Gene Huh, Eun‐Jae Chung, Won Shik Kim, Seong Keun Kwon, Myung‐Whun Sung, Bhumsuk Keam, Hong‐Gyun Wu, Joo Ho Lee, Jin Ho Kim, Soon‐Hyun Ahn
Publication date 14-09-2024
Abstract Background This study evaluates functional larynx preservation in patients with hypopharyngeal cancer (HPC) and laryngeal cancer (LC) who achieved complete remission following radiotherapy (RT) or concurrent chemoradiation (CCRT).
MethodsHPC and LC patients treated with RT/CCRT from 1999 to 2017 were retrospectively analyzed. Severe late dysphagia and tracheostomy cases were assessed to determine laryngeal function. Long-term preservation rate of functional larynx and associated factors were evaluated.
Results Of 152 patients (55 HPC, 97 LC), nine developed severe dysphagia, occurring on average 58.2 months post-treatment. HPC and cervical node metastasis significantly increased the risk of laryngeal function impairment (p < 0.001 and p = 0.014, respectively), presenting a continued decline in functional larynx preservation rate beyond 10 years.
Conclusions Patients with HPC and cervical node metastasis demonstrate an increased risk for long-term laryngeal function impairment despite successful oncologic outcomes. This risk extends beyond 10 years, underscoring the need for prolonged monitoring and comprehensive support.
Filippo Marchi, Valentina Campagnari, Marta Filauro, Andrea Iandelli, Cesare Piazza, Giorgio Peretti
Publication date 12-09-2024
Wenda Ye, Evan A. Clark, Quanhu Sheng, C. Alessandra Colaianni, Sarah L. Rohde, Alexander Gelbard
Publication date 12-09-2024
Abstract Background Tracheal adenoid cystic carcinoma (ACC) is a slow growing yet aggressive malignancy with high rates of local recurrence as well as distant metastasis. Tracheal ACC exhibit a low mutation burden along with high mutational diversity, and generally do not respond well to chemotherapeutics.
Methods We present a rare case of primary tracheal ACC initially presenting with nonspecific cervicalgia and globus sensation that was ultimately treated with tracheal resection followed by chemoradiation. Immune profiling of intratumoral T-cell receptor (TCR) repertoire was subsequently performed using single cell RNA sequencing (scRNAseq).
Results We describe a rare case of primary tracheal adenoid cystic carcinoma highlighting several management principles as well as providing new insights into intratumor T cell populations.
Conclusions Primary tracheal ACC is most commonly treated with surgical resection followed by adjuvant therapy. Further characterization of the tumor immune microenvironment is necessary to better understand ACC disease biology and to identify potential therapeutic targets.
Binav Baral, Riham Suleiman, Casey A. Fazer‐Posorske, Daniel J. Ma, Patrick W. McGarrah, Stephan D. Thome, Julian R. Molina, Katharine A. Price, Thorvardur R. Halfdanarson, Harry E. Fuentes
Publication date 12-09-2024
Abstract Background Head and neck cancers (HNC) present diagnostic challenges due to multifocal disease manifestations, posing difficulties in distinguishing between metastatic disease and second primary malignancies (SPM). This complexity underscores the need for advanced diagnostic approaches. Emerging technologies, such as next-generation sequencing (NGS) and molecular classifier assays, show promise in providing precise insights into the diverse etiologies of HNC.
Method In this article, we employed NGS and molecular classifier assays to delve into three distinct clinical cases. The objective was to showcase the instrumental role of these technologies in facilitating accurate diagnoses and differentiating between metastatic disease and SPM in HNC cases.
Results The results of this series highlight the effectiveness of NGS and molecular classifier assays in enhancing diagnostic accuracy for HNC and contributing to the precise differentiation of disease etiologies. The utilization of these advanced technologies proved instrumental in avoiding unnecessary interventions and paved the way for more targeted and effective treatment strategies.
Conclusion Our findings underscore the necessity of incorporating advanced molecular testing technologies into the diagnostic and therapeutic approaches for HNC, thereby championing a more nuanced and effective approach to managing these complex cases.
Publication date 12-09-2024
Srivatsa Surya Vasudevan, Haya Deeb, Anuhya Katta, Lindsay Olinde, John Pang, Ameya A. Asarkar, Sanford Katz, Cherie‐Ann O. Nathan
Publication date 12-09-2024
Abstract To comprehensively evaluate the therapeutic efficacy and safety when utilizing proton therapy (PT) versus intensity-modulated radiation therapy (IMRT) in head and neck cancer patients. Pubmed, Science Direct, Embase, Scopus, and Web of Science were systematically searched for studies on comparative PT and IMRT outcomes. We performed a random effect model meta-analysis to estimate the hazard ratio (HR) and odds ratio (OR) for efficacy and safety outcome variables between PT and IMRT. From 641 identified articles, 11 studies met the inclusion criteria, comprising 3087 patients (606 treated with PT and 2481 with IMRT). On toxicity analysis, PT is associated with decreased acute grade 1 nausea (OR = 0.34, 95% CI: 0.13–0.84, p = 0.02) compared to IMRT. In grade 2 toxicity, PT showed significant advantages over IMRT in mucositis (OR = 0.44, p < 0.0001), dysgeusia (OR = 0.35, p = 0.02), dysphagia (OR = 0.36, p < 0.0001), fatigue (OR = 0.29, p = 0.001), pain (OR = 0.34, p = 0.01), and weight loss (OR = 0.54, p = 0.02). Proton therapy also exhibited increased safety in grade 3 dysphagia incidence (OR = 0.44, p < 0.0001) compared to IMRT. PT demonstrated improved overall survival (OS) compared to IMRT across multiple time points: 1-year OS (HR = 0.43, p = 0.02), 2-year OS (HR = 0.44, p < 0.0001), and 5-year OS (HR = 0.78, p = 0.004). In terms of disease-free survival (DFS), PT also showed improved outcomes at 2-year DFS (HR = 0.65, p = 0.03) and 5-year DFS (HR = 0.81, p = 0.03). Proton therapy demonstrated superior overall survival (OS), disease-free survival (DFS), and better local control rate (LCR) compared to IMRT. The data also showed better safety outcomes in PT patients, particularly when involving grade 2 acute toxicity events.
Pubmed PDF Web"Ebraheem Albazee, Hemail M. Alsubaie, Justin M. Hintze, Isobel ORiordan, Conrad Timon, John Kinsella, Paul Lennon, Conall W. R. Fitzgerald"
Publication date 12-09-2024
Abstract Thyroidectomy can lead to significant challenges such as neck pain, disability, and limited range of motion. Therefore, our objective is to conduct a systematic review and meta-analysis of clinical trials to investigate the clinical effectiveness of neck stretching exercises in alleviating neck pain and self-reported disability immediately after thyroidectomy. We systematically searched Pub Med, CENTRAL, Scopus, and Web of Science from inception until July 28th, 2023. We assessed the selected trials for the risk of bias using both the RoB-2 and ROBINS-I tools. Our specific outcomes were the severity of neck pain and self-reported disability after thyroidectomy. The results were synthesized using risk ratio (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) in a random-effects model using Stata software. Nine clinical trials, comprising five randomized and four non-randomized trials, were included, with a total of 1026 patients. Neck stretching exercises were significantly associated with improved mean pain scores both after 1 week (n = 625 patients, SMD = −2.43, 95% CI −4.65, −0.22, p = 0.03, I2 = 98%) and 1 month (n = 545 patients, SMD = −4.11, 95% CI −8.12, −0.11, p = 0.04, I2 = 99%). Similarly, neck stretching exercises were significantly associated with improved mean self-reported disability scores both after 1 week (n = 298 patients, SMD = −0.70, 95% CI −1.36, −0.04, p = 0.04, I2 = 87%) and 1 month (n = 298 patients, SMD = −0.42, 95% CI −0.65, −0.19, p = 0.0004, I2 = 0%). The pooled analysis showed heterogeneity (chi-square p < 0.01, I2 > 80%), except for the mean self-reported neck disability score after 1 month, which showed homogeneity (chi-square p > 0.01, I2 = 0%). This systematic review and meta-analysis, involving 1026 patients, revealed the potential benefits of neck stretching exercises in alleviating neck pain and self-reported disability after thyroidectomy. However, further research is required to address methodological limitations, evaluate long-term outcomes, investigate potential moderators (i.e., the duration or intensity of the exercise program), and explore patients analgesic consumption.
Pubmed PDF WebFrancesca De Felice, Maria Serpone, Carlo Guglielmo Cattaneo, Federico Di Giammarco, Alberto Fallico, Alessia Delle Donne, Maura Lanzilao, Elisa Vitti, Francesco Marampon, Daniela Musio, Vincenzo Tombolini, Giuseppe Minniti
Publication date 12-09-2024
Gianluca Ferini, Corrado Fichera, Andrea Boncoraglio, Giuseppe Emmanuele Umana, Stefano Forte
Publication date 12-09-2024
Jacquelyn K. Callander, Spenser S. Souza, Yasmin Eltawil, Ivan H. El‐Sayed, Jonathan R. George, Patrick Ha, William R. Ryan, Mary Jue Xu, Chase M. Heaton
Publication date 12-09-2024
Abstract Objectives To describe the clinicopathologic presentation of buccal squamous cell carcinoma and identify risks factors for recurrence and overall survival.
Methods This is a retrospective case–control study of patients with oral cavity squamous cell carcinoma (OCSCC) treated at a single tertiary care center between 2010 and 2022. All patients with buccal subsite OCSCC treated during this time frame were included and paired with a randomly selected age and gender matched patient with non-buccal OCSCC. Relevant data was collected via chart review.
Results Seventy-seven patients with buccal SCC were matched with 77 non-buccal OCSCC controls. The median follow-up time was 27 months (IQR 14–61). Median age was 67 years (IQR 57–75) and 53% of the cohort was female. Twenty (26%) buccal SCC patients experienced a recurrence versus 19 (25%) in the controls. Age ≥65-years-old increased odds of all-cause mortality in the buccal SCC group, but not in the control group. Perineural invasion and positive margins increased odds of recurrence in the buccal group only. Overall survival and progression-free survival did not differ between the groups, despite a greater number of T2 buccal tumors and T1 non-buccal tumors.
Conclusions Buccal SCC presents at a higher T stage than other oral cavity SCC subsite and may exhibit variance in the pathologic risk factors that predict poor outcomes versus non-buccal OCSCC. Despite these relatively minor differences, however, oncologic outcomes between these groups were similar.
Jane Kwon, Douglas Farquhar, Jason Tasoulas, Trevor G. Hackman
Publication date 12-09-2024
Abstract Background Otolaryngology patients are a high-readmission-risk group due to the complexity of surgeries, significant alterations to speech and swallowing functions, and high postoperative complications risk.
MethodsA retrospective review was performed on patients who underwent otolaryngologic surgery at a single-academic-institution between March 2019 and February 2020.
Results Among 365 discharges, 21 patients had unplanned readmissions within 30 days. On univariable analysis, acute myocardial infarction, number of total comorbidities, prior chemotherapy/radiation, active smoking, airway surgery, and enteral feeding, and on multivariable analysis, prior chemotherapy/radiation and active smoking were identified as significant readmission risk factors. Readmission risk increased from 2.43% to 7.48% and 41.67% with the addition of each risk factor.
Conclusion Nearly 75% of the readmissions were due to potentially preventable reasons. By identifying and proactively intervening on “at risk” patients during the perioperative timeframe, complications and readmission can be reduced, thereby improving the overall quality of care delivered.
Maryline Hoste, Sébastien Van der Vorst, Georges Lawson, Marie‐Cécile Nollevaux, Anne‐Sophie Pirson, Vincent Bachy, Olivier Desgain, Samantha Hassid, Gilles Delahaut
Publication date 12-09-2024
Abstract Background In oral and oropharyngeal squamous cell carcinoma (SCC), sentinel node biopsy (SNB) was described as a reliable and reproductive alternative to elective neck dissection for the staging of clinical N0 T1–T2 patients. The SNB technique in supraglottic laryngeal SCC was successfully described in small series. The aim of this study is to analyze retrospectively the results of SNB technique in supraglottic SCC in CHU Godinne, to determine if the technique is reliable and may be proposed in a future multicentral prospective trial.
Methods The study involved a retrospective analysis of 39 patients who underwent surgery between 2003 and 2019 at CHU Godinne. All patients presented with clinical N0 neck status. The SNB procedure included general anesthesia, 99-technetium colloid peritumoral injection, and lymphoscintigraphy. The hand-held gamma probe was utilized for SNB after tumoral resection during the same operating session. Out of 39 patients, 36 underwent SNB as the sole staging tool, while 3 patients received SNB in combination with elective neck dissection.
Primary outcome was the 2-years neck recurrence-free survival (RFS). Secondary outcomes were the 2- and 5-years disease-specific survival (DSS). Additionally, sensitivity and negative predictive value (NPV) of the SNB technique were analyzed.
Results Sentinel nodes were successfully identified in all 39 patients. An average of 4 nodes excised per patient. Positives SN were detected in 23% (9 in 39) cases, leading to subsequent selective neck dissection. Two cases of neck recurrence were observed, both considered as false negatives, occurring after an average of 3.5 months. Th median follow-up period was 48 months with a 2-year RFS of 95%. Sensitivity and NPV of the SNB technique were found to be 82% and 94%, respectively. Two and five years DSS were 84% and 71.7%, respectively.
Conclusions The results suggest that SNB in T1–T2 supraglottic SCC is a feasible and reliable technique for managing the neck in N0 early-stage patients. However, to establish its oncological equivalence with selective node dissection, further prospective and comparative studies are warranted. The findings of this study underscore the importance of ongoing research in refining and validating the role of SNB in the management of supraglottic SCC, potentially paving the way for more widespread adoption in clinical practice.
Shinichi Okada, Takashi Mukaigawa, Seiya Goto, Yohei Hiiragi, Fuyuki Sato, Shoichi Deguchi, Hirofumi Ogawa, Tsuyoshi Onoe, Shigeyuki Murayama, Yoshichika Yasunaga, Nakamasa Hayashi
Publication date 12-09-2024
Abstract Background This study aimed to examine treatment outcomes and postoperative complications associated with salvage skull base surgery following radical proton beam therapy (PBT).
Methods Nine patients who underwent salvage skull base surgery following curative PBT as the initial treatment at our institution between September 2002 and May 2023 were retrospectively reviewed.
Results The cohort comprised four males and five females with a mean age of 48.1 years. The average proton dose administered during initial therapy was 68.5 Gy (relative biological effectiveness). Among the salvage surgeries, eight were anterior skull base surgeries, and one was an anterior middle skull base surgery. No local recurrences or perioperative deaths were observed. Postoperative complications occurred in three patients (33.3%), all experiencing surgical site infections, with one also having cerebrospinal fluid leakage.
Conclusion The study demonstrates that salvage skull base surgery after PBT effectively achieves local control and safety in patients with recurrent sinonasal malignancies.
Constantina Nadia Christou, Karl Sandström, Naresh Regula, Ylva Tiblom Ehrsson, Hemming Johansson, Jens Sörensen, Göran Laurell
Publication date 12-09-2024
Abstract Aims To examine the prognostic value of F-18 fluorodeoxyglucose (FDG) uptake in the bone marrow (BM) for disease recurrence and survival in patients with oropharyngeal squamous cell carcinoma (OP-SCC). The secondary aims were to evaluate the prognostic value of PET/CT parameters for the primary oropharyngeal tumor and total tumor burden, and to assess the correlation between FDG uptake variables and serum inflammatory markers.
Methods This was an observational study of 91 patients with OP-SCC who underwent pretreatment FDG-PET/CT. The patients blood samples were collected before treatment, and treatment was administered with the intention to cure. The median follow-up time was 40 months. The PET parameters measured were SUVmeanBM for the assessment of BM FDG uptake, SUVmean, SUVmax, total lesion glycolysis (TLG), and metabolic tumor volume (MTV) for the evaluation of primary oropharyngeal tumor and total tumor burden.
Blood samples were analyzed to determine each patients white cell, red cell, and platelet cell counts, hemoglobin, and C-reactive protein level. In a subgroup of 33 patients, blood serum was analyzed to evaluate the expression of serum immune proteins using a proximity extension assay (Olink Proteomics).
Results The univariate analysis revealed that SUVmeanBM and tumor-specific parameters (SUVmaxtumor, SUVmeantotal, SUVmaxtotal, MTVtotal, TLGtotal) were significantly associated with recurrence-free survival (RFS). After adjusting for age, sex, and stage only SUVmeanBM remained significantly associated with RFS. Spearmans correlation identified several correlations between PET parameters and inflammatory markers.
Conclusions Our results show that several FDG-PET/CT parameters may have a prognostic value of treatment outcome in patients with OP-SCC. However, SUVmeanBM was the only independent PET parameter that showed a prognostic value for RFS in the study cohort. Moreover, the study findings might suggest an association between systemic inflammation and the metabolic activity in the BM.
Hasan Abdulbaki, Patrick K. Ha, Philip D. Knott, Andrea M. Park, Rahul Seth, Chase M. Heaton, Katherine C. Wai
Publication date 12-09-2024
Abstract Background Complications following head and neck microvascular free tissue transfer (MFTT) are common. Less is known about when they occur.
Method Retrospective study of patients with primary or recurrent head and neck cancer undergoing MFTT reconstruction at a tertiary care institution. MFTT reconstructions with inpatient postoperative complications were included. The Kruskal–Wallis test was used to compare median postoperative day (POD) onset of complication by flap type.
Results Of 1090 patients undergoing MFTT reconstruction, 126 (11.6%) patients experienced inpatient complications including fibula (n = 35), anterolateral thigh (n = 60), or radial forearm (n = 31) MFTTs. POD onset was shortest for surgical site hematoma (median = 1 IQR 1–5), and longest for donor site infection (median = 11.5 IQR 8–15). There was no significant difference between flap types and POD onset of complications (p > 0.05).
Conclusion Hematoma formation and flap failure occur earliest during hospitalization, while dehiscence, infection, and fistula occur later. There is no difference in complication timing between flap types.
Han Lei, Yu Lin, Weixiong Chen, Tianrun Liu, Jin Ye, Qian Cai, Fei Ye, Long He, Xingqiang Xie, Guoping Xiong, Wenxiang Gao, Wenbin Lei
Publication date 12-09-2024
Abstract BackgroundsA deep neck space abscess (DNSA) is a critical condition resulting from infection of deep neck fascia and soft issue, leading to high morbidity and mortality. Therefore, intensive care can be very significant for patients with DNSA. This study aimed to develop models to predict the need for postoperative intensive care in patients with DNSA.
Methods We retrospectively analyzed the records of 332 patients with DNSA who received drainage operation between 2015 and 2020. Multivariate logistic regression analysis and the e Xtrem Gradient Boosting (XGBoost) algorithm were used to develop predictive models.
Results We developed two predictive models, the nomogram and the XGBoost model. The area under the curve (AUC) of the nomogram was 0.911 and of the XGBoost model was 0.935.
Conclusion We developed two predictive models for guiding clinical decision making for postoperative ICU admission for DNSA patients, which may help improve prognosis and optimize intensive care resource allocation.
Joshua K. Kim, Karen Tawk, Jonathan M. Kim, Hady Shahbaz, Joshua A. Lipton, Yarah M. Haidar, Tjoson Tjoa, Mehdi Abouzari
Publication date 12-09-2024
Abstract Background We analyzed online rating scores and comments of head and neck surgeons to understand factors that contribute to higher ratings.
Methods Numerical ratings and comments for American Head and Neck Society physicians were extracted from Healthgrades, Vitals, RateMDs, and Yelp, with narrative comments categorized based on content. Physician practice location, education, and residency training were also compiled.
Results Patient ratings were significantly higher with supportive staff and affable physician demeanor but showed significant drops with longer wait times and difficulties scheduling appointments or follow-ups. Physician education and postgraduate training did not significantly affect ratings.
Conclusion Online ratings and comments correlated to modifiable factors in clinical practice and may be informative in understanding patient needs.
Sagar Kansara, Evrim Oral, Indrani Sarkar, Vlad Sandulache, Rula Mualla, Rohan R. Walvekar, William Ryan, Patrick Ha
Publication date 12-09-2024
Abstract Objectives The rate of occult metastasis in lip cancer is poorly studied. Management of the regional nodal basin in lip cancer is thus controversial. This study sought to understand the true rate of micrometastasis in lip cancer.
Materials and Methods Systematic review and meta-analysis was conducted of English language studies reporting lip cancer sentinel node biopsy results. Studies were obtained from the Pub Med database between the years 2000 and 2023 using the search terms “sentinel node biopsy” and “squamous cell carcinoma.” Random effect and fixed effect meta-analyses were performed.
Results Thirteen studies met inclusion criteria. Low heterogeneity was noted among the studies, as indicated by the I2 inconsistency test (I2 = 0%). The rate of occult metastasis ranged between 0 and 33% (mean 9%). A total of 189 lip sentinel node biopsies had been performed. Of these, 21 revealed occult nodal metastasis (11.1%, 95% CI 7.36%–16.44%). One step, generalized linear mixed modeling revealed the true rate of occult nodal metastasis to be 10% (95% CI (0.0504, 0.1746), p < 0.0001).
Conclusion The rate of occult metastasis in lip cancer approaches the threshold for elective management of the regional nodal basin. Sentinel node biopsy is optimally suited for management of high-risk early T stage lip cancer.
Caitlin McMullen, Alexandra Kejner, Elizabeth Nicolli, Marianne Abouyared, Orly Coblens, Katie Fedder, Punam Thakkar, Rusha Patel
Publication date 12-09-2024
Abstract Background The availability of paid parental leave is an important factor for retention and wellness. The experiences of head and neck surgeons with parental leave have never been reported.
MethodsA survey was electronically distributed to head and neck subspecialty surgeons in the United States. Responses were collected and analyzed.
Results Male surgeons had more children and took significantly less parental leave than women. Thirty percent of respondents reported that parental leave negatively impacted compensation, and 14% reported a delay in promotion due to leave, which impacted women more than men. The vast majority reported they are happy or neutral about covering those on leave. Most respondents utilized paid childcare, and approximately one quarter of respondents spending 11%–20% of their income on childcare.
Conclusions This study illuminates the current disparities regarding parental leave-taking within the subspecialty of head and neck surgery in the United States. Women surgeons are more likely to be impacted professionally and financially.
Kun Zhang, Xinyi Wang, Tao Wei, Zhihui Li, Jingqiang Zhu, Ya‐Wen Chen
Publication date 12-09-2024
Abstract Background Oncocytic carcinoma of the thyroid (OCA) is an independent type of thyroid cancer. Radioactive iodine (RAI) therapy was frequently administered to OCA patients, but its contribution to improving survival is indefinite.
Methods4641 OCA patients from 2000 to 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazard regression and competing risk analysis were applied.
Results Tumor size, SEER stage, primary surgery, and neck dissection were prognostic factors for cancer-specific survival. The results of competing risk analysis demonstrated that age over 55 years dramatically increased non-OCA death risks. Treatments that improve non-OCA survival (including total thyroidectomy, RAI therapy, and systemic therapy) should be recommended in OCA patients older than 55 years of age. Neck lymphadenectomy should not be recommended for OCA, since the metastatic lymph node ratio was low (about 3%).
ConclusionsRAI therapy can improve survival in OCA by reducing noncancer death risks.
Magdalena Fay, Paul E. Clavijo, Clint T. Allen
Publication date 12-09-2024
Abstract Background Neutrophilic cells are among the most abundant immune populations within the head and neck tumor microenvironment (TME) and harbor multiple mechanisms of immunosuppression. Despite these important features, neutrophilic cells may be underrepresented in contemporary studies that aim to comprehensively characterize the immune landscape of the TME due to discrepancies in tissue processing and analysis techniques. Here, we review the role of pathologically activated neutrophilic cells within the TME and pitfalls of various approaches used to study their frequency and function in clinical samples.
Methods The literature was identified by searching Pub Med for “immune landscape” and “tumor immune microenvironment” in combination with keywords describing solid tumor malignancies. Key publications that assessed the immune composition of solid tumors derived from human specimens were included. The tumor and blood processing methodologies in each study were reviewed in depth and correlated with the reported abundance of neutrophilic cells.
Results Neutrophilic cells do not survive cryopreservation, and many studies fail to identify and study neutrophilic cell populations due to cryopreservation of clinical samples for practical reasons. Additional single-cell transcriptomic studies filter out neutrophilic cells due to low transcriptional counts.
Conclusions This report can help readers critically interpret studies aiming to comprehensively study the immune TME that fail to identify and characterize neutrophilic cells.
Behrus Puladi, Beatrice Coldewey, Julia S. Volmerg, Kim Grunert, Jeff Berens, Ashkan Rashad, Frank Hölzle, Rainer Röhrig, Myriam Lipprandt
Publication date 12-09-2024
Abstract Background Early detection of oral cancer (OC) or its precursors is the most effective measure to improve outcome. The reasons for missing them on conventional oral examination (COE) or possible countermeasures are still unclear.
Methods In this randomized controlled trial, we investigated the effects of standardized oral examination (SOE) compared to COE. 49 dentists, specialists, and dental students wearing an eye tracker had to detect 10 simulated oral lesions drawn into a volunteers oral cavity.
ResultsSOE had a higher detection rate at 85.4% sensitivity compared to 78.8% in the control (p = 0.017) due to higher completeness (p < 0.001). Detection rate correlated with examination duration (p = 0.002).
ConclusionsA standardized approach can improve systematics and thereby detection rates in oral examinations. It should take at least 5 min. Perceptual and cognitive errors and improper technique cause oral lesions to be missed. Its wide implementation could be an additional strategy to enhance early detection of OC.
Mohammad Altawil, Isabella Stanisz, Nadia H. Van Den Berg, Patrick Sheahan
Publication date 12-09-2024
Abstract Background Selective neck dissection (SND) has traditionally been applied to clinically negative (cN0) necks in mucosal squamous cell carcinoma (SCC). We aimed to examine the oncological safety and patterns of regional recurrence (RR) of SND in clinically positive (cN+) necks.
Methods Retrospective review of prospective cohort of 206 patients with mucosal SCC undergoing neck dissection. RR was classified as occurring within previously dissected levels, within ipsilateral undissected levels, within unusual locations of ipsilateral neck, or contralateral neck.
Results Seven of seventy-seven (9.1%) cN+ patients undergoing SND developed isolated RR, versus 16.2% after MRND, and 8.7% after SND for cN0 disease. RR was rarely seen within undissected levels of the ipsilateral neck. RR and survival rates were not associated with ND extent (SND vs. MRND) among either cN+ or pN+ patients.
ConclusionSND can be safely performed in most patients with cN+ SCC, who do not have gross sternocleidomastoid infiltration or level V metastases.
Marian Mikhael, Bhargav Kansara, Ameer Basta, Emma Hume, Oliver T. Nguyen, Maija Reblin, Young‐Rock Hong, Amir Alishahi Tabriz, Krupal Patel, Jeffery Scott Magnuson, Kea Turner
Publication date 12-09-2024
Abstract Background There has been limited study of oncology professionals perspectives on optimizing delivery of presurgical education for individuals with head and neck cancer (HNC). Therefore, we assessed oncology professionals perspectives about presurgical education for laryngectomy and free flap surgeries, which have a significant impact on patients quality of life.
Methods Interviews were conducted with 27 oncology professionals from an NCI-designated Comprehensive Cancer Center and a community oncology setting.
Results Participants identified six recommendations to improve presurgical education: (1) establishing preoperative consultations with allied health professionals; (2) educating patients and providers on the concept of team-based care; (3) optimizing education through multimodal strategies; (4) connecting patients with other HNC surgical patients; (5) preparing caregivers for their role; and (6) educating patients on insurance navigation.
Conclusions Study findings demonstrate gaps in the timing, content, and mode of delivery for presurgical education and suggest strategies for further evaluation in future studies.
Frederick G. Durrant, Jorge A. Gutierrez III, Shaun A. Nguyen, Cherie‐Ann O. Nathan, Jason G. Newman
Publication date 12-09-2024
Abstract Background Increased sexual activity is associated with higher human papillomavirus (HPV) rates; however, there is a lack of analysis comparing the sexual history of patients with HPV positive and HPV negative oropharyngeal cancer (OPC).
Methods In this meta-analysis, Pub Med, Scopus, and CINAHL were searched for articles that included patients with OPC and reported information regarding HPV status and either history of oral sex, number of sexual partners, or sexually transmitted infections (STI).
ResultsA total of 11 studies were included with 3296 patients with OPC. Patients with HPV positive OPC were more likely than patients with HPV negative OPC to report a history of oral sex (92%, 95% CI: 87.0–97.0 vs. 74.5%, 95% CI: 50.6–98.4, p < 0.0001), higher mean number of sexual partners (18.4 partners, 95% CI: 1.5–35.4 vs. 7.2 partners, 95% CI: 1.0–13.4, p < 0.0001), and more frequent history of STI (23.7%, 95% CI: 18.4–29.0 vs. 8.8%, 95% CI: 4.7–12.8, p = 0.0001).
Conclusions Compared to patients with HPV negative OPC, our analysis shows a larger proportion of patients with HPV positive OPC had participated in oral sex, had a higher number of sexual partners, and had a higher proportion of STI history.
Marika Russell, Matti L. Gild, Lori J. Wirth, Bruce Robinson, Amanda Silver Karcioglu, Ayaka Iwata, Tejas S. Athni, Amr H. Abdelhamid Ahmed, Gregory W. Randolph
Publication date 12-09-2024
Abstract Background Experience with targeted neoadjuvant treatment for locoregionally advanced thyroid cancer is nascent.
Methods Multicenter retrospective case series examining targeted neoadjuvant treatment for locoregionally advanced thyroid cancer. The primary outcome was change in surgical morbidity as measured by two metrics developed for use in clinical trials to characterize surgical complexity and morbidity. Secondary outcomes included percentage of patients proceeding to surgery and percentage receiving an R0/R1 resection.
Results Seventeen patients with varied molecular alterations, pathologies, and treatment regimens were included. Mean surgical complexity scores decreased between time points for baseline and postneoadjuvant treatment, postneoadjuvant treatment and surgery, and between baseline and surgery. Eleven patients (64.7%) underwent surgical resection, with 10 (58.8%) receiving an R0/R1 resection.
Conclusions Neoadjuvant treatment of advanced thyroid cancer improves resectability and decreases the morbidity of required surgical procedures. However, treatment is not uniformly effective.
Julie Kjems, Jacob Kinggaard Lilja‐Fischer, Jeppe Friborg, Trine Tramm, Jens Overgaard
Publication date 12-09-2024
Abstract Background In head and neck squamous cell carcinomas (HNSCC), there is no clinically available method to separate distant metastases (DMs) from SCC secondary primary tumors. The study aimed to assess the genetic relationship in paired tumor samples.
Methods Patients with pairs of solid biopsies from the primary HNSCC and suspected DMs were identified (2007–2017). Targeted next-generation sequencing of 22 genes was applied, including TP53, supplemented with human papillomavirus (HPV) genotyping.
Results Of 55 pairs obtained, 33 were successfully analyzed. Distant biopsies included lung, liver, and bone. A genetic match was found in 23/33 (70%) patients, primarily with identical TP53 mutations or HPV genotypes. In 10/33 patients (30%), the genetic relationship was absent, all with lung involvement. In patients with no lung involvement, 8/8 had a match.
Conclusions One-third of patients with DMs in HNSCC lack a genetic relationship with the primary tumors. The risk of misclassification is most prominent for patients with lung involvement.
Chao Luo, Wenjie Huang, Shuqi Li, Haojiang Li, Guangying Ruan, Gui Fu, Lizhi Liu
Publication date 12-09-2024
Abstract Background We aimed to establish the most suitable threshold for objective response (OR) in the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 in patients with nasopharyngeal carcinoma (NPC).
Methods According to RECIST 1.1, we retrospectively evaluated MR images of NPC lesions in patients before and after induction chemotherapy (IC). Restricted cubic spline and maximally selected rank statistics were used to determine the cut-off value. Survival rates and differences between groups were compared with Kaplan–Meier curves and log-rank tests.
Results Of 1126 patients, 365 cases who received IC treatment were suitable for RECIST 1.1 evaluation. The 20% cut-off value maximized between-group differences according to maximally selected rank statistics. No difference in distant metastasis-free survival between OR and non-response groups was shown using the primary threshold of OR (30%), while it differed when 20% was employed.
Conclusions With an optimal cut-off value of 20%, RECIST may assist clinicians to accurately evaluate disease response in NPC patients.
Anne‐Sophie Becker, Jenny Merkel, Inci Bozkurt, Daniel Fabian Strüder, Claudia Maletzki, Maja Hühns, Annette Helene Zimpfer
Publication date 12-09-2024
Abstract Background Human papillomavirus (HPV) is an increasing risk factor for cancer. HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable outcome. Blockstaining for p16 is a surrogate marker for HPV+ OPSCC. In oral and laryngeal squamous cell carcinoma (OSCC/LSCC), the relevance of p16 immunohistochemistry, alone or in combination with other cell cycle-related proteins, to identify HPV-driven non-OPSCC is less well understood.
Methods We stained for p16, p Rb, cyclin D1, and p53 in 327 HNSCC. In 310 OPSCC, HPV-status was assessed by HPV DNA PCR. In 119 non-OPSCC, RNA in situ hybridization was additionally performed. HPV-status was correlated with staining patterns, p53 and clinical data.
Results The OPSCC showed blockstaining for p16 in 36%, 8% were equivocal. Of these, HPV-testing was performed in 57%, and 53% were positive for HPV DNA. HPV-association correlated with absence of p Rb and cyclin D1 and favorable outcome. In non-OPSCC, 18% showed p16-blockstaining, and 13% showed E6/E7 RNA. Six of seven HPV+ OSCC and 8/8 LSCC lost p Rb and cyclin D1. Compared to HPV-negative counterparts, patients with HPV+ cancers had lower rates of alcohol consumption and keratinizing morphology. HPV-positive OSCC had a longer overall survival (p < 0.05). HPV subtype 16 was the most common.
Conclusions We conclude that HPV-positive non-OPSCC are associated with p16 overexpression and low levels of p Rb and cyclin D1. High expression of p Rb and cyclin D1 indicates HPV-negativity.
Johannes N. van der Lely, Niek J. Nieuwdorp, Ineke C. A. W. Smits, Floris V. W. J. van Zijl, Eveline M. L. Corten, Marc A. M. Mureau
Publication date 12-09-2024
Abstract Background Facial palsy profoundly affects patients quality of life (QoL). We evaluated the effect of various surgical procedures on QoL using patient-reported outcome measures (PROMs) to provide evidence-based recommendations for improved care.
Methods Embase, Medline, Web of Science, Cochrane, and CINAHL were searched for studies on QoL in patients with facial palsy who had undergone reconstructive surgery with preoperative and postoperative data from validated PROMs. After conducting the quality assessment, data were subtracted from the articles. Meta-analyses of subgroups were performed when study outcomes where compatible.
Results Incorporating 24 studies (522 patients), our systematic review revealed consistent and significant QoL improvements following diverse reconstructive surgical procedures.
Conclusions Our systematic review and meta-analysis showed the positive effects of different reconstructive surgical procedures on QoL of patients with facial palsy. These results support clinicians to better inform patients about their potential outcomes, optimizing informed and shared decision-making and ultimately improving overall QoL in patients with facial palsy.
Zui Chen, Jie Ling, Sujuan Zhang, Yuhua Feng, Yangchun Xie, Xianling Liu, Tao Hou
Publication date 12-09-2024
Abstract Background Serum biomarkers have a significant impact on the prediction of treatment outcomes in patients diagnosed with nasopharyngeal carcinoma (NPC). The primary aim of this study was to develop and validate a nomogram that incorporates hemoglobin, albumin, and globulin ratio (HAGR) and clinical data to accurately forecast treatment outcomes in patients with NPC.
MethodsA total of 796 patients diagnosed with NPC were included in the study.
Results The results of the multivariate Cox analysis revealed that TNM stage and HAGR were found to be significant independent prognostic factors for OS and PFS. Furthermore, the utilization of the nomogram demonstrated a significant improvement in the evaluation of OS, PFS compared with the eighth TNM staging system. Additionally, the implementation of Kaplan–Meier curves and decision curve analysis curves further confirmed the discriminability and clinical effectiveness of the nomogram.
Conclusions The HAGR, an innovative prognostic factor grounded in the realm of immunonutrition, has emerged as a promising prognostic marker for both OS and PFS in individuals afflicted with NPC.
David Virós Porcuna, Carlos M. Pollán Guisasola, Constanza Viña Soria, Pablo Vergés Fort, Mar Palau Viarnès, Luis Juesas Iglesias, Armando De Virgilio
Publication date 12-09-2024
Abstract Transoral robotic surgery (TORS) provides a minimally invasive approach to address tumors in selected and challenging anatomical locations. Among the critical areas where TORS demonstrates its prowess is the oropharynx. Oropharyngeal tumors can invade parapharyngeal space (PPS) which contains vital structures such as the carotid artery, internal jugular vein, and cranial nerves IX–XII. A deeper understanding of the endoscopic anatomy of the parapharyngeal space could reduce the morbidity associated with tumor resection in this dense neurovascular area. This video-article provides a step-by-step cadaveric dissection of the lower PPS though a transoral robotic approach.
Pubmed PDF WebViraj M. Patel, Saad M. Alshammari, David W. Jang, Ali R. Zomorodi, Ralph Abi Hachem
Publication date 12-09-2024
Abstract As the indications for endoscopic skull base approaches have increased, so has the need for more versatile vascularized flaps for skull base reconstruction. Here, we describe a novel lateral based nasopharyngeal flap (LNPF). Two cadaver heads were dissected to elucidate flap anatomy, dimensions, and technique. A retrospective review was performed on two cases where LNPF was used to repair CSF leaks in the nasopharyngeal area, and outcomes reported. The LNPF is an ascending pharyngeal artery myomucosal flap that includes the nasopharyngeal mucosa and the superior pharyngeal constrictor muscle. The flap was 1.2 × 2.2 cm in greatest dimensions.
The LNPF was used for salvage CSF leak repair in two cases: one clival and one tubal. Both patients had resolution of leak at 7 months follow-up. The LNPF is a novel flap with reconstruction potential for the nasopharynx, including the lower clivus and the eustachian tube.
Publication date 11-09-2024
Kun Liu, Youwen Zhu, Shan Li, Hong Zhu
Publication date 08-09-2024
Abstract Background Research focused on the addition of immune checkpoint inhibitors (ICIs) to radiotherapeutic regimens in patients with cancer has become increasingly common, revealing promising improvements in efficacy outcomes. In patients with locoregionally advanced nasopharyngeal carcinoma (NPC), combining immunotherapy with chemoradiotherapy can facilitate the significant prolongation of survival, emphasizing the need for pharmacoeconomic studies focused on the clinical uptake of these innovative treatment regimens.
MethodsA three-state Markov model was developed based on clinical data from the randomized phase 3 CONTINUUM trial and used to compare the cost-effectiveness of chemoradiotherapy plus sintilimab (sintilimab group) to chemoradiotherapy alone (standard group), analyzing outcomes including incremental cost-effectiveness ratio (ICER), incremental net monetary benefit (INMB), and incremental net-health benefit (INHB) values at a willingness-to-pay (WTP) threshold corresponding to three times the Chinese GDP per capita ($37 035 per quality-adjusted life year QALY).
Results The total costs for patients in the sintilimab and standard groups (QALYs LYs) were $92 116 (6.68 10.03) and $53 255 (3.75 5.55), respectively, for an ICER of $13 230/QALY ($8672/LY), an INMB of $70 021 with INHB of 1.89 QALYs. Using the selected WTP threshold. On the standard WTP threshold, the prevalence of sintilimab group as the primary treatment was 90.55% in China. The establishment of the model is stable.
Conclusions Adding sintilimab to chemoradiotherapeutic regimens represents an innovative and cost-effective means for patients with locoregionally advanced NPC management in China.
Oh‐Hyeong Lee, Jooin Bang, Geun‐Jeon Kim, Dong‐il Sun, Sang‐Yeon Kim
Publication date 07-09-2024
Abstract This systematic review and meta-analysis investigated the impact of salvage surgery on 5-year overall survival (OS) and prognostic factors in recurrent oral cavity cancer (rOCC) patients. Relevant literature before May 2022 was reviewed, including retrospective cohort studies and observational studies comparing salvage surgery to other treatments. Risk-of-bias assessments were conducted using the Newcastle–Ottawa scale. Statistical and subgroup analyses assessed the impact of salvage surgery on 5-year OS and prognostic factors. 3036 documents were initially retrieved, with 14 retrospective cohort studies (2069 participants) included. Meta-analysis of 5-year OS in salvage surgery patients yielded a rate of 43.0%. Subgroup analysis showed higher OS in Asians (49.9% vs. 36.9%, p = 0.003) and late-relapse (63.8% vs. 30.0%, p = 0.004) groups. Prognostic factors revealed hazards associated with nodal recurrence, extranodal extension, and perineural invasion. Salvage surgery is a viable option for rOCC patients, showing favorable 5-year OS outcomes. Low publication bias enhances study reliability, but its single-arm design limits conclusions on salvage surgery superiority over other treatments.
Pubmed PDF Web"Amara Naseer, Sinead Brennan, Denise MacCarthy, John Edward OConnell, Eleanor OSullivan, Michelle Leech"
Publication date 30-08-2024
Abstract Background Osteoradionecrosis is a long-term, serious side effect of head and neck radiation therapy and is associated with significant morbidity and quality of life issues.
Methods This paper sought to determine consensus on the prevention and management of osteoradionecrosis by an international panel of multidisciplinary professionals expert in the management of patients with head and neck cancer using a Delphi methodology. Unique to this work is our direct inclusion of the views of patients and carers in our findings.
Results This study reached consensus on the importance of pre and post oral health assessment and education for patients with head and neck cancer. This was also noted by the patients and carers who took part in the study.
Conclusions This work highlights the need for a standardized oral health assessment tool and multidisciplinary care of patients to prevent and manage osteoradionecrosis.
Naohiro Nakamura, Tomofumi Sakagami, Minaki Shimizu, Kensuke Suzuki, Takuo Fujisawa, Takuya Shijimaya, Sanshiro Kobayashi, Yu Takahashi, Tomomitsu Tahara, Yuri Noda, Koji Tsuta, Makoto Naganuma
Publication date 29-08-2024
Abstract Background With the development of endoscopic imaging, superficial pharyngeal squamous cell carcinoma can now be detected during routine endoscopy. Recently, the effectiveness of endoscopic resection for superficial pharyngeal squamous cell carcinoma have been reported.
Methods This study had a retrospective single-center design that included patients with superficial pharyngeal squamous cell carcinoma who underwent endoscopic resection. A total 47 patients with 53 lesions were analyzed.
Results En bloc and R0 resection rates were 83.0% and 56.6%. Local recurrence and cervical lymph node metastasis (CLNM) were detected in 1 and 3 patients during follow-up. The macroscopic type 0-I was an independent factor for CLNM. The 3-year cumulative incidence of metachronous pharyngeal squamous cell carcinoma following endoscopic resection was 33.0%, and the 5-year overall survival rate was 89.2%.
Conclusions Endoscopic resection is an effective treatment for superficial pharyngeal squamous cell carcinomas, and the macroscopic type 0-I is a useful predictor of CLNM.
Carly Fassler, Pratyusha Yalamanchi, Marina Aweeda, Julie Rezk, Barbara Murphy, Natalie A. Lockney, Ryan Whitaker, Ryan Rigsby, Joseph Aulino, Emily Hosokawa, Mitra Mehrad, Kim Ely, James S. Lewis Jr., Evan Derman, Ed LaHood, Sarah L. Rohde, Robert J. Sinard, Eben L. Rosenthal, Michael C. Topf
Publication date 29-08-2024
Abstract Purpose Multidisciplinary tumor boards (TB) are the standard for discussing complex head and neck cancer cases. During TB, imaging and microscopic pathology is reviewed, but there is typically no visualization of the resected cancer.
MethodsA pilot study was conducted to investigate the utility of visual pathology reports at weekly TB for 10 consecutive weeks. Faculty-level participants completed a pre-survey and post-survey to assess understanding of resected cancer specimens.
Results Providers (n = 25) across seven medical specialties completed pre-survey and post-survey. Following intervention, providers reported significant improvement in understanding of anatomic orientation of the specimen and sites of margin sampling (mean 47.4–96.1, p < 0.001), ability to locate the site of a positive margin (mean 69.5–91.1, p < 0.001), and confidence in treatment plans created (mean 69.5–89.2, p < 0.001) with the addition of visual pathology reports.
Conclusions Visual pathology reports improve provider understanding of resected cancer specimens at multidisciplinary TB.
Sonja Steen, Dominik Horn, Christa Flechtenmacher, Jürgen Hoffmann, Kolja Freier, Oliver Ristow, Jochen Hess, Julius Moratin
Publication date 23-08-2024
Abstract Background Lately SOX2 and SOX9, transcription factors associated with stemness-like phenotypes of cancer cells, have been linked to tumor growth, metastasis, and resistance to therapy.
Methods This study aimed on evaluating the expression of SOX2 and SOX9 in a large cohort of patients with OSCC including primary and recurrent tumors and corresponding lymph node metastases. Semiautomatic digital pathology scoring was used to determine protein expression and survival analysis was performed to evaluate its prognostic significance.
Results We found a significant downregulation of SOX9 from primary disease to lymph node metastases (p < 0.001). SOX9 expression and the subgroup SOX2lowSOX9high were significantly correlated with worse overall survival (p < 0.05). Additionally, SOX2lowSOX9high expression pattern was confirmed as independent prognosticator for overall survival.
Conclusions These results indicate the relevant role of SOX2 and SOX9 in patients with OSCC and show the clinical relevance for further investigation on the molecular mechanisms underlying SOX-related gene expression.
Mohammed Holkom, Karim A. Sakran, Hui Zhao, Abdo A. S. Mohammed, Xu Chen, Edres A. Mohammed, Ke Liu, Zhengjun Shang
Publication date 22-08-2024
Abstract Objective This study investigates the unsatisfactory outcomes observed in mandibular reconstruction procedures attributed to improper condylar positioning in the Temporomandibular Joint. It also proposes a systematic classification for post-reconstruction condylar positioning dissatisfaction.
MethodsA retrospective analysis was conducted on 337 patients who underwent tumor removal and mandibular reconstruction with vascularized osteocutaneous flaps. Reconstruction techniques included conventional surgery (43.3%) and 3D technology-guided procedures (56.7%). Evaluation utilized preoperative and postoperative CT scans to assess mandibular vertical ramus length (V) and condylar alignment in both sagittal (S) and coronal (C) planes. Accordingly, a classification system for condylar positioning was developed and abbreviated as VSC.
It includes four classes: Class I, proper condylar reconstruction; Class II, short ramus length; Class III, one or two aspects of sagittal/coronal condylar positions dissatisfaction; and Class IV, two or three aspects dissatisfaction.
Results The overall success rate for condylar reconstruction was 85.16%. Though not statistically significant, the success rate was marginally higher in the 3D-assisted group (85.86%) compared to the conventional group (84.25%). In terms of the VSC classification, the distribution of cases across Class I, II, III, and IV were 287, 4, 9, and 37 cases, respectively. Notably, condylar dislocation was significantly associated with the defect site, particularly the body and condyle (p < 0.001, OR = 49.734, 95% CI 12.995–190.342), and the number of reconstructed segments (p = 0.025, OR = 3.480, 95% CI 1.173–10.328).
Conclusion The findings highlight the importance of accurate reconstruction methods and reveal implications of the defect site and the number of reconstructed segments in condylar dislocation. Consequently, we propose a classification system to refine condylar positioning assessment and enhance surgical outcomes in mandibular reconstruction.
Nikhil Bellamkonda, Evan L. Tooker, Anne Naumer, Luke O. Buchmann, Wendy Kohlmann, Hilary C. McCrary, Neil S. Patel, Mana Espahbodi
Publication date 21-08-2024
Abstract Background Bilateral head and neck paragangliomas (HNPGLs) require nuanced management to balance tumor control with functional preservation.
Methods All patients seen at a single-institution for bilateral paraganglioma between 1983 and 2023 were retrospectively reviewed. Demographics, genetic testing results, and tumor characteristics were analyzed and compared to treatment modality and cranial nerve outcomes.
Results There were 49 patients with 116 tumors (90 carotid body tumors CBTs, 15 vagal paragangliomas VPs, and 11 jugular paragangliomas JPs). Twenty-six patients had SDH pathologic variants (PV). Surgical management was more commonly utilized in younger patients (OR: 0.97, 95% CI: 0.950–0.992) and for JPs (OR: 9, 95% CI: 1.386–58.443). In surgical cases, CBTs had a lower risk of postoperative cranial nerve deficits compared to JPs and VPs (OR: 0.095, 95% CI: 0.013–0.692).
Conclusions Younger patients with bilateral HNPGLs, especially those with JP and CBT, are more often treated with surgery. CBTs have lowest risk of cranial nerve deficits after surgery.
Giacomo Bertazzoni, Alessandro Vinciguerra, Domitille Camous, Marco Ferrari, Davide Mattavelli, Mario Turri‐Zanoni, Alberto Schreiber, Stefano Taboni, Vittorio Rampinelli, Alberto Daniele Arosio, Benjamin Verillaud, Cesare Piazza, Paolo Battaglia, Maurizio Bignami, Alberto Deganello, Paolo Castelnuovo, Piero Nicolai, Philippe Herman
Publication date 21-08-2024
Abstract Introduction In the management of sinonasal malignancies treatment-induced morbidity and mortality is gaining relevance both for surgical approaches (endoscopic and open resection) and non-surgical therapies. The aim of this multicenter study is to assess complications associated with endoscopic surgery and non-surgical treatments (neoadjuvant and/or adjuvant) for malignant sinonasal tumors.
Methods All patients with nasoethmoidal malignancies treated with curative intent with endoscopic or endoscopic-assisted surgery at three referral centers with uniform management policies were included. Neo- and/or adjuvant (chemo)radiotherapy was administered according to histology and pathological report. Demographics, treatment characteristics, and complications related both to the surgical and non-surgical approaches were retrieved. The data were analyzed with univariate and multivariate statistics to assess independent predictors of complications.
Results Nine hundred and forty patients were included, 643 males (68%) and 297 females (32%). A total of 225 complications were identified in 187 patients (19.9%): cerebrospinal fluid (CSF) leak (3.5%), mucocele (2.3%), surgical site bleeding (2.0%), epiphora (2.0%), and radionecrosis (2.0%) were the most common. Treatment-related mortality was 0.4%. Variables independently associated with complications at multivariate analysis were principally dural resection (OR 1.92), cranioendoscopic or multiportal resection (OR 2.93), dural repair with multilayer technique with less than three layers (OR 2.17), and graft different from iliotibial tract (OR 3.29).
Conclusion Our study shows that modern endoscopic treatments and radiotherapy for sinonasal malignancies are associated with limited morbidity and treatment-related mortality. CSF leak and radionecrosis, although rare, remain the most frequent complications and should be further addressed by future research efforts.
Manuela Burggraf, Stefan Schiele, Rubens Thölken, Francisco José Farfán López, Noran Elawany, Johannes Zenk, Johannes Doescher
Publication date 20-08-2024
Abstract Induction chemotherapy (IC) recently gained importance for treatment of sinonasal undifferentiated carcinoma (SNUC). We analyzed our SNUC cases and performed a meta-analysis with focus on survival-rates stratified by treatment. SNUC cases at our institution were retrospectively evaluated. A systematic literature review was conducted to analyze treatment and outcome of SNUC. To calculate 5-year and 2-year overall survival (OS), individual patient data (IPD) were analyzed using Kaplan–Meier estimators and Cox proportional hazard regression to identify associations between types of therapy and survival. A random effects model for pooled estimates of 5-year survival was applied to studies without IPD data. Five-year OS of our SNUC cases (n = 9) was 44.4%. The IPD analysis (n = 192) showed a significantly better 5-year OS for patients who received induction chemotherapy (72.6% vs. 44.5%). The pooled 5-year OS of 13 studies identified in the literature search was 43.8%. IC should be considered in every patient diagnosed with SNUC.
Pubmed PDF WebShuyong Zhang, Rong Xie, Liuhuan Wang, Guoxue Fu, Chenxi Zhang, Yang Zhang, Jichun Yu
Publication date 16-08-2024
Abstract Background Papillary thyroid carcinoma (PTC) accounts for about 85% of thyroid cancer cases. Transmembrane protein 252 (TMEM252) is a gene encoding a transmembrane protein that has only been reported to be associated with triple-negative breast cancer. Herein, we first elucidated the physiological roles and possible regulatory proteins of TMEM252 in PTC pathogenesis.
Methods Quantitative real-time polymerase chain reaction, western blot, and immunohistochemical analyses were utilized to ascertain the relative TMEM252 expression in PTC and surrounding normal tissues. Functional investigations involved CCK-8 viability assay, EdU incorporation assay for proliferation, transwell assays for migration and invasion, and an in vivo tumor development assessment to evaluate the TMEM252-mediated regulation of tumor formation.
Results Our results first revealed diminished TMEM252 transcript and protein expressions in PTC tissues and cell lines. TMEM252 overexpression suppressed cell proliferation through reducing p53, p21, and p16 expression. Conversely, TMEM252 depletion has opposite effects in PTC cells both in vivo. Additionally, the upregulation of TMEM252 demonstrated cell migration and invasion suppression by impeding the epithelial–mesenchymal transition (EMT) process via inhibition of the Notch pathway. Furthermore, overexpression of TMEM252 suppressed tumor growth in vivo.
Conclusion Our study elucidates that TMEM252 suppresses PTC progression by modulating the Notch pathway. These findings underscore TMEM252 is a potential therapeutic target in managing PTC.
Shreya Sriram, Deborah Xie, Rebecca A. Gersten, Christine G. Gourin
Publication date 16-08-2024
Abstract Background The palliative care (PC) needs of patients with head and neck cancer (HNC) are complex, due to high and unique symptom burdens. Uniform outcome measures are critical to assessing the impact of PC interventions in HNC.
MethodsA scoping review of outcome measures used in patients with HNC receiving PC was performed using Pub Med, Embase, and Web of Science from 1980 to 2022.
Results Of 20 eligible studies, 19 unique instruments were identified which assessed 22 physical, 5 mental, 4 social, 7 related quality of life, and 9 advanced care planning outcomes. Instruments were underutilized, with a larger number of outcomes measurable for instruments used than were reported. The average instrument assessed three domains whereas the average study only reported outcomes from two domains.
Conclusions Comparison across studies is limited due to heterogeneity in outcome measures. Future work is needed to develop core PC outcome measures for use in HNC care.
Nicole E. Schaen‐Heacock, Linda M. Rowe, Michelle R. Ciucci, John A. Russell
Publication date 16-08-2024
Abstract Background Common treatments for head and neck cancer (radiation and chemotherapy) can lead to dysphagia; tongue exercise is a common intervention. This study aimed to assess swallow biomechanics and bolus kinematics using a well-established rat model of radiation or chemoradiation treatment to the tongue base, with or without tongue exercise intervention.
Methods Pre- and post-treatment videofluoroscopy was conducted on 32 male Sprague–Dawley rats treated with radiation/chemoradiation and exercise/no exercise. Rats in the exercise groups completed a progressive resistance tongue training paradigm. Swallow biomechanics, bolus kinematics, jaw opening, and post-swallow respiration were assessed.
Results Both treatments impacted outcome measures; the addition of exercise intervention showed benefit for some measures, particularly in rats treated with radiation, vs. chemoradiation.
Conclusions Radiation and chemoradiation can significantly affect aspects of deglutition; combined treatment may result in worse outcomes. Tongue exercise intervention can mitigate deficits; more intensive intervention may be warranted in proportion to combined treatment.
Samuel Doty, Amanda Goslawski, Claudia I. Cabrera, Eve Tranchito, Nicole Fowler, Shawn Li, Jason E. Thuener, Theodoros N. Teknos, Rod P. Rezaee, Cyrus C. Rabbani, Akina Tamaki
Publication date 15-08-2024
Abstract Background Facial paralysis is a life-altering condition that may arise from various etiologies, ranging from trauma to malignancy. Permanent facial paralysis may occur secondary to facial nerve sacrifice or irreversible damage to the nerve. In these particularly devastating cases, protection and maintaining function of the eye is paramount. There are many effective lagophthalmos corrective surgical procedures available for these patients. While placement of eyelid weights and lid tightening surgeries are the cornerstone of eyelid rehabilitation, limited information exists on whether the timing of eyelid interventions in the setting of permanent facial paralysis impact outcomes, including need for revision surgery.
MethodsA single-center retrospective chart review was performed for patients with irreversible facial paralysis treated with an upper eyelid weight between 2013 to 2022. Electronic health records were acquired to obtain facial paralysis etiology, associated clinical characteristics, the type of intervention, and the timing of intervention. Patients were classified as immediate if the eyelid weight operation occurred within 29 days of the initial facial paralysis and delayed if the surgery occurred 30 days or more after initial presentation. Outcomes were assessed in terms of revision procedures and surgical complications.
Results There were 70 patients in total, with 35 patients in the immediate category and 35 patients in the delayed category. The most common etiology related to parotid gland pathology, and 58.6% of patients had facial paralysis from cancer-related surgeries. There were no significant differences in revision rates (p < 0.208) or in the types of procedures (p = 0.077) between the two groups. The complication rates also did not differ significantly between groups; however, there were only complications in the delayed intervention group.
Conclusions These findings suggest there is no difference in postoperative complications between groups, including the need for revision surgeries when comparing groups with immediate or delayed intervention. Thus, treatment plans should be customized based on patient and provider preferences.
Saikrishna Ananthapadmanabhan, Eugene Wong, Lydia Natsis, Anand Suruliraj, Niranjan Sritharan, Mark Smith, Carsten E. Palme, Faruque Riffat
Publication date 15-08-2024
Abstract Background The presence of a pseudodiverticulum of the anterior pharyngeal wall, or prominent “pharyngeal bar,” is a well-known phenomenon that occurs following total laryngectomy, which can be visualized by nasolaryngoscopy or videofluoroscopy. Among the different techniques of pharyngeal reconstruction, there is higher incidence following primary vertical multilayered closure. It has been postulated to cause dysphagia and lack of dietary progression despite a paucity of data. However, the direct impact of pseudodiverticulum is less clear and anecdotally its presence and severity does not necessarily correlate with dysphagia.
MethodsA retrospective case series was performed of all consecutive patients who underwent total laryngectomy or laryngopharyngectomy between 2015 and 2022 at two tertiary head and neck institutions. All patients underwent routine videofluoroscopy postoperatively for swallow assessment. The presence of pseudodiverticulum on postoperative contrast swallow study was recorded to investigate the relationship with patients ability to tolerate oral intake at 3 months discharge from the hospital.
Results Of 50 laryngectomized patients (mean age 63.8 ± 10.0, 86% male), the main closure techniques were primary vertical (n = 9, 18%), primary T-closure (n = 14, 28%), and flap reconstruction (n = 27, 54%). Pseudodiverticulum was identified in 19 cases (38%). 43 patients underwent primary surgery and 30 had adjuvant radiotherapy. The presence of pseudodiverticulum was significantly associated with vertical primary closure versus non-vertical (T-closure or flap reconstruction) techniques (χ2 (df 1) = 7.4, p = 0.007, OR = 5.7, 95% CI 1.3–24.7). Pseudodiverticulum was not associated with an increased inability to tolerate solid intake or full diet compared to patients without pseudodiverticulum. 26.3% of patients with pseudodiverticulum were on full diet compared to 25.8% of patients without. The vertical closure technique showed no difference in ability to maintain solid intake compared with non-vertical closure; however, no patients were on full diet. Only one patient in the pseudodiverticulum group required surgical management during the study period for retention.
Conclusion The presence of a pseudodiverticulum does not appear to be significantly associated with a need for postoperative dietary modification. The authors postulate that postlaryngectomy dysphagia is multifactorial with sensorimotor aperistalsis of the pharynx and cricopharyngeal stenosis. While a pseudodiverticulum is a common phenomenon, patients did not require modification of diet at higher rates than those without, and they seldom require intervention.
Einav G. Levin, Amit Ritter, Gideon Bachar, Aviram Mizrachi, Hagit Shoffel‐Havakuk, Noga Kurman, Aron Popovtzer, Yaniv Hamzany
Publication date 13-08-2024
Abstract Background Laryngeal chondroradionecrosis (LCRN) is a rare but severe complication of radiation therapy. The study aimed to review the management of LCRN and evaluate the clinical benefit of hyperbaric oxygen therapy (HBOT).
Methods We retrospectively analyzed all radiation-induced LCRN patients between 2006 and 2019 at a tertiary medical center. Diagnosis was based on signs and symptoms of Chandlers classification, imaging, and/or histopathology report. The primary outcome was improvement in Chandlers grade after HBOT.
Results Of 678 irradiated laryngeal cancer patients, 29 (4.3%) were diagnosed with LCRN. The most common primary management was tracheostomy with intravenous steroids and antibiotics (59%). Ten patients received HBOT (34.5%), and six underwent total laryngectomy (21%). In HBOT-treated patients, Chandlers grade significantly improved from a median of 4 (range 2–4) to 2.5 (range 1–4; p = 0.005).
ConclusionsHBOT may benefit in the management of patients with persistence and unresponsive symptoms of LCRN following radiation therapy for laryngeal SCC.
Angela A. Colback, Daniel V. Arkfeld, Alireza Paydar, Osama Raslan, Daniel J. Cates, Marianne Abouyared
Publication date 13-08-2024
Abstract Background Malnutrition is a major consequence of head and neck cancer (HNC), often leading to decreased skeletal muscle mass and impacting survival. The goal of this study is to determine the effect of sarcopenia, as defined by skeletal muscle index (SMI), on survival in patients with HNC.
Methods This is a retrospective review of patients with HNC treated with surgery and/or radiation at a single tertiary care institute. All had pre-treatment imaging available for skeletal muscle index (SMI) measurements, and SMI was calculated at the level of the 3rd cervical vertebra. Sarcopenia was defined as an SMI < 41 cm2/m2 in females and as <43 cm2/m2 in underweight or healthy weight males. Sarcopenia was defined as <53 cm2/m2 in overweight or obese males. Chi-square analysis was performed to compare recurrence and survival rates, and survival analysis was performed via Kaplan–Meir curve.
Results Hundred and twelve patients with HNC were evaluated, 84 men and 28 women with an average age of 60.9 years. Tumors were primarily located in the oral cavity (24.1%) and oropharynx (42%). The majority (69.6%) underwent surgery. Mean body mass index prior to treatment was 28. Sixty-nine patients (61.6%) in our cohort had low SMI. Mean follow-up was 3.9 ± 2.2 years. Recurrence rate was 26% in those with low SMI versus 2% in those without. Patients with low SMI were more likely to have a recurrence (p = 0.02). Overall survival was 72.5% in those with low SMI and 81% in those with normal SMI (p = 0.09).
Conclusions Defining sarcopenia as a low skeletal muscle index at the third cervical vertebra is clinically relevant. This study demonstrates that low SMI at this level, and thus sarcopenia, was strongly associated with higher rates of recurrence.
Zhuowei Yao, Jingshuo Wang, Yongquan Jiang, Yi Zhang, Jun Liu, Li Dai, Silin Shen, Xiang Zhou, Qiang Liu, Luying Zheng, Minfei Qian, Jiping Li
Publication date 13-08-2024
Abstract Purpose Head and neck cancer cells commonly express programmed death ligand 1 (PD-L1) and epidermal growth factor receptor (EGFR), both of which play pivotal roles in the antitumor cellular immune response. Pembrolizumab, a PD-1 inhibitor, and cetuximab, an EGFR inhibitor, are typically effective agents combined with neoadjuvant platinum-based chemotherapy for the treatment of head and neck squamous cell carcinoma (HNSCC). This study aims to evaluate the efficacy and safety of neoadjuvant immunochemotherapy in patients with HNSCC.
Methods Patients with HNSCC underwent radical surgery and complete cervical lymph node dissection following neoadjuvant immunochemotherapy at Ren Ji Hospital from January 2021 to June 2024 were retrospectively analyzed. The primary endpoint was major pathological response (MPR). We further explored the relationship between the efficacy and immune estimators.
Findings Twenty-one patients were enrolled in this retrospective study. The MPR was 66.7%, including 11 patients who achieved a pathological complete response (pCR). The overall response rate (ORR) was 90.5%, and the complete response (CR) rate was 28.6%. The oropharynx, as the primary site, was the sensitive tumor type to neoadjuvant immunochemotherapy. The most common adverse event (AEs) was anemia (61.9%). No grade 4 AE or delayed surgery was reported. Laryngeal preservation rates were 90.9% (10/11), and pathological findings confirmed negative surgical margins for all patients. Moreover, pre-treatment peripheral lymphocyte count, monocyte count, and platelet to lymphocyte ratio (PLR) displayed a significant correlation with the treatment response.
Conclusion Pembrolizumab plus cetuximab with chemotherapy for patients with HNSCC is a feasible and safe clinical protocol fulfilling organ preservation and life quality improvement. Pre-treatment peripheral immune estimators could help to screen patients who may respond to the neoadjuvant immunochemotherapy.
Zikun Yu, Qin Wang, Zimeng Wang, Sihan Liu, Tianliang Xia, Chongyang Duan, Youping Liu, Xi Ding, Siyuan Chen, Tao Yu, Rui You, Mingyuan Chen, Peiyu Huang
Publication date 12-08-2024
Abstract Background Effective biomarkers for assessing anti-PD-1/PD-L1 therapy efficacy in patients with nasopharyngeal carcinoma (NPC) are still lacking. The human gut microbiota has been shown to influence clinical response to anti-PD-1/PD-L1 therapy in many cancers. However, the relationship between the gut microbiota and the efficacy of immunotherapy in patients with nasopharyngeal carcinoma has not been determined.
Methods We conducted a prospective study in which fecal and blood samples from patients with NPC were subjected to 16S rDNA sequencing and survival analysis. To investigate potential differences in the gut microbiome between these groups and to identify potential biomarkers indicative of immunotherapy efficacy, patients were categorized into two groups according to their clinical response to immunotherapy, the responder group (R group) and the non-responder group (NR group). Progression-free survival (PFS) between these subgroups was analyzed using Kaplan–Meier survival analysis with the log-rank test. Additionally, we performed univariate and multivariate analyses to evaluate prognostic factors. Finally, we carried out non-targeted metabolomics to examine the metabolic effects associated with the identified microbiome.
Results Our 16S rDNA sequencing results showed that the abundance of Lachnoclostridium was higher in the NR group than in the R group (p = 0.003), and alpha diversity analysis showed that the abundance of microbiota in the NR group was higher than that in the R group (p = 0.050). Patients with a lower abundance of Lachnoclostridium had better PFS (p = 0.048). Univariate (p = 0.017) and multivariate analysis (p = 0.040) showed that Lachnoclostridium was a predictor of PFS. Non-targeted metabolomics analysis revealed that Lachnoclostridium affects the efficacy of immunotherapy through the usnic acid.
Conclusions High abundance of Lachnoclostridium predicts poor prognosis in patients with NPC receiving immunotherapy.
Qifeng Jin, Yonghong Hua, Ting Jin, Lei Wang, Changjuan Tao, Shuang Huang, Weifeng Qin, Xiaozhong Chen
Publication date 11-08-2024
Abstract Background Induction chemotherapy of docetaxel plus cisplatin (TP) is myelosuppressive, leading to severe neutropenia and febrile neutropenia (FN). Herein, we aimed to investigate the efficacy and safety of mecapegfilgrastim in the prevention of neutropenia in patients with locally advanced nasopharyngeal carcinoma who received the TP regimen.
MethodsA total of 30 treatment-naive patients with locally advanced nasopharyngeal carcinoma were included in this study. Mecapegfilgrastim 6 mg was injected 24–48 h after the completion of induction chemotherapy with the TP regimen.
Results The incidence of grade ≥3 neutropenia during the three induction chemotherapy cycles was 6.7% (95% CI, 0.8%–22.1%). In the first cycle of chemotherapy, the incidence of grade ≥3 neutropenia was 3.3% (95% CI, 0.1%–17.2%). No FN or antibiotic usage was reported. All 30 patients completed the induction chemotherapy cycles.
Conclusion Mecapegfilgrastim effectively reduced the incidence of chemotherapy-induced neutropenia and FN in patients with locally advanced nasopharyngeal carcinoma.
Ardalan Ebrahimi, Ruta Gupta, Lachlan McDowell, Matthew J. R. Magarey, Paul N. Smith, Klaus‐Martin Schulte, Diana M. Perriman, Michael Veness, Sandro Porceddu, Tsu‐Hui Hubert Low, Allan Fowler, Jonathan R. Clark
Publication date 09-08-2024
Abstract Background We aimed to identify predictors of distant metastatic recurrence (DMR) in patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases treated with curative intent.
Methods Predictors of DMR were identified using Cox regression in a multicenter study of 1151 patients.
Results The 5-year risk of DMR was 9.6%. On multivariate analysis, immunosuppression (HR 2.93; 95% CI: 1.70–5.05; p < 0.001), nodal size >6 cm versus ≤3 cm (HR 2.77; 95% CI: 1.09–7.03; p = 0.032), ≥5 nodal metastases versus 1–2 (HR 2.79; 95% CI: 1.63–4.78; p < 0.001), and bilateral disease (HR 3.11; 95% CI: 1.40–6.90; p = 0.005) predicted DMR. A DMR risk score was developed that stratified risk from 6.6% (no risk factors) to 100% (≥3 risk factors) (p < 0.001).
Conclusions The risk of DMR in nodal metastatic HNcSCC increases with immunosuppression, nodal size >6 cm, ≥5 nodal metastases, and bilateral disease. A simple DMR risk score estimated prior to treatment may be clinically useful.
Samuel M. Vorbach, Thomas Seppi, Manuel P. Sarcletti, Siegfried Kollotzek, Julian Mangesius, Jens Lehmann, David Riedl, Martin J. Pointner, Matthias Santer, Daniel Dejaco, Meinhard Nevinny‐Stickel, Ute Ganswindt
Publication date 08-08-2024
Abstract Background We report on the characterization and introduction of a novel prognostic score for patients undergoing stereotactic body radiotherapy (SBRT) for the treatment of single and multiple pulmonary metastases (PMs) derived from head and neck cancer (HNC).
Methods In this retrospective study, we examined selected factors associated with progression-free survival (PFS) and overall survival (OS) among 59 patients with HNC treated with SBRT for a total of 118 PMs, between 2009 and 2023. Factors related to survival were included in the prognostic scoring system.
Results Prognostic factors including histology, age, number of metastases, and performance status at first SBRT were weighted differently depending on the strength of correlation to PFS and OS. Total prognostic scores (HAMP) ranged from 13 to 24 points, with a cut-off total score of ≤18 scoring points for patients in a high-risk (HR) subcohort, and of ≥19 scoring points for patients in a low-risk group (LR). Median PFS (23.8 vs. 5.5 months, p < 0.001) and OS (61.3 vs. 16.4 months, p < 0.001) were significantly longer in the low-risk group compared to the high-risk group.
Conclusion The HAMP score might be a convenient tool to facilitate individualized treatment decisions and appropriate follow-up. The accuracy and reliability of the score requires further evaluation in prospective studies.
Allen M. Chen, Jeremy P. Harris, Tjoson Tjoa, Yarah Haidar, William B. Armstrong
Publication date 07-08-2024
Abstract Purpose To report a single-institutional experience with hypofractionated radiation therapy alone for human papillomavirus (HPV)-positive oropharyngeal cancer.
Methods and materialsA total of 101 consecutive patients were treated by radiation therapy alone using a regimen of 66 Gy in 30 fractions (60 patients) or 70 Gy in 33 fractions (41 patients) for newly diagnosed p16-positive squamous cell carcinoma of the oropharynx. Sixty-seven patients (67%) were never smokers.
Results The 3-year actuarial rates of overall survival, local-regional control, and progression-free survival were 94%, 93%, and 89%, respectively. Among never-smokers, the 3-year rates of overall survival and local–regional control were 98% and 100%, respectively. The grade 3+ acute toxicity rate was 21%, with the most commonly observed side effects related to mucositis.
Conclusion Hypofractionated radiation alone resulted in excellent outcomes for patients with HPV-positive oropharyngeal cancer. A prospective clinical trial investigating this modality in the setting of de-escalation is currently underway.
Luca Canali, Marika D. Russell, Anthea Sistovaris, Amr H. Abdelhamid Ahmed, Michael Otremba, Hien T. Tierney, Frédéric Triponez, Fares Benmiloud, Giuseppe Spriano, Giuseppe Mercante, Gregory W. Randolph
Publication date 05-08-2024
Abstract Background Hypocalcemia is the most common postoperative complication of total thyroidectomy. Near-infrared autofluorescence (NIRAF) technology is a surgical adjunct that has been increasingly utilized with the aim of preventing postoperative hypocalcemia, but its clinical benefits have not yet been firmly established. The aim of this study was to assess the clinical benefit of utilizing NIRAF technology in patients undergoing total thyroidectomy.
MethodsA systematic review and meta-analysis of randomized clinical trials was performed according to PRISMA guidelines.
Results Seven randomized clinical trials with 1437 patients (318 males, 22.13%) undergoing total thyroidectomy were included for analysis. Risk of postoperative hypocalcemia was reduced in the NIRAF arm (RR, 0.65; 95%CI, 0.50–0.84). Use of NIRAF was also associated with a reduction in the risk of permanent parathyroid dysfunction (RR, 0.46; 95%CI, 0.22–0.95) and inadvertent parathyroid gland resection (RR, 0.40; 95%CI, 0.26–0.60).
Conclusions We present a systematic review and meta-analysis of randomized clinical trials examining the impact of NIRAF technology on preservation of parathyroid function. Our results suggest that use of camera-based NIRAF technology reduces the risk of postoperative hypocalcemia, permanent parathyroid dysfunction, and inadvertent parathyroid gland resection.
Anouk W. M. A. Schaeffers, Anouk V. M. Burger, Charlotte W. Duinkerken, Klaske E. van Sluis, Jan Paul de Boer, Lisette van der Molen, Alex E. Hoetink, Abrahim Al‐Mamgani, Katarzyna Jóźwiak, Lot A. Devriese, Remco de Bree, Charlotte L. Zuur
Publication date 02-08-2024
Abstract Introduction Patients with head and neck squamous cell carcinoma (HNSCC) treated with cisplatin-based chemoradiotherapy (CRT) frequently experience irreversible sensorineural hearing loss (SNHL). Patients with low lumbar skeletal muscle index (LSMI) may experience higher serum peak dosages of cisplatin. This study investigated whether pre-treatment low LSMI is associated with increased SNHL upon cisplatin-based CRT.
Materials and methodsLSMI was assessed using routine pre-treatment CT scans. Pure tone audiometry was performed at baseline and at follow-up to assess treatment-related SNHL. Linear mixed models were used to reveal a potential association between the continuous variable LSMI and SNHL.
Results This retrospective cohort study included 81 patients and found a significant association between low LSMI and increased treatment-related SNHL at pure tone frequencies vital for the perception of speech (averaged of 1, 2, and 4 k Hz) (p = 0.048).
ConclusionsHNSCC patients with low LSMI suffer increased treatment-related SNHL upon cisplatin-based CRT.
Bailey Balouch, Aakanksha Gupta, Bruce Tjaden, Joseph V. Lombardi, Jeffrey P. Carpenter, Nadir Ahmad, Yekaterina Shapiro
Publication date 02-08-2024
Abstract Background Postoperative carotid endarterectomy (CEA) patch infection is a rare but well-recognized complication of CEA. It is important for otolaryngologists to be aware of the presentation and challenges in its diagnosis.
Methods Patients who presented with a neck mass or hemorrhage and a known prior history of carotid endarterectomy with synthetic patch reconstruction were worked up with ultrasound, CT, or MRI imaging. In one case, fine needle aspiration biopsy was performed. Ultimately, all patients were taken to the operating room for neck exploration.
Results Of the three patients presented in this case series, two presented with a chronic neck mass, two-to-three years after carotid endarterectomy. One patient presented acutely with hemorrhage from the carotid endarterectomy site. Carotid patch infection was diagnosed after neck exploration in all cases. Vascular surgery was consulted intra-operatively to perform definitive vascular repair.
Conclusions Infected carotid patch should be suspected in patients with a history of prior CEA, as many of the presenting complaints may resemble or mimic pathology managed by otolaryngology. The onset of symptoms can be perioperative or very delayed. A multidisciplinary approach with vascular surgery and infectious disease is required for appropriate management of these patients.
Tyler G. Chan, Jaime Wicks, Ila Sethi, Jennifer Becker, David Brandon, Nicole C. Schmitt, Azeem Kaka, Brian Boyce, Harry Michael Baddour, Mark W. El‐Deiry, Mihir R. Patel, Jennifer H. Gross
Publication date 02-08-2024
Abstract Introduction Occult nodal disease (OND) during clinically-N0 salvage total laryngectomy (TL) can be detected with the Neck-Imaging-Reporting-and-Data-Systems (NI-RADS). However, some patients will still have OND revealed on final pathology.
MethodsA retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features.
Results Among 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length SD was 0.6 cm 0.3. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUVmax below blood pool. One patient scored NI-RADS 2; the rest scored 1.
Conclusions On re-review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information.
Kwang Hyun Yoon, Jong Cheol Lee, Yong Jin Song, Won Jun Kim, Myoung Sook Shim, Ha Young Kim, Jin Yub Kim, Byeong‐Joo Noh, Dong Gyu Na
Publication date 02-08-2024
Abstract Background Accurate intraoperative identification of normal parathyroid glands (PTGs) is vital to avoid hypocalcemia post total thyroidectomy. Although ultrasonography (US) has been shown to identify normal PTGs, the significance of preoperative US PTG mapping in this context is not well studied. This study evaluated the impact of preoperative US PTG mapping on intraoperative identification of normal PTGs during total thyroidectomy.
Methods The study involved 161 consecutive patients who underwent total thyroidectomy between January 2020 and June 2022. These included patients without preoperative US PTG mapping (group 1, n = 91) and those with the mapping (group 2, n = 70). Propensity score matching yielded 61 matched patients from each group. We developed a preoperative US PTG mapping technique combining US identification of normal PTGs with their localization on thyroid CT images. The intraoperative detectability of normal PTGs during thyroid surgery and detectability of normal PTGs by the preoperative US mapping were assessed by the number of PTGs identified per patient and by location.
Results In the matched cohort, group 2 demonstrated a higher median number of identified PTGs (3 vs. 2, p = 0.011), a greater proportion of patients with three or more identified PTGs (65.5% vs. 44.3%, p = 0.018), and a higher ratio of identified to expected PTGs (70.5% vs. 60.2%, p = 0.011) than group 1. In group 2, the median number of normal PTGs identified preoperatively was 3, with at least one identified in 95.7% of patients, two or more in 84.3%, three or more in 52.9%, and four or five in 24.3%.
Conclusions Preoperative US PTG mapping identified two or more normal PTGs in the majority of adult patients undergoing total thyroidectomy. Those with preoperative mapping showed a higher number of intraoperatively identified normal PTGs, including inferior PTGs, compared to those without. This technique appears to enhance the intraoperative identification of normal PTGs, thereby potentially improving surgical outcomes in total thyroidectomy.
Kerstin Petersson, Caterina Finizia, Nina Pauli, Lisa Tuomi
Publication date 01-08-2024
Abstract Background Radiation-induced dysphagia and restricted mouth opening are common problems among patients with head and neck cancer. The aim of the present randomized controlled trial was to determine if an exercise protocol could prevent swallowing and mouth opening impairment.
Methods Eighty-nine participants were randomly assigned to either an active group performing preventive swallowing and mouth opening exercises (n = 45) or to a control group (n = 44). Outcome measures were collected at baseline before radiotherapy and approximately 1-month post-treatment. Primary endpoints were changes in swallowing function according to the Penetration Aspiration Scale and mouth opening ability measured in millimeters. Intention-to-treat analysis was used.
Results Swallowing function and mouth opening deteriorated in both groups, with no statistically significant positive effect of the protocol detected at follow-up. Among patients who completed >75% of exercises, there was a trend toward better outcomes.
Conclusions Preventive exercises did not improve short-term swallowing function and mouth opening after radiotherapy.
Claudio Sampieri, Eleonora Cioccoloni, Andrea Costantino, Dahee Kim, Kyuin Lee, Giuseppe Meccariello, Giovanni Cammaroto, Claudio Vicini, Se‐Heon Kim
Publication date 01-08-2024
Abstract Background Transoral robotic surgery (TORS) performed after neoadjuvant chemotherapy (NAC) is a promising treatment for advanced-stage oropharyngeal carcinoma (OPSCC) able to reduce the adjuvant therapy administration rate.
MethodsA retrospective bi-centric study was conducted to analyze NAC + TORS versus upfront TORS patients. A 1:1 propensity score matching was used to compare the two groups.
Results Among the 300 patients with stage III-IV OPSCC, 204 patients were matched for comparing NAC + TORS versus upfront TORS. Between the two groups, no significant difference was observed in recurrences and in survival for RFS, OS, and DSS. In the NAC + TORS p16-positive population, adjuvant therapy could be spared in 51% versus 16% in the upfront surgery cohort (p < 0.001) due to the lower frequency of pathological risk factors after NAC.
ConclusionsNAC followed by TORS for locoregionally advanced OPSCC demonstrated to achieve non-inferior survival outcomes to upfront surgery, while in the p16-positive population allowed to significantly spare adjuvant therapy.
Xin Zhao, Ziqi Pei, Xiang Song, Gang Jin
Publication date 31-07-2024
Abstract Background Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive disease with ambiguous management and poor prognosis. This study aimed to evaluate the role of radiation therapy (RT) and explore the optimal treatment sequence.
Methods Retrospective analysis of survival trends of 410 SNUC patients between 1973 and 2015.
Results The 5-year cancer-specific survival (CSS) rate (45.1%) and overall survival (OS) rates (38.1%) were reported in the 84-month median follow-up. Radiotherapy was a prognosticator for improving CSS (hazard ratio HR = 0.425, 95% confidence interval CI: 0.299–0.603, p = 0.000) and OS (HR = 0.415, 95% CI: 0.303–0.570, p = 0.000), either with surgery (p = 0.000) or without surgery (p = 0.000). However, in a combined therapy of surgery and RT, preoperative and postoperative RT (5-year OS rates were 47.1% and 45.6%, respectively, p = 0.486) were not significantly different.
Conclusions Radiotherapy plays a key role in improving SNUC survival rates. No significant difference in survival rates was observed in preoperative and postoperative RT treatment.
Dan P. Zandberg, Serafettin Zenkin, Murat Ak, Priyadarshini Mamindla, Vishal Peddagangireddy, Ronan Hsieh, Jennifer L. Anderson, Greg M. Delgoffe, Ashely Menk, Heath D. Skinner, Umamaheswar Duvvuri, Robert L. Ferris, Rivka R. Colen
Publication date 30-07-2024
Abstract Background We retrospectively evaluated radiomics as a predictor of the tumor microenvironment (TME) and efficacy with anti-PD-1 m Ab (IO) in R/M HNSCC.
Methods Radiomic feature extraction was performed on pre-treatment CT scans segmented using 3D slicer v4.10.2 and key features were selected using LASSO regularization method to build classification models with XGBoost algorithm by incorporating cross-validation techniques to calculate accuracy, sensitivity, and specificity. Outcome measures evaluated were disease control rate (DCR) by RECIST 1.1, PFS, and OS and hypoxia and CD8 T cells in the TME.
Results Radiomics features predicted DCR with accuracy, sensitivity, and specificity of 76%, 73%, and 83%, for OS 77%, 86%, 70%, PFS 82%, 75%, 89%, and in the TME, for high hypoxia 80%, 88%, and 72% and high CD8 T cells 91%, 83%, and 100%, respectively.
Conclusion Radiomics accurately predicted the efficacy of IO and features of the TME in R/M HNSCC. Further study in a larger patient population is warranted.
Filippo Marchi, Andrea Iandelli, Gian Marco Pace, Elisa Bellini, Alessandro Tirrito, Andrea Costantino, Luca Cerri, Antonio Greco, Antonella Polimeni, Giampiero Parrinello, Giorgio Peretti, Armando De Virgilio
Publication date 30-07-2024
Abstract Objective This study aims to evaluate the efficacy of the profunda artery perforator (PAP) flap in head and neck reconstruction.
MethodsA single arm meta-analysis was performed for flap survival rate (primary outcome), reoperation for major complication, and overall complication rates (secondary outcomes).
Results The search strategy yielded a total of 295 potentially relevant publications, of which 13 were included. A total of 305 patients (males: 80.8%, n = 232/281), with a median age of 56.1 years (n = 305/305; 95% CI 53.9–63), who underwent a total of 307 PAP flap reconstructions for head and neck defects were included. Flap survival rate was 100% (n = 306/307; 95% CI 99.6%–100%), with a reoperation rate for major complications of 3.7% (n = 15/307; 95% CI 1.85%–6.1%) and an overall complication rate of 26.5% (n = 92/307; 95% CI 15.7%–38.9%). Notable postoperative complications included wound dehiscence (n = 15/307, 4.9%), delayed healing (n = 14/307, 4.6%), and wound infection (n = 12/307, 3.9%). Partial flap necrosis and hematoma occurred in 2.6% of cases (n = 8/307), while arterial and venous thrombosis were documented in 0.7% (n = 2/307) and 1.3%, respectively (n = 4/307).
Conclusion The application of the PAP flap in head and neck reconstructions showed several favorable aspects, such as an exceptionally low flap failure rate, versatility in achieving variable dimensions, and a relatively low incidence of complications. PAP flap might be considered as a compelling alternative to the traditionally employed soft tissue free flaps in head and neck reconstruction.
Zhichao Zuo, Jie Ma, Mi Yan, Wu Ge, Ting Yao, Lu Zhou, Ying Zeng, Yang Liu
Publication date 30-07-2024
Abstract Background Early detection of high-risk nasopharyngeal carcinoma (NPC) recurrence is essential. We created a machine learning-derived prognostic signature (MLDPS) by combining three machine learning (ML) models to predict progression-free survival (PFS) in patients with non-metastatic NPC.
MethodsA cohort of 653 patients with non-metastatic NPC was divided into a training (n = 457) and validation (n = 196) dataset (7:3 ratio). The study included clinicopathological characteristics, hematologic markers, and MRI findings in three machine learning models—random forest (RF), extreme gradient boosting (XGBoost), and least absolute shrinkage and selection operator (LASSO)—to predict progression-free survival (PFS). A Venn diagram identified the overlapping signatures from the three ML algorithms. Cox proportional hazard analysis determined the MLDPS for PFS.
Results The RF, XGBoost, and LASSO algorithms identified six consensus factors from the 33 signatures. Cox proportional hazards analysis showed that the MLDPS includes age, lymphocyte count, number of positive lymph nodes, and regional lymph node density. Additionally, MLDPS effectively stratified prognosis, with low-risk individuals showing better PFS than high-risk individuals (p < 0.001).
ConclusionMLDPS, based on clinicopathological characteristics, hematologic markers, and MRI findings, is crucial for guiding clinical management and personalizing treatments for patients with non-metastatic NPC.
Amanda J. Bastien, Luv Amin, Missael Vasquez, Iris Cong, Michael Luu, Meghan Laszlo, Saori Yen, Heather Thompson, Elana L. Teitelbaum, Julie K. Jang, Alain C. Mita, Kevin S. Scher, Justin Moyers, Jon Mallen‐St. Clair, Evan S. Walgama, Zachary S. Zumsteg, Allen S. Ho
Publication date 30-07-2024
Abstract Background As a surrogate of malnutrition, degree of weight loss and recovery from head and neck cancer (HNC) treatment is understudied. The influence of modifiable factors that affect weight, including speech/language pathology (SLP) and nutrition counseling, is also poorly defined. We characterize weight loss trends, baseline weight recovery (BWR), and the impact of interdisciplinary care on oncologic outcomes.
Methods Retrospective cohort study assessing 266 newly diagnosed patients with HNC who completed curative-intent radiation (definitive or adjuvant) between January 2016 to January 2022. Relevant treatment factors were analyzed using multivariable Cox regression models.
Results Altogether, 266 patients completed full-course radiation therapy (RT), encompassing definitive chemoRT (53.0%), surgery with chemoRT (18.4%), surgery with RT (17.7%), and RT alone (10.9%). Patient weight reached a nadir at median 3.0 months (IQR 3.0–11.3) after radiation, with a median weight loss of 12.6% (IQR 7.9–18.7). Notably, only 47.4% exhibited BWR. For those who recovered, median time to BWR was 10.5 months (IQR 3.0–24.0). On multivariable analysis, BWR by 6 months was significantly associated with overall survival (HR 0.28 95% CI 0.10–0.76, p = 0.013), as was SLP consultation (HR 0.40 95% CI 0.17–0.92, p = 0.031) and nutrition consultation (HR 0.34 95% CI 0.13–0.89, p = 0.028).
ConclusionA high proportion of patients with HNC fail to recover baseline weight after treatment; those that do can take longer than expected to return. Failure to recover baseline weight is associated with a notable decrease in survival. Similarly, SLP and nutrition consultation are independent, modifiable determinants correlated with outcomes, supporting the emphasis on multidisciplinary management. Measures to promote BWR may reduce mortality.
Shaghauyegh S. Azar, Courtney B. Shires, Karuna Dewan, Dinesh K. Chhetri
Publication date 30-07-2024
Abstract Objectives Tracheoesophageal prosthesis (TEP) is a common method for post-laryngectomy speech rehabilitation. Despite its common use, some patients ultimately fail TEP rehabilitation. TEP dysfunction negatively affects quality of life due to poor voice quality and need for repeated interventions to restore TEP function. Occasionally, voice rehabilitation with TEP is completely unsuccessful. We performed a scoping review to characterize the main reasons for total TEP failure, in hopes of guiding selection of optimal TEP candidates.
Study design Scoping review using Pub Med of all English language articles from 1990 to 2020 addressing causes of TEP failure.
Methods This scoping review followed the population, intervention, comparison, outcome and study (PICOS) guidelines. Total TEP failure was defined as complete loss or abandonment of TEP voice or tract. A comprehensive search strategy using Pub Meds MeSH subject headings and keywords was created. Causes and rates of failure were reviewed.
Results Among 544 peer-reviewed journal articles reviewed for inclusion. Seventy articles met inclusion criteria, resulting in a total of 4928 TEP voice restoration patients for analysis. 15.2% of these patients had total TEP failure. The most common reasons for failure were dissatisfaction with voice (26.3%), leakage (17.9%), inadequate patient motivation (14.7%), comorbidities (14.2%), stoma problems (11.6%), and abandonment of TEP after dislodgement (10.6%).
Conclusion Common reasons for TEP failure included voice dissatisfaction, leakage, lack of patient motivation, patient comorbidities, and stoma problems. These factors should be considered when selecting candidates for TEP voice restoration.
Christopher D. Goodman, Franco DeMonte, Theresa P. Nguyen, Adam S. Garden, Catherine He Wang, Xin A. Wang, Kevin Diao, Anna Lee, Jay Reddy, Amy Moreno, Michael Spiotto, Clifton D. Fuller, David Rosenthal, Renata Ferrarotto, Shaan M. Raza, Shirley Y. Su, Andrew Warner, Ehab Hanna, Jack Phan
Publication date 29-07-2024
Abstract Background Treatment for dural recurrence of olfactory neuroblastoma (ONB) is not standardized. We assess the outcomes of stereotactic body radiotherapy (SBRT) in this population.
MethodsONB patients with dural recurrences treated between 2013 and 2022 on a prospective registry were included. Tumor control, survival, and patient-reported quality of life were analyzed.
Results Fourteen patients with 32 dural lesions were evaluated. Time to dural recurrence was 58.3 months. Thirty lesions (94%) were treated with SBRT to a median dose of 27 Gy in three fractions. Two patients (3 of 32 lesions; 9%) developed in-field radiographic progression, five patients (38%) experienced progression in non-contiguous dura. Two-year local control was 85% (95% CI: 51–96%). There were no >grade 3 acute toxicities and 1 case of late grade 3 brain radionecrosis.
Conclusion In this largest study of SBRT reirradiation for ONB dural recurrence to date, high local control rates with minimal toxicity were attainable.
Catherine H. Frenkel, Erin E. Donahue, Allyson Cochran, Daniel Brickman, Steven Hong, Matthew C. Ward, Benjamin J. Moeller, Daniel R. Carrizosa, Zvonimir L. Milas
Publication date 28-07-2024
Abstract Objective The Commission on Cancer (CoC) recently introduced a quality metric to optimize time between major head and neck surgery and adjuvant treatment (TAT) ≤6 weeks, as TAT delay adversely impacts patient survival. This study evaluates whether enhanced recovery after surgery (ERAS) for this population reduces the rate of postoperative complications, length of stay (LOS), and TAT.
Methods Patients undergoing larynx or oral cavity resection with free flap reconstruction, ERAS, and adjuvant treatment after 2018 were compared to a historical pre-ERAS cohort. Patients underwent surgery at a single-institution tertiary referral center for complex head and neck oncology. Differences between groups were compared by chi-square, Fishers exact, or Wilcoxon rank-sum test. TAT >6 weeks was evaluated with univariate and multivariable logistic regression.
Results Thirty-nine pre-ERAS patients were compared to 39 ERAS patients. No demographic differences existed between groups. LOS was improved with ERAS (p = 0.005). ERAS patients were discharged to home and returned to their activities of daily living (ADL) earlier (p = 0.004, 0.001). ADL recovery was associated with on-time TAT ≤42 days on univariate analysis (OR 1.36, 95% CI 1.13–1.63, p = 0.001). TAT delay was less frequent with ERAS (51.3% vs. 69.2%), but this was not significant after multivariable logistic regression (p = 0.11).
ConclusionERAS decreases LOS and returns advanced head and neck cancer patients to their ADL sooner. Postoperative ADL recovery independently predicts on-time adjuvant treatment. Still, compliance beyond 50% with the TAT ≤6 weeks CoC quality metric remains a major treatment barrier.
Beatriz Cirauqui Cirauqui, Adrià Bernat Peguera, Ariadna Quer Pi‐Sunyer, Angelica Ferrando‐Díez, Jose Luis Ramírez Serrano, Marta Domenech Viñolas, Iris Teruel García, Vanesa Quiroga García, Imane Chaib Oukadour, Andrea González Valencia, Pilar Hernández Vergara, Itziar de Aguirre Egaña, Cristina Queralt Herrero, Oscar Mesía Carbonell, Assumpció López Paradís, Anna Esteve, Mireia Margelí Vila, Rafael Rosell, Anna Martínez‐Cardús, Ricard Mesía
Publication date 27-07-2024
Abstract Background Squamous cell carcinoma of the head and neck (SCCHN) is an aggressive disease with poor prognosis. It is known that the activation of STAT3 signaling pathways promotes the development and progression of this neoplasia and it has been described the role of PTPRT as a negative regulator of STAT3. Then, we have evaluated the impact of them as biomarkers of outcome in a series of patients with recurrent and/or metastatic SCCHN treated with weekly paclitaxel-plus-cetuximab (ERBITAX) regimen.
Patients and methods Between 2008 and 2017, 52 patients with recurrent/metastatic SCCHN were treated with ERBITAX at our center, 34 of whom had available tumor samples. Phosphorylated STAT3 (pSTAT3) protein expression was analyzed by immunohistochemistry, STAT3 mRNA expression by qPCR, and PTPRT promoter methylation by methylation-specific PCR. Molecular results were correlated with response rate (RR), progression-free survival (PFS), and overall survival (OS).
ResultspSTAT3 overexpression was detected in 67% and PTPRT promoter hypermethylation in 41% of tumor samples. PTPRT promoter hypermethylation showed a trend towards an association with lower RR (21% vs. 60%; p = 0.06). A lower RR was also observed in patients with pSTAT3 overexpression (36% vs. 54%) and in those with high STAT3 mRNA levels (43% vs. 64%), but these differences did not reach statistical significance. PTPRT promoter hypermethylation correlated with pSTAT3 overexpression (p = 0.009) but not with STAT3 mRNA overexpression. OS and PFS was shorter in patients with activated STAT3, but the difference did not reach statistical significance.
Conclusions Although this was a relatively small retrospective study, it provides preliminary indications of the potential role of the STAT3 pathway on outcome in SCCHN and confirms that PTPRT acts as a negative regulator of STAT3. Our findings warrant investigation in a larger patient cohort to determine if inactivating this pathway through specific targeted treatments could improve outcomes in recurrent/metastatic SCCHN patients.
Lisa Nachtsheim, L. Jansen, S. Shabli, C. Arolt, A. Quaas, J. P. Klussmann, M. Mayer, P. Wolber
Publication date 27-07-2024
Abstract Background Primary salivary gland carcinomas (SGC) are rare neoplasms that present therapeutic challenges especially in recurrent tumors. The aim of this study was to investigate the incidence and distribution of tumor recurrence, associated risk factors, and survival.
Methods This analysis includes data from 318 patients treated for SGC between 1992 and 2020. Survival analysis was performed using the Kaplan–Meier method. Univariate and multivariate analyses were used to identify risk factors associated with recurrence.
Results21.7% of the patients developed recurrent disease after a mean of 38.2 months. In multivariate analysis, positive-resection margins, vascular invasion, and tumor localization in the submandibular gland and small salivary glands were independent factors for recurrence. The 5-year overall survival was 67%, the 5-year disease-free survival was 54%.
Conclusion Tumor recurrence in SGC occurred in one out of five patients. In highly aggressive entities and patients with risk factors, treatment intensification should be considered.
Omar A. Karadaghy, Andrew M. Peterson, Tuleen Sawaf, Bryan Renslo, Brevin Miller, Celina Virgen, Kevin J. Sykes, Michelle M. Doering, Christopher J. Moran, Henrik Ullman, Jeremy Peterson, Patrik Pipkorn, Andrés M. Bur
Publication date 26-07-2024
Abstract Background The management of acute hemorrhage in patients with previously treated head and neck squamous cell carcinoma (HNSCC) is challenging due to the lack of substantial evidence to guide clinical decision making.
MethodsA systematic review and retrospective chart review were performed to identify patients with a history of HNSCC who underwent either primary or adjuvant radiation therapy (RT) and presented with hemorrhagic complications requiring embolization. Patient characteristics, history, presentation, and outcomes were reviewed.
Results The systematic review included a total of 182 patients. Heterogeneity existed in outcomes reporting; 1-year overall survival approached 50%. From the retrospective chart review, 51 patients were included. Median survival time following hemorrhage was 2.2 months (range 1.2–11.4 months). Patients with malignancy at time of hemorrhage were identified as having worse survival.
Conclusions Acute hemorrhage in patients with a history of previously radiated HNSCC portends a high risk of mortality, with patients with active malignancy representing a worse prognostic group.
Jenan A. Altamimi, Janet A. Wilson, Justin Roe, Joanne M. Patterson
Publication date 24-07-2024
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.
Faye G. Zhang, Shankar Viswanathan, Chenxin Zhang, Richard V. Smith, Bradley A. Schiff, Thomas J. Ow, Madhur K. Garg, Rafi Kabarriti, Vikas Mehta
Publication date 24-07-2024
Abstract Background Delay in time to treatment initiation (TTI) is associated with worsened survival outcomes in laryngeal squamous cell carcinoma (LSCC). It is unclear whether this is due to tumor growth or an increased risk of metastatic disease.
Methods This retrospective cohort study at one academic center included patients with LSCC who underwent radiotherapy/chemoradiotherapy between 2005 and 2017. We examined the association between tumor growth rate (TGR) and survival outcomes.
Results Among 105 patients (mean age, 63.8 ± 11.1 years; 72% male), the threshold between “slow-growing” and “fast-growing” tumors was >0.036 mL/day (survival) and >0.082 mL/day (recurrence). Faster growth was associated with worse overall survival (OS) (hazard ratio, 1.97; 95% confidence interval CI, 0.94–4.13) and increased recurrence (odds ratio, 9.10; 95% CI, 2.40–34.4).
ConclusionsTGR >0.036 mL/day during TTI was associated with decreased OS, and >0.082 mL/day was associated with increased recurrence. Tumor measurement in patients experiencing delay may identify those who could benefit from escalated therapy.
Anthony M. Tonsbeek, Caroline A. Hundepool, Aprilia L. Molier, Eveline Corten, Bianca Rijken, Aniel Sewnaik, Marc A. M. Mureau
Publication date 24-07-2024
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.
Allen M. Chen
Publication date 24-07-2024
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.
Sophie McGregor, Katrina Zaraska, Matthew Lynn, Sena Turkdogan, Khanh Linh Tran, Eitan Prisman
Publication date 24-07-2024
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.
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 23-07-2024
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.
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 23-07-2024
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.
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 20-07-2024
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.
Michael T. Werner, Dylan J. Cooper, Seth E. Kaplan
Publication date 19-07-2024
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.
George A. Hung, Sanah Vohra, Gina Kim, Armaan Jamal, Malathi Srinivasan, Robert J. Huang, Gloria Kim, Latha Palaniappan, A. Dimitrios Colevas
Publication date 18-07-2024
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.
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 17-07-2024
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.
Klara Stagl, Stefan Grasl, Boban M. Erovic, Stefan Janik
Publication date 16-07-2024
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.
Anu Sharma, Humzah Quereshy, Claudia I. Cabrera, Nicole Fowler, Shawn Li, Jennifer Dorth, Jason E. Thuener, Rod P. Rezaee, Akina Tamaki
Publication date 16-07-2024
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.
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 16-07-2024
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.
Justin M. Hintze, Paul Lennon
Publication date 16-07-2024
Tian Wang, Jie Wang, Qiang Li, Yi Li, Xinmao Song
Publication date 14-07-2024
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.