Causes of death in patients with locally advanced head and neck cancer treated with radiotherapy and systemic therapy.

BACKGROUND: To investigate the incidence of non-cancer mortalities and prognostic factors associated with competitive causes of death in a homogeneous cohort of patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment. METHODS: This study included 284 patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment between 2005 and 2017. The cumulative incidence of death associated with tumour, second tumours, treatment, side effects and comorbidity was calculated. A Fine and Gray regression model was used to investigate factors associated with cancer and competitive mortality. RESULTS: The cumulative incidence of tumoral death at 5 and 10 years were 35 and 47% respectively, whereas the cumulative incidence of competitive mortality were 10 and 12% respectively. In the multivariate analysis, age and comorbidity were independent factors for non-cancer mortality. Patients with a high risk of non-cancer mortality presented a cumulative incidence of 17.3% at 5 years and 18.4% at 10 years. CONCLUSIONS: This study demonstrated a high incidence of competing mortality in older patients with comorbidities. Non-cancer deaths should be considered when selecting patients for combination therapies and in the study design ofclinical trials.

Subcellular localisation of pMEK has a different prognosis in locally advanced head and neck cancer treated with concomitant radiochemotherapy.

BACKGROUND: MEK1 (MAP2K1) and MEK2 (MAP2K2) are closely related dual-specificity protein kinases which function by phosphorylating both serine/threonine and tyrosine residues of their substrates ERK1 and ERK2, controlling fundamental cellular processes that include cell growth and proliferation. To investigate the prognostic significance of pMEK expression in the nucleus and cytoplasm among patients with locally advanced head and neck cancer treated with concurrent radiochemotherapy. METHODS: Immunohistochemistry was performed on the retrieved archival tissue of 96 patients to detect pMEK, p53 and Ki-67. RESULTS: Sixty-six percent of patients were positive for pMEK expression in the nucleus and 41 % in cytoplasm. On univariate analysis, high nuclear pMEK was predictive of worse 5y-DFS and 5y-OS, with a trend to significance (26 % vs. 41 %, p = 0.09; 36 % vs. 47 %, p = 0.07). High cytoplasmic pMEK was predictive of better 5-y OS and 5-y DFS outcomes (61 % vs. 27 %, p = 0.01; 46 % vs. 22 %, p = 0.02). On multivariate analysis, low cytoplasmic pMEK and high nuclear pMEK predicted worse DFS and OS (p = 0.01; p = 0.04 and p = 0.02; p = 0.02 respectively). CONCLUSIONS: Subcellular localisation of pMEK has different prognosis in locally advanced head and neck cancer treated with radiochemotherapy.

Environmental profile of latent energy storage materials applied to industrial systems.

Industry sector is an intensive-energy consumer and approximately 20-50% of industrial energy consumption is lost as waste heat. Therefore, there is a great potential for reducing energy consumption and, subsequently, decreasing the fossil fuels used if this lost energy can be recovered. Thermal Energy Storage (TES) based on Latent Heat Storage systems (LHS) using Phase Change Materials (PCMs) has become one of the most feasible solutions in achieving energy savings through waste heat recovery, especially when there is a mismatch between the supply and consumption of energy processes. In this paper, a shell and tube heat exchanger incorporating PCMs has been considered to store the excess energy available in an industrial process. Several attempts have been made to design the most appropriate system considering many cost-benefit and technical criteria to maximise the heat recovery. However, the environmental criterion also is an important factor when determining whether this technology is not only energy and cost-efficient but also environmentally friendly, considering the whole life of the system from its manufacture to its disposal. To this end, this research includes a Life Cycle Assessment (LCA) to determine whether the energy savings of conventional fuels during the operation stage are large enough to balance the environmental impact originated in an industrial TES system including the manufacture, use and disposal phases. Inputs and outputs of each management stage have been defined, and the inventory emissions calculated by SIMAPRO v7.3.2. A midpoint and endpoint approaches have been carried out using two methods, CML 2001 and Eco-indicator 99, respectively. As a preliminary result, a promising reduction in the overall impacts was obtained by the use of this technology. From the environmental impact results, a matrix of possible technical solutions is displayed, to improve the environmental performance.

Concurrent radiotherapy plus epidermal growth factor receptor inhibitors in patients with human papillomavirus-related head and neck cancer.

PURPOSE: Concurrent radio-chemotherapy (RT-CT) is the standard treatment for locally advanced head and neck squamous cell carcinoma (LA-HNSCC), but RT plus epidermal growth factor receptor (EGFR) inhibitors is an effective option when CT is not appropriate. Human papillomavirus (HPV) is associated with an improved prognosis in LA-HNSCC; however, it has not been fully studied as a prognostic factor after RT + EGFR inhibitors. EXPERIMENTAL DESIGN: Immunohistochemical expression of p16INK4A and PCR of HPV16 DNA were retrospectively analyzed in tumor blocks from 52 stage III/IV LA-HNSCC patients treated with RT + EGFR inhibitors. Disease-free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method. RESULTS: DNA of HPV16 was found in six of 52 tumors (12 %) and p16 positivity in eight tumors (15 %). After a median follow-up time of 45 months (6-110), p16-positive patients treated with RT + EGFR inhibitors showed an improved DFS (2-year DFS 75 vs. 44 %, HR 0.25, 95 % CI 0.06-0.99, p = 0.047) compared with p16-negative patients. These differences were outperformed when compared by HPV16 status (2-year OS rates of 83 vs. 58 %, HR 0.17, 95 % CI 0.02-0.99, p = 0.049 and 2-year DFS rates of 83 vs. 45 %, HR 0.17, 95 % CI 0.02-0.99, p = 0.049). In the Cox regression analysis with OS as the end point, ECOG 0-1 was the only prognostic factor independently associated with a good prognosis in the multivariable analysis. CONCLUSION: In this study, p16/HPV16-positive patients with LA-HNSCC treated with RT + EGFR inhibitors showed a better survival, not confirmed in multivariate analysis.

Competing causes of death in patients with locoregionally advanced head and neck cancer treated with concomitant boost radiation plus concurrent weekly cisplatin

BACKGROUND: This study analyzes the morbidity and the contribution of different causes of death to the outcome of patients with locally advanced head and- neck cancer after weekly cisplatin plus concomitant boost accelerated radiation treated in our center. MATERIALS AND METHODS: Ninety-four patients with locally advanced head and neck carcinoma were included in this phase II trial consisting of concomitant boost radiation plus concurrent weekly cisplatin. The 43 patients treated in our centered with long-term follow-up were analyzed. Patients received radiotherapy with a concomitant boost scheme (1.8 Gy on days 1-40 and 1.5 Gy boost on days 25-40 with a total dose of 72 Gy) and concurrent cisplatin, 40 mg/m(2) weekly, for the first 4 weeks. RESULTS: Most patients (93 %) received both radiation and complete chemotherapy according to protocol. Severe late toxicity presented were subcutaneous (5 %), larynx (2 %) and esophagous (5 %). Grade I-II late toxicity included mainly xerostomy (30 %), skin (16 %) and mucosal (16 %) toxicity. With a median follow-up of 95 months (9-135), the median overall survival and progression-free survival were 26 and 19 months, respectively (95 % CI 1-52; and 95 % CI 0-45); 60 % of the patients died because of head and neck cancer and 12 % of a second neoplasm, while 27 % of non-cancer patients died. CONCLUSIONS: Patients with locoregionally advanced head and neck cancer treated with concomitant boost accelerated radiation plus chemotherapy show significant risks of mortality from causes other than disease progression (AU)

Phase change material applications in buildings: an environmental assessment for some Spanish climate severities.

This work proposes an environmental analysis based on the life cycle assessment (LCA) methodology. LCA was applied to determine if energy savings are large enough to balance the environmental impact caused during phase change material (PCM) manufacture and its installation on tiles. Inputs and outputs of each management stage have been defined and the inventory emissions were calculated by SIMAPRO v 7.3.2. Emissions were classified into several impact categories; climate change, human toxicity, acidification, ozone depletion, particulate matter formation and eutrophication. Three commercial PCMs, evaluated using five different Spanish weather climates, were studied to explore a wide range of conditions. The main results conclude that the use of PCM can reduce the overall energy consumption and the environmental impacts. This reduction is strongly influenced by the climate conditions and the PCM introduced.