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Systemic therapy in the management of metastatic or locally recurrent adenoid cystic carcinoma of the salivary glands: a systematic review

Adenoid cystic carcinomas (ACC) are rare cancers usually arising in the salivary glands. Once metastatic, the natural history can vary; some patients with indolent cancer remain asymptomatic for long periods, whereas others have rapidly progressive disease. Chemotherapy is generally reserved for the palliative treatment of symptomatic locally recurrent or metastatic disease that is not amenable to further surgery or radiation. Prospective trials of chemotherapy in advanced ACC are limited, and the optimum regimen is unclear. The aim of this systematic review is to summarise and rate the quality of trials assessing chemotherapy for treatment of ACC, by use of the European Lung Cancer Working Party scoring system. Endpoints evaluated include tumour response and rates of symptomatic improvement. 34 trials involving 441 patients are included. We give evidence-based recommendations for management of ACC with chemotherapy, along with considerations for the design of future clinical trials in this disease.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin

The term “cancer of unknown primary” refers to a condition in which a patient has metastatic malignancy without an identified primary source. This is a very heterogeneous disease in which the type of tumour, the extent of spread, and the outcome of treatment all vary widely. When categorising patients with cancer of unknown primary, one important factor initially considered is the cell type of origin of the metastatic disease. The majority of patients have malignancy which appears to derive from epithelial cells, and hence are regarded as having carcinoma of unknown primary. Patients with tumours of non-epithelial lineage (melanoma, sarcoma, lymphoma, germ-cell) form a distinct and important minority, since subsequent management can often be satisfactorily undertaken even in the absence of an identifiable primary source. Such patients are not considered in this guideline, since their care is adequately defined in existing guidelines for their specific tumour type. The term “carcinoma of unknown primary” (CUP) is used henceforth to refer to those patients with metastatic malignancy of epithelial, neuroendocrine or undifferentiated lineage whose investigation and management is considered within the scope of this guideline.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: July 2010
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Cancer of the Upper Aerodigestive Tract: Assessment and Management in People Aged 16 and Over

There is no single universal definition of the upper aerodigestive tract; for the purposes of this guideline, it encompasses the oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, and paranasal sinuses. The vast majority of cancers at these sites are squamous cell carcinomas (National Head and Neck Cancer Audit, 2014). Some other cancers with less common histological diagnoses, such as mucosal melanomas of the upper aerodigestive tract, are also covered by this guideline.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: February 2016
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Particle Beam Radiation Therapies for Cancer [Internet]

Radiotherapy with charged particles can potentially deliver maximal doses while minimizing irradiation of surrounding tissues. It may be more effective or less harmful than other forms of radiotherapy for some cancers. Currently, seven centers in the United States have facilities for particle (proton) irradiation, and at least four are under construction, each costing between $100 and $225 million. The aim of this Technical Brief was to survey the evidence on particle beam radiotherapy.

Comparative Effectiveness Technical Briefs - Agency for Healthcare Research and Quality (US).

Version: November 2009
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Prognostic significance of VEGF immunohistochemical expression in oral cancer: a meta-analysis of the literature

Vascular endothelial growth factor (VEGF) is considered as a prime mediator of angiogenesis and has been implicated in carcinogenesis and metastasis. Various studies examined the relationship between VEGF protein overexpression with the clinical outcome in patients with oral cancer, but yielded conflicting results. Electronic databases updated to March 2013 were searched to find relevant studies. A meta-analysis was conducted with eligible studies which quantitatively evaluated the relationship between VEGF overexpression and survival of patients with oral cancer. Survival data were aggregated and quantitatively analyzed. We performed a meta-analysis of 17 studies (n = 1,207 patients) that evaluated the correlation between VEGF overexpression detected by immunohistochemistry and survival in patients with oral cancer. Combined hazard ratios suggested that VEGF overexpression had an unfavorable impact on overall survival (hazard ratio [HR] = 1.89; 95 % confidence interval [CI], 1.24-2.55) and disease-free survival (HR = 2.08; 95 % CI, 1.14-3.02) in patients with oral cancer: 1.77 (1.09-1.44) in oral squamous cell carcinoma (SCC) patients and 4.28 (1.35-7.21) in adenoid cystic carcinoma (ACC) and mucoepidermoid carcinoma (MEC) of the salivary glands. No significant heterogeneity was observed among all studies. VEGF overexpression indicates a poor prognosis for patients with oral SCC, ACC, and MEC of the salivary glands.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Radiotherapy Treatments for Head and Neck Cancer Update [Internet]

This report is an update of a Comparative Effectiveness Review (CER) published in final form in May 2010 on the benefits and harms of radiotherapy (RT) to treat patients with head and neck cancer (CER No. 20). RT modalities included two-dimensional RT (2DRT), three-dimensional conformal RT (3DCRT), intensity-modulated RT (IMRT), and proton-beam RT (PBT).

Comparative Effectiveness Review - Agency for Healthcare Research and Quality (US).

Version: December 2014
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Salivary Gland Cancer Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of salivary gland cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 21, 2016

Unusual Cancers of Childhood Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of unusual cancers of childhood such as cancers of the head and neck, chest, abdomen, reproductive system, skin, and others.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 4, 2017

Non-Small Cell Lung Cancer Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of non-small cell lung cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 31, 2017

Genetics of Skin Cancer (PDQ®): Health Professional Version

Expert-reviewed information summary about the genetics of skin cancer — basal cell carcinoma, squamous cell carcinoma, and melanoma — including information about specific gene mutations and related cancer syndromes. The summary also contains information about interventions that may influence the risk of developing skin cancer in individuals who may be genetically susceptible to these syndromes.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 11, 2017

Metastatic Spinal Cord Compression: Diagnosis and Management of Patients at Risk of or with Metastatic Spinal Cord Compression

It is difficult to know what the true incidence of metastatic spinal cord compression (MSCC) is in England and Wales because the cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Ontario, Canada, suggests that the incidence may be up to 80 cases per million population per year. This would mean around 4000 cases per year in England and Wales or more than 100 cases per cancer network per year.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: November 2008
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Systematic review and meta-analysis of radiotherapy in various head and neck cancers: comparing photons, carbon-ions and protons

This review found improved survival with carbon-ion therapy in comparison with photon therapy for treatment of mucosal malignant melanomas. Except for paranasal and sinonasal cancer, tumour control and survival appeared similar for proton and photon therapies. Photon therapy had greater toxicity. Given potential limitations in the evidence and review methods, these conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Systematic Reviews in PubMed

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