Precision association of lymphatic disease spread with radiation-associated toxicity in oropharyngeal squamous carcinomas
Section snippets
Patient cohort
An IRB-approved, retrospective review of patients diagnosed with oropharyngeal cancer (OPC) and treated at MD Anderson Cancer Center from 2005 to 2013 was performed. Patients with lymph node positive, biopsy-proven, OPC who were treated with radiotherapy (RT) with or without chemotherapy with curative intent and had at least 6 months post-treatment follow-up assessment were eligible for inclusion. Patients’ demographic, clinical, treatment, and outcome measures are summarized in (Table 1).
Results
Out of 644 OPC patients available for the study, 582 patients had affected lymph nodes and were included in the final cohort. Ignoring laterality, 63 distinct patterns of affected LNs were present in the 582 patient cohort, with 6 patterns comprising 78% of the cases (Table 2). Of the patterns with over 10 cases, patients with bilaterally affected 2A-2B-3 levels showed the highest incidence of RAD (53%), while the group with unilaterally affected 2A-2B-3 regions had the lowest incidence (18%).
Discussion
Head and neck cancers account for nearly 3% of all malignancies in the U.S. with approximately 62,000 HNC cases diagnosed per year [3]. More than two-thirds of those diagnosed with HNC will survive 5 years or more if treated with locoregional curative therapy. However, almost all radiotherapy survivors will suffer from at least mild-to-moderate symptoms from head and neck radiation [26], [16]. Recent phase III studies [27], [28] suggest that concurrent chemoradiation will remain the standard
Conclusion
In conclusion, this study demonstrates that clustering based on lymph nodes spread is associated with radiation-associated dysphagia, both aspiration toxicity and feeding tube dependency. Our anatomical representation of lymph node spread showed superior association to RAD compared to the current N-category classification. Our method relies only on discrete information on nodal spread at time of diagnosis, and thus does not require complex dose-planning or organ segmentation to determine RAD
Co-author specific contributions
All listed co-authors performed the following:
- 1.
Substantial contributions to the conception or design of the work;
or the acquisition, analysis, or interpretation of data for the work;
- 2.
Drafting the work or revising it critically for important intellectual content;
- 3.
Final approval of the version to be published;
- 4.
Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Prior presentation
Preliminary analyses and portions of this data were accepted for a poster presentation at the 2019 American Society of Radiation Oncology (ASTRO) Annual Meeting, September 25–28, 2019, Chicago, IL, USA.
A detailed description of the spatial neighborhood similarity method used in this work has been published in the Journal of Biomedical Informatics in 2020.
A brief description of a subpart of Fig. 2 was accepted as a short conference presentation at the 2020 IEEE VIS conference, October 2020, Salt
Data sharing statement
Research data is not available at this time.
Conflict of interest statement
The authors have nothing to disclose.
Acknowledgements/funding disclosures
Dr. van Dijk receives funding from the Nederlandse Organisatie voor Wetenschappelijk Onderzoek/Netherlands Research Organization Rubicon Award (452182317).
Dr. Mohamed receives funding support from an MD Anderson Institutional Research Grant (IRG).
Dr.s Canahuate, Fuller, Mohamed, Vock and Marai received/receive funding and salary support related to this project during the period of study execution from: the National Institutes of Health (NIH) Big Data to Knowledge (BD2K) Program of the National
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Questions about statistical analyses can be directed to Andrew Wentzel.