: 17.46, 95% CrI: 2.94-121.51); however, this effect was limited to the short-term postoperative period (≤ 2 years after TORS). In contrast, subsequent major surgery after TORS and treatment of more advanced tumors (pT2-pT3 vs. pTis-pT1) were associated with persistently worse swallowing outcomes, including long-term follow-up (OR: 23.81, 95% CrI: 4.48-142.59; OR: 15.03, 95% CrI: 3.06-81.45, respectively).
Conclusions: TORS offers excellent and stable long-term swallowing outcomes when used as a single-modality treatment for OPSCC. While outcomes remain satisfactory with additional therapies, swallowing results are influenced by tumor stage, adjuvant treatment, and further major surgery.
{"title":"Long-term swallowing outcomes following transoral robotic surgery for oropharyngeal cancer - Five years and beyond.","authors":"Bartosz P Wojtera, Avinash Beharry, Victoria Salati, Karma Lambercy, Nina Wahler, Edouard Romano, Wojciech Golusinski, Christian Simon","doi":"10.1016/j.oraloncology.2026.107876","DOIUrl":"https://doi.org/10.1016/j.oraloncology.2026.107876","url":null,"abstract":"<p><strong>Objective: </strong>Transoral robotic surgery (TORS), either used alone or combined with radiotherapy, is a common treatment for operable T-stage oropharyngeal squamous cell carcinoma (OPSCC). Due to high survival rates, maintaining quality of life-especially swallowing function-is an important long-term consideration. This study aimed to assess swallowing outcomes five years and beyond following TORS in patients with primary OPSCC.</p><p><strong>Methods: </strong>\"Functional outcome swallowing scale\" (FOSS) was used to retrospectively assess long-term dysphagia in 47 OPSCC patients, with a median follow-up of 6.8 years. All patients had a minimum follow-up of five years.</p><p><strong>Results: </strong>The FOSS scores remained stable at five years compared to 1-4 years post-TORS (all p > 0.99). Furthermore, there were no significant differences in FOSS from 1 to 10 years post-TORS compared to preoperative score. Adjuvant therapy was a univariate predictor of worse swallowing outcomes (OR: 17.46, 95% CrI: 2.94-121.51); however, this effect was limited to the short-term postoperative period (≤ 2 years after TORS). In contrast, subsequent major surgery after TORS and treatment of more advanced tumors (pT2-pT3 vs. pTis-pT1) were associated with persistently worse swallowing outcomes, including long-term follow-up (OR: 23.81, 95% CrI: 4.48-142.59; OR: 15.03, 95% CrI: 3.06-81.45, respectively).</p><p><strong>Conclusions: </strong>TORS offers excellent and stable long-term swallowing outcomes when used as a single-modality treatment for OPSCC. While outcomes remain satisfactory with additional therapies, swallowing results are influenced by tumor stage, adjuvant treatment, and further major surgery.</p>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"107876"},"PeriodicalIF":3.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.oraloncology.2026.107875
Xinjia Cai , Saman Warnakulasuriya
{"title":"Integrating betel nut control into routine health management strategies","authors":"Xinjia Cai , Saman Warnakulasuriya","doi":"10.1016/j.oraloncology.2026.107875","DOIUrl":"10.1016/j.oraloncology.2026.107875","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"Article 107875"},"PeriodicalIF":3.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.oraloncology.2026.107865
Nan Wang , Haotian Gao , Shuai-xia Yu , Jiangang Fan , Bin Li , Xiaolong Zhao
{"title":"The first report of contralateral parapharyngeal space metastasis of papillary thyroid carcinoma: report of a case","authors":"Nan Wang , Haotian Gao , Shuai-xia Yu , Jiangang Fan , Bin Li , Xiaolong Zhao","doi":"10.1016/j.oraloncology.2026.107865","DOIUrl":"10.1016/j.oraloncology.2026.107865","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"Article 107865"},"PeriodicalIF":3.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-25DOI: 10.1016/j.oraloncology.2026.107866
Jing Zhong , Hongye Chen , Zhiwei Yan , Hanchuan Xu , Peng Shi , Peide Zhu , Yahan Zheng , Youping Xiao , Dechun Zheng , Caizhu Pan , Yunbin Chen , Shaojun Lin , Jianji Pan , Qiaojuan Guo
Objectives
To ascertain the prognostic value of grade 2 imaging extranodal extension (G2 iENE), also called matted nodes (MNs), in nasopharyngeal carcinoma (NPC) based on the 9th-version of AJCC/UICC TNM staging system (TNM-9) and the Head and Neck Cancer International Group (HNCIG)’s criteria for diagnosing iENE, and propose future refinement of the TNM-9 N category.
Materials and methods
Non-metastatic NPC patients treated between 2017 and 2018 were screened. MRI data were reviewed for re-staging according to the TNM-9 and iENE status per the HNCIG-criteria. Five-year overall survival (OS), locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) were analyzed. Recursive partitioning analysis (RPA) based on the ordinal N category of TNM-9 and the G2 iENE status were performed to propose a refined N category.
Results
Totally, 1334 patients were included, with 462 (34.6%) patients presenting with G2 iENE at baseline. Besides N Category, G2 iENE also showed independent prognostic value for OS (HR: 1.453, P = 0.042), PFS (HR: 1.293, P = 0.057) and DMFS (HR: 1.363, P = 0.042). The RPA-N category was then derived: RPA-N0 (N0), RPA-N1 (N1 without G2 iENE), RPA-N2 (N1 with G2 iENE and N2) and RPA-N3 (N3). The RPA-N classification had a lower Akaike information criterion (AIC) and higher C-index for all endpoints, and performed better in hazard consistency, hazard discrimination, sample size balance and outcome prediction when compared to TNM-9.
Conclusions
G2 iENE, based on the HNCIG-criteria, constitute an independent adverse prognostic factor for NPC based on the TNM-9. The RPA-N category, which integrated N category of TNM-9 and G2 iENE, demonstrated better performance than N category in TNM-9, further validation in multicenter cohorts is warranted.
{"title":"Refinement of N category in version-nine of AJCC/UICC TNM staging system for nasopharyngeal carcinoma based on the international consensus recommendations for diagnosing extranodal extension","authors":"Jing Zhong , Hongye Chen , Zhiwei Yan , Hanchuan Xu , Peng Shi , Peide Zhu , Yahan Zheng , Youping Xiao , Dechun Zheng , Caizhu Pan , Yunbin Chen , Shaojun Lin , Jianji Pan , Qiaojuan Guo","doi":"10.1016/j.oraloncology.2026.107866","DOIUrl":"10.1016/j.oraloncology.2026.107866","url":null,"abstract":"<div><h3>Objectives</h3><div>To ascertain the prognostic value of grade 2 imaging extranodal extension (G2 iENE), also called matted nodes (MNs), in nasopharyngeal carcinoma (NPC) based on the 9th-version of AJCC/UICC TNM staging system (TNM-9) and the Head and Neck Cancer International Group (HNCIG)’s criteria for diagnosing iENE, and propose future refinement of the TNM-9 N category.</div></div><div><h3>Materials and methods</h3><div>Non-metastatic NPC patients treated between 2017 and 2018 were screened. MRI data were reviewed for re-staging according to the TNM-9 and iENE status per the HNCIG-criteria. Five-year overall survival (OS), locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) were analyzed. Recursive partitioning analysis (RPA) based on the ordinal N category of TNM-9 and the G2 iENE status were performed to propose a refined N category.</div></div><div><h3>Results</h3><div>Totally, 1334 patients were included, with 462 (34.6%) patients presenting with G2 iENE at baseline. Besides N Category, G2 iENE also showed independent prognostic value for OS (HR: 1.453, P = 0.042), PFS (HR: 1.293, P = 0.057) and DMFS (HR: 1.363, P = 0.042). The RPA-N category was then derived: RPA-N0 (N0), RPA-N1 (N1 without G2 iENE), RPA-N2 (N1 with G2 iENE and N2) and RPA-N3 (N3). The RPA-N classification had a lower Akaike information criterion (AIC) and higher C-index for all endpoints, and performed better in hazard consistency, hazard discrimination, sample size balance and outcome prediction when compared to TNM-9.</div></div><div><h3>Conclusions</h3><div>G2 iENE, based on the HNCIG-criteria, constitute an independent adverse prognostic factor for NPC based on the TNM-9. The RPA-N category, which integrated N category of TNM-9 and G2 iENE, demonstrated better performance than N category in TNM-9, further validation in multicenter cohorts is warranted.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"Article 107866"},"PeriodicalIF":3.9,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.oraloncology.2026.107863
K. Sandström , L. Farnebo , A. Hafström , A. Westerborn , M. Olin , E. Hammerlid , L. Hammarstedt-Nordenvall , M. Gebre-Medhin , B. Granström , T. Andersson-Säll , G. Laurell
Intro
Population-based studies predominantly focused on carcinoma of the parotid gland (CPG) are rare. The study aims were to analyze the incidence of CPG and to assess treatment outcomes in relation to histopathology, preoperative diagnosis and adjuvant radiotherapy.
Methods
A retrospective analysis was conducted on data from the Swedish Head and Neck Cancer Register (SweHNCR), including 1,018 patients diagnosed with CPG between 2008 and 2019.
Results
The age-adjusted incidence remained stable with a mean of 0.9 (range 0.65–1.08) cases per 100,000 person-years (ASR-Europe). Curative treatment was administered to 90 % of the patients, with a recurrence rate of 9 % within 3 years. The highest recurrence rates were observed in patients with salivary duct carcinoma and adenocarcinoma, while patients with acinic cell and mucoepidermoid carcinomas had lower recurrence rates. For stage I–II tumors, the 5-year relative survival was unaffected by whether the malignant diagnosis was known preoperatively. Male sex, increasing age, stage III–IV disease, and a World Health Organization/ Eastern Cooperative Oncology Group (WHO/ECOG) performance status 2–4 was independently associated with increased overall mortality risk, whereas the timing of adjuvant radiotherapy was not.
Conclusion
This study contributes to establishing the incidence and treatment outcomes of CPG in Sweden and highlights the diverse histopathological diagnoses of these tumors. Notably, unknown malignancy at the time of surgery did not impact survival in early-stage disease, and the timing of postoperative radiotherapy was not associated with overall survival.
{"title":"Carcinoma of the parotid Gland: A Population-Based study of incidence and treatment outcomes in 1018 patients","authors":"K. Sandström , L. Farnebo , A. Hafström , A. Westerborn , M. Olin , E. Hammerlid , L. Hammarstedt-Nordenvall , M. Gebre-Medhin , B. Granström , T. Andersson-Säll , G. Laurell","doi":"10.1016/j.oraloncology.2026.107863","DOIUrl":"10.1016/j.oraloncology.2026.107863","url":null,"abstract":"<div><h3>Intro</h3><div>Population-based studies predominantly focused on carcinoma of the parotid gland (CPG) are rare. The study aims were to analyze the incidence of CPG and to assess treatment outcomes in relation to histopathology, preoperative diagnosis and adjuvant radiotherapy.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on data from the Swedish Head and Neck Cancer Register (SweHNCR), including 1,018 patients diagnosed with CPG between 2008 and 2019.</div></div><div><h3>Results</h3><div>The age-adjusted incidence remained stable with a mean of 0.9 (range 0.65–1.08) cases per 100,000 person-years (ASR-Europe). Curative treatment was administered to 90 % of the patients, with a recurrence rate of 9 % within 3 years. The highest recurrence rates were observed in patients with salivary duct carcinoma and adenocarcinoma, while patients with acinic cell and mucoepidermoid carcinomas had lower recurrence rates. For stage I–II tumors, the 5-year relative survival was unaffected by whether the malignant diagnosis was known preoperatively. Male sex, increasing age, stage III–IV disease, and a World Health Organization/ Eastern Cooperative Oncology Group (WHO/ECOG) performance status 2–4 was independently associated with increased overall mortality risk, whereas the timing of adjuvant radiotherapy was not.</div></div><div><h3>Conclusion</h3><div>This study contributes to establishing the incidence and treatment outcomes of CPG in Sweden and highlights the diverse histopathological diagnoses of these tumors. Notably, unknown malignancy at the time of surgery did not impact survival in early-stage disease, and the timing of postoperative radiotherapy was not associated with overall survival.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"Article 107863"},"PeriodicalIF":3.9,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.oraloncology.2026.107859
Neil D. Almeida , Tyler V. Schrand , Daniel Sullivan , Han Yu , Song Yao , Sung Jun Ma , Andrew Koempel , Dukagjin Blakaj , Elizabeth A. Repasky , Craig M. Brackett , David W. Goodrich , Elizabeth G. Bouchard , Mukund Seshadri , Mark K. Farrugia , Anurag K. Singh
Background/Objectives: Inflammation and immune evasion are linked to tumor progression. This cancer-related inflammatory response is reflected by a biomarker named the systemic inflammatory response (SIRI). SIRI is calculated by multiplying the peripheral blood neutrophil and monocyte counts and dividing by the lymphocyte count is a biomarker that has shown prognostic capacity in squamous cell head and neck cancer. We sought to perform a meta-analysis of SIRI data for head and neck cancer. Methods: A meta-analysis using a mixed-effects model was performed to estimate the overall effect size of prognostic capacity. The primary outcomes of interest were overall survival and progression-free survival, with effect sizes measured as log hazard ratios (HR). Results: Ten studies reporting data on overall survival revealed a pooled HR of 2.4 (p < 0.0001). This indicates higher SIRI patients are at greater risk of mortality relative to lower SIRI patients. Additionally, 3 studies reported metrics on progression-free survival, with a pooled HR of 2.32 (1.72, 3.13) (p < 0.0001). Minimal heterogeneity was observed for progression-free survival (I2 = 0%, p< 0.74). Conclusions: High SIRI portends worse overall survival. Since SIRI correlates to immune function and demonstrated minimal heterogeneity, these factors are among those most likely to be impacted by altered SIRI parameters.
{"title":"Prognostic associations of systemic inflammation response index (SIRI) in patients with head and neck cancer: a systematic review and meta-analysis","authors":"Neil D. Almeida , Tyler V. Schrand , Daniel Sullivan , Han Yu , Song Yao , Sung Jun Ma , Andrew Koempel , Dukagjin Blakaj , Elizabeth A. Repasky , Craig M. Brackett , David W. Goodrich , Elizabeth G. Bouchard , Mukund Seshadri , Mark K. Farrugia , Anurag K. Singh","doi":"10.1016/j.oraloncology.2026.107859","DOIUrl":"10.1016/j.oraloncology.2026.107859","url":null,"abstract":"<div><div>Background/Objectives: Inflammation and immune evasion are linked to tumor progression. This cancer-related inflammatory response is reflected by a biomarker named the systemic inflammatory response (SIRI). SIRI is calculated by multiplying the peripheral blood neutrophil and monocyte counts and dividing by the lymphocyte count is a biomarker that has shown prognostic capacity in squamous cell head and neck cancer. We sought to perform a <em>meta</em>-analysis of SIRI data for head and neck cancer. Methods: A <em>meta</em>-analysis using a mixed-effects model was performed to estimate the overall effect size of prognostic capacity. The primary outcomes of interest were overall survival and progression-free survival, with effect sizes measured as log hazard ratios (HR). Results: Ten studies reporting data on overall survival revealed a pooled HR of 2.4 (p < 0.0001). This indicates higher SIRI patients are at greater risk of mortality relative to lower SIRI patients. Additionally, 3 studies reported metrics on progression-free survival, with a pooled HR of 2.32 (1.72, 3.13) (p < 0.0001). Minimal heterogeneity was observed for progression-free survival (I2 = 0%, p< 0.74). Conclusions: High SIRI portends worse overall survival. Since SIRI correlates to immune function and demonstrated minimal heterogeneity, these factors are among those most likely to be impacted by altered SIRI parameters.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"Article 107859"},"PeriodicalIF":3.9,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1016/j.oraloncology.2026.107858
J.T. Lovett , M.T. Wotman , W.H. Westra , S. Ahn , V. Gupta , R.L. Bakst , Scott Roof , B.A. Miles , E Genden , K. Misiukiewicz , L. Worona , E. Ramos , J. Botzler , T. Chen , M. Posner
Importance
The rising incidence of HPV-positive oropharynx cancer (HPV-OPC) underscores the need for treatment strategies that maintain disease control while minimizing long-term toxicity. This study reports the long-term follow-up of de-escalation in poor prognosis HPV-OPC, providing critical data for future studies.
Objective
To evaluate long-term outcomes in patients with locally advanced HPV-OPC treated with induction chemotherapy (IC) followed by reduced-dose chemoradiation (rdCRT). We hypothesized that de-escalated radiation therapy after IC would be non-inferior to standard-dose CRT (sdCRT).
Design: Two sequential clinical trials; Quarterback (QB) 1: phase III randomized control trial, QB 2: phase II non-randomized trial; patient accrual conducted between December 2012 and February 2022; final data cutoff April 2025. Median follow-up (IQR): 88.5 (64.6–118.2) months.
Setting: Single-institution academic center.
Participants: 62 patients with HPV-OPC were screened. 47 patients received rdCRT after IC and were included in the primary analysis. Key eligibility: smoking history ≤20 pack-years, no active smoking, no distant metastases, molecularly confirmed HPV status.
Interventions: Three cycles of induction TPF (docetaxel, cisplatin, 5-fluorouracil) followed by rdCRT (5600 cGy) with weekly carboplatin in clinical responders; non-responders in both QB trials and responders in the control arm of QB1 received sdCRT (7000 cGy).
Main Outcomes and Measures: Primary endpoints: 3-year locoregional relapse-free survival (LRRFS) and 3-year progression-free survival (PFS). Secondary: overall survival (OS). Tertiary: disease-specific survival.
Results
Among 47 patients treated with rdCRT after IC, the 3-year and 5-year LRRFS were 89.3% and 86.6%. PFS was 87.2% and 84.6% at 3 and 5 years. OS was 91.5% and 89.1% at 3 and 5 years. Six patients (13%) experienced locoregional failure, and two (4%) developed distant metastases. 7/8 treatment failures (87.5%) occurred in patients with extracapsular extension.
Conclusions and Relevance
rdCRT following IC yields durable disease control in poor prognosis HPV-OPC, with outcomes comparable to historical benchmarks. Extended follow-up supports the safety and efficacy of this de-escalation strategy, even in patients with aggressive disease characteristics, but also underscores the need for careful patient selection, particularly in those with extracapsular extension.
{"title":"Long-Term outcomes of induction chemotherapy–guided reduced-dose chemoradiotherapy in poor-risk HPV-Positive oropharyngeal Cancer: Results from the sequential quarterback trials","authors":"J.T. Lovett , M.T. Wotman , W.H. Westra , S. Ahn , V. Gupta , R.L. Bakst , Scott Roof , B.A. Miles , E Genden , K. Misiukiewicz , L. Worona , E. Ramos , J. Botzler , T. Chen , M. Posner","doi":"10.1016/j.oraloncology.2026.107858","DOIUrl":"10.1016/j.oraloncology.2026.107858","url":null,"abstract":"<div><h3>Importance</h3><div>The rising incidence of HPV-positive oropharynx cancer (HPV-OPC) underscores the need for treatment strategies that maintain disease control while minimizing long-term toxicity. This study reports the long-term follow-up of de-escalation in poor prognosis HPV-OPC, providing critical data for future studies.</div></div><div><h3>Objective</h3><div>To evaluate long-term outcomes in patients with locally advanced HPV-OPC treated with induction chemotherapy (IC) followed by reduced-dose chemoradiation (rdCRT). We hypothesized that de-escalated radiation therapy after IC would be non-inferior to standard-dose CRT (sdCRT).</div><div>Design: Two sequential clinical trials; Quarterback (QB) 1: phase III randomized control trial, QB 2: phase II non-randomized trial; patient accrual conducted between December 2012 and February 2022; final data cutoff April 2025. Median follow-up (IQR): 88.5 (64.6–118.2) months.</div><div>Setting: Single-institution academic center.</div><div>Participants: 62 patients with HPV-OPC were screened. 47 patients received rdCRT after IC and were included in the primary analysis. Key eligibility: smoking history ≤20 pack-years, no active smoking, no distant metastases, molecularly confirmed HPV status.</div><div>Interventions: Three cycles of induction TPF (docetaxel, cisplatin, 5-fluorouracil) followed by rdCRT (5600 cGy) with weekly carboplatin in clinical responders; non-responders in both QB trials and responders in the control arm of QB1 received sdCRT (7000 cGy).</div><div>Main Outcomes and Measures: Primary endpoints: 3-year locoregional relapse-free survival (LRRFS) and 3-year progression-free survival (PFS). Secondary: overall survival (OS). Tertiary: disease-specific survival.</div></div><div><h3>Results</h3><div>Among 47 patients treated with rdCRT after IC, the 3-year and 5-year LRRFS were 89.3% and 86.6%. PFS was 87.2% and 84.6% at 3 and 5 years. OS was 91.5% and 89.1% at 3 and 5 years. Six patients (13%) experienced locoregional failure, and two (4%) developed distant metastases. 7/8 treatment failures (87.5%) occurred in patients with extracapsular extension.</div></div><div><h3>Conclusions and Relevance</h3><div>rdCRT following IC yields durable disease control in poor prognosis HPV-OPC, with outcomes comparable to historical benchmarks. Extended follow-up supports the safety and efficacy of this de-escalation strategy, even in patients with aggressive disease characteristics, but also underscores the need for careful patient selection, particularly in those with extracapsular extension.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"Article 107858"},"PeriodicalIF":3.9,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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