One-year evolution of the quality of life in patients with locally advanced human papilloma virus positive treated with neoadjuvant chemotherapy followed by transoral robotic surgery and neck dissection
Notice bibliographique
Résumé
Background: Oropharyngeal cancer is the most common type of head and neck cancers, with a 5-year survival of 64.7%. Over the last 40 years, such risk factors and aetiology have changed, with a reduced incidence due to usage of tobacco and alcohol, but with an increased incidence due to Human Papilloma Virus (HPV) infection in 70% of cases. Chronic treatment-related toxicity and functional loss of the standard of care concurrent chemoradiation (CRT) have had a significant impact on the quality of life (QOL) of survivors of oropharyngeal squamous cell carcinoma (OPSCC). Currently, there are different de-escalation treatments and trials that aim to reduce the treatment-related toxicity while maintaining the survival for locally advanced OPSCC. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ30) is the quality of life questionnaire most used worldwide to assess the quality of life of cancer patients.Objectives: The objectives of this thesis are: (a) to review literature on 1-year evolution of quality of life of patients treated for OPSCC with standard of care CRT, and (b) to assess the quality of life in human papillomavirus positive (HPV+) OPSCC patients with locoregionally advanced disease treated with the experimental treatment neoadjuvant chemotherapy (NeC) followed by transoral robotic surgery (TORS) as definitive treatment. Methods: The first study was a narrative literature review of treated OPSCC patients assessed with EORTC QLQ-30 and EORTC Head and Neck -35 (a) at pre-treatment, and (b) at 12-months post-treatment. The second study was a prospective cohort study that took place at McGill University Health Centre in Montreal, Canada. Patients were diagnosed with stage III and IV (according to AAJC 7th edition) HPV+ OPSCC and treated with NeC (docetaxel and cisplatin) followed by TORS and selective neck dissection, between January 2017 and July 2018.Results: a) The first study showed that standard-of-care treatment surgery and adjuvant radiotherapy or more commonly utilized CRT produced chronic side effects, such as xerostomia, poor oral and dental health, dysphagia, feeding tube dependency, and other fibrotic changes likely caused by radiotherapy. or a combination of surgery and radiotherapy. b) The second study (19 eligible HPV+ patients of 23 recruited; 90% male; median age: 58; 7 patients with localized base-of-tongue cancer; 12 with localized palatine-tonsil cancer) showed that EORTC- H&N35 scores at 12-month post-treatment were not significantly different than pre-treatment values in the scales known to be most affected by standard of care CRT treatment toxicity, such as swallowing (p = 0.38), social eating problems (p = 0.70), or dry mouth and sticky saliva (p = 0.87). No patient in this cohort required a gastrostomy tube (PEG) at any time-point assessed. Conclusions: Results of the first literature-review study showed that chronic standard of care CRT treatment-related toxicity and functional loss, such as xerostomia, poor oral and dental health, dysphagia, as well as feeding tube dependency, had a significant negative impact on the 1-year QOL of survivors of oropharyngeal squamous cell carcinoma (OPSCC). Results of the second prospective study showed that QOL 12 months post-NeC-TORS treatment returned to the pre-treatment baseline, or improved, on all scales, including the symptom scales that are most negatively affected by the current standard of care treatment CRT. Patients had a rapid return to an oral diet. Findings suggest that NeC followed by TORS provides maintenance of QOL and improvement in many areas compared to pre-treatment levels
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».