Carl Stöcker, Jens Greve, Meinrad Beer, Beate Hosch, Thomas F. E. Barth, Thomas K. Hoffmann, Adrian von Witzleben
Publication date 19-11-2024
ABSTRACTBackground Most challenging treatment needs are in recurrent or persisting head and neck squamous cell carcinoma (HNSCC) patients after (((chemo-)radiotherapy) (C)RT).
Materials and Methods This 10-year retrospective study included 100 patients, who initially received (C)RT followed by neck dissection (ND). The results of computed tomography (CT) and sonography were evaluated for residual/recurrent cervical lymph nodes and compared to the histopathology. On this basis we calculate the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV).
ResultsA total of 144 ND specimens were analyzed. The combination of CT and sonography (n = 103) reached values 97% sensitivity, 71% specificity, 98% NPV, 66% PPV, and 81% overall accuracy.
For patients who received as primary treatment CRT the values for the combined imaging were: 100.0%, 73.5%, 100.0%, 66.7% and 82.7% respectively.
Conclusion Our study demonstrates that the combined use of CT and sonography reliably detects lymph node metastases, particularly in patients previously treated with CRT, even after a long time after treatment.
Pelin Güneri, Gaye Bolukbasi, Betul Ilhan, Joel B. Epstein, Saman Warnakulasuriya
Publication date 18-11-2024
ABSTRACTOral epithelial dysplasia (OED) is the primary histological marker for assessing the progression of oral potentially malignant disorders (OPMDs) to cancer. Despite challenges in grading and low inter-pathologist reproducibility, OED severity remains the key predictor of malignant transformation. However, globally accepted guidelines for OED monitoring are lacking, despite calls for individualized management based on host and lesion characteristics. The proposed research protocol involves acquiring high-quality intraoral images, assessing oral hygiene and periodontal status, eliminating chronic mechanical irritation and Candida infections, and applying adjunctive diagnostic methods like toluidine blue staining, optical evaluation, and brush cytology. Tailored follow-up regimens based on individual risk assessments are emphasized, with frequent monitoring for high-grade dysplasia or patients at higher risk of progression. Therefore, effective OED management should consider the patients immune status, dietary habits, and oral microbiota, aiming to develop personalized treatment strategies that optimize patient-centered care.
Pubmed PDF WebPo‐Wen Chuang, Wen‐Yu Chuang, Ta‐Jen Lee, Po‐Hung Chang, Yi‐Wei Chen, Chia‐Hsiang Fu
Publication date 18-11-2024
ABSTRACTIntroduction Solitary extramedullary plasmacytomas (SEP) of the head and neck are rare and pose unique challenges. This study aimed to explore the clinical spectrum and treatment outcomes of these neoplasms using multimodal management.
MethodsA retrospective review of 13 patients with SEP of the head and neck. Data on demographics, clinical presentation, diagnostics, treatment, and survival outcomes were analyzed.
Results One patient refused the treatment and was lost to follow-up. Another one received operation alone. The other 11 patients underwent surgical resection when feasible and showed favorable responses to radiation. Two of them (16.7%) experienced local recurrence, and another two patients (16.7%) progressed to multiple myeloma (MM) within the first 2 years following the initial treatment. Tumor > 2.6 cm significantly affected the post-radiation prognosis.
Conclusion Although radiotherapy yields favorable immediate outcomes in our limited case series, a subset of cases progresses to MM within the initial 2 years. Despite all tumors being categorized as Stage I, tumor size may still influence prognosis.
Kevin Yu‐Ting Chen, Angela Chien‐Yu Chen, Chung‐Kan Tsao, Shao‐Yu Hung, David Chon‐Fok Cheong, Huang‐Kai Kao
Publication date 18-11-2024
ABSTRACTBackground The primary objective of this study was to ascertain the risk factors associated with hardware complications following segmental mandibular reconstruction in head and neck cancer patients. Additionally, we sought to develop a nomogram model that enables accurate risk prediction.
Methods Patients who underwent segmental mandibulectomy with immediate free or local regional tissue transfer between January 2016 and December 2020 were reviewed. Hardware complications were defined. Patient demographics and perioperative parameters were analyzed.
ResultsA total of 510 patients were analyzed. Postoperative radiation therapy (OR = 2.296, 95% CI = 1.339–3.938, p = 0.003), postoperative wound infection (OR = 2.367, 95% CI = 1.472–3.806, p < 0.001), and debridement for flap-related complications (OR = 5.484, 95% CI = 3.269–9.199, p < 0.001) were identified as independent risk factors. The nomogram model demonstrated good discriminatory ability.
Conclusion This comprehensive analysis identified three independent risk factors, and the nomogram provides a valuable tool for predicting the risks. Further research is needed to validate these findings and explore preventive strategies.
Reineke A. Schoot, Pieter Taselaar, Giovanni Scarzello, Frederic Kolb, Beatrice Coppadoro, Simone ter Horst, Henry Mandeville, Andrea Ferrari, Raquel Hladun, Sylvie Helfre, Sima Ferman, Anna Kelsey, Marinka L. F. Hol, Christine Devalck, Myriam Ben‐Arush, Daniel Orbach, Julia Chisholm, Meriel Jenney, Veronique Minard‐Colin, Gianni Bisogno, Johannes H. M. Merks
Publication date 15-11-2024
ABSTRACTBackground Parameningeal (PM) site is an unfavorable characteristic in rhabdomyosarcoma (RMS). We described the treatment and outcome for patients with PM RMS and investigated the prognostic value of risk factors. We scored PM site by originating site and by highest risk extension.
Methods Patients with PM RMS were treated within the European pediatric Soft tissue sarcoma Study Group (EpSSG) RMS 2005 study with risk-adapted, multi-modal treatment.
Results Three-hundred-eighty-one patients with PM RMS were included. Radiotherapy was administered in 359 patients (77 with surgery). After a median follow-up of 75 months, 5-year event-free survival was 60% (95% confidence interval (CI) 55%–65%), 5-year overall survival was 65% (95% CI 60%–70%).
Conclusions The outcome for patients with PM RMS has not improved in comparison to previous historical studies, despite the more rigorous application of radiotherapy (94% of patients). Signs of meningeal involvement, PM site, and age at diagnosis remained prognostic risk factors.
Trial Registration EudraCT number 2005-000217-35
Jin‐Hui Rao, Cheng‐Peng Zha, Wen‐Da Zhang, Liu‐Han Cheng, Qian Lei, Tao Xie, Wen Peng, Pei‐Jing Ye, Min‐Yue Zhang, Yu‐Jie Xing, Chuan‐Zheng Sun, Lei Li
Publication date 15-11-2024
ABSTRACTObjective To investigate the clinicopathological features of individuals who have cervical lymph node metastasis (CLNM) from non-head and neck primary carcinomas.
Methods The data of 1448 patients diagnosed with CLNM from non-head and neck primary carcinomas at the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, China, from January 2013 to December 2023 were collected. The patients general information, imaging data, and pathological information were retrospectively analyzed.
Results There were 780 men and 668 women among the 1448 patients, for a male-to-female ratio of 1.17:1. The median age was 56 years (range 21–81 years). The most prevalent primary sites in males were the lung (n = 508, 65.1%) and, in females, the breast (n = 276, 41.3%). The most prevalent pathological kind (n = 949), or 65.5% of cases, was adenocarcinoma. There was a significant difference in the proportion of adenocarcinoma between males (n = 385, 49.4%) and females (n = 564, 84.4%). The common sites of CLNM from non-head and neck primary carcinomas were level V (1,236 cases, 85.4%). In a subgroup of 1133 patients with primary cancer located in symmetrical or unilateral organs, 60.3% exhibited ipsilateral lymph node metastasis, 27.6% had bilateral lymph node metastasis, and 12.1% showed contralateral lymph node metastasis exclusively.
Conclusion For patients with CLNM, especially those with metastasis to cervical areas IV-V and those with adenocarcinoma pathology, it is particularly important to screen for primary foci in the lungs, breast, urogenital system, and digestive system after excluding head and neck primary cancers.
Ying Xu, Kuanke Gao, Jing Liu, Defu Yang, Tong Wu, Haibo Zhang, Ying Yan, Dongyang Lv
Publication date 15-11-2024
ABSTRACTBackground Giant cell reparative granulomas are nonneoplastic, benign lesions that can expand and dissolve bone. Fibrous dysplasia is a benign condition in which normal bone tissue is replaced by abnormally proliferating immature reticular bone and fibrous tissue. The combination of giant cell reparative granuloma and fibrous dysplasia is extremely rare and can pose diagnostic and therapeutic challenges because of the complexity of clinical presentation.
Case Presentation We here present a patient who had a combination of fibrous dysplasia of bone and a giant cell reparative granuloma. An elderly male was admitted to the hospital with a blood-streaked nasal discharge, blurry vision in his right eye, and an enlarged mass under the chin. A CT scan revealed that the lesion had infiltrated the head and face extensively, including the right maxillary sinus, sieve sinus, and the right nasal cavity, contraindicating surgery. The patient received a total dose of 30 Gy of 6 MV x-ray radiotherapy delivered through helical tomotherapy over 15 sessions, with a single dose of 2 Gy being administered five times a week. Concurrently, The dose is 4 mg of zoledronic acid administered intravenously once every 21 days. After treatment, the patients nasal congestion was significantly relieved, the vision of the right eye improved, and the mandibular lesion was significantly reduced.
Conclusions Treatment with radiotherapy combined with zoledronic acid for our patients inoperable osteolytic giant cell reparative granuloma adjacent to vital nerves and blood vessels was extremely effective and safe. This case report provides a reference for the management of this rare combination.
Naoya Ishida, Kentaro Tanaka, Kyoichi Murakami, Mayu Ueno, Hiroki Mori
Publication date 15-11-2024
ABSTRACTBackground Various methods for closing tracheocutaneous fistulas have been reported; however, there is no established consensus. This study reports the successful closure of a large tracheocutaneous fistula using a Modified Hinge Flap and DP flap.
Methods Between July 2014 and December 2023, four patients underwent a modified hinge flap and DP flap for tracheocutaneous fistula at a single center.
Results The maximum diameter of the fistula was 10–33 mm, the cartilage defect was 1/4–1/2 of the total circumference of the trachea, and no radiation was administered to the neck during the perioperative period. In all cases, postoperative speech and swallowing improved, and none of the patients complained of cosmetic appearance.
Conclusions The method in this study is simple and allows reliable closure of relatively large tracheocutaneous fistula of 10 mm or more, and we believe that it can be a new treatment method for tracheocutaneous fistula closure.
Publication date 15-11-2024
Alyssa Webster, Rami M. Elshazli, Dylan Pinion, Robert D. E. Clark, Grace Kelly, Peter P. Issa, Mohammad H. Hussein, Manal S. Fawzy, Eman A. Toraih, Emad Kandil
Publication date 15-11-2024
ABSTRACTBackground Activating mutations in the BRAF oncogene occur in 45% of papillary thyroid carcinomas (PTCs). Though less studied, K601E may identify a clinically distinct subset of thyroid neoplasms.
MethodsA bioinformatics assessment was conducted using the COSMIC database and in silico data analysis. A systematic search was conducted through August 2024 to identify studies reporting BRAF mutation in thyroid neoplasms. Pooled prevalence, histopathological subtype distribution, extrathyroidal extension, lymph node metastasis, recurrence, and survival were extracted/analyzed from 32 studies (13 191 patients).
Results In the COSMIC database, BRAF K601E was found in various tissue types but mainly in the thyroid. In silico data analysis revealed a structural and functional basis for differences between K601E and V600E. Upon systematic review, the BRAF K601E mutation was identified in 2.8% of PTCs compared to 22% with V600E. The stratified analysis revealed geographical differences, with higher rates in Italy (5.23%) and the United States of America (3.31%). The K601E mutant was enriched for follicular-patterned variants like NIFTP (11.2% of cases). Meta-analysis demonstrated significantly reduced extrathyroidal extension for K601E versus V600E mutants (RR = 0.22, 95% CI = 0.10–0.50, p = 0.0003).
ConclusionK601E-mutated neoplasms could be a unique clinicopathological entity associated with low-risk histology and reduced extrathyroidal extension, consistent with a more indolent course than V600E mutants. Although detecting K601E may potentially guide conservative management, further prospective studies are needed.
Filippo Marchi, Valentina Campagnari, Marta Filauro, Andrea Iandelli, Cesare Piazza, Giorgio Peretti
Publication date 15-11-2024
Eric A. Dik, Tim Verhoeven, Satish Lubeek, Ellen Zwijnenburg, Jeroen van Rijssel, Willem Weijs, Casper Coppen
Publication date 15-11-2024
Abstract Background Reconstruction of skin defects after oncological surgery for a cutaneous squamous cell carcinoma is often mandatory to facilitate adjuvant treatment and/or to prevent chronic wound problems. Some of the most challenging regions to reconstruct after resection of a skin tumor are the frontal and parietal parts of the skull.
Methods This article describes three patients with large skin defects after oncological surgery that were reconstructed with the use of a (hemi) visor flap.
Results The (hemi) visor flap is easy to harvest, resulting in a concise procedure and short hospitalization with maximum wound control.
Conclusion The (hemi) visor flap is a safe and reliable option for the closure of large skin defects on the skull. Especially in the older and frail patient group.
Shuang Wang, Xinming Yang, Qinglai Tang, Ying Zhang, Shisheng Li, Xia Peng, Weiyu Zhu, Danhui Yin
Publication date 15-11-2024
Abstract Background Preserving laryngeal function after partial laryngectomy for laryngeal cancer is an important consideration. Therefore, we examined the use of thyroid flaps for this purpose.
Methods We analyzed 21 patients who underwent thyroid flap reconstruction after partial laryngectomy for laryngeal cancer in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from January 2010 to January 2020. All patients were male and aged 51–64 years. Seventeen patients underwent modified tracheocricohyoidoepiglottopexy, and the remaining four patients underwent modified cricohyoidopexy. The thyroid flap was pedicled from the superior thyroid blood vessels. In the modified tracheocricohyoidoepiglottopexy, the flap was turned to cover the area between the tracheal ring and epiglottis to reconstruct the anterior wall of the cricoid cartilage, whereas in the modified cricohyoidopexy, it was turned over between the cricoid cartilage and tongue root to reduce anastomotic tension. A total of seven patients underwent radiotherapy and chemotherapy after surgery.
Results Thyroid flap reconstruction was successfully performed in all patients. The postoperative hospitalization time was 9–21 days, the postoperative nasal feeding time was 18–47 days, and the tracheotomy tube was removed 30–160 days after surgery. No laryngeal stenosis, flap necrosis, bleeding complication, or dysfunction of the thyroid and parathyroid glands was observed after surgery. Two patients experienced wound infections about 1 week after discharge and were admitted again for antibiotic treatment. After dressing and compressing the neck wound, the patients were discharged. Three patients experienced local tumor recurrence after surgery, two of whom did not receive radiotherapy and chemotherapy after modified tracheocricohyoidoepiglottopexy. No patients had distant metastasis after surgery.
Conclusions Thyroid flaps have significant application value in the reconstruction of the laryngeal cavity after partial laryngectomy for laryngeal cancer. It has high safety and feasibility, convenient surgical procedure, and satisfactory postoperative outcomes.
George A. Hung, Sanah Vohra, Gina Kim, Armaan Jamal, Malathi Srinivasan, Robert J. Huang, Gloria Kim, Latha Palaniappan, A. Dimitrios Colevas
Publication date 15-11-2024
Abstract Background Nasopharyngeal carcinoma (NPC) mortality varies based on multiple risk factors. While NPC mortality is higher in Asia, little is known about Asian subgroups in the United States (US).
Methods Using the 2005–2020 National Vital Statistics System, we examined NPC mortality by age, race (non-Hispanic black, Hispanic white (HW), non-Hispanic white (NHW), Chinese, Filipino, Asian Indian, Japanese, Korean, Vietnamese), sex, and nativity (Untied States or foreign-born).
Results Upon disaggregation, Chinese (1.
96 CI: 1.78–2.16), Filipino (0.68 0.68–1.11), and Vietnamese Americans (0.68 0.52–1.10) had the top age-adjusted mortality rates (AAMR per 100 000 person-years). Foreign-born Chinese, Vietnamese, Filipinos, Asian Indians, and NHW had higher AAMRs compared to US-born persons. All male groups had higher AAMR compared to females. Stratifying for race, nativity, and sex, foreign-born Chinese males (4.09 3.79–4.40) had the highest AAMR.
Conclusion These findings demonstrate the importance of disaggregating NPC mortality data by Asian subgroups, providing valuable insights for targeted public health interventions in the United States.
Shamini Kosgallana, Prasanna Jayasekara, Prasad Abeysinghe, Ratilal Lalloo
Publication date 15-11-2024
Abstract Background Radiotherapy is used to treat oral cancer, yet it negatively affects patients health-related quality of life (HRQOL). The aim was to evaluate the impact of an oral healthcare intervention on HRQOL of patients with oral cancer who receive radiotherapy with or without chemotherapy.
Methods An oral healthcare intervention was provided to 41 patients with oral cancer before radiotherapy (fluoride varnish application, scaling, permanent restorations, adjustment of sharp teeth, and extraction of teeth with questionable prognosis, oral hygiene instructions), during, and 3 months after radiotherapy (baking soda mouthwash, artificial saliva spray). EORTC QLQ-H&N35 was used to compare the HRQOL of the intervention and control groups, with the latter having received routine oral healthcare.
Results The intervention group showed lesser values for HRQOL domains and items indicating fewer side effects during the last week of radiotherapy and 3 months after, compared to the control group. Most of the changes in HRQOL were significantly less in the intervention group compared to the control group (p < 0.01).
Conclusion The oral healthcare intervention effectively reduced the effect of radiotherapy and positively impacted on HRQOL of patients with oral cancer.
Michael T. Werner, Dylan J. Cooper, Seth E. Kaplan
Publication date 15-11-2024
Abstract Background This scoping review aims to review cases of extranodal marginal zone lymphoma (MZL) of the larynx to establish best management practices for this rare clinical entity.
Methods In this paper, we report a case of laryngeal MZL, in accordance with CARE guidelines. We then performed a scoping review according to PRISMA-ScR criteria of published cases of MZL involving the larynx.
The following data were collected for each case: age, sex, size, location(s) involved, stage, treatment, follow-up, and recurrence duration.
Results Sixty-six patients with laryngeal MZL, first reported in 1990, were identified. Characterized by its low-grade histological appearance and indolent course, laryngeal MZL is generally confined to the larynx and has an excellent prognosis with radiation used as first-line therapy.
Conclusions It is imperative for clinicians to consider lymphoma in the differential diagnosis of a laryngeal tumor from any subsite, as certain pathologies may carry high risks of metastasis.
Larissa Sweeny, Anne C. Kane, Carissa M. Thomas, Neal Futran, Joseph M. Curry, Andrés M. Bur, G Nina Lu, Aishwarya Shukla, Hunter Skoog, Jaime A. Pena Garcia, Angela E. Alnemri, Rahul Alapati, Michael DiLeo, Andrew Fuson, Kenneth Tan, Farshid Taghizadeh, Gina D. Jefferson, Daniel Petrisor, Mark K. Wax
Publication date 15-11-2024
Abstract Background Free flap (FF) reconstruction of traumatic injuries to the head and neck is uncommon.
Methods Multi-institutional retrospective case series of patients undergoing FF reconstruction for a traumatic injury (n = 103).
Results Majority were gunshot wounds (GSW; 85%, n = 88) and motor vehicle accidents (11%, n = 11). Majority underwent osseous reconstruction (82%, n = 84). FF failures (9%, n = 9/103) occurred in GSW patients (100%, n = 9/9) and when multiple subsites were injured (89%, n = 8/9). Preoperative antibiotics correlated with lower rates of a neck washouts (4% vs. 19%) (p = 0.01) and 30-day readmissions (4% vs. 17%) (p = 0.02).
Conclusions All FF failures occurred in the setting of a GSW and the majority involved multiple subsites. Preoperative antibiotics correlated with lower rates of postoperative washout procedures and 30-day readmission.
Tian Wang, Jie Wang, Qiang Li, Yi Li, Xinmao Song
Publication date 15-11-2024
Abstract Introduction Head and neck rhabdomyosarcoma (HNRMS) is an aggressive malignant soft tissue tumor that easily develops lymph node metastasis (LNM) and distant metastasis. No literature investigates the pattern of LNM in HNRMS.
Methods Ninety-five consecutive patients with HNRMS newly diagnosed at one institution between November 2011 and July 2023 were retrospectively reviewed. All the patients underwent head and neck contrast-enhanced MRI and/or CT, PET-CT if necessary. The associations between LNMs and clinical characteristics and histopathological parameters were discovered.
Results44.2% of patients had evidence of LNM at diagnosis, and the most common LNM occurred in the ipsilateral retropharyngeal space. The primary tumor metastasizes to the retropharyngeal space, and then next to level II is the most common LN drainage basin. In multivariate analysis, only distant metastasis determines the prognosis, other than LN status.
ConclusionsLNM has a high incidence in HNRMS and rarely causes contralateral metastasis for localized lesions or skip metastasis.
Leba Michael Sarkis, Christopher MKL Yao, Aaron Hendler, Ravi Mohan, Michael Au, Han Zhang, Antoine Eskander, Kevin Higgins, Danielle MacNeil, Sharon Tzelnick, David Goldstein, Ali Hosni, John R. de Almeida
Publication date 15-11-2024
Abstract Background Lymphatic mapping with SPECT–CT has been demonstrated to accurately define lymphatic drainage patterns in oropharyngeal cancer but there has yet to be a study demonstrating its feasibility across multiple institutions.
Methods Twelve adult patients with lateralized oropharyngeal carcinoma (T1-T3) who were planned for definitive or adjuvant radiotherapy without contralateral nodal disease underwent injection of 99-m technetium sulfur colloid followed by static planar lymphoscintigraphy to verify tracer migration, and SPECT–CT acquired at 30 ± 15 min (optional) and 3 h (±1 h) (mandatory time-point).
Results All 12 patients completed the study with 7/12 patients having the injections performed under local anesthetic and 5 patients requiring general anesthetic. There were no tracer migration failures and there were no serious adverse events or complications encountered. Four out of 12 patients (33%) showed contralateral drainage patterns.
Conclusions Lymphatic mapping with SPECT–CT of lateralized oropharyngeal squamous cell carcinoma can be performed safely across multiple institutions.
Anu Sharma, Humzah Quereshy, Claudia I. Cabrera, Nicole Fowler, Shawn Li, Jennifer Dorth, Jason E. Thuener, Rod P. Rezaee, Akina Tamaki
Publication date 15-11-2024
Abstract Background We aim to describe the management and outcomes of patients with persistent lymphadenopathy (LAD) after primary chemoradiation for head and neck squamous cell carcinoma (HNSCC) based on post-treatment PET/CT results.
Methods Retrospective chart review was conducted of all patients who underwent primary concurrent chemoradiation for HNSCC at a tertiary care center from 2010 to 2022 and had persistent post-treatment LAD.
Results Nearly 62% of patients were managed conservatively, and 27.0% underwent neck dissection. PET-positive patients were more likely to undergo neck dissection than PET-negative patients (p = 0.042). Positive predictive value (PPV) and negative predictive values (NPV) of PET/CT in detecting residual disease in the neck were 48.0% and 73.7%, respectively.
ConclusionsPPV and NPV of PET/CT for detecting residual neck disease in patients with post-treatment LAD was lower than those of HNSCC patients with and without persistent LAD reported in other studies.
Yuji Imahara, Takeharu Ono, Norimitsu Tanaka, Shun‐ichi Chitose, Fumihiko Sato, Shuichi Tanoue, Takashi Kurita, Yusaku Miyata, Koichiro Muraki, Etsuyo Ogo, Chikayuki Hattori, Toshi Abe, Hirohito Umeno
Publication date 15-11-2024
Abstract Background Chemoradiation therapy with high-dose cisplatin is the standard regimen against advanced squamous cell carcinoma of the larynx (SCC-L). However, patients with renal dysfunction are ineligible for this regimen. We investigated the effectiveness and feasibility of selective intra-arterial low-dose cisplatin infusion and radiotherapy (modified m-RADPLAT) for patients with impaired renal function.
Methods We retrospectively reviewed the data of 77 patients with SCC-L who received m-RADPLAT.
Results Fourteen and 63 patients had creatinine clearance (Cr Cl) values of 30 ≤ Cr Cl < 60 mL/min and ≥60 mL/min, respectively. The m-RADPLAT regimen led to no significant changes in serum creatinine or Cr Cl values post-treatment. The 5-year local control, overall survival, and laryngectomy-free survival rates of the Cr Cl < 60 and ≥60 groups were 90.0% and 90.5%, 100% and 81.8%, and 100% and 79.0%, respectively. Grade 3 or higher toxicity rates were not significantly different between the groups.
Conclusions The m-RADPLAT regimen yielded favorable survival rates and clinical outcomes in patients with impaired renal function.
Keita Kishida, Keiichi Jingu, Kengo Ito, Rei Umezawa, Takaya Yamamoto, Noriyoshi Takahashi, Yu Suzuki, So Omata, Hinako Harada, Yasuhiro Seki, Nanae Chiba, Shinsaku Okuda
Publication date 15-11-2024
Abstract Background There has been no study in which the correlation between clinical results and dosimetry based on a 3D treatment planning system in patients with 198Au grains for head and neck cancer was evaluated.
Methods Thirty-two patients who were treated with 198Au grains for head and neck cancer were reviewed. Twenty-five patients were treated with brachytherapy alone and seven patients were treated with a combination of brachytherapy and neoadjuvant external beam radiation therapy.
Results With a median observation period of 60 months, the 5-year local control rate was 82.9%. V85Gy of CTV in patients with local recurrence tended to be lower than that in patients without local recurrence (p = 0.07). The maximum dose of the keratinized gingiva in patients in whom bone exposure occurred was significantly higher than that in patients in whom bone exposure did not occur (p = 0.001).
Conclusions Dose distribution with 198Au grains can predict local control and late adverse events.
Klara Stagl, Stefan Grasl, Boban M. Erovic, Stefan Janik
Publication date 15-11-2024
Abstract Background The study aimed to evaluate the diagnostic efficacy of routine follow-up in detecting recurrent disease in hypopharyngeal carcinoma.
Methods Data from 76 patients with a total of 620 follow-up visits, 367 radiological studies, and 126 panendoscopies were retrospectively assessed regarding the diagnosis of recurrent disease based on the results of (I) radiological studies, (II) clinical examinations, and (III) clinical symptoms.
Results All locally relapsed patients became symptomatic, and new onset of dysphagia (p < 0.001) was the most frequent complaint. The sensitivity for detecting local recurrences was 100% for both patients symptom assessments and clinical examinations. The highest overall accuracy was found for clinical examinations (93.4%), followed by symptom assessments (80.5%), and radiological studies (73.8%). The risk of false positive radiological reports and subsequent panendoscopies was 2.2 times higher after previous radiotherapy (32.0% vs. 14.6%; p < 0.001).
Conclusion Symptom assessments and clinical examinations are highly efficient for detection of local failures.
Annu Singh, Sallie M. Long, Amy L. Tin, Andrew J. Vickers, SaeHee K. Yom, Nancy Y. Lee, Joseph M. Huryn, Jennifer R. Cracchiolo, Cherry L. Estilo
Publication date 15-11-2024
Abstract Purpose To determine whether objective measures of oral health and salivary gland irradiation correlates with subjective measures of eating, drinking, and salivation in patients following head and neck radiation therapy (HNRT).
Methods This cross-sectional study included 112 patients following HNRT with a completed patient-reported outcome (PRO) scale. Objective measures at post-HNRT visit included decayed–missing–filled teeth (DMFT) scores, periodontal disease condition, oral hygiene status, dental prosthesis use, and prescribed radiation dose to salivary glands. Data were collected and statistical analysis was performed.
Results There was no significant association between PRO scales and dental prosthesis use, periodontal disease, and oral hygiene. Although some significant findings were seen with DMFT and prescribed radiation dose to salivary glands, this explained only very small amounts of the variation in eating, drinking, and salivation measures in these patients.
ConclusionPRO measures should be integrated in the routine care of patients with head and neck cancer.
Allen M. Chen
Publication date 15-11-2024
Abstract Purpose As society grows in cultural diversity, an increasing proportion of patients are expected to be from non-English speaking backgrounds. This study sought to compare the clinical outcomes between non-English speakers and English speakers treated by radiation therapy for head and neck cancer.
Methods and materials Seventy-five non-English speaking patients with squamous cell carcinoma of the head and neck were matched to English-speaking controls based on patient and disease variables; clinical outcomes were compared.
Results Non-English speaking patients had inferior 3-year overall survival (64% vs. 77%, p = 0.02) and progression-free survival (59% vs. 73%, p = 0.01) compared with the English-speaking cohort. On logistical regression, non-English-speaking status was associated with a significantly increased risk of overall death (OR = 1.41; 95% CI, 1.09–1.92).
Conclusions Prognosis differed significantly between non-English speaking and English-speaking patients. Culturally tailored programs to address language barriers should be considered to ameliorate disparities in outcome.
Shuwen Yang, Zhirong Sun, Changming Zhou, Wenjun Wei, Ning Qu, Rongliang Shi, Ben Ma, Weibo Xu, Qinhai Ji, Jun Zhang, Yu Wang
Publication date 15-11-2024
Abstract Background To investigate feasibility of utilizing enhanced neuromuscular blocking agents with selective recovery protocol during thyroid surgery with intraoperative neuromonitoring (IONM).
Methods Two-hundred and ninety patients were randomized into two groups: group A 0.3 mg/kg rocuronium and group B 0.6 mg/kg. Sugammadex 2 mg/kg was injected if needed followed initial vagal stimulation (V0). Electromyography signals from vagus and recurrent laryngeal nerves before and after resection were recorded as V1, V2, R1, and R2.
Results In group B, 30 patients (20.7%) had V0 signals <100 μV, compared to 9 (6.2%) in group A. After sugammadex administration, 144 patients (99.3%) in both groups achieved positive V1 signals. Group B demonstrated a shorter surgical time from rocuronium injection to V2 stimulation compared to group A, accompanied by a significantly lower incidence of intraoperative body movement (0 vs. 16 patients).
Conclusions0.6 mg/kg rocuronium with selective use 2 mg/kg sugammadex for IONM in thyroid surgery can meet both anesthesia and surgery demands.
Jenan A. Altamimi, Janet A. Wilson, Justin Roe, Joanne M. Patterson
Publication date 15-11-2024
Abstract Objectives Swallowing function in patients with head and neck cancer (HNC) is often assessed pre-treatment, during and at intervals post-treatment to identify those with dysphagia as early as possible. This study aims to investigate the minimal clinical important difference (MCID) for the 100 mL water swallow test (100 mL WST) to increase its utility in clinical practice and in clinical trials.
Methods Data from 211 HNC patients, treated by either single or combined modality were included. Patients completed both the 100 mL WST and M.
D. Anderson Dysphagia Inventory (MDADI) at baseline (i.e., prior to treatment) and 12 months post-treatment. The MCID for the 100 mL WST was calculated using two approaches of the anchor-based method (using the MDADI), including mean change, and ROC curve. Additionally, the distribution-based method was used utilizing the half standard deviation approach.
Results In the anchor-based method, a 4 mL/s in the 100 mL WST was defined as an MCID for deterioration, with a sensitivity of 75% and a 1-specificity of 46%. In contrast, a change of 5 mL/s was deemed as an MCID for improvement, based on the distribution-based method.
Conclusion The findings showed that deterioration of 4 mL, or an increase of 5 mL from baseline to 12 months post-HNC treatment equates to an MCID from the patients perspective. Based on these findings, it may be beneficial to increase the utilization of the 100 mL WST in clinical practice to observe the changes, and in clinical trials to interpret and compare different study arms.
Valentine Poissonnet, Bertille Segier, Raphaël Lopez, Aurore Siegfried, Agnès Dupret‐Bories, Jérôme Sarini, Vinciane Poulet, Franck Delanoë, Sébastien Vergez, Emilien Chabrillac
Publication date 15-11-2024
Abstract Objective To elucidate the prognostic implications of mucosal and deep margin distances in oral tongue squamous cell carcinoma (OTSCC), and to assess a different margin cut-off value in T1-T2 versus T3-T4 tumors.
Methods This single-center retrospective study included 223 patients who received surgery for a primary OTSCC between January 2017 and December 2021.
Results Multivariable analysis showed that deep margin distance ≥3 mm in T1-T2 tumors and ≥5 mm in T3-T4 tumors was significantly associated with better RFS and OS. Mucosal and deep margin distances were globally clinically useful for 2-year RFS prediction of T1-T2 tumors, for which deep margins seemed to have more clinical utility than mucosal margins. The influence of margin distances on 2-year RFS seemed greater for T1-T2 tumors than T3-T4 tumors.
Conclusion Mucosal and deep margin distances were associated with OS and RFS in OTSCC. Shorter deep margin distances may be aimed for in T1-T2 versus T3-T4 tumors.
Lu Wang, Pan Ren, Peng‐Cheng Cui, Le‐Ping Liang, Qian‐Qian Zhao, Da‐Qing Zhao
Publication date 15-11-2024
Abstract Objective Patients with laryngotracheal stenosis (LTS) often have dysphagia after laryngotracheal reconstruction with T-tube insertion, which affects the quality of life. The purpose of this study is to observe the effect of swallowing rehabilitation therapy on the improvement of quality of life in patients of otolaryngology-head and neck surgery with dysphagia undergoing T-tube implantation treatment through longitudinal study.
Methods Thirty-eight patients with LTS who experienced dysphagia after laryngotracheal reconstruction and T-tube implantation were recruited. All patients received swallowing rehabilitation therapy. The assessment of swallowing function was performed using the 10-item Eating Assessment Tool (EAT-10), the 30 mL water swallow test (WST), and flexible endoscopic evaluation of swallow (FEES).
Results After swallowing rehabilitation therapy, timing of swallowing, grade of dysphagia, performance on FEES and 30 mL WST, and EAT-10 score all improved. Thirty-eight patients successfully transitioned to oral feeding and were able to remove their nasogastric tubes without experiencing any complications, including aspiration pneumonia.
Conclusion For patients with LTS who experienced dysphagia after laryngotracheal reconstruction and T-tube implantation, swallowing rehabilitation therapy could improve swallowing function of the patients, so as to reduce the potential harm caused by the pain and complications of surgery experienced by patients.
Emma Charters, Jamie Loy, Kai Cheng, Masako Dunn, Timothy Manzie, Boyang Wan, Vinay Tumuluri, Jonathan R. Clark
Publication date 15-11-2024
Abstract Background Trismus therapy is often delayed after jaw reconstruction to avoid hardware failure or non-union. The aim of this study is to document the forces that have been applied to patients undergoing free flap reconstruction of the oral cavity in the 12 months following oral cavity reconstruction, and to analyze the associations between force and maximal interincisal opening (MIO) over time.
Methods Participants with trismus after free flap reconstruction of the oral cavity completed a 10-week jaw stretching program using Restorabite™. Primary outcome measures included the minimum and maximal force applied by a trismus device during rehabilitation, MIO, bone union, and health-related quality of life outcomes up to 12 months postoperatively.
ResultsA mean of 20.6 Newtons (N) was used during passive exercises and 38.9 N during active exercises was used during trismus therapy. The mean increase in MIO for the 45 participants after 10 weeks, 6 months, and 12 months of therapy was 8.4 mm (p < 0.001), 12.6 mm (p < 0.001), 12.7 mm (p < 0.001), respectively. There was no significant difference in the mean minimal (p = 0.37) or mean maximal (p = 0.08) force applied between those who underwent osseous free flap reconstruction compared to fasciocutaneous only, respectively. In patients who underwent osseous reconstruction, 25 (67.6%) had complete bone union and 12 (32.4%) had partial union at 12 months postsurgery.
Conclusions In participants undergoing osseous free flap reconstruction, there was no association between the force applied to the rates of bone union. Further research to define safe and optimal loading may benefit patients undergoing jaw reconstruction.
Seong Hoon Bae, Haeng Ran Park, Hyunseo Lim, Hyo Yeol Kim, Taeuk Cheon, Jinsei Jung, Young‐Min Hyun
Publication date 15-11-2024
Abstract Background Corticosteroid therapy is commonly recommended for acute facial nerve weakness; however, its effectiveness in treating traumatic nerve injuries remains controversial. This study investigated the functional recovery and cellular effects of systemic dexamethasone administration after facial nerve injury.
MethodsC57BL/6 mice were assigned to two groups by intraperitoneal injection: the phosphate-buffered saline group and the dexamethasone group. Facial nerve crush injury was induced, followed by the functional grading of recovery. Cellular effects were investigated using transmission electron microscopy, flow cytometry, immunofluorescence, and intravital imaging.
Results Macrophage infiltration into the facial nerves was significantly inhibited by systemic dexamethasone administration. However, dexamethasone group slightly delayed the functional recovery of the facial nerve compared to the PBS group. In addition, the morphological changes in the nerve were not significantly different between the two groups at 14 days post-injury. Macrophage migration analysis in the intravital imaging also showed no difference between groups.
Conclusions In summary, systemic dexamethasone successfully inhibited leukocyte infiltration; however, functional recovery was delayed compared to the PBS control group. Clinically, these findings indicate that more evidence and research are required to use steroid pulse therapy for the treatment of traumatic facial nerve injuries.
Robbie Woods, Daniel Scholfield, Lucas Axiotakis, Conall Fitzgerald, Dauren Adilbay, Jennifer Cracchiolo, Snehal Patel, Jatin Shah, Lara Dunn, David Pfister, Nancy Lee, Snjezana Dogan, Ian Ganly, Marc Cohen
Publication date 15-11-2024
Abstract Background We evaluate outcomes of SMARCB1-deficient sinonasal carcinomas in the largest single-institution study.
Methods Retrospective cross-sectional study of patients with SMARCB1-deficient sinonasal carcinoma between 1998 and 2024. Disease-specific survival (DSS) and recurrence-free probability (RFP) at 1 and 5 years were measured by Kaplan–Meier method.
Results There were 47 patients with a median age of 53. Initial pathological diagnosis was altered in 33%. Twelve (34%) patients received neoadjuvant chemotherapy, with one partial response. Curative surgical approach was undertaken in 73%. Definitive chemoradiation was administered in 20%. DSS at 1 and 5 years was 93% and 45%, respectively. RFP at 1 and 5 years was 73% and 33%, respectively. On multivariate analysis, cranial nerve involvement (p = 0.01 for DSS) remained significantly worse for DSS and overall survival.
ConclusionsSMARCB1-deficient tumors had limited response to neoadjuvant chemotherapy. Cranial nerve involvement was associated with worse prognosis. Optimal treatment is unclear. Surgery should be offered to patients with resectable disease.
Anthony M. Tonsbeek, Caroline A. Hundepool, Aprilia L. Molier, Eveline Corten, Bianca Rijken, Aniel Sewnaik, Marc A. M. Mureau
Publication date 15-11-2024
Abstract Background Few studies have examined health-related quality of life (HRQOL) outcomes in long-term total laryngectomy survivors in relation to the type of hypopharyngeal defect.
MethodsA cross-sectional study was performed in long-term total laryngectomy survivors, treated between 2000 and 2020. The primary outcome was HRQOL, assessed using the FACE-Q Head and Neck Cancer Module, in relation to the type of hypopharyngeal closure (primary closure, partial or circumferential reconstruction).
Results Seventy-nine survivors were included with a median follow-up of 92.1 months (IQR 75.6–140.2 months). Patients requiring partial hypopharyngeal reconstruction (n = 18) scored significantly worse than patients with primary closure (n = 51) on 4 of 13 FACE-Q domains: functional domains of eating (p = 0.03), speech (p = 0.05), and swallowing (p = 0.03), and the psychological domain of speaking-related distress (p = 0.02). No statistically significant differences were found between the circumferential hypopharyngeal defect reconstruction group (n = 10). Stricture occurrence was the only clinical factor associated with worse eating, speaking, swallowing, eating-related distress, and cancer worry in multivariable analyses.
Conclusion Several functional and psychological domains were significantly worse following partial hypopharyngeal reconstruction than in patients who received primary closure. Efforts to reduce stricture rates to enhance reconstructive outcomes following total laryngectomy merit further research.
Sophie McGregor, Katrina Zaraska, Matthew Lynn, Sena Turkdogan, Khanh Linh Tran, Eitan Prisman
Publication date 15-11-2024
Abstract Background The scapula free flap is becoming increasingly more utilized in head and neck reconstruction due to its natural geometry and soft tissue versatility. This study reviews the incidence rate, risk factors, and treatments of complications of scapula donor site morbidity.
MethodsA review was performed for articles published between October 1990 and November 2022 in Medline (OVID), Pub Med, Web of Science, and CENTRAL. After screening, 24 articles meeting the criteria were included.
Results Overall, 660 head and neck surgeries with the scapula donor bone across 24 studies were included. Twenty studies of 612 scapula free flaps reported a pooled postoperative complication rate of 10.7%, with no major complications. Seven studies of 199 scapula reconstructions showed a mean Disability of Arm, Shoulder and Hand (DASH) score of 14.39/100.
Conclusion With its low rate of morbidity, the scapula flap presents itself as a good alternative for patients at risk for poor healing.
Jessica W. Gregor, Brent Chang, Nandita Keole, Alyssa McGary, Samir Patel
Publication date 12-11-2024
ABSTRACTBackground External and internal head and neck cancer related lymphedema (HNCRL) is a common consequence of radiation treatment (RT). Currently, internal HNCRL can be clinically assessed endoscopically using a visuoperceptual, ordinal rating scale. Use of fluoroscopy to identify and measure internal HNCRL has been explored but is not widely used in clinical practice. Advanced Pneumatic Compression (APC) has shown external HNCRL reduction after a single treatment, whereas internal HNCRL reduction has not yet been assessed.
Methods Fluoroscopic lateral scouts and TIMS Review software (TIMS Medical) were used to assess immediate internal HNCRL measures of 30 HNC patients with RT history following a single APC treatment. Pre and post external measures were also obtained. Paired t-test was used to assess changes in pre and post measures. A post-treatment survey was completed.
Results All 30 patients had both immediate external and internal HNCRL reductions, and all reductions were statistically significant. All reported positive benefit.
ConclusionsA single, external APC treatment immediately impacted the extent of pharyngeal and laryngeal edema in post-radiated HNC survivors. Fluoroscopy can be a clinically useful and complementary modality to detect, surveil, and measure internal HNCRL.
Ya‐Hsuan Yu, Rushil Rajiv Dang, Wan‐Shiun Fan, Min‐Chi Chen, Yu‐Feng Hu, Chung‐Kang Tsao, Po‐Wen Chuang, Ellen Michelle Lee, Chi‐Kuang Young, Chun‐Ta Liao, Chung‐Jan Kang, Shiang‐Fu Huang
Publication date 11-11-2024
ABSTRACTBackground This study evaluates the impact of maxillary sinus mucosa preservation on radiographic outcomes after an inferior maxillectomy and soft-tissue free flap reconstruction.
MethodsA total of 90 patients in two cohorts (mucosal sacrifice versus mucosa preservation) were evaluated from an institutional dataset. Imaging was reviewed at set time points and sinus scores were allotted based on a modification of the Lund—Mac Kay system. Patients were evaluated for changes in sinus scores. A univariate (UVA) and multivariate (MVA) analysis was performed.
Results In gp1 (mucosal sacrifice), mean postoperative sinus score was 1.21 ± 1.30 (p = < 0.001) at 24 months. On UVA, advanced T-stage at 12 months (OR 7.143, 95% CI 1.484–34.384, p = 0.014) and 24 months (OR 5.500, 95% CI 1.219–24.813, p = 0.027), and on MVA, advanced T-stage were associated with increased odds for higher sinus score (OR 4.993, 95% CI 1.084–22.995, p = 0.039). In Gp2 (Mucosa preserved), the mean postoperative sinus score was 0.31 ± 0.47 (p = 0.021) at 24 months. On UVA and MVA, no predictors were identified for a higher sinus score.
Conclusion Following an inferior maxillectomy and soft-tissue free flap reconstruction, notably reduced sinus scores were seen in patients with preservation of the remaining maxillary sinus mucosa.
Yi‐Fan Kang, Lie Yang, Yi‐Fan Hu, Kai Xu, Lan‐Jun Cai, Bin‐Bin Hu, Xiang Lu
Publication date 11-11-2024
ABSTRACTBackground The early diagnosis of laryngeal cancer (LCA) is crucial for prognosis, driving our search for an accurate, precise, and sensitive deep learning model to assist in LCA detection.
Methods We collected 5768 laryngoscopic images from 1462 patients and created the intelligent laryngeal cancer detection system (ILCDS) based on Swin-Transformer. Following training and validation, we assessed the ILCDS performance on the internal and external test sets and compared it with previous convolutional neural network (CNN) models and three professional laryngologists.
Results The ILCDS outperformed the six CNNs, with the highest accuracy of 92.78% and an area under the curve (AUC) of 0.9732. Despite a slight drop in performance on external sets, the ILCDS maintained the best superiority, with 85.79% accuracy and an AUC of 0.9550. Surpassing professional laryngologists, the ILCDS achieved 92.00% accuracy.
Conclusions The ILCDS offers high accuracy and stability for LCA detection, reducing the burden on laryngologists.
Xiaoxuan Chen, Kiran Abraham‐Aggarwal, David I. Kutler
Publication date 11-11-2024
ABSTRACTBackground Ewing sarcoma (ES) of the ethmoid sinus with orbital involvement in an adult is very rare, with 16 reported cases in the literature. Immunohistochemical studies show small blue round cells positive for CD99 and fluorescence in situ hybridization (FISH) testing reveals positivity for the EWSR1 gene.
MethodsA 38-year-old male with a diagnosis of ES of the ethmoid sinus presented with left-sided periorbital pain and edema, rhinorrhea, and proptosis. The patient underwent neoadjuvant chemotherapy, surgical resection of the left skull base, and postoperative proton radiotherapy.
Results The patient tolerated chemotherapy, surgical resection, and adjuvant proton radiotherapy well with resolution of proptosis, diplopia, and pain. Due to local recurrence, he is currently undergoing adjuvant chemotherapy.
Conclusion Our findings provide insight on the clinical presentation and appropriate management of extraosseous ES, specifically in the ethmoid sinus in the adult population.
Oliver P. Sutter, Alexander Maurer, Thomas M. Stadler, Martin Lanzer, Martin W. Huellner, Martina A. Broglie
Publication date 08-11-2024
ABSTRACTBackground In the clinical management of advanced stage head and neck squamous cell carcinoma, the use of hybrid 18FFDG-PET imaging is well established. However, there is ongoing debate regarding the optimal frequency of hybrid PET scans to be included in follow-up protocols, particularly if the initial post-therapeutic scan is negative.
Methods We conducted a single-center 10-year retrospective study involving all patients who underwent hybrid PET scans for the follow-up of advanced stage head and neck cancer. A total of 285 patients were included.
Results Out of 199 patients with a negative 3-month hybrid PET, 15% subsequently developed a recurrence during further follow-up. Notably, 90% of these recurrences were detected by hybrid PET.
Conclusion Fifteen percent of patients with a negative 3-month hybrid PET experienced a recurrence. Given that the majority of recurrences were detected by hybrid PET scans, there is a compelling argument for incorporating regular repetitive scans during follow-up.
Diana S. Shaari, Danielle A. Kapustin, Michelle Yoon, Samuel J. Rubin, Azita Khorsandi, Ricardo J. Ramirez, Michael Schiff, Mark L. Urken
Publication date 08-11-2024
ABSTRACTBackground Radiation therapy with or without chemotherapy is commonly used as an adjunct or alternative to surgery for treating head and neck cancer (HNC). In rare cases, radiation-induced side effects such as posterior pharyngeal wall necrosis, fistula formation, and osteoradionecrosis (ORN) can lead to dangerous complications of the cervical spine (C-spine).
Methods We conducted a literature review on C-spine ORN in HNC, and we reported four additional cases following the treatment of oropharyngeal carcinoma.
Results We identified 26 reported cases of C-spine ORN following radiation for HNC. Of the four cases from our institution, two were treated with surgical management and two with conservative measures. Two patients were able to resume oral intake. The median time to diagnosis was 121.5 (range: 22–194) months after completion of radiation.
Conclusion Late complications of radiation can be devastating, severely limiting functional status and quality of life. C-spine ORN is related to total radiation dose and should be discussed with patients as a rare but serious side-effect.
Ahneesh J. Mohanty, Joep A. F. van Rooij, Renée M. L. Miseré, Arno Lataster, Shai M. Rozen, René R. W. J. van der Hulst, Stefania M. H. Tuinder
Publication date 07-11-2024
ABSTRACTBackground Despite indications of a close interaction between the trigeminal (CN V) and facial nerve (CN VII) within the buccinator muscle, a combination of anatomical dissection and histological analysis has not been reported.
Methods Five formalin-fixed and fresh-frozen hemifaces were dissected to reveal the buccal fat pad, the buccinator muscle, and anastomotic connections between CN V and CN VII within it. Samples were taken for histological processing and immunostaining.
Results Branches of CN V and CN VII formed pronounced sensorimotor anastomotic connections in and surrounding the buccinator muscle. These findings were histologically evident with close intramuscular coupling of sensory and motor fibers. There was an evident but gradual shift from motor to sensory fibers in the interconnections when analyzing them from the side of CN V toward the side of CN VII and vice versa.
Conclusions These results further elucidate connections between CN V and CN VII and their possible role in proprioception of the facial muscles.
Adebayo Alade, Melissa Persad, George Bitar, Alina Dragan, Nicos Fotiadis, Joshua Shur, Kee\xa0Howe Wong, Brian Ng‐Cheng‐Hin, Vinidh Paleri, Kevin Harrington, Derfel\xa0Ap Dafydd
Publication date 06-11-2024
ABSTRACTBackground Traditional head and neck cancer treatment involves open surgery, cytotoxic chemotherapy, and conventional radiotherapy planning. Emerging techniques aim to improve precision and reduce associated toxicity and functional impairment in current practice. This review article describes four such adaptations in image guidance, tailored to next generation therapies.
Methods This is a review of current literature, including feasibility studies from our cancer center, relating to: saline-aided intra-oral ultrasound-guided retropharyngeal biopsy; intra-oral ultrasound guided trans-oral robotic surgery (TORS); ultrasound-guided injection of “directly injected therapies”; and magnetic resonance imaging-guided radiotherapy.
Results Presented within the context of the wider literature, initial local experience and data indicate good technical outcomes and patient tolerance, and low technical complications in all four image guidance techniques.
Conclusion Initial findings suggest a potentially important future role for these four image guidance techniques, on which next generation therapies are reliant. The broader implications on cross-disciplinary collaboration are also explored herein.
Shu Zhang, Ni Zeng, Jiangping Yang, Jiaqi Han, Jinlan He, Baofeng Duan, Xiaoqiang Chen, Xiaofang Gou, Fubin Zhu, Huizhen Liu, Ming Zeng, Di Yan, Nianyong Chen
Publication date 05-11-2024
ABSTRACTObjective To investigate the failure patterns of recurrent nasopharyngeal carcinoma (NPC), especially to identify the relationship between the recurrent-prone anatomic structures and the tumor regression sites after the introduction of chemotherapy (IC).
MethodA cohort of 1121 non-metastatic patients with NPC was retrospectively enrolled. The pretreatment and recurrent images of each patient were registered to the planning CT. Tumor regression sites after IC (Vicr) overlapped with recurrent tumor (rGTV) were evaluated for the delineation accuracy and dose sufficiency in marginal failure patients.
ResultsA total of 126 (11.24%) experienced tumor recurrence. Re-evaluation of 12 patients with local marginal recurrence, their rGTV within Vicr predominantly located at choanae, sphenoidal sinus, and cavernous sinus. The regression sites did not receive the full 70 Gy but over half receiving with 60Gy.
Conclusion Analysis from marginal failure that exempts tumor regression sites from GTV or an insufficient prescription dose of less than 70 Gy may contribute to marginal failure.
Yu‐Hao Liao, Ya‐Fang Chen, Min‐Shu Hsieh, Mei‐Chun Lin, Chun‐Wei Wang, Cheng‐Ping Wang, Pei‐Jen Lou, Tseng‐Cheng Chen
Publication date 04-11-2024
ABSTRACTBackground Extranodal extension (ENE) had been included in the latest cancer staging system in hypopharyngeal squamous cell carcinoma (HypoSCC). However, the impact of ENE on HypoSCC survival and treatment outcomes are still unclear.
Methods Records from all HypoSCC patients diagnosed at the National Taiwan University Hospital from January 2007 to December 2018 were reviewed. All patients were divided into two groups, with or without ENE. Clinical features, pathological factors, and survival rates between the two groups were reviewed.
Results We analyzed data from 388 HypoSCC patients, 125 (32.22%) with and 263 (67.78%) without ENE. The 5-year overall survival of the HypoSCC patients with radiological ENE, pathological ENE, and without ENE were 22.9%, 40.3%, and 55.5%. From the multivariate analysis, primary T3/T4 classification (p = 0.001) and radiological ENE (p < 0.001) were independent risk factors for disease-free and overall survival (OS). Finally, upfront neck dissection may significantly benefit disease-free survival (DFS) and neck nodal control in ENE+ (p = 0.002 and p = 0.007, respectively) or ENE− patients (p = 0.003 and p = 0.02, respectively).
Conclusion More than one-third of HypoSCC patients have ENE, with significantly lower OS and DFS. The upfront neck dissection could provide better DFS and neck nodal control.
Julie.\xa0A. Theurer, Rosemary Martino, Nedeljko Jovanovic, John\xa0R. de Almeida, David\xa0P. Goldstein, Kevin Fung, John Yoo, S.\xa0Danielle MacNeil, Eric Winquist, J.\xa0Alex Hammond, Varagur Venkatesan, Nancy Read, Sarah Kuruvilla, Andrew Warner, Philip\xa0C. Doyle, Ian Ross, Colleen Dreyer, Sarah Hawkins, Kendra Thouless, Courtney McCallum, David\xa0A. Palma, Anthony\xa0C. Nichols
Publication date 04-11-2024
ABSTRACTBackground This ORATOR sub-study evaluated swallowing physiology in patients treated with transoral robotic surgery (TORS) versus radiotherapy (RT) for early-stage oropharynx cancer.
Methods Swallowing physiology was evaluated using videofluoroscopy and outcomes were compared across treatment arms and correlated with MDADI scores.
Results Of the 68 patients in the ORATOR trial, 21 participated in this sub-study (30.8%), including 15 RT Arm and six TORS Arm patients. Swallowing profiles were not significantly different between the arms. MBSImP pharyngeal scores for RT Arm versus TORS Arm patients were 4.8 (±2.1) versus 4.3 (±1.5) at baseline, 6.2 (±1.2) versus 9.6 (±4.8) at 6 months and 5.9 (±1.8) versus 8.0 (±4.7) at 12 months. MBSImP pharyngeal scores demonstrated weak associations with several MDADI subscales and PAS scores.
Conclusions To best describe swallowing outcomes in studies of RT and/or surgery, instrumental swallowing assessments should be strongly considered in addition to quality of life measures.
Iulia Tapescu, Abigail Kohler, Neel R. Sangal, Jason A. Brant, Robert M. Brody, Timothy Chao, Ryan M. Carey
Publication date 04-11-2024
ABSTRACTBackground Spindle epithelial tumors with thymus-like differentiation (SETTLE) and carcinomas showing thymus-like differentiation (CASTLE) are rare intrathyroid tumors.
Methods This retrospective cohort study included patients diagnosed with SETTLE, CASTLE, and papillary thyroid carcinoma (PTC) from 2004 to 2020 within the National Cancer Database (NCDB). Demographic, tumor, and treatment characteristics were compared. Overall survival (OS) was analyzed using the Kaplan–Meier method and Cox regression models.
Results This study identified 19 patients with CASTLE, 11 with SETTLE, and 483 474 with PTC. CASTLE and SETTLE patients had larger tumors, lymphovascular invasion, and positive surgical margins. They were rarely treated with radioactive iodine treatment but frequently received external beam radiation and chemotherapy. Five-year OS was significantly lower for CASTLE and SETTLE compared to PTC. SETTLE was associated with an increased risk of death.
ConclusionSETTLE and CASTLE are rare intrathyroid tumors with worse survival compared to PTC, often managed with radiation, chemotherapy, and surgery.
Gozde Yazici, Serkan Akin, Alper Kahvecioglu, Ecem Yigit, Fatma\xa0Alev Turker, Ferah Yildiz
Publication date 01-11-2024
ABSTRACTBackground This study evaluates the oncological outcomes and toxicities of indolent ocular adnexal and orbital lymphomas (OOLs) treated with radiotherapy (RT) ± systemic therapy.
MethodsA retrospective analysis of 44 patients with indolent OOLs treated with RT was conducted.
Results Most patients (87%) had early-stage disease. Treatment involved RT alone (34%) or RT + systemic therapy (66%). The median RT dose was 30 Gy, with a median follow-up of 45 months. Local and systemic recurrence rates were 4% and 9%, respectively. Five-year overall and disease-free survival (DFS) rates were 96.2% and 83.6%. Early-stage patients showed similar DFS rates regardless of whether they received RT alone or RT plus systemic therapy. No grade 3 RT-related toxicity occurred, but systemic therapy led to grade 3 toxicity in 17% of patients.
ConclusionsRT is essential for treating indolent OOLs, and combination with systemic therapies does not enhance outcomes for early-stage patients.
Emma Charters, Rebecca Venchiarutti, Masako Dunn, Jonathan Clark
Publication date 31-10-2024
ABSTRACTObjective This study evaluates how health care professionals manage trismus in Australia and identifies facilitators and barriers experienced by clinicians in routine patient care.
MethodsA mixed-methods approach was used to evaluate the experience of clinicians. Medical, nursing, and allied health practitioners in Australia were invited to participate if they had treated patients with trismus in the last 5 years. Participants completed an investigator-designed survey and were invited to participate in a semi-structured audio-recorded interview to explore practice in more depth. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed thematically using an inductive, data-driven approach.
Results Fifty-six clinicians (38 speech pathologists, 9 physiotherapists, 7 medical doctors, 1 nurse, and 1 osteopath) completed the survey, 12 of which also participated in an interview. The most common assessment tool was a commercially available measurement tool (Therabite or Orastretch), the most common treatment approach was stacked tongue depressors, and the most common exercise regimen was a 30- s stretch 25 times per day. Common barriers to trismus management included the high cost of devices, lack of clinical experience, and lack of training opportunities outside their institution. Clinician-perceived facilitators were different modes of information provision and time to consider the exercise instructions and rationale. Several clinicians relied on telehealth to reach patients in remote locations and improve efficiency.
ConclusionA range of clinicians treat trismus arising from a variety of conditions. Training opportunities are critical for clinicians to develop and extend their skills in assessing and treating trismus.
Impact Statement The morbidity associated with trismus, and the absence of a clinical guideline or consensus document warrants careful consideration as to the translation of evidence into the clinical context.
Michele Sassano, Stefania Boccia, Yuan‐Chin\xa0Amy Lee, Mia Hashibe, Paolo Boffetta
Publication date 30-10-2024
Shih‐Wei Lai
Publication date 30-10-2024
"Claire\xa0M. Rooney, Shao\xa0Hui Huang, Jie Su, Scott Bratman, John Cho, John de Almeida, Michael Glogauer, David Goldstein, Ezra Hahn, Ali Hosni, Andrew Hope, Jonathan Irish, John Kim, Brian OSullivan, Jolie Ringash, Anna Spreafico, Jillian Tsai, John Waldron, Christopher Yao, Erin Watson, Andrew McPartlin"
Publication date 30-10-2024
ABSTRACTBackground We investigate the association of postoperative radiotherapy (PORT) volumes and salivary function in oral cavity SCC (OSCC).
MethodsOSCC patients undergoing PORT 2005–2021 underwent modified Schirmer test (MST) pre-PORT, 6 and/or 12 months post-PORT. Hyposalivation rates were compared by PORT volumes. MVA identified predictors for chronic hyposalivation.
Results Among 165 eligible patients, 88 (53%) received bilateral, 66 (40%) ipsilateral, and 11 (7%) no-neck (primary-only) PORT. Baseline characteristics were similar, except more N2b/N2c disease received bilateral PORT vs. ipsilateral or no-neck (60% vs. 36% vs. 0%, p < 0.001). Baseline hyposalivation was similar (26% vs. 30% vs. 18%, p = 0.67). Hyposalivation occurred more frequently in bilateral vs. ipsilateral vs. no-neck PORT at 6 (90% vs. 62% vs. 9%) and 12 months (90% vs. 48% vs. 0%) (both p < 0.001). On MVA, bilateral neck PORT and smoking predicted chronic hyposalivation.
Conclusion Increasing PORT volumes predict saliva function recovery and chronic hyposalivation, informing treatment discussions.
A.\xa0A. Thai, R.\xa0J. Young, M. Bressel, G.\xa0L. Kelly, N. Sejic, S.\xa0W. Tsao, A. Trigos, D. Rischin, B.\xa0J. Solomon
Publication date 30-10-2024
ABSTRACTBackground The success of BH3 mimetics in hematological malignancies has spurred interest in their application in solid tumors. We examined the expression of the BCL-2 family of molecules in NPC tumors and cell lines and explored the anticancer efficacy of BH3 mimetics in vitro.
Methods Immunohistochemistry for BCL-2, MCL-1, BCL-xL, and transcriptomic analyses was conducted on NPC tumors. The efficacy of ABT-199, S63845, and ABT-737 were examined as monotherapy and in combination with cisplatin in NPC cell lines. RNA sequencing was performed to identify up and downregulated pathways in sensitive cell lines.
Results One hundred and forty-nine EBV-positive NPC and 15 EBV-negative NPC were identified. Expression of BCL-2 was more frequent in EBV-positive NPC. BCL-2, MCL-1, and BCL-xL expression was not prognostic for overall survival. Marked sensitivity was seen with the combination of S63845 and cisplatin in NPC43.
Conclusion Our study demonstrates the therapeutic potential of combining cisplatin and S63845, which warrants further investigation.
Nofar Edri, Dean Dudkiewicz, Dan Yaniv, Amit Ritter, Yulia Strenov, Aviram Mizrachi, Gideon Bachar, Thomas Shpitzer, Eyal Yosefof
Publication date 30-10-2024
ABSTRACTBackground Depth of invasion (DOI) has a significant clinical impact on the staging system of oral squamous cell carcinoma (OSCC). We aimed to compare the prognostic impact of treating DOI as a continuous variable rather than a categorical one.
MethodsA retrospective review of 277 OSCC patients surgically treated in a tertiary care center from 2000 to 2020, with a minimum 2-year follow-up. The analyses were performed using Cox and logistic regression.
ResultsDOI as a continuous variable significantly predicted mortality in both univariate (p < 0.001) and multivariate (p < 0.001) analyses. It was also a significant predictor of locoregional recurrence (multivariate p = 0.039) and occult lymph node metastasis (univariate p = 0.005, multivariate p = 0.04). Categorical analysis failed to demonstrate the same significance.
ConclusionsDOI as a continuous factor rather than a categorical one is significantly associated with mortality, locoregional recurrence, and occult lymph node metastasis. This innovative approach promotes personalized risk stratification and better decision-making.
Publication date 29-10-2024
Keerthi\xa0E. Kurian, Osama Hamdi, Zoe\xa0A. Roecker, Simone\xa0A. Barker, Andrew Strumpf, Jonathan\xa0C. Garneau, David\xa0C. Shonka
Publication date 28-10-2024
ABSTRACTBackground Preoperative localization of parathyroid adenomas aids surgical planning for patients with hyperparathyroidism. This study explores the diagnostic accuracy of surgeon-reviewed 4D computed tomography (4D CT) scans for localization of parathyroid adenomas.
MethodsA retrospective review of 95 patients with hyperparathyroidism who underwent parathyroidectomy at a tertiary care center was performed. The sensitivity, specificity, positive and negative predictive values, accuracy of identifying abnormal glands by surgeon, and interrater reliability between two head and neck surgeons was assessed.
Results The sensitivity of surgeon localization of all glands was 71% (95% CI, 63%–78%), improving to 76% when combined with radiology reads. The specificity was 98% (95% CI, 95%–99%), the positive predictive value was 95% (95% CI, 90%–99%), and the negative predictive value was 84% (95% CI, 79%–88%) for all abnormal glands. Interrater reliability between surgeons was κ = 0.771.
Conclusions The diagnostic accuracy of surgeon localization of abnormal glands on the 4D CT scan was substantial. Improvement with radiology report integration highlights the benefits of multidisciplinary collaboration. Interrater reliability between two fellowship-trained surgeons was moderate. These findings support the importance of surgeons developing proficiency in reading 4D CT scans to engage in interdisciplinary communication and improve patient outcomes.
Michelle Yoon, Ricardo Ramirez, Jun Yun, Christina Wiedmer, Margaret Brandwein‐Weber, Azita\xa0S. Khorsandi, Daniel Buchbinder, Mohemmed\xa0N. Khan
Publication date 28-10-2024
ABSTRACTIntroduction Bisphosphonates (BPs) are widely used for osteoporosis and cancer-induced bone diseases due to their antiresorptive properties, yet they pose risks such as medication-related osteonecrosis of the jaw (MRONJ).
Methods We present a unique case of concurrent oral squamous cell carcinoma (SCC) and MRONJ in a 72-year-old female chronically treated with oral ibandronate for osteoporosis. Following a dental extraction, she developed a nonhealing wound in the maxilla. Following conservative treatment, the patient underwent a maxillectomy and extensive tissue reconstructions to control her infection and address suspicions of an underlying malignancy.
Results Histopathological examinations confirmed simultaneous osteonecrosis and well-differentiated SCC in the maxillary sinus and surrounding tissues. Despite multiple surgeries, the patients disease progressed rapidly. Upon examining the literature for patients with a history of BP use diagnosed with MRONJ and/or SCC, a total of 16 cases report a diagnostic dilemma between MRONJ and locoregional SCC. Three of the 16 cases report a final diagnosis of concurrent MRONJ and SCC. This report is the fourth reported case of concurrency to date.
Conclusions The patients complex clinical course underscores the diagnostic challenges and therapeutic dilemmas in managing concurrent MRONJ and SCC, highlighting the need for vigilant monitoring and interdisciplinary collaboration in similar cases.
Sebastião\xa0Silvério Sousa‐Neto, Thaís\xa0Cerqueira\xa0Reis Nakamura, Daniela Giraldo‐Roldan, Giovanna\xa0Calabrese dos Santos, Felipe\xa0Paiva Fonseca, Cinthia\xa0Verónica\xa0Bardález\xa0López de Cáceres, Ana\xa0Lúcia\xa0Carrinho\xa0Ayroza Rangel, Manoela\xa0Domingues Martins, Marco\xa0Antonio\xa0Trevizani Martins, Amanda\xa0De\xa0Farias Gabriel, Virgilio\xa0Gonzales Zanella, Alan\xa0Roger Santos‐Silva, Marcio\xa0Ajudarte Lopes, Luiz\xa0Paulo Kowalski, Anna\xa0Luíza\xa0Damaceno Araújo, Matheus\xa0Cardoso Moraes, Pablo\xa0Agustin Vargas
Publication date 27-10-2024
ABSTRACTAims To develop a model capable of distinguishing carcinoma ex-pleomorphic adenoma from pleomorphic adenoma using a convolutional neural network architecture.
Methods and ResultsA cohort of 83 Brazilian patients, divided into carcinoma ex-pleomorphic adenoma (n = 42) and pleomorphic adenoma (n = 41), was used for training a convolutional neural network. The whole-slide images were annotated and fragmented into 743 869 (carcinoma ex-pleomorphic adenomas) and 211 714 (pleomorphic adenomas) patches, measuring 224 × 224 pixels. Training (80%), validation (10%), and test (10%) subsets were established. The Residual Neural Network (Res Net)-50 was chosen for its recognition and classification capabilities. The training and validation graphs, and parameters derived from the confusion matrix, were evaluated. The loss curve recorded 0.63, and the accuracy reached 0.93. Evaluated parameters included specificity (0.88), sensitivity (0.94), precision (0.96), F1 score (0.95), and area under the curve (0.97).
Conclusions The study underscores the potential of Res Net-50 in the microscopic diagnosis of carcinoma ex-pleomorphic adenoma. The developed model demonstrated strong learning potential, but exhibited partial limitations in generalization, as indicated by the validation curve. In summary, the study established a promising baseline despite limitations in model generalization. This indicates the need to refine methodologies, investigate new models, incorporate larger datasets, and encourage inter-institutional collaboration for comprehensive studies in salivary gland tumors.
Mathias Fiedler, Alisa Off, Andreas Gärtner, Gero Brockhoff, Jonas Eichberger, Maximilian Gottsauner, Johannes\xa0G. Schuderer, Michael Maurer, Richard\xa0J. Bauer, Michael Gerken, Torsten\xa0E. Reichert, Tobias Ettl, Florian Weber
Publication date 27-10-2024
ABSTRACTBackground This study aimed to explore the disparities in PD-1 and PD-L1 expression among oral squamous cell carcinomas (OSCCs) in individuals categorized as never-smokers/never-drinkers versus smokers/drinkers.
Methods Immunohistochemical staining for PD-1 and PD-L1, along with PDCD1LG2/cen9 dual color probe analysis, was conducted on 130 OSCC specimens from both smoker/drinker and never-smoker/never-drinker cohorts. Associations between smoking/drinking status, clinicopathologic data, immunohistochemical antibody expression, fluorescence in situ hybridization, and survival outcomes were assessed.
ResultsOSCC in never-smokers/never-drinkers exhibited significantly elevated PD-1 expression (p = 0.003), increased PD-L1-TPS expression (p = 0.044), and elevated PD-L1-CPS expression (p < 0.001). High PD-L1-ICS expression was more prevalent in never-smokers (p = 0.042). Moreover, never-smokers and never-drinkers demonstrated augmented PD-L1 gene copy numbers (p = 0.081 and p = 0.054, respectively). Increased PD-L1 gene copy number, particularly amplification, correlated with PD-L1-TPS (p = 0.039 and p < 0.001). Conversely, PD-L1 gene copy loss was associated with negative PD-L1-CPS (p = 0.023). Notably, positive PD-L1-CPS was significantly linked with improved overall survival (p = 0.023).
ConclusionsOSCC arising in never-smokers/never-drinkers exhibit heightened PD-1/PD-L1 signaling, suggesting potential efficacy of immune checkpoint therapy in this subgroup of tumors.
Kenzie K. Lee, John C. Morris III, Aditi Kumar, Ashish V. Chintakuntlawar, Candy Peskey, Crystal R. Hilger, Keith C. Bible, Mabel Ryder
Publication date 27-10-2024
Abstract Background The overall survival of patients with advanced thyroid cancers that have progressed following targeted therapies is limited, indicating a strong need for salvage treatments.
Methods We retrospectively analyzed patients with refractory advanced thyroid cancer treated with pemetrexed-carboplatin (PC) at Mayo Clinic since 2019.
Results Eleven patients, three with anaplastic thyroid cancer (ATC), seven with differentiated or poorly differentiated thyroid cancer (DTC), and one with oncocytic carcinoma of the thyroid, were treated with novel salvage PC. Patients with DTC (n = 7) had durable responses with a median progression-free survival of 29 months. One responder included a patient with ATC whose disease progressed following pembrolizumab/axitinib, lenvatinib, and dabrafenib/trametinib. On this fourth line treatment, the patient remains on therapy to date, over 12 months after initial response.
Conclusions This case series reinforces prior published phase I clinical trial data and shows that pemetrexed can have potent efficacy in the treatment of the most advanced thyroid cancers.
"Justin\xa0M. Hintze, Eoin Cleere, Isobel ORiordan, Conrad Timon, John Kinsella, Paul Lennon, Conall\xa0W.\xa0R. Fitzgerald"
Publication date 25-10-2024
ABSTRACTBackground Preoperative radiological findings of hypopharyngeal cancers are used to determine suitability for surgical resection. We sought to examine preoperative imaging characteristics to determine how well imaging findings predicted surgical resectability.
MethodsA retrospective case–control study of patients undergoing a pharyngolaryngectomy in a tertiary referral center over a 2-year period was completed. Demographic details, previous treatment, subsite, TNM staging, imaging characteristics, and operative characteristics were collected.
ResultsA total of 78 patients met initial inclusion criteria, of which 71 patients ultimately underwent successful surgical resection (91.1%). Preoperative images identified suspicion of prevertebral fascia invasion in 24 (30.7%) cases and carotid artery involvement in 14 (17.9%) cases. In cases of suspicion of prevertebral fascia invasion (24), 19 cases (79.2%) were resectable, and in those with carotid artery involvement (14), 11 (78.6%) were resectable. Concern for prevertebral fascia invasion on radiology led to a higher likelihood of a close margin (42% vs. 17%) in those without concerning features (p = 0.088).
Conclusions The present study demonstrated a high rate of resectability of hypopharyngeal and upper esophageal cancers despite imaging findings suspicious for factors that could limit resectability. In patients with advanced hypopharyngeal, especially in the salvage setting, surgery should be considered.
James\xa0R. Janopaul‐Naylor, Nancy Lee, Sean McBride
Publication date 24-10-2024
Yusuf Ilhan, Kadriye\xa0Bir Yucel, Muhammet\xa0Bekir Hacıoglu
Publication date 24-10-2024
Marise Neijman, Frans\xa0J.\xa0M. Hilgers, Michiel\xa0W.\xa0M. van den Brekel, Rob\xa0J.\xa0J.\xa0H. van Son, Martijn\xa0M. Stuiver, Lisette van der Molen
Publication date 23-10-2024
ABSTRACTBackground This study investigated long-term outcomes of dysphagia rehabilitation with an adjustable resistance training device (Swallowing Exercise Aid, SEA2.0) in laryngectomized individuals.
Methods Seventeen laryngectomized participants who participated in a Clinical Phase II Trial were reevaluated at T3 (approximately 6 months after T2), including an interview, PROMS, oral intake, and swallowing capacity. Results of T3 were compared with the earlier time points T0 (baseline), T1 (after 6 weeks of training), and T2 (after 8 weeks of rest).
Results All outcomes at T3 remained improved compared to T0. Compared to findings at T2, participants reported some deterioration in swallowing at T3. Swallowing capacity and oral intake slightly decreased. Swallowing-related quality of life slightly improved.
Conclusions Benefits of swallowing rehabilitation with the SEA2.0 in laryngectomized individuals are still noticeable long term. The need for continued exercising to fully maintain improved function is likely, but the required intensity and extent should be determined in further research.
Publication date 21-10-2024
Publication date 21-10-2024
Ann Kearney, Idris Samad, Michael\xa0A. Belsky, Philip\xa0C. Doyle, Edward\xa0J. Damrose
Publication date 19-10-2024
ABSTRACTObjectives Although total laryngectomy (TL) is a well-established surgical procedure with clear functional or oncologic indications, the peri- and postoperative care for those undergoing TL is variable, particularly regarding postlaryngectomy tracheostoma management. This study examined TL outcomes from a single institution with the immediate perioperative use of soft silicone laryngectomy tubes. More specifically, we explored potential complications associated with immediate perioperative use of a flexible laryngectomy tube (Lary Tube and Stoma Soft) and the use of heat and moisture exchange (HME) devices in association with peri- and postoperative care.
MethodsA case series including all patients undergoing TL by one primary surgeon at a tertiary care hospital between 2006 and 2023 were assessed. Variables of interest included hospital average length of stay (LOS) in hospital, use of laryngectomy tube and an HME, primary tracheoesophageal puncture voice restoration at time of TL, discharge feeding, stoma-related complications, and overall complications.
Results Seventy-two patients were included over the study period, and all utilized a laryngectomy tube and HME in the perioperative period without complications. Fifty-six patients (77.7%) had concurrent neck dissections and nine (15%) underwent total laryngopharyngectomy. Sixty-two patients (86%) underwent TL for squamous cell carcinoma of the larynx or hypopharynx and 35 of these (56%) were salvage surgeries. Mean LOS was 8.4 (3–45) days, and 63 patients (88%) were discharged with nasal gastric tube feeding. Of the six patients (8%) who were readmitted for complications, zero (0%) were related to the laryngectomy tube or to stoma-related complications (e.g., dehiscence, infection, mucous plugging). No patient who utilized a laryngectomy tube and HME device in the perioperative period experienced stomal stenosis.
Conclusions Laryngectomy tubes combined with an HME can be employed safely and successfully in a high percentage of laryngectomy patients placed perioperative. No instances of postlaryngectomy tracheostoma stenosis occurred in association with perioperative laryngectomy tube with HME use. These collective data support the use of a laryngectomy tube with HME in the immediate perioperative period, with low risk of complications.
Keyue Liu, Linsong Lu, Yuan Zhi, Moxin Zi, Xiangyu Zhang, Kun Wu, Zhaojian Gong
Publication date 18-10-2024
ABSTRACTBackground This study aimed to evaluate the effect of low molecular weight heparin calcium (LMWH-Ca) on the prevention of deep venous thrombosis (DVT) in patients with anterolateral thigh (ALT) flap reconstruction.
Methods In total, 1001 patients with oral cancer who underwent ALT flap reconstruction were recruited. Based on the postoperative use of LMWH-Ca, the patients were divided into case (n = 633) and control groups (n = 368). The incidence of postoperative DVT was compared between groups.
Results There was no significant difference in DVT incidence between the two groups. Among patients older than 60 years, the incidence of lower limb DVT in the case group (0.813%) was significantly lower than that in the control group (8.108%, p = 0.012).
Conclusion The postoperative use of LMWH in oral cancer patients with ALT flap transfer does not prevent the development of lower limb DVT. However, patients older than 60 years old benefited from the postoperative use of LMWH-Ca.
Pranit\xa0R. Sunkara, Emily Chow, Jacob Waitzman, Ammar Sukari, John\xa0D. Cramer
Publication date 16-10-2024
ABSTRACTBackground Hematological markers, such as neutrophils (ANC), lymphocyte (ALC), and neutrophil-lymphocyte ratio (NLR), may serve as indicators of systemic inflammation and immune response in head and neck squamous cell carcinoma (HNSCC). However, their prognostic significance across HNSCC subtypes remains to be fully elucidated.
Methods We conducted a secondary analysis of a randomized clinical trial involving patients with surgically resected HNSCC with either positive margins or extranodal extension. These patients received either adjuvant chemoradiation with or without lapatinib. We explored the correlation between pre-therapy ANC, ALC, and NLR levels and overall survival (OS) as well as disease-free survival (DFS). A sub-group analysis examined potential links between these markers, primary tumor location, and HPV status.
Results Of the 688 patients in the trial, we included 681 patients with documented pre-therapy ANC and ALC values. High pre-therapy ANC and ALC were significantly associated with reduced OS (HR, 1.56; 95% CI: 1.19–2.05) and (HR, 1.34; 95% CI: 1.01–1.79), respectively. High NLR did not significantly affect OS (HR, 1.09; 95% CI: 0.81–1.47). Subgroup analysis indicated significantly reduced OS in patients with high ANC across oropharyngeal, non-oropharyngeal, and HPV-negative subtypes. High ANC, ALC, and NLR did not impact DFS notably.
Conclusion Elevated pre-therapy ANC is strongly associated with decreased survival across all patients and subgroups, ALC was only significant in the general patient analysis. NLRs association with reduced OS was not statistically significant. These biomarkers may provide greater prognostic value in patients with oropharyngeal cancer and seemed to be more strongly associated with OS than DFS.
Trial Registration Clinicaltrials.
gov identifier: NCT00424255; URL: https://clinicaltrials.gov/ct2/show/study/NCT00424255
"Laura Mc\xa0Loughlin, Henry Zhang, Megan Blom, Michael Walsh, Tom Moran, Benjamin Dixon, Matthew Magarey, Fergal ODuffy"
Publication date 16-10-2024
ABSTRACTBackground The use of transoral robotic surgery (TORS) lingual tonsillectomy in the diagnostic algorithm for head and neck carcinoma of unknown primary (CUP) has gained recent popularity. The primary aim of our study was to determine the identification rate of primary tumors in our cohort undergoing lingual ± palatine tonsillectomy for the workup of head and neck CUP.
Methods This was a retrospective study of all patients undergoing diagnostic TORS for head and neck CUP over an eight-year period, across four centers in two countries.
Results Fifty-six patients undergoing TORS to aid diagnosis of a primary site were included. Overall, TORS lingual ± palatine tonsillectomy identified a primary tumor in 41 (73.2%) patients. Over half were T1 tumors, with 25% measuring under 10 mm. Among those with human papilloma virus (HPV)+ nodal disease, the identification rate was 82.6%.
ConclusionsTORS lingual tonsillectomy is an effective addition to the diagnostic workup of CUP, particularly in those with HPV+ nodal disease.
Lise\xa0J. van de Velde, W.\xa0F.\xa0Julius Scheurleer, W.\xa0Weibel Braunius, Caroline\xa0M. Speksnijder, Mischa de Ridder, Lot\xa0A. Devriese, Remco de Bree, Gerben\xa0E. Breimer, Johannes\xa0A. Rijken, Boukje\xa0A.\xa0C. van Dijk
Publication date 16-10-2024
ABSTRACTBackground Sinonasal squamous cell carcinoma is known for its rarity and poor prognosis. This study aims to investigate the trends in the incidence of sinonasal squamous cell carcinoma in the Netherlands and to analyze patient characteristics and treatment practices in order to assess their relation with patient outcomes.
Methods In this prospectively designed population-based cohort study, all patients diagnosed with sinonasal squamous cell carcinoma between 2008 and 2021 in the Netherlands were included. Patients with a squamous cell carcinoma of the nasal vestibule were excluded, leading to a definitive study population of 568 cases.
Results The annual incidence rate for the overall population displayed a slight upward trend over the inclusion period with an annual percentage change of 1.6%. The 5-year overall, disease-free, and relative survival were 43.0%, 52.0%, and 47.2%, respectively. Relative survival decreased marginally over the course of the inclusion period.
Conclusion Sinonasal squamous cell carcinoma is rare with approximately stable incidence rates. There is a limited, non-statistically significant, decrease in survival between 2008 and 2021. Therefore, there is a clear need for innovative treatment approaches to improve outcomes for patients with sinonasal squamous cell carcinoma.
Khalid Azalmad, Karma Lambercy, Avinash Beharry, Nathalie Piazzon, Marie Barbesier, Margaux Dalla‐Vale, Manuela Moraru, Sabina Berezowska, Christian Simon
Publication date 14-10-2024
ABSTRACTBackground The efficacy of transoral robotic surgery (TORS) for HPV-negative oropharyngeal cancers (OPSCC) is less explored, especially regarding long-term outcomes and prognostic factors.
Methods We conducted a retrospective monocentric study on 37 patients with HPV-negative OPSCC treated with TORS with a median follow-up of 3 years, assessing survival outcomes using Kaplan-Meyer statistics and swallowing function via the functional outcome swallowing scale (FOSS). Histopathological parameters were collected either from medical records or histology slides were re-evaluated.
Results Patients demonstrated high disease-specific survival (DSS) but lower overall survival (OS), with a cohort characterized by high comorbidity rates. Vascular invasion was a significant adverse factor for relapse-free survival (RFS) and OS, while lymphatic invasion was not. Most patients demonstrated significant preservation of swallowing function.
ConclusionsTORS for HPV-negative OPSCC demonstrates high DSS and preserved swallowing function. Vascular invasion is a key prognostic factor for survival outcomes.
Melani\xa0Camryn Zuckerman, Heather\xa0Ann Edwards
Publication date 14-10-2024
ABSTRACTBackground This study assesses whether national initiatives undertaken to improve diversity in clinical trial enrollment have been successful within head and neck cancer (HNC) trials.
MethodsA retrospective analysis was conducted of HNC trials published on clinicaltrials.gov with start dates between 2000 and 2023. Demographic data for 8998 HNC trial enrollees was abstracted and analyzed to investigate potential demographic shifts.
Results In the past 20 years, the percentage of White patients increased 6.1%, Asian patient population decreased 3.1%, and Black patient population increased 0.8%. Compared with previously published SEER data, HNC trials have significantly more White patients, fewer Black patients, and fewer Asian/Native-Hawaiian patients than HNC patients at large.
Conclusions Despite efforts to increase diversity in HNC clinical trials in the United States, diversity has significantly decreased in the past 10 years. As current approaches are failing to show improvement, novel approaches to improving representation in clinical trials are necessitated.
Shreya Sriram, Akua Owusu‐Boahene, Rebecca\xa0A. Gersten, Christine\xa0G. Gourin
Publication date 07-10-2024
ABSTRACTBackground To explore provider perspectives about palliative care (PC) in head and neck cancer (HNC) care.
MethodsA 25-question electronic survey was disseminated to the membership of the American Head and Neck Society (AHNS) from April 10, 2023, through June 13, 2023.
Results Respondents were most likely to refer to PC at symptomatic disease progression (52%) or terminal diagnosis (29%) rather than at initial diagnosis (17%). Participants less likely to refer to PC were less likely to refer to symptomatic progression (8% vs. 39%, p = 0.0006) or address advance directives (62% vs. 87%, p = 0.0406). Symptom burden questionnaires were used by only 29% of respondents. Discordance was identified between self-reported and actual access to local inpatient and outpatient PC services.
Conclusions Barriers to PC identified include a lack of established optimal timing of PC referral, a perceived lack of local access to PC, and a lack of uniform standardized assessment of symptom burden.
Luca\xa0Giovanni Locatello, Nicole Caiazza, Federico Cavallo\xa0Ronchi, Anna\xa0Maria Bergamin‐Bracale, Cesare Miani
Publication date 06-10-2024
ABSTRACTBackground Thyroid nodules are common findings during the diagnostic work-up in potential organ donors. A fast yet thorough assessment to rule out cancer is mandatory but their management remains heterogeneous among hospitals and the evidence in this field is scarce. We present our institutional experience and review the most recent literature on this topic.
Methods Retrospective case series and systematic review of the literature.
Results In the years 2000–2023, 47 total thyroidectomies were performed on potential brain-dead donors. Intraoperative frozen section (FS) revealed 6 cases (13.9%) of papillary carcinoma that led to organ discarding in 3 cases (6.9%). The mean operative time of the procedures was 42.75 min and no procurement-delaying complications were registered.
Conclusion Total thyroidectomy with an intraoperative FS is a sound method for assessing suspicious nodules before organ harvesting. Future randomized studies comparing its performance against fine needle aspiration biopsy are needed to define the most cost-effective and time-saving strategy.
Georgia Grzybowski, Molly Murray Stewart, Thomas D. Milner, Anat Bahat Dinur, Orla M. McGee, Amir Pakdel, Khanh Linh Tran, Sidney S. Fels, Antony J. Hodgson, Eitan Prisman
Publication date 04-10-2024
ABSTRACTBackground This study assesses the feasibility of real-time surgical navigation to plan and guide sequential steps during mandible reconstruction on a series of cadaveric specimens.
Methods An image-guided surgical (IGS) system was designed including customized mandible and fibula fixation devices with navigation reference frames and an accompanied image-guided software. The mandibular and fibular segmental osteotomies were performed using the IGS in all five cadaveric patients. Procedural time and cephalometric measurements were recorded.
Results Five real-time IGS mandibulectomy and fibular reconstruction were successfully performed. The mean Dice score and Hausdorff-95 distance between the planned and actual mandible reconstructions was 0.8 ± 0.08 and 7.29 ± 4.81 mm, respectively. Intercoronoid width, interangle width, and mandible projection differences were 1.15 ± 1.17 mm, 0.9 ± 0.56 mm, and 1.47 ± 1.62 mm, respectively.
Conclusion This study presents the first demonstration of a comprehensive image-guided workflow for mandibulectomy and fibular flap reconstruction on cadaveric specimens and resulted in adequate cephalometric accuracy.
Arianna Winchester, David Strum, Arman Saeedi, Nupur Bhatt, Michael Chow, Ghayoour Mir, Adam Jacobson
Publication date 03-10-2024
ABSTRACTIntroduction Tracheostomy is a commonly performed procedure in Otolaryngology and can be performed in different settings. We evaluate patient characteristics and cost efficacy of tracheostomy at the bedside versus operating room (OR).
Materials and Methods Retrospective chart review was performed for adult intensive care unit (ICU) patients who underwent tracheostomy from 2020 to 2023. Data and cost of procedures were analyzed using descriptive statistics.
Results One hundred and sixty-five patients were included. One hundred and thirty-four (81.2%) patients underwent bedside tracheostomy. Age, sex, and BMI were not significantly different. Average time from consult to procedure and operative time was significantly shorter (p = 0.03; 0.008). There were no differences in postoperative complications, 30-day mortality, ICU length of stay (LOS), or overall LOS. Tracheostomy at the bedside offered a 73.1% cost reduction compared with performed in the OR.
Conclusion Advantages of bedside tracheostomy include decreased operative time, time from consult to procedure, and cost reduction for the hospital system. We advocate for consideration of bedside tracheostomy when appropriate.
Level of Evidence4.
Chi‐Yu Kuo, Yi‐Chiung Hsu, Ming‐Jen Chen, Chi‐Hsin Lin, Ying‐Syuan Li, Shih‐Ping Cheng
Publication date 03-10-2024
ABSTRACTBackground Less differentiated thyroid cancer may upregulate the expression of glucose transporter 1 (GLUT1) and increase glycolytic activity. However, it is uncertain whether GLUT1 can be used as a target for therapy.
Methods Thyroid cancer cell lines were treated with two different GLUT1 inhibitors, STF-31 and BAY-876. Functional assays were conducted to evaluate the effects of these inhibitors on cell biology.
ResultsGLUT1 inhibitors dose-dependently decreased cell growth and clonogenicity of thyroid cancer cells. Cell cycle analysis showed that these inhibitors caused G2/M arrest instead of apoptosis. Additionally, treatment with GLUT1 inhibitors led to the activation of autophagy. In both the Transwell and spheroid models, GLUT1 inhibitors significantly suppressed cell invasiveness. Moreover, GLUT1 inhibitors demonstrated synergistic interactions when combined with lenvatinib.
Conclusions Treatment with GLUT1 inhibitors activates autophagy and provokes cell cycle arrest, accompanied by a decrease in colony formation and invasive capacity in thyroid cancer cells.
Alessandra Ruaro, Stefano Taboni, Harley\xa0H.\xa0L. Chan, Tiziana Mondello, Patricia Lindsay, Teesha Komal, Lara Alessandrini, Marta Sbaraglia, Elena Bellan, Roberto Maroldi, Jason Townson, Michael\xa0J. Daly, Federica Re, Chiara Pasini, Marco Krengli, Luciana Sartore, Domenico Russo, Piero Nicolai, Marco Ferrari, Ralph\xa0W. Gilbert, Jonathan\xa0C. Irish
Publication date 03-10-2024
ABSTRACTPurpose Radiotherapy (RT) plays a crucial role in head and neck (HN) cancer treatment. Nevertheless, it can lead to serious and challenging adverse events such as osteoradionecrosis (ORN). A preclinical rabbit model of irradiated bone and ORN is herein proposed, with the aim to develop a viable model to be exploited for investigating new therapeutic approaches.
Methods Nine New Zealand white rabbits were irradiated using a single beam positioned to the left of the mandible and directed perpendicular to the left mandible. A 10 × 10 mm2 region of interest (ROI) located below the first molar tooth on the left side was identified and irradiated with 7 Gy each fraction, once every 2 days, for five fractions. Dose distributions demonstrated that the corresponding ROI on the contralateral (right) mandibular side received approximately 5 Gy each fraction, thus bilateral irradiation of the mandible was achieved. ROIs were categorized as ROIH on the left side receiving the high dose and ROIL on the right side receiving the low dose. Rabbits were followed up clinically and imaged monthly. After 4 months, the irradiated bone was excised, and histological examination of ROIs was performed.
Results Radiological signs suggestive for ORN were detected in the entire population (100%) 16 weeks after irradiation on ROIH, which consisted of cortical erosion and loss of trabeculae. ROIL did not show any radiological evidence of bone damage. Histologically, both sides showed comparable signs of injury, with marked reduction in osteocyte count and increase in empty lacunae count.
ConclusionsA preclinical double model was successfully developed. The side receiving the higher dose showed radiological and histological signs of bone damage, resulting in an ORN model. Whereas the contralateral side, receiving the lower dose, presented with histological damage only and a normal radiological appearance. This work describes the creation of a double model, an ORN and irradiated bone model, for further study using this animal species.
Zhibin Cui, Hyunseok Kang, Hua Li, Eliot\xa0D. Lee, Yoon\xa0Se Lee, Christopher\xa0N. Peterson, Steven\xa0R. Long, Jennifer\xa0R. Grandis, Daniel\xa0E. Johnson
Publication date 30-09-2024
ABSTRACTBackground Human papilloma virus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) is an emerging epidemic and a subset of HPV-positive patients experience aggressive disease with metastases. The CYLD gene is frequently altered in HPV-positive HNSCC, but the role of these alterations in disease progression is poorly understood.
Methods We identified 11 HPV-positive HNSCC patients with CYLD alterations and assessed their clinical course. We also characterized a unique, HPV-positive, metastatic, HNSCC patient-derived xenograft (PDX).
Results All 11 patients developed metastasis with reduced overall survival when compared with metastatic HPV-positive patients with wild-type CYLD. The metastatic PDX harbored a CYLD mutation (S371*) and exhibited reduced expression of connexin 43, a potentially antimetastatic protein. We also investigated the functional impact of the S371* mutation, as well as 2 CYLD mutations from our 11-patient cohort.
Conclusion Our findings indicate that alterations in CYLD in HPV-positive HNSCC are associated with metastasis and poor prognosis.
Alhadi Almangush, Lauri Jouhi, Caj Haglund, Jaana Hagström, Antti\xa0A. Mäkitie, Ilmo Leivo
Publication date 28-09-2024
ABSTRACTBackground Evaluation of the prognostic impact of tumor microenvironment (TME) has received attention in recent years. We introduce a TME-based risk stratification for oropharyngeal squamous cell carcinoma (OPSCC).
Material and MethodsA total of 182 patients treated for OPSCC at the Helsinki University Hospital were included. TME-based risk stratification was designed combining tumor-stroma ratio and stromal tumor-infiltrating lymphocytes assessed in hematoxylin and eosin-stained sections.
Results In multivariable analysis, TME-based risk stratification associated with poor disease-free survival with a hazard ratio (HR) of 2.68 (95% CI 1.11–6.48, p = 0.029). In addition, the proposed risk stratification was associated with poor disease-specific survival (HR 2.687, 95% CI 1.28–5.66, p = 0.009) and poor overall survival (HR 2.21, 95% CI 1.23–3.99, p = 0.008).
Conclusion Our TME-based risk stratification provides a powerful prognostic tool that can be used in daily treatment planning of OPSCC together with tumor-related prognostic markers.
Linus L. Kienle, Leon R. Schild, Felix Boehm, Viola D. Hahn, Jens Greve, Adrian von Witzleben, Thomas K. Hoffmann, Patrick J. Schuler
Publication date 26-09-2024
Abstract Background Transoral laser microsurgery, the standard surgical approach for early-stage laryngeal cancer, necessitates an unobstructed line of sight to the operating field. However, achieving adequate laryngeal exposure can be challenging, potentially compromising treatment outcomes.
Methods We developed a 3D-printed curved laryngoscope (sMAC), designed to match the upper airway anatomy. In a user study (n = 15) with a human body donor we compared the sMAC system to conventional microlaryngoscopy regarding laryngeal exposure and accessibility in a difficult exposure scenario.
Results All 15 participants achieved complete glottic exposure and successfully manipulated laryngeal landmarks using the sMAC system. Only four participants achieved partial exposure using microlaryngoscopy. Positioning of the sMAC system was significantly faster (p = 0.023). A vocal cord resection was conducted successfully (n = 2) using the sMAC system.
Conclusion The sMAC system effectively addresses challenges associated with transoral laryngeal surgery. Ongoing development aims to overcome current limitations of the system and prepare first clinical trials.
Claes Mercke, Signe Friesland, Anders Berglund, Gun Wickart Johansson, Gregori Margolin, Michael Gubanski, Einar Björgvinsson, Josef Nilsson
Publication date 26-09-2024
Abstract Background Radiotherapy is a well-established treatment for lip cancer, with external radiotherapy (EBRT) or brachytherapy (BT).
Methods This study evaluated outcome, tumor control, and aesthetics, for 101 patients with carcinoma of the lip, not suitable for surgery, treated with combined EBRT and BT.
Results Squamous cell carcinoma was seen in 78 patients, basal cell carcinoma in 15, and other histologies in 8 patients.
Tumors were advanced: 73% in category T2-T4. Local control at 3 and 5 years was 89%. Local failure appeared in 4/56 patients (7%) with primary RT compared to 7/45 (16%) in those with prior surgery, regional recurrence in 5 patients. Toxicity was mild. Cosmetic outcome, 87 patients evaluated, was bad for 9/40 patients with upfront surgery compared to 1/47 for primary RT patients (p = 0.003). Seven patients died from lip cancer (7%), three with originally N+ disease (43%).
Conclusions Combined EBRT and BT could be considered for lip tumors not candidates for surgery.
Marcelo Elias Schempf Cattan, Talita de Carvalho Kimura, Luccas Lavareze, Erika Said Abu Egal, Albina Altemani, Fernanda Viviane Mariano
Publication date 25-09-2024
Abstract Purpose This study analyzed the demographics, clinicopathological, treatment, and survival characteristics of head and neck sarcomas (HNS) diagnosed in a tertiary reference center in Brazil.
Materials and methodsHNS cases were retrospectively retrieved from the Department of Pathological Anatomy of the School of Medical Sciences of the State University of Campinas. The medical records were examined to extract demographic, clinicopathological, and follow-up information. The Pearson chi-square test, Kaplan–Meier curve, and Cox proportional hazards regression model were employed to identify survival and potential prognostic factors.
ResultsA total of 47 patients were included in the study. The majority were men (61.7%) with a mean age of 38.9 years. The nasal cavity (34.0%) was the most common anatomical site. The lesions are usually presented as volume increases (78.7%). The most common histological subtypes were chondrosarcoma, osteosarcoma, and alveolar rhabdomyosarcoma. Surgical excision alone was the most common treatment modality. Local recurrence was observed in 10 cases, and metastases in 3 cases. During a mean follow-up period of 71.9 months, from diagnosis to the last follow-up, 31 patients (65.9%) were alive without the disease. A total of 10 patients (21.3%) died of the HNS for a mean follow-up period of 14.3 months. The time to presentation of more than 6 months (p = 0.0309) and the presence of metastases (p = 0.0315) were identified as prognostic factors for survival, while male sex was found to be an independent prognostic factor for recurrence.
Conclusion In conclusion, the results of this study indicate that the occurrence of a shorter lesion time to presentation and the presence of metastases were associated with a reduction in survival rates in patients with HNS.
"David M. Bruss, David J. Fei‐Zhang, Helena Kim, Daniel C. Chelius, Anthony M. Sheyn, John P. Maddalozzo, Jeffrey C. Rastatter, Jill N. DSouza"
Publication date 25-09-2024
Abstract Introduction Technology and internet access have become increasingly integrated into healthcare as the primary platform for health-related information and provider-patient communication. Disparities in access to digital resources exist in the United States and have been shown to impact health outcomes in various head and neck malignancies. Our objective is to evaluate the associations of digital inequity on health outcomes in patients with salivary gland cancer (SGC).
Methods The Digital Inequity Index (DII) was developed using 17 census-tract level variables obtained from the American Community Survey and Federal Communications Commission. Variables were categorized as digital infrastructure or sociodemographic (e.g., non-digital) and scored based on relative rankings across all US counties. Scores were assigned to patients from the Surveillance-Epidemiology-End Results (SEER) database diagnosed with SGC between 2013 and 2017 based on county-of-residence. Regressions were performed between DII score and outcomes of surveillance time, survival time, tumor stage at time of diagnosis, and treatment modality.
Results Among 9306 SGC-patients, increased digital inequity was associated with advanced-staging at presentation (OR: 1.04, 95% CI: 1.01–1.07, p = 0.033), increased odds of chemotherapy receipt (OR: 1.05, CI: 1.01–1.10, p = 0.010), and decreased odds of surgical intervention (OR: 0.94, 95% CI: 0.91–0.98, p = 0.003) after accounting for traditional sociodemographic factors. Increased digital inequity was also associated with decreased surveillance time and survival periods.
Conclusions Digital inequity significantly and independently associates with negative health and treatment outcomes in SGC patients, highlighting the importance of directed efforts to address these seldom-investigated drivers of health disparities.
Shu Yi, Xiaoming Lyu, Wei Wang, Mingwei Huang, Shuming Liu, Jie Zhang
Publication date 25-09-2024
Abstract Background Vascularized bone grafting (VBG) is preferred for mandibular reconstruction post-tumor ablation. Although various bone-free flaps are used, their application is compromised by limitations including insufficient bone volume and poor shape. Here, we report mandibular reconstruction using axial split-step osteotomy with an iliac crest-free flap.
Methods Over December 2018–November 2020, 12 patients underwent mandibular reconstruction via axial split osteotomy using a free iliac-crest flap.
Results The preoperative iliac-crest length was 5.7–9.5 mm (median, 7.5 cm); the mean post-axial split-osteotomy iliac-crest length increased to 9.59 mm (range, 6.34–15.15 mm). All patients presented with initial healing 2 weeks postoperation; good bone healing was achieved in all grafted flaps by the third month of follow-up.
Conclusions We propose a new axial split-step osteotomy technique using free iliac-crest flaps for mandibular reconstruction. We demonstrated this novel techniques reliability for safe and effective bone lengthening and establishing a reliable occlusal relationship.
Ting Jin, Pei‐Jing Li, Qi‐Feng Jin, Yong‐Hong Hua, Xiao‐Zhong Chen
Publication date 25-09-2024
Abstract Background This study evaluates the outcomes of omitting the high- and low-risk clinical tumor volume (CTV1 and CTV2) radiation in de novo metastatic nasopharyngeal carcinoma (dnm-NPC) patients in the immunotherapy era.
Methods We retrospectively analyzed 45 consecutive dnm-NPC patients receiving chemotherapy and immunotherapy combined with radiotherapy (CIR) from October 9, 2018 to June 1, 2022. Irradiation was only delivered to the primary tumor and retropharyngeal nodes (GTVnx+rn) and gross cervical lymph nodes (GTVnd).
Results The median follow-up was 45 (range, 15–67) months. There was no recurrence in the omitted elective regions. The 36-month LRRFS, PFS, and OS were 95.4%, 44.6%, and 90.8%, respectively. The main grade 3/4 hematologic toxicities were neutropenia (42.2%), anemia (20.0%), and thrombocytopenia (13.3%). The incidence of acute grade 3/4 dermatitis, mucositis, and xerostomia were 4.4%, 8.9%, and 4.4%, respectively.
Conclusions Omitting CTV1 and CTV2 was well-tolerated and provided favorable clinical outcomes in the era of immunotherapy.
Mingjun Rui, Yingcheng Wang
Publication date 23-09-2024
Abstract Background Nasopharyngeal carcinoma (NPC) is a significant health concern in southern China, like Guangdong and Hong Kong. This study aims to predict the effectiveness and cost-effectiveness of two prevalent NPC treatments, intensity-modulated radiotherapy (IMRT) and endoscopic nasopharyngectomy (ENPG).
MethodsA microsimulation model was developed to project the long-term outcomes of IMRT and ENPG, simulating 5000 patients with hypothetical locally recurrent NPC for each treatment option. The tumors of patients confined to the nasopharyngeal cavity, the post-naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Analyses were performed from the healthcare system perspectives of Mainland China and the healthcare provider perspective of Hong Kong, with input parameters sourced from the existing literature and databases. The robustness of findings was evaluated through one-way and probabilistic sensitivity analyses.
Results For DFS, ENPG showed a 29% reduction in risk with an HR of 0.71 (95% CI: 0.64–0.77) compared to IMRT. ENPG demonstrated a significant survival benefit in OS with an HR of 0.59 (95% CI: 0.54–0.65), equating to a 41% reduction in mortality risk. In Hong Kong, IMRT and ENPG yielded QALY gains of 4.59 and 6.29, respectively, with ENPG exhibiting an incremental cost-effectiveness ratio (ICUR) of USD 13 057 per QALY. For Mainland China, ENPG denominated the IMRT and the ICUR was USD −1450 QALY. Probabilistic sensitivity analysis showed a 100% probability of ENPG being cost-effective at the willingness-to-pay thresholds of USD 130 490 per QALY in Hong Kong and USD 12 741 per QALY in Mainland China.
Conclusion The analysis confirms that ENPG is more effective and cost-effective than IMRT for treating recurrent NPC in both Hong Kong and Mainland China.
Linmei Zhang, Enzhao Zhu, Shaokang Cao, Zisheng Ai, Jiansheng Su
Publication date 20-09-2024
Abstract Purpose The use of postoperative radiotherapy (PORT) in patients with oral squamous cell carcinoma (OCSCC) lacks clear boundaries due to the non-negligible toxicity accompanying its remarkable cancer-killing effect. This study aims at validating the ability of deep learning models to develop individualized PORT recommendations for patients with OCSCC and quantifying the impact of patient characteristics on treatment selection.
Methods Participants were categorized into two groups based on alignment between model-recommended and actual treatment regimens, with their overall survival compared. Inverse probability treatment weighting was used to reduce bias, and a mixed-effects multivariate linear regression illustrated how baseline characteristics influenced PORT selection.
Results4990 patients with OCSCC met the inclusion criteria. Deep Survival regression with Mixture Effects (DSME) demonstrated the best performance among all the models and National Comprehensive Cancer Network guidelines. The efficacy of PORT is enhanced as the lymph node ratio (LNR) increases. Similar enhancements in efficacy are observed in patients with advanced age, large tumors, multiple positive lymph nodes, tongue involvement, and stage IVA. Early-stage (stage 0–II) OCSCC may safely omit PORT.
Conclusions This is the first study to incorporate LNR as a tumor character to make personalized recommendations for patients. DSME can effectively identify potential beneficiaries of PORT and provide quantifiable survival benefits.