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Cancers of the head & neck最新文献

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Genomically personalized therapy in head and neck cancer. 头颈癌的基因组个性化治疗。
Pub Date : 2016-06-09 eCollection Date: 2016-01-01 DOI: 10.1186/s41199-016-0004-y
Kyaw L Aung, Lillian L Siu

The current treatment paradigm in head and neck cancer does not adequately address its clinical and biological heterogeneity. Data from genomic profiling studies in head and neck squamous cell carcinoma (HNSCC) have revealed the molecular features that are unique to HNSCC subgroups. This progress in the understanding of HNSCC biology provides an opportunity to develop personalized therapies for patients with distinct molecular subtypes to achieve better clinical outcomes including survival. However there are several well-recognized challenges that need to be overcome before genotype-matched therapies make precision medicine a reality for patients with HNSCC. Selection of appropriate patients for biomarker directed clinical trials based on sound scientific rationale will be critical in making cancer genomics more applicable in this malignancy.

目前头颈癌的治疗模式没有充分解决其临床和生物学异质性。来自头颈部鳞状细胞癌(HNSCC)基因组谱研究的数据揭示了HNSCC亚群特有的分子特征。对HNSCC生物学理解的这一进展为开发针对不同分子亚型患者的个性化治疗提供了机会,以实现更好的临床结果,包括生存率。然而,在基因型匹配疗法使精确医学成为HNSCC患者的现实之前,有几个公认的挑战需要克服。根据合理的科学原理选择合适的患者进行生物标志物定向临床试验,对于使癌症基因组学更适用于这种恶性肿瘤至关重要。
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引用次数: 29
Introducing cancers of the head and neck, a new open access journal. 介绍头颈部癌症,一个新的开放获取期刊。
Pub Date : 2016-06-03 eCollection Date: 2016-01-01 DOI: 10.1186/s41199-016-0001-1
Barbara Burtness
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引用次数: 0
Employment and return to work following chemoradiation in patient with HPV-related oropharyngeal cancer. hpv相关口咽癌患者放化疗后的就业和重返工作岗位。
Pub Date : 2016-06-03 eCollection Date: 2016-01-01 DOI: 10.1186/s41199-016-0002-0
Shrujal S Baxi, Talya Salz, Han Xiao, Coral L Atoria, Alan Ho, Stephanie Smith-Marrone, Eric J Sherman, Nancy Y Lee, Elena B Elkin, David G Pfister

Background: Human papillomavirus (HPV)-positive oropharyngeal cancer primarily affects working-age adults. Chemotherapy and radiation (CTRT) used to treat this disease may adversely impact a survivors' ability to work after treatment.

Methods: We surveyed participants with HPV-positive oropharyngeal cancer who completed CTRT regarding employment. We examined the associations between 1) sociodemographic and clinical factors and employment outcomes, and 2) health-related quality of life and satisfaction with ability to work.

Results: 102 participants were employed full-time at diagnosis for pay and surveyed at a median of 23 months post-CTRT (range 12-57 months). The median age at diagnosis was 57 years (range 25-76 years). During CTRT, 8 % stopped working permanently, 89 % took time off or reduced responsibility but later returned, and 3 % reported no change. For those who took time off but returned, median time to return to work was 14.5 weeks. In multivariable analysis, younger age predicted for needing more than the median time off. At time of survey, 85 % participants were working, 7 % had retired, and 8 % were not working for other reasons. Seventeen percent of participants were not satisfied with their current ability to work, which was associated with poorer health-related quality of life and persistent treatment toxicities (p < 0.001).

Conclusions: CTRT interrupts employment in the majority of working patients with HPV-positive oropharyngeal cancer but most return. However, treatment-related toxicities might lead to dissatisfaction with ability to work.

背景:人乳头瘤病毒(HPV)阳性口咽癌主要影响工作年龄的成年人。化疗和放疗(CTRT)用于治疗这种疾病可能会对幸存者治疗后的工作能力产生不利影响。方法:我们调查了完成CTRT的hpv阳性口咽癌患者的就业情况。我们研究了1)社会人口统计学和临床因素与就业结果之间的关系,以及2)健康相关的生活质量和工作能力满意度之间的关系。结果:102名参与者在诊断时全职受雇,并在ctrt后的中位数23个月(范围12-57个月)接受调查。诊断时的中位年龄为57岁(范围25-76岁)。在CTRT期间,8%的人永久停止工作,89%的人休假或减少责任,但后来又回来了,3%的人报告没有变化。对于那些休过假但又回来工作的人来说,重返工作岗位的平均时间是14.5周。在多变量分析中,年龄越小,需要的休假时间越长。调查时,85%的受访者在工作,7%已经退休,8%因其他原因没有工作。17%的参与者对他们目前的工作能力不满意,这与较差的健康相关生活质量和持续治疗毒性有关(p结论:CTRT中断了大多数hpv阳性口咽癌工作患者的工作,但大多数患者返回。然而,治疗相关的毒性可能导致对工作能力的不满。
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引用次数: 21
Informational and Support Needs of Patients with Head and Neck Cancer: Current Status and Emerging Issues. 头颈癌患者的信息和支持需求:现状和新出现的问题。
Pub Date : 2016-01-01 Epub Date: 2016-11-11 DOI: 10.1186/s41199-016-0017-6
Carolyn Y Fang, Carolyn J Heckman

The objective of this article is to review and summarize the extant literature on head and neck cancer (HNC) patients' informational needs and to characterize emerging issues in this patient population in order to define priorities for future research. HNC patients may undergo challenging treatment regimens and experience treatment-related alterations in primary daily functions such as speech and eating. These changes often persist following treatment and may lead to significant deficits in quality of life and interpersonal relations. Despite empirical evidence demonstrating that receipt of adequate information and support is predictive of improved outcomes post-treatment, relatively limited attention has been paid to the informational and support needs of HNC patients. This review focuses primarily on three topic domains: (1) managing treatment-related side effects; (2) addressing alcohol and tobacco dependence; and (3) informational needs in the areas of human papillomavirus (HPV) and clinical trials. While there is increasing awareness of the rehabilitation and survivorship needs in this patient population, patients note that the impact of treatment on social activities and interactions is under-discussed and of key concern. In addition, there is a significant gap in addressing communication and informational needs of caregivers and family members who are integral for promoting healthy behaviors and self-care post-treatment. Greater integration of programs that address tobacco or alcohol dependency within a comprehensive treatment and support plan may increase patient motivation to seek help and enhance patient success in maintaining long-term abstinence. Finally, emerging patient-provider communication needs, particularly in the context of decision making about clinical trials or surrounding an HPV-related diagnosis, have been noted among both patients and healthcare providers. Future research on the development of novel programs that offer feasible and acceptable methods for addressing unmet informational and support needs is warranted and may yield benefit for improving patient-reported outcomes.

本文的目的是回顾和总结有关头颈癌(HNC)患者信息需求的现有文献,并描述该患者群体中出现的问题,以便确定未来研究的重点。HNC患者可能会经历具有挑战性的治疗方案,并经历与治疗相关的基本日常功能(如言语和饮食)的改变。这些变化通常在治疗后持续存在,并可能导致生活质量和人际关系的严重缺陷。尽管经验证据表明,获得足够的信息和支持可以预测治疗后的改善结果,但对HNC患者的信息和支持需求的关注相对有限。本综述主要集中在三个主题领域:(1)治疗相关副作用的管理;(2)解决酒精和烟草依赖问题;(3)人乳头瘤病毒(HPV)和临床试验领域的信息需求。虽然这一患者群体对康复和生存需求的认识日益提高,但患者指出,治疗对社会活动和互动的影响尚未得到充分讨论,这是一个关键问题。此外,在解决照顾者和家庭成员的沟通和信息需求方面存在重大差距,而这些人是促进健康行为和治疗后自我护理不可或缺的组成部分。在综合治疗和支持计划中解决烟酒依赖的更大整合方案可能会增加患者寻求帮助的动机,并提高患者在保持长期戒断方面的成功。最后,新出现的医患沟通需求,特别是在临床试验决策或围绕hpv相关诊断的背景下,已经在患者和医疗保健提供者中被注意到。未来的研究将为解决未满足的信息和支持需求提供可行和可接受的方法,并可能为改善患者报告的结果带来好处。
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引用次数: 34
Genomic insights into head and neck cancer. 头颈癌的基因组研究。
Pub Date : 2016-01-01 Epub Date: 2016-06-03 DOI: 10.1186/s41199-016-0003-z
Tim N Beck, Erica A Golemis

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide and is frequently impervious to curative treatment efforts. Similar to other cancers associated with prolonged exposure to carcinogens, HNSCCs often have a high burden of mutations, contributing to substantial inter- and intra-tumor heterogeneity. The heterogeneity of this malignancy is further increased by the rising rate of human papillomavirus (HPV)-associated (HPV+) HNSCC, which defines an etiological subtype significantly different from the more common tobacco and alcohol associated HPV-negative (HPV-) HNSCC. Since 2011, application of large scale genome sequencing projects by The Cancer Genome Atlas (TCGA) network and other groups have established extensive datasets to characterize HPV- and HPV+ HNSCC, providing a foundation for advanced molecular diagnoses, identification of potential biomarkers, and therapeutic insights. Some genomic lesions are now appreciated as widely dispersed. For example, HPV- HNSCC characteristically inactivates the cell cycle suppressors TP53 (p53) and CDKN2A (p16), and often amplifies CCND1 (cyclin D), which phosphorylates RB1 to promote cell cycle progression from G1 to S. By contrast, HPV+ HNSCC expresses viral oncogenes E6 and E7, which inhibit TP53 and RB1, and activates the cell cycle regulator E2F1. Frequent activating mutations in PIK3CA and inactivating mutations in NOTCH1 are seen in both subtypes of HNSCC, emphasizing the importance of these pathways. Studies of large patient cohorts have also begun to identify less common genetic alterations, predominantly found in HPV- tumors, which suggest new mechanisms relevant to disease pathogenesis. Targets of these alterations including AJUBA and FAT1, both involved in the regulation of NOTCH/CTNNB1 signaling. Genes involved in oxidative stress, particularly CUL3, KEAP1 and NFE2L2, strongly associated with smoking, have also been identified, and are less well understood mechanistically. Application of sophisticated data-mining approaches, integrating genomic information with profiles of tumor methylation and gene expression, have helped to further yield insights, and in some cases suggest additional approaches to stratify patients for clinical treatment. We here discuss some recent insights built on TCGA and other genomic foundations.

头颈部鳞状细胞癌(HNSCC)是全球第六大常见癌症,通常无法治愈。与其他与长期暴露于致癌物有关的癌症类似,HNSCCs通常具有很高的突变负担,导致肿瘤间和肿瘤内存在大量异质性。这种恶性肿瘤的异质性进一步增加了人乳头瘤病毒(HPV)相关(HPV+) HNSCC发病率的上升,这定义了一种病因亚型,与更常见的烟草和酒精相关的HPV阴性(HPV-) HNSCC明显不同。自2011年以来,癌症基因组图谱(TCGA)网络和其他组织的大规模基因组测序项目的应用已经建立了广泛的数据集来表征HPV-和HPV+ HNSCC,为先进的分子诊断,鉴定潜在的生物标志物和治疗见解提供了基础。一些基因损伤现在被认为是广泛分布的。例如,HPV- HNSCC的特点是使细胞周期抑制因子TP53 (p53)和CDKN2A (p16)失活,并经常扩增CCND1(细胞周期蛋白D),其磷酸化RB1以促进细胞周期从G1向s的进展。相反,HPV+ HNSCC表达抑制TP53和RB1的病毒癌基因E6和E7,并激活细胞周期调节因子E2F1。在HNSCC的两种亚型中都可以看到频繁的PIK3CA激活突变和NOTCH1失活突变,强调了这些途径的重要性。对大型患者队列的研究也开始确定不太常见的遗传改变,主要发现于HPV肿瘤,这提示了与疾病发病有关的新机制。这些改变的靶点包括AJUBA和FAT1,它们都参与NOTCH/CTNNB1信号的调控。参与氧化应激的基因,特别是CUL3、KEAP1和NFE2L2,与吸烟密切相关,也已被确定,但其机制尚不清楚。应用复杂的数据挖掘方法,将基因组信息与肿瘤甲基化和基因表达谱相结合,有助于进一步产生见解,并在某些情况下提出了临床治疗患者分层的其他方法。我们在这里讨论一些基于TCGA和其他基因组基础的最新见解。
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引用次数: 67
期刊
Cancers of the head & neck
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