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Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group
SIMPLE SUMMARY: Older patients are at risk of skin cancer. Head and neck cutaneous squamous-cell carcinoma is due to prolonged sun exposure. When the disease is advanced, it requires a combination of an operation to remove the cancer, followed by radiotherapy for possible cure. However, older patien...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10605563/ https://www.ncbi.nlm.nih.gov/pubmed/37894347 http://dx.doi.org/10.3390/cancers15204981 |
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author | Nguyen, Nam P. Thariat, Juliette Gorobets, Olena Vinh-Hung, Vincent Kim, Lyndon Blanco, Sergio Calleja Vasileiou, Maria Arenas, Meritxell Mazibuko, Thandeka Giap, Huan Vincent, Felix Chi, Alexander Loganadane, Gokoulakrichenane Mohammadianpanah, Mohammad Rembielak, Agata Karlsson, Ulf Ali, Ahmed Bose, Satya Page, Brandi R. |
author_facet | Nguyen, Nam P. Thariat, Juliette Gorobets, Olena Vinh-Hung, Vincent Kim, Lyndon Blanco, Sergio Calleja Vasileiou, Maria Arenas, Meritxell Mazibuko, Thandeka Giap, Huan Vincent, Felix Chi, Alexander Loganadane, Gokoulakrichenane Mohammadianpanah, Mohammad Rembielak, Agata Karlsson, Ulf Ali, Ahmed Bose, Satya Page, Brandi R. |
author_sort | Nguyen, Nam P. |
collection | PubMed |
description | SIMPLE SUMMARY: Older patients are at risk of skin cancer. Head and neck cutaneous squamous-cell carcinoma is due to prolonged sun exposure. When the disease is advanced, it requires a combination of an operation to remove the cancer, followed by radiotherapy for possible cure. However, older patients may not tolerate surgery. Recent studies show that this type of cancer may be very vulnerable to immunotherapy. We propose to combine immunotherapy with a short treatment course of radiotherapy instead of the conventional surgery and radiotherapy because those two treatments may work together to improve cure rates. However, clinical studies should be performed to verify our hypothesis. ABSTRACT: Cutaneous skin carcinoma is a disease of older patients. The prevalence of cutaneous squamous-cell carcinoma (cSCC) increases with age. The head and neck region is a frequent place of occurrence due to exposure to ultraviolet light. Surgical resection with adjuvant radiotherapy is frequently advocated for locally advanced disease to decrease the risk of loco-regional recurrence. However, older cancer patients may not be candidates for surgery due to frailty and/or increased risk of complications. Radiotherapy is usually advocated for unresectable patients. Compared to basal-cell carcinoma, locally advanced cSCC tends to recur locally and/or can metastasize, especially in patients with high-risk features such as poorly differentiated histology and perineural invasion. Thus, a new algorithm needs to be developed for older patients with locally advanced head and neck cutaneous squamous-cell carcinoma to improve their survival and conserve their quality of life. Recently, immunotherapy with checkpoint inhibitors (CPIs) has attracted much attention due to the high prevalence of program death ligand 1 (PD-L1) in cSCC. A high response rate was observed following CPI administration with acceptable toxicity. Those with residual disease may be treated with hypofractionated radiotherapy to minimize the risk of recurrence, as radiotherapy may enhance the effect of immunotherapy. We propose a protocol combining CPIs and hypofractionated radiotherapy for older patients with locally advanced cutaneous head and neck cancer who are not candidates for surgery. Prospective studies should be performed to verify this hypothesis. |
format | Online Article Text |
id | pubmed-10605563 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-106055632023-10-28 Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group Nguyen, Nam P. Thariat, Juliette Gorobets, Olena Vinh-Hung, Vincent Kim, Lyndon Blanco, Sergio Calleja Vasileiou, Maria Arenas, Meritxell Mazibuko, Thandeka Giap, Huan Vincent, Felix Chi, Alexander Loganadane, Gokoulakrichenane Mohammadianpanah, Mohammad Rembielak, Agata Karlsson, Ulf Ali, Ahmed Bose, Satya Page, Brandi R. Cancers (Basel) Perspective SIMPLE SUMMARY: Older patients are at risk of skin cancer. Head and neck cutaneous squamous-cell carcinoma is due to prolonged sun exposure. When the disease is advanced, it requires a combination of an operation to remove the cancer, followed by radiotherapy for possible cure. However, older patients may not tolerate surgery. Recent studies show that this type of cancer may be very vulnerable to immunotherapy. We propose to combine immunotherapy with a short treatment course of radiotherapy instead of the conventional surgery and radiotherapy because those two treatments may work together to improve cure rates. However, clinical studies should be performed to verify our hypothesis. ABSTRACT: Cutaneous skin carcinoma is a disease of older patients. The prevalence of cutaneous squamous-cell carcinoma (cSCC) increases with age. The head and neck region is a frequent place of occurrence due to exposure to ultraviolet light. Surgical resection with adjuvant radiotherapy is frequently advocated for locally advanced disease to decrease the risk of loco-regional recurrence. However, older cancer patients may not be candidates for surgery due to frailty and/or increased risk of complications. Radiotherapy is usually advocated for unresectable patients. Compared to basal-cell carcinoma, locally advanced cSCC tends to recur locally and/or can metastasize, especially in patients with high-risk features such as poorly differentiated histology and perineural invasion. Thus, a new algorithm needs to be developed for older patients with locally advanced head and neck cutaneous squamous-cell carcinoma to improve their survival and conserve their quality of life. Recently, immunotherapy with checkpoint inhibitors (CPIs) has attracted much attention due to the high prevalence of program death ligand 1 (PD-L1) in cSCC. A high response rate was observed following CPI administration with acceptable toxicity. Those with residual disease may be treated with hypofractionated radiotherapy to minimize the risk of recurrence, as radiotherapy may enhance the effect of immunotherapy. We propose a protocol combining CPIs and hypofractionated radiotherapy for older patients with locally advanced cutaneous head and neck cancer who are not candidates for surgery. Prospective studies should be performed to verify this hypothesis. MDPI 2023-10-13 /pmc/articles/PMC10605563/ /pubmed/37894347 http://dx.doi.org/10.3390/cancers15204981 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Perspective Nguyen, Nam P. Thariat, Juliette Gorobets, Olena Vinh-Hung, Vincent Kim, Lyndon Blanco, Sergio Calleja Vasileiou, Maria Arenas, Meritxell Mazibuko, Thandeka Giap, Huan Vincent, Felix Chi, Alexander Loganadane, Gokoulakrichenane Mohammadianpanah, Mohammad Rembielak, Agata Karlsson, Ulf Ali, Ahmed Bose, Satya Page, Brandi R. Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group |
title | Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group |
title_full | Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group |
title_fullStr | Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group |
title_full_unstemmed | Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group |
title_short | Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group |
title_sort | immunotherapy and hypofractionated radiotherapy in older patients with locally advanced cutaneous squamous-cell carcinoma of the head and neck: a proposed paradigm by the international geriatric radiotherapy group |
topic | Perspective |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10605563/ https://www.ncbi.nlm.nih.gov/pubmed/37894347 http://dx.doi.org/10.3390/cancers15204981 |
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