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Simple Summary: Patients treated with definitive accelerated radiotherapy (DART) struggle with low quality of life, pain and persistent treatment-related symptoms even many years after the treatment. Everyday pain in the head, neck and shoulder areas is present among almost all HNC survivors treated with DART. One-third of the examined DART patients were depressed. The depressed group scored significantly worse in most of the quality-of-life subscales and suffered more intense pain than the non-depressed. Head and neck cancer survivors, especially those who are depressed, may require additional psychosocial, physiotherapeutic and medical intervention programs. (1) Background: The goal of this study is to evaluate psychological tolerance and health-related quality of life (QOL) in head and neck (HN) cancer patients treated with definitive accelerated radiotherapy (DART). (2) Methods: 76 recurrence-free patients eligible for the study, who were treated with DART in the CAIR-2 phase III clinical study (median of follow-up = 47 months), completed EORTC QLQ-C30 with the H&N35 module, Hospital Anxiety and Depression Scale (HADS) and Visual–Analog Scales (VAS) of pain in HN and the neck/arm areas. (3) Results: The most dominant symptoms measured with QLQ-C30 were as follows: fatigue (44/100), sleeplessness (39/100), financial problems (38/100) and pain (32/100). Within the H&N35, the highest scores were reported on the subscales of sticky saliva (60/100), mouth dryness (65/100) and increased intake of painkillers (50/100). Pain (VAS) was reported by 87% (HN area) and 78% (shoulder area) of the patients, with a mean score of 3/10. One-third of the patients reported depressive moods (HADS ≥ 15 points) with an average score of 12.5/42 p. The depressed group, who smoked more as compared to the non-depressed group before DART (96% vs. 78%) and required steroids treatment (85% vs. 58%) during DART, also scored significantly worse on 23 of the 35 subscales of QLQ-C30 and H&N35 and experienced more intense pain (VAS). Women and less-advanced patients scored better in several aspects of quality of life. (4) Conclusions: Patients treated with DART struggle with low quality of life and persistent treatment-related symptoms including constant pain. HNC survivors, especially those who are depressed, may require additional psychosocial, rehabilitation and medical intervention programmes. [ABSTRACT FROM AUTHOR]

The paper aims to show the multilevel and complex cooperation and the inclusion of the psychotherapist leading the psychotherapy in the medical team at the radiotherapy and clinical oncology clinic. We illustrate these interventions with the case of Stan. This 43‐year‐old firefighter was diagnosed with advanced head and neck cancer and pre‐existing mental health problems meeting the criteria of ICD‐10: obsessive‐compulsive disorder, post‐traumatic stress disorder and psychoactive substance abuse. During the treatment, suicidal thoughts and impulses emerged, triggered at the hospital by electronic noises and the feeling of entrapment without a way out. This situation put the patient at high risk and the whole healthcare team needed an urgent effective response. The patient agreed to stay in the secured room, where he was cared for by doctors, nurses, a dietitian, and a psychotherapist. He actively attended daily sessions with noticeable engagement. Psychotherapy sessions focused on alleviating posttraumatic stress disorder and OCD. Mindfulness and breathwork‐based exercises were implemented to increase non‐judgemental self‐awareness and regulate the over‐aroused nervous system. As a result, the patient's mental health has improved and the completion of the cancer treatment was possible. Psychotherapy, good therapeutic alliance, and attentive teamwork effectively managed his mental health and treatment‐related symptoms. [ABSTRACT FROM AUTHOR]

Supported by the National Science Centre, Poland, 2020/39/O/NZ5/02625. Induction chemotherapy (iCH) although is not a standard approach, is often used in clinical practice for patients with advanced head and neck cancer (HNSCC). Tumor regression is a potential goal of induction treatment to reduce target volume in the second stage of treatment - radiochemotherapy or radiotherapy. In this study the most common iCH, TPF (docetaxel, cisplatin, and 5-fluoruracil) has been replaced with two-drugs regimen combined with low-dose radiation. Complementary mechanisms of action and excellent radiation sensitization of drugs together with hyperradiosensitivity (HRS) phenomenon of low-dose fractionated radiation therapy may be beneficial for patients with bulky disease. Additionally, lower toxicity could be expected for two-drugs modality. Preliminary results on effectiveness and toxicity has been presented. The group consisted of 27 patients treated due to advanced HNSCC in National Research Institute of Oncology, Gliwice branch between 2020 and 2023. There were 23 (85%) men and 4 (15%) women in the median age of 60 years. In most cases primary tumor site was oropharynx followed by hypopharynx and CUP in 17 (63%), 7 (26%) and 3 (11%) cases respectively. All patients presented advanced stage - III stage in 16 cases (59%) and IV stage in 11 cases (41%). HPV- positive tumors were found in 13 (48%) patients. There were 2 cycles of iCHT consisting of carboplatin (AUC 6) and paclitaxel (75 mg/m2) combined with low-dose radiotherapy 2 x 0.5 Gy on days 1, 8 and 15. Additionally, two doses of 0.5 Gy was given on day 2. CT, MRI and PET-CT scans were performed to estimate the staging of the cancer, all according to the 8th edition of the TNM classification for malignant tumors. The volume of the primary tumor and metastatic lymph nodes were estimated in cm3 before and after induction radiochemotherapy with low dose fractionation radiotherapy to analyze the potential value of tumor volume regression. After ICHRTL, all patients were qualified for the second stage of treatment - radiochemotherapy in 24 cases and radiotherapy in 3 cases, respectively. To investigate the presence of HRS effect, fibroblasts were irradiated in vitro with doses ranging from 0.1 to 4 Gy (6-MV X-ray beam) and cell radiosensitivity was estimated by flow cytometry-based clonogenic survival assay and RIANS test (pATM and H2AX foci assays). [Display omitted] Clinical and experimental data will be presented.The mean volumes of tumor and metastatic lymph nodes among 27 patients before ICHRTL were 32.5 cm3 (Vt) and 45.1 cm3 (Vn), respectively. After ICHRTL, these mean values were 17.2 cm3 (Vt) and 22.2 cm3 (Vn). Wilcoxon test analize showed significant decrease in T volume (Vt) and N volume (Vn) before and after iCHRTL (p=0.003) and p=0.00008) respectively. Due to complications 16 patients (60%) did not receive the full dose of chemotherapy and radiotherapy (ICHRTL). Leukopenia and neutropenia occurred in 12 (44%) and 11 (40%) patients respectively. Poor drug tolerance (vomiting, nausea, abdominal pain) was observed in 3 (11%) patients, and renal failure in 1 (4%) patient. Among normal skin fibroblasts assessed from 21 patients two demonstrated HRS effect. The use of ICHRTL in patients with advanced HNSCC is a low-toxicity and effective method. The obtained regression of tumor volume (Vt) and metastatic lymph nodes (Vn) in most patients managed to reduce the high dose area in the second stage of treatment (radiotherapy/radiochemotherapy). Further observations are needed to estimate the potential role of decrease in T volume (Vt) and N volume (Vn) after ICHRTL on the expected survival of patients. [ABSTRACT FROM AUTHOR]

Background: Early detection of treatment failure may improve clinical outcome and overall survival in patients with head and neck cancer after first-line treatment. Circulating cell-free HPV16 DNA (cfHPV16 DNA) was evaluated as a possible complementary marker to radiological assessment of early response in patients with HPV-related oropharyngeal cancer (OPC) after radiotherapy alone or combined with chemotherapy.Methods: The study included 66 patients with HPV-related OPC receiving radical radiotherapy alone or in combination with chemotherapy. cfHPV16 DNA was assessed in the blood of all patients before treatment using TaqMan-based qPCR. Subsequent analysis of cfHPV16 DNA was performed 12 weeks after treatment completion, along with radiological assessment of early treatment results.Results: Complete (CRR) and incomplete radiological response (IRR) was found in 43 (65%) and 23 (35%) patients respectively. cfHPV16 DNA was present in 5 (28%) patients with IRR, while only in 1 (4%) with CRR. Three of five patients with IRR that were positive for cfHPV16 DNA exhibited histopathologically confirmed local or regional treatment failure, and other two developed distant metastases. None of the patients with negative cfHPV16 DNA presented disease failure.Conclusion: The post-treatment assessment of cfHPV16 DNA in patients with HPV-related OPC may be used as a complementary biomarker to conventional imaging-based examinations for early identification of treatment failure. [ABSTRACT FROM AUTHOR]

Paragangliomas of the head and neck are a group of neoplasms which occur very rarely. Most of them are benign tumours. Tinnitus, headaches and dysfunction of the cranial nerves are typical symptoms. Some paragangliomas have metastatic abilities and they can produce catecholamines. There are some typical imaging features in CT and MRI scans which help to determine the correct diagnosis without the necessity of performing a biopsy which can be associated with a haemorrhage risk. Therapeutic management consists of the choice between an active observation, surgical procedure, as well as radiotherapy and systemic therapy in the case of malignant paragangliomas. [ABSTRACT FROM AUTHOR]

Purpose: The plasma proteome was analysed as a potential source of markers of radiosensitivity in patients treated with definitive radiotherapy for head and neck cancer. Materials and methods: Acute mucosal reactions that developed during radiotherapy were assessed in 55 patients. Blood samples were collected from each patient before the treatment and also from 50 healthy donors. The low-molecular-weight fraction of the plasma proteome (2,000--10,000 Da range) was analysed by the Matrix-Assisted Laser Desorption Ionisation mass spectrometry. The capacity for DNA break repair was assessed by the comet assay using lymphocytes irradiated in  vitro. Results: Spectral components registered in plasma samples were used to build classifiers that discriminated patients from healthy individuals with about 90%% specificity and sensitivity (components of 4469, 6929 and 8937 Da were the most essential for cancer classification). Four spectral components were identified (2219, 2454, 3431 and 5308 Da) whose abundances correlated with a maximal intensity of the acute reaction. Several spectral components whose abundances correlated with the rate of DNA repair in irradiated lymphocytes were also detected. Additionally, a more rapid escalation of an acute reaction was correlated with a higher level of unrepaired damage assessed by the comet assay. Conclusions: The plasma proteome could be considered as a potential source of predictive markers of acute reaction in patients with head and neck cancer treated with radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: To update 5-year results of a previously published study on special 7-days-a-week fractionation continuous accelerated irradiation (CAIR) for head-and-neck cancer patients. Methods and Materials: One hundred patients with squamous cell carcinoma of head and neck in Stage T2-4N0-1M0 were randomized between two definitive radiation treatments: accelerated fractionation 7 days a week including weekends (CAIR) and conventional 5 days a week (control). Hence the overall treatment time was 2 weeks shorter in CAIR. Results: Five-year local tumor control was 75% in the CAIR group and 33% in the control arm (p < 0.00004). Tumor-cure benefit corresponded with significant improvement in disease-free survival and overall survival rates. Confluent mucositis was the main acute toxicity, with the incidence significantly higher in CAIR patients than in control (respectively, 94% vs. 53%). When 2.0-Gy fractions were used, radiation necrosis developed in 5 patients (22%) in the CAIR group as a consequential late effect (CLE), but when fraction size was reduced to 1.8 Gy no more CLE occurred. Actuarial 5-year morbidity-free survival rate was similar for both treatments. Conclusions: Selected head-and-neck cancer patients could be treated very effectively with 7-days-a-week radiation schedule with no compromise of total dose and with slight 10% reduction of fraction dose (2 Gy–1.8 Gy), which article gives 1 week reduction of overall treatment time compared with standard 70 Gy in 35 fractions over 47–49 days. Although this report is based on the relatively small group of patients, its results have encouraged us to use CAIR fractionation in a standard radiation treatment for moderately advanced head-and-neck cancer patients. [Copyright &y& Elsevier]