add hnscc ict 2024 talk

topics/induction-hnscc-2024/package.json

@@ -0,0 +1,9 @@
+{
+  "version": "0.0.0",
+  "private": false,
+  "scripts": {
+    "dev": "slidev",
+    "build": "slidev build --base /induction-hnscc-2023/ --out ../../dist/induction-hnscc-2023",
+    "export": "slidev export --output ../../dist/induction-hnscc-2023/induction-hnscc-2023.pdf"
+  }
+}

topics/induction-hnscc-2024/public/shared

@@ -0,0 +1 @@
+../../../public/shared

topics/induction-hnscc-2024/slides.md

@@ -0,0 +1,283 @@
+---
+theme: academic
+layout: cover
+class: text-white
+coverAuthor: beau hilton
+coverAuthorUrl: https://www.beauhilton.com
+coverDate: "2024-07-18"
+themeConfig:
+  paginationX: r
+  paginationY: t
+  paginationPagesDisabled: [1]
+title: Induction Chemotherapy for HNSCC
+info: |
+  # Case Conference
+  Case Conference 2024-07-18, [Beau Hilton](https://www.beauhilton.com)
+
+---
+
+# Induction Chemotherapy for Head and Neck SCC
+
+---
+
+# Case presentation
+
+61M, previously healthy. Heavy smoker, quit a couple of months ago.
+
+<v-clicks>
+
+5 weeks of progressive facial pain.
+
+Seen by local doctors, given antibiotics for a presumed sinus infection.
+
+Purulent drainage.
+
+Dentures stopped fitting.
+
+Face started to go numb.
+
+Admitted, biopsied.
+
+Nasopharyngeal SCC, nonkeratinizing, discharged home.
+
+</v-clicks>
+
+---
+
+# Case presentation
+
+## Exam
+
+<v-clicks>
+
+Swollen left eye
+
+Numb left cheek and lips
+
+
+</v-clicks>
+
+## Labs
+
+<v-clicks>
+
+mild anemia, mild leukocytosis, BMP and LFTs fine, really nothing interesting
+
+</v-clicks>
+
+---
+
+# Imaging
+
+Similar case on Radiopaedia:
+
+<https://radiopaedia.org/cases/59258/studies/66600?lang=us>
+
+
+---
+
+
+# Questions
+
+- What is induction? (What is the difference between induction and neoadjuvant therapy?)
+- When is induction a good idea?
+- When is it a bad idea?
+- Why are the surgeons always asking us to induce?
+- What regimens are available/have been studied?
+- How do I select a regimen for a given patient and situation?
+
+
+---
+
+
+# induction chemotherapy (ICT) through the ages
+
+## 1960s
+
+<v-clicks>
+
+- MTX
+
+</v-clicks>
+
+## 1970s
+
+<v-clicks>
+
+- MTX vs cisplatin (response rate 14-41%)
+- cisplatin+bleomycin
+- cisplatin+bleomycin+[MTX vs vinca]
+  - cisplatin+bleomycin+vincristine response rate 80%, CR 29%
+- cisplatin+5-FU (PF)
+  - response rate 88%, CR 19%
+- PF with 120h of 5-FU
+  - response rate 93%, Cr 38%
+- PF with 120h of 5-FU and higher dose of cisplatin
+  - no benefit, more tox
+
+</v-clicks>
+
+
+---
+
+
+# ICT through the ages
+
+## 1980s
+
+<v-clicks>
+
+- 5x RCT w MTX - 4/5 -ve, 1/5 +ve only for stage II oral cavity disease (and used intra-arterial MTX)
+- many other RCTs, no benefit (outside of limited stage oral cavity disease)
+
+</v-clicks>
+
+## 1990s
+
+<v-clicks>
+
+- Concurrent Cisplatin-based chemoRadioTherapy (CCRT)
+
+<img src="/images/ICT_vs_CCRT_1990s.png" class="h-50 rounded flex-col"/>
+<img src="/images/ICT_vs_CCRT_2021.png" class="h-100 rounded absolute bottom-10 right-10" alt="Lacas et al 2021, Radiotherapy and Oncology" />
+
+</v-clicks>
+
+
+---
+
+
+# ICT through the ages
+
+
+## 2000s
+
+<v-clicks>
+
+- PF vs TPF
+- European study (TAX323) had RT afterward, American Study (TAX324) had CCRT afterward.
+
+<br>
+<img src="/images/TAX324_TAX323_20221209151920.png" class="h-80 rounded "/>
+
+</v-clicks>
+
+
+---
+
+
+# ICT through the ages
+
+## 2000s
+
+<v-clicks>
+
+- ICT + CCRT vs CCRT alone
+- OS doesn't increase, toxicity does
+<img src="/images/ICT_vs_CCRT_2000s.png" class="h-80 rounded "/>
+- nuanced (locoregional vs distant recurrence)
+- later meta-analyses suggest perhaps TPF+CCRT has benefit over CCRT alone (fitter patients?)
+
+</v-clicks>
+
+
+---
+
+
+# ICT through the ages
+
+## 2010s
+
+<v-clicks>
+
+Rise of the mods:
+
+- modified TPF (dose reduced)
+- weekly carbo-taxol followed by CCRT
+- TPEx (cisplatin, docetaxel, cetuximab)
+
+Our patient:
+
+- docetaxel 75, cisplatin 75, q3wk x3 and reimage
+
+</v-clicks>
+
+
+---
+
+
+# ICT today
+
+<v-clicks>
+
+- NPC
+  - gem+cis ICT f/b CCRT: +OS benefit if EBV+ (NEJM 2019, JCO 2022)
+- larynx preservation
+  - CCRT not clearly better than ICT in pts who qualify for total laryngectomy but not partial - SALTORL trial is comparing ICT and CCRT head-to-head
+- treatment intensification
+  - TPF+CCRT in the fittest patients?
+- converting borderline resectable to resectable
+  - ~30% conversion rate
+- oligometastatic disease
+  - shrink/eliminate distant sites, spot weld prn, then CCRT/surgery?
+- neurologic and airway compromise (i.e. true urgencies, nonoperable)
+    - dental procedures wrt timing of RT, may need to start ICT to bridge until dental procedures are done plus ~2wks (h/t Ronak Mistry)
+
+</v-clicks>
+
+* https://www.nejm.org/doi/full/10.1056/NEJMoa1905287#:~:text=In%20conclusion%2C%20the%20addition%20of,risk%20locoregionally%20advanced%20nasopharyngeal%20cancer.
+* https://pubmed.ncbi.nlm.nih.gov/35709465/
+
+---
+
+# ICT for NPC
+
+
+<img src="/images/npc-ebv.png" class="h-80 rounded "/>
+
+---
+
+# Induction radiotherapy?
+
+"Quad-shot" RT: 14-15 Gy over 4 fractions
+- 2x/day (6h separation) x 2 days
+- palliative
+- if response, can continue monthly (usually cap around Gy in the low 40s)
+- studies looking at quad-shot+something are ongoing (e.g. http://clinicaltrials.gov/study/NCT04454489 - +pembro)
+---
+
+
+
+
+---
+layout: index
+indexEntries:
+  - { title: "HemOnc.org entry", uri: "https://hemonc.org/wiki/Head_and_neck_cancer#Locally_advanced_disease.2C_induction" }
+  - { title: "NCCN Guidelines", uri: "https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437" }
+  - { title: "PathologyOutlines", uri: "https://www.pathologyoutlines.com/oralcavity.html" }
+  - { title: "notes", uri: "https://notes.beauhilton.com/reference/vermorkenWhereWhenUse2021" }
+indexRedirectType: external
+---
+
+
+# Resources
+
+
+---
+
+
+# Bibliography
+
+<div class="csl-bib-body text-sm" style="line-height: 1.35; margin-left: 2em; text-indent:-2em;">
+  <div class="csl-entry">Ferrari, Daris, Maria Grazia Ghi, Ciro Franzese, Carla Codecà, Max Gau, and Jerome Fayette. “The Slippery Role of Induction Chemotherapy in Head and Neck Cancer: Myth and Reality.” <i>Frontiers in Oncology</i> 10 (January 23, 2020): 7. <a href="https://doi.org/10.3389/fonc.2020.00007">https://doi.org/10.3389/fonc.2020.00007</a>.</div>
+  <span class="Z3988" title="url_ver=Z39.88-2004&amp;ctx_ver=Z39.88-2004&amp;rfr_id=info%3Asid%2Fzotero.org%3A2&amp;rft_id=info%3Adoi%2F10.3389%2Ffonc.2020.00007&amp;rft_id=info%3Apmid%2F32038985&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=The%20Slippery%20Role%20of%20Induction%20Chemotherapy%20in%20Head%20and%20Neck%20Cancer%3A%20Myth%20and%20Reality&amp;rft.jtitle=Frontiers%20in%20Oncology&amp;rft.stitle=Front%20Oncol&amp;rft.volume=10&amp;rft.aufirst=Daris&amp;rft.aulast=Ferrari&amp;rft.au=Daris%20Ferrari&amp;rft.au=Maria%20Grazia%20Ghi&amp;rft.au=Ciro%20Franzese&amp;rft.au=Carla%20Codec%C3%A0&amp;rft.au=Max%20Gau&amp;rft.au=Jerome%20Fayette&amp;rft.date=2020-01-23&amp;rft.pages=7&amp;rft.issn=2234-943X"></span>
+  <div class="csl-entry">Jacobs, John R., Thomas F. Pajak, Jeannie Kinzie, Muhyi Al-Sarraf, Lawrence Davis, Gerald A. Hanks, Irving Weigensberg, and Steven Leibel. “Induction Chemotherapy in Advanced Head and Neck Cancer: A Radiation Therapy Oncology Group Study.” <i>Archives of Otolaryngology–Head &amp; Neck Surgery</i> 113, no. 2 (February 1, 1987): 193–97. <a href="https://doi.org/10.1001/archotol.1987.01860020085018">https://doi.org/10.1001/archotol.1987.01860020085018</a>.</div>
+  <span class="Z3988" title="url_ver=Z39.88-2004&amp;ctx_ver=Z39.88-2004&amp;rfr_id=info%3Asid%2Fzotero.org%3A2&amp;rft_id=info%3Adoi%2F10.1001%2Farchotol.1987.01860020085018&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Induction%20Chemotherapy%20in%20Advanced%20Head%20and%20Neck%20Cancer%3A%20A%20Radiation%20Therapy%20Oncology%20Group%20Study&amp;rft.jtitle=Archives%20of%20Otolaryngology%E2%80%93Head%20%26%20Neck%20Surgery&amp;rft.stitle=Archives%20of%20Otolaryngology%E2%80%93Head%20%26%20Neck%20Surgery&amp;rft.volume=113&amp;rft.issue=2&amp;rft.aufirst=John%20R.&amp;rft.aulast=Jacobs&amp;rft.au=John%20R.%20Jacobs&amp;rft.au=Thomas%20F.%20Pajak&amp;rft.au=Jeannie%20Kinzie&amp;rft.au=Muhyi%20Al-Sarraf&amp;rft.au=Lawrence%20Davis&amp;rft.au=Gerald%20A.%20Hanks&amp;rft.au=Irving%20Weigensberg&amp;rft.au=Steven%20Leibel&amp;rft.date=1987-02-01&amp;rft.pages=193-197&amp;rft.spage=193&amp;rft.epage=197&amp;rft.issn=0886-4470"></span>
+  <div class="csl-entry">Okano, Susumu, Akihiro Homma, Naomi Kiyota, Makoto Tahara, Nobuhiro Hanai, Takahiro Asakage, Kazuto Matsuura, et al. “Induction Chemotherapy in Locally Advanced Squamous Cell Carcinoma of the Head and Neck.” <i>Japanese Journal of Clinical Oncology</i> 51, no. 2 (February 1, 2021): 173–79. <a href="https://doi.org/10.1093/jjco/hyaa220">https://doi.org/10.1093/jjco/hyaa220</a>.</div>
+  <span class="Z3988" title="url_ver=Z39.88-2004&amp;ctx_ver=Z39.88-2004&amp;rfr_id=info%3Asid%2Fzotero.org%3A2&amp;rft_id=info%3Adoi%2F10.1093%2Fjjco%2Fhyaa220&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Induction%20chemotherapy%20in%20locally%20advanced%20squamous%20cell%20carcinoma%20of%20the%20head%20and%20neck&amp;rft.jtitle=Japanese%20Journal%20of%20Clinical%20Oncology&amp;rft.stitle=Japanese%20Journal%20of%20Clinical%20Oncology&amp;rft.volume=51&amp;rft.issue=2&amp;rft.aufirst=Susumu&amp;rft.aulast=Okano&amp;rft.au=Susumu%20Okano&amp;rft.au=Akihiro%20Homma&amp;rft.au=Naomi%20Kiyota&amp;rft.au=Makoto%20Tahara&amp;rft.au=Nobuhiro%20Hanai&amp;rft.au=Takahiro%20Asakage&amp;rft.au=Kazuto%20Matsuura&amp;rft.au=Takenori%20Ogawa&amp;rft.au=Yuki%20Saito&amp;rft.au=Daisuke%20Sano&amp;rft.au=Takeshi%20Kodaira&amp;rft.au=Atsushi%20Motegi&amp;rft.au=Koichi%20Yasuda&amp;rft.au=Shunji%20Takahashi&amp;rft.au=Kaoru%20Tanaka&amp;rft.au=Takuma%20Onoe&amp;rft.au=Tomoya%20Yokota&amp;rft.au=Yoshinori%20Imamura&amp;rft.au=Yosuke%20Ariizumi&amp;rft.au=Tetsuo%20Akimoto&amp;rft.au=Ryuichi%20Hayashi&amp;rft.date=2021-02-01&amp;rft.pages=173-179&amp;rft.spage=173&amp;rft.epage=179&amp;rft.issn=1465-3621"></span>
+  <div class="csl-entry">Vermorken, Jan B. “Where and When to Use Induction Chemotherapy in Head and Neck Squamous Cell Cancer.” In <i>Critical Issues in Head and Neck Oncology</i>, edited by Jan B. Vermorken, Volker Budach, C. René Leemans, Jean-Pascal Machiels, Piero Nicolai, and Brian O’Sullivan, 155–79. Cham: Springer International Publishing, 2021. <a href="https://doi.org/10.1007/978-3-030-63234-2_11">https://doi.org/10.1007/978-3-030-63234-2_11</a>.</div>
+  <span class="Z3988" title="url_ver=Z39.88-2004&amp;ctx_ver=Z39.88-2004&amp;rfr_id=info%3Asid%2Fzotero.org%3A2&amp;rft_id=info%3Adoi%2F10.1007%2F978-3-030-63234-2_11&amp;rft_id=urn%3Aisbn%3A978-3-030-63234-2&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&amp;rft.genre=proceeding&amp;rft.atitle=Where%20and%20when%20to%20Use%20Induction%20Chemotherapy%20in%20Head%20and%20Neck%20Squamous%20Cell%20Cancer&amp;rft.btitle=Critical%20Issues%20in%20Head%20and%20Neck%20Oncology&amp;rft.place=Cham&amp;rft.publisher=Springer%20International%20Publishing&amp;rft.aufirst=Jan%20B.&amp;rft.aulast=Vermorken&amp;rft.au=Jan%20B.%20Vermorken&amp;rft.au=Jan%20B.%20Vermorken&amp;rft.au=Volker%20Budach&amp;rft.au=C.%20Ren%C3%A9%20Leemans&amp;rft.au=Jean-Pascal%20Machiels&amp;rft.au=Piero%20Nicolai&amp;rft.au=Brian%20O%E2%80%99Sullivan&amp;rft.date=2021&amp;rft.pages=155-179&amp;rft.spage=155&amp;rft.epage=179&amp;rft.isbn=978-3-030-63234-2&amp;rft.language=en"></span>
+  <div class="csl-entry">Lacas, B., Carmel, A., Landais, C., Wong, S. J., Licitra, L., Tobias, J. S., Burtness, B., Ghi, M. G., Cohen, E. E. W., Grau, C., Wolf, G., Hitt, R., Corvò, R., Budach, V., Kumar, S., Laskar, S. G., Mazeron, J.-J., Zhong, L.-P., Dobrowsky, W., … Zackrisson, B. (2021). Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. <i>Radiotherapy and Oncology</i>, <i>156</i>, 281–293. <a href="https://doi.org/10.1016/j.radonc.2021.01.013">https://doi.org/10.1016/j.radonc.2021.01.013</a></div>
+  <span class="Z3988" title="url_ver=Z39.88-2004&amp;ctx_ver=Z39.88-2004&amp;rfr_id=info%3Asid%2Fzotero.org%3A2&amp;rft_id=info%3Adoi%2F10.1016%2Fj.radonc.2021.01.013&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Meta-analysis%20of%20chemotherapy%20in%20head%20and%20neck%20cancer%20(MACH-NC)%3A%20An%20update%20on%20107%20randomized%20trials%20and%2019%2C805%20patients%2C%20on%20behalf%20of%20MACH-NC%20Group&amp;rft.jtitle=Radiotherapy%20and%20Oncology&amp;rft.stitle=Radiotherapy%20and%20Oncology&amp;rft.volume=156&amp;rft.aufirst=Benjamin&amp;rft.aulast=Lacas&amp;rft.au=Benjamin%20Lacas&amp;rft.au=Alexandra%20Carmel&amp;rft.au=C%C3%A9cile%20Landais&amp;rft.au=Stuart%20J.%20Wong&amp;rft.au=Lisa%20Licitra&amp;rft.au=Jeffrey%20S.%20Tobias&amp;rft.au=Barbara%20Burtness&amp;rft.au=Maria%20Grazia%20Ghi&amp;rft.au=Ezra%20E.W.%20Cohen&amp;rft.au=Cai%20Grau&amp;rft.au=Gregory%20Wolf&amp;rft.au=Ricardo%20Hitt&amp;rft.au=Renzo%20Corv%C3%B2&amp;rft.au=Volker%20Budach&amp;rft.au=Shaleen%20Kumar&amp;rft.au=Sarbani%20Ghosh%20Laskar&amp;rft.au=Jean-Jacques%20Mazeron&amp;rft.au=Lai-Ping%20Zhong&amp;rft.au=Werner%20Dobrowsky&amp;rft.au=Pirus%20Ghadjar&amp;rft.au=Carlo%20Fallai&amp;rft.au=Branko%20Zakotnik&amp;rft.au=Atul%20Sharma&amp;rft.au=Ren%C3%A9-Jean%20Bensadoun&amp;rft.au=Maria%20Grazia%20Ruo%20Redda&amp;rft.au=S%C3%A9verine%20Racadot&amp;rft.au=George%20Fountzilas&amp;rft.au=David%20Brizel&amp;rft.au=Paolo%20Rovea&amp;rft.au=Athanassios%20Argiris&amp;rft.au=Zolt%C3%A1n%20Tak%C3%A1csi%20Nagy&amp;rft.au=Ju-Whei%20Lee&amp;rft.au=Catherine%20Fortpied&amp;rft.au=Jonathan%20Harris&amp;rft.au=Jean%20Bourhis&amp;rft.au=Anne%20Aup%C3%A9rin&amp;rft.au=Pierre%20Blanchard&amp;rft.au=Jean-Pierre%20Pignon&amp;rft.au=D.J.%20Adelstein&amp;rft.au=M.%20Alfonsi&amp;rft.au=Y.%20Belkacemi&amp;rft.au=V.%20Bar-Ad&amp;rft.au=J.%20Bernier&amp;rft.au=%C3%85.%20Bratland&amp;rft.au=G.%20Calais&amp;rft.au=B.%20Campbell&amp;rft.au=J.%20Caudell&amp;rft.au=S.%20Chabaud&amp;rft.au=E.%20Chamorey&amp;rft.au=D.%20Chaukar&amp;rft.au=K.N.%20Choi&amp;rft.au=O.%20Choussy&amp;rft.au=L.%20Collette&amp;rft.au=J.J.%20Cruz&amp;rft.au=C.%20Dani&amp;rft.au=E.%20Dauzier&amp;rft.au=A.A.%20Forastiere&amp;rft.au=P.%20Garaud&amp;rft.au=V.%20Gregoire&amp;rft.au=A.%20Hackshaw&amp;rft.au=E.%20Haddad&amp;rft.au=B.G.%20Haffty&amp;rft.au=A.%20Hansen&amp;rft.au=S.%20Hayoz&amp;rft.au=J.C.%20Horiot&amp;rft.au=B.%20Jeremic&amp;rft.au=T.G.%20Karrison&amp;rft.au=J.A.%20Langendijk&amp;rft.au=M.%20Lapeyre&amp;rft.au=E.%20Lartigau&amp;rft.au=T.%20Leong&amp;rft.au=Q.T.%20Le&amp;rft.au=P.P.Y.%20Lee&amp;rft.au=F.%20Lewin&amp;rft.au=A.%20Lin&amp;rft.au=A.%20Lopes&amp;rft.au=S.%20Mehta&amp;rft.au=J.%20Moon&amp;rft.au=E.%20Moyal&amp;rft.au=B.V.%20Occ%C3%A9an&amp;rft.au=P.%20Olmi&amp;rft.au=R.%20Orecchia&amp;rft.au=B.%20O'Sullivan&amp;rft.au=J.%20Overgaard&amp;rft.au=C.%20Petit&amp;rft.au=H.%20Quon&amp;rft.au=G.%20Sanguineti&amp;rft.au=T.%20Satar&amp;rft.au=J.%20Simes&amp;rft.au=C.%20Simon&amp;rft.au=C.%20Sire&amp;rft.au=S.%20Staar&amp;rft.au=C.%20Stromberger&amp;rft.au=P.%20Strojan&amp;rft.au=S.%20Temam&amp;rft.au=D.%20Thomson&amp;rft.au=A.%20Timochenko&amp;rft.au=V.%20Torri&amp;rft.au=V.%20Tseroni&amp;rft.au=J.%20Vermorken&amp;rft.au=E.E.%20Vokes&amp;rft.au=J.%20Waldron&amp;rft.au=K.D.%20Wernecke&amp;rft.au=J.%20Widder&amp;rft.au=B.%20Zackrisson&amp;rft.date=2021-03&amp;rft.pages=281-293&amp;rft.spage=281&amp;rft.epage=293&amp;rft.issn=01678140&amp;rft.language=en"></span>
+
+</div>

topics/induction-hnscc-2024/style.css

@@ -0,0 +1,22 @@
+.slidev-layout a{
+  border-style: inherit
+}
+
+a {
+  @apply text-sky-700;
+}
+
+h1 {
+  @apply text-green-600;
+}
+
+.slidev-layout h2 {
+  font-size: 1.6em; 
+  @apply text-pink-700;
+}
+
+iframe {
+    width: 100%;
+    height: 90%;
+    overflow: hidden;
+}

topics/induction-hnscc-2024/vite.config.js

@@ -0,0 +1,13 @@
+import { defineConfig } from 'vite'
+import svgLoader from 'vite-svg-loader'
+
+export default defineConfig({
+  plugins: [
+    svgLoader(),
+  ],
+  resolve: {
+    dedupe: [
+      'vue'
+    ]
+  },
+})