Shoulder recovery for head and neck cancer patients after unilateral neck dissection: a pilot exploratory study
Published on: 28th September, 2022
An established side-effect of neck dissection (ND) for head and neck (HNC) tumour management includes shoulder dysfunction (SD), which can impact quality of life (QOL). Shoulder strength and range of movement (ROM) are key parameters to be monitored in SD. However, such evaluations are not routinely conducted in the clinical setting. The aim of this study was to evaluate objectively the impact of ND on shoulder functions. Methods: This is a pilot exploratory study in a tertiary cancer centre. Five participants with unilateral ND and advanced HNC, completed the study. Outcome measures consisted of self-reported QOL questionnaires, C2–T1 dermatomes and shoulder ROM and strength testing. Data was collected at baseline, 1.5-months after surgery and 6-months after diagnosis (after adjuvant treatment completion). Results: Most outcome measures on the surgically affected side were negatively impacted post-operatively, with varied recovery seen at follow-up. Sensory loss was noted at C3–4 dermatome levels. Shoulder ROM and strength was reduced on the surficial side for all participants, with some recovery after six months except for two participants.Conclusion: Results of SD after ND are diverse and unique to each patient. Findings from this pilot study indicate that regular rehabilitation/exercise may facilitate recovery of shoulder function post HNC surgery. However, customised rehabilitation may yield better outcomes. Future studies with a larger sample are indicated to validate the findings of this study.
Radiation-induced salivary gland damage/dysfunction in head and neck cancer: Nano-bioengineering strategies and artificial intelligence for prevention, therapy and reparation
Published on: 20th December, 2022
Saliva is produced by and secreted from salivary glands. It is an extra-cellular fluid, 98% water, plus electrolytes, mucus, white blood cells, epithelial cells, enzymes, and anti-microbial agents. Saliva serves a critical role in the maintenance of oral, dental, and general health and well-being. Hence, alteration(s) in the amount/quantity and/or quality of secreted saliva may induce the development of several oro-dental variations, thereby the negatively-impacting overall quality of life. Diverse factors may affect the process of saliva production and quantity/quality of secretion, including medications, systemic or local pathologies and/or reversible/irreversible damage. Herein, chemo- and/or radio-therapy, particularly, in cases of head and neck cancer, for example, are well-documented to induce serious damage and dysfunction to the radio-sensitive salivary gland tissue, resulting in hypo-salivation, xerostomia (dry mouth) as well as numerous other adverse Intra-/extra-oral, medical and quality-of-life issues. Indeed, radio-therapy inevitably causes damage to the normal head and neck tissues including nerve structures (brain stem, spinal cord, and brachial plexus), mucous membranes, and swallowing muscles. Current commercially-available remedies as well as therapeutic interventions provide only temporary symptom relief, hence, do not address irreversible glandular damage. Further, despite salivary gland-sparing techniques and modified dosing strategies, long-term hypo-function remains a significant problem. Although a single governing mechanism of radiation-induced salivary gland tissue damage and dysfunction has not been yet elucidated, the potential for synergy in radio-protection (mainly, and possibly -reparation) via a combinatorial approach of mechanistically distinct strategies, has been suggested and explored over the years. This is, undoubtfully, in parallel to the ongoing efforts in improving the precision, safety, delivery, and efficacy of clinical radiotherapy protocols/outcomes, and in designing, developing, evaluating and optimizing (for translation) new artificial intelligence, technological and bio-pharmaceutical alternatives, topics covered in this review.
A Novel Strategy to Improve Radiotherapy Effectiveness: First-in-Human MR-guided Focused Ultrasound-Stimulated Microbubbles (MRgFUS+MB) Radiation Enhancement Treatment
Published on: 24th August, 2023
Background and aim: Preclinical in vitro and in vivo experiments suggest that radiation-induced tumour cell death can be enhanced 10- to 40-fold when combined with focused-ultrasound (FUS)-stimulated microbubbles (MB). The acoustic exposure of MB in the tumour volume causes vasculature perturbation, activation of the acid sphingomyelinase (ASMase) ceramide pathway, and resultant endothelial cell apoptosis. When the tumour is subsequently treated with radiation, there is increased endothelial cell death and anoxic tumour killing. Here we describe a first-in-human experience treating patients with magnetic resonance (MR)-guided FUS-stimulated MB (MRgFUS+MB) radiation enhancement.Case presentation: A head and neck cancer patient with recurrent disease underwent radiotherapy for 5 separate sites of locoregional disease followed by systemic therapy. The first consisted of a course of 45 Gy in 5 fractions alone, the second of 30 Gy in 5 fractions with hyperthermia, and the three others of 20-30 Gy in 5 fractions along with MRgFUS+MB treatment. The treatment methodology used an MR-coupled FUS-device operating at 500 KHz and 540 kPa peak negative pressure with an insonification time of 750 ms spread over 5 minutes to stimulate intravenously administered MB within tumour target. All sites treated with stimulated MB had a complete radiological response, and subsequently, the patient’s other cutaneous metastatic disease disappeared. The patient has been under surveillance for over two years without active treatment or disease progression.Discussion: MRgFUS+MB was well-tolerated with no reported treatment-related adverse events, which can be attributed to the capability of FUS to selectively stimulate MB within the tumour volume while sparing the surrounding normal tissue. Sustained local control at all target sites aligns with earlier preclinical findings suggesting the radiation enhancement potential of FUS+MB.Conclusion: MRgFUS+MB represents a novel and promising therapy for enhancing radiation efficacy and improving therapeutic index with potential improvements in disease control.
Assessment of using an Octavius 4D Measuring System for Patient-specific VMAT Quality Assurance in Togo
Published on: 3rd September, 2024
Purpose and objective: Quality assurance (QA) programs are designed to improve the quality and the safety of radiation treatments, including machine- and patient-specific QA (PSQA). The objective of this study was to evaluate the current state of PSQA practice and identify the area for potential improvement for VMAT delivery. Materials and methods: The Octavius 4D (O4D) system accuracy was evaluated using an O4D homogeneous phantom for different field sizes. The system response to dose linearity, field sizes, and PDD difference tests were performed against the calculated dose of the treatment planning system (TPS) for a 6 MV photon beam. The deviation of the delivered dose was evaluated at the isocenter and different depths. Moreover, pretreatment verification of 40 VMAT plans was performed including prostate cancer (PC), head and neck cancer (HNC), uterine and cervical cancer (UCC), and breast cancer (BC). The PTW VeriSoft software was used to perform the local and global 3D gamma analysis by comparing the reconstructed 3D dose against the calculated dose using criteria 2%/2 mm and 3%/3 mm, 20% of low-dose threshold, and 95% of gamma passing rate (%GP) tolerance level. In the clinical scenario, the sensitivity of the O4D system in detecting VMAT delivery and setup errors has been investigated by measuring the variation of %GP values before and after the simulated errors using one of the VMAT plans related to each treatment site. Results: The O4D system reported good agreement for linearity, field size, and PDD differences with TPS dose being within ± 2% tolerance for a 6 MV photon beam. Output factors were consistent between the ionization chamber and the O4D detector 1500 array down to 4 x 4 cm2 field size with a maximum deviation of less than 1%. The introduction of deliberate errors caused the decrease of %GP values. In most scenarios, the %GP value of simulated errors was detected with 2%/2 mm and ranged between the detection threshold and gamma passing threshold.Conclusion: The results indicate that the O4D system is sensitive to detect delivery and setup errors with restrictive criteria of 2%/2 mm for routine pretreatment verification. Moreover, this system should be used in combination with kV-CBCT to improve dosimetry accuracy and treatment reproducibility.
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