\nSteven J. Charous, \nBrian Yuhan, \nKerstin M. Stenson, \nVidit Talati, \nPhillip McMullen\n
Publicatie 02-01-2025
ABSTRACTBackgroundChondrosarcomas of the larynx, relatively rare tumors with low grade pathology in approximately 95% of cases, can most often be managed with conservation laryngeal procedures. Dedifferentiated chondrosarcomas are much more rare and aggressive requiring more aggressive surgical extirpation.MethodsA patient underwent three debulking procedures for a laryngeal chondrosarcoma Grade I/II histologically over a 2.5 year period of time during which slow growth was closely monitored. He then presented with relatively rapid onset of hoarseness and shortness of breath. Fiberoptic laryngoscopy demonstrated new bilateral vocal fold fixation with near occlusion of his subglottis by soft tissue mass.ResultsA total laryngectomy was performed that pathologically demonstrated a Grade III dedifferentiated chondrosarcoma. Shortly thereafter, the patient developed regional metastases, then distant metastases and then succumbed to the disease.ConclusionThis first case of a Grade III dedifferentiating chondrosarcoma arising from closely monitored and multiple debulked previously Grade I/II tumor demonstrates the potential change in aggressiveness in low-grade chondrosarcomas of the larynx. Sudden increase in growth along with a soft tissue component to the tumor based on exam and/or imaging should heighten suspicion for dedifferentiation of the tumor and necessitates a more aggressive surgical resection. However, the chance of cure once dedifferentiation occurs is drastically reduced.
Pubmed PDF Web\nShashank Shenoy, \nAnkita Mallick, \nSudipta Pati, \nSanjoy Chatterjee, \nIndranil Mallick\n
Publicatie 31-12-2024
ABSTRACTBackgroundPatients with locally advanced, surgically unresectable oral squamous cell cancers (SU-OSCC) are often treated with palliative intent. There is limited information on the outcomes of radical intent treatment with radiotherapy (RT) or chemoradiotherapy (CRT).MethodsWe retrospectively examined patients with Stage III/IV previously untreated SU-OSCC treated definitively from 2011 to 2021 in a single institution with RT or CRT with or without neoadjuvant chemotherapy (NACT).ResultsSixty-nine patients met the inclusion criteria. Oral tongue (38%) and buccal mucosa (32%) were the commonest subsites. T4a, T4b, and N2-3 disease were present in 28 (40.6%), 26 (37.7%), and 39 (56.5%) patients, respectively. Median OS and PFS of the whole group were 16 months and 10 months. The 2-year loco-regional control was 60.4%. Bone involvement or NACT use did not affect outcomes.ConclusionsUpfront radical RT/CRT in patients with SU-OSCC with good performance status results in good outcomes and should be preferred to a palliative approach.
Pubmed PDF Web\nSophie Dugast, \nJulie Longis, \nMarine Anquetil, \nPierre Corre, \nSvetlana Komarova, \nHélios Bertin\n
Publicatie 31-12-2024
ABSTRACTBackgroundDental implantation of bone reconstructions in oncologic situations improves patients orofacial function and quality of life. There are currently no recommendations on the timing of implantation.MethodsThis systematic review with meta-analysis aimed to compare primary and secondary dental implantation of free bone flaps in reconstructions for malignant tumors of the oral cavity. The primary objective was to evaluate the implant survival rate, with secondary criteria including time to prosthesis placement, postoperative complications, and data on quality of life. Results—Three databases were screened for articles published between January 1990 and April 2024. Out of 2438 studies, 16 met the eligibility criteria, encompassing 284 patients. In total, 319 implants were placed in the primary implantation group and 1108 in the second group. Implant survival rate was 92.5% in the primary implantation group compared to 88.5% in the secondary implantation group. This systematic review underscores a higher success rate for implants placed primarily in patients with oral cancer.ConclusionsGiven the rapid functional and aesthetic improvement offered by prosthetic rehabilitation, primary implantation should be systematically considered in the oncological population.
Pubmed PDF Web\nSarbani Ghosh Laskar, \nShwetabh Sinha, \nPritha Roy, \nRabi Das, \nShivakumar Thigarajan, \nAnuj Kumar, \nSamarpita Mohanty, \nAshwini Budrukkar, \nMonali Swain, \nDevendra Chaukar, \nGouri Pantvaidya, \nAnuja Deshmukh, \nPrathamesh Pai, \nDeepa Nair, \nSudhir Nair, \nPoonam Joshi, \nRathan Shetty, \nArjun Singh, \nVidisha Tuljapurkar, \nRicha Vaish, \nPankaj Chaturvedi\n
Publicatie 31-12-2024
ABSTRACTObjectivesTo address controversies regarding target volume delineation for adjuvant intensity-modulated radiation therapy for oral cavity squamous cell carcinoma with pedicled flap reconstruction and elective nodal irradiation (ENI).Materials and MethodsDuring target volume delineation, the primary tumor bed was the pre-surgical gross tumor volume with an additional isotropic margin of 5-10 mm. Additionally, the flap and body tissue junction were given a margin of 5-10 mm (if not already given). An effort was not made to trace the flap for inclusion in the clinical target volume (CTV), except when it traversed through the involved nodal regions. Contralateral ENI was carried out only in tumors crossing the midline when there was a heavy nodal burden at Ia/Ib.ResultsIn the 143 patients analyzed, the most common sub-site was buccal mucosa (78, 54.5%). Contralateral ENI was done in 63 patients (36 Tongue, 23 Buccoalveolar). The median follow-up of surviving patients was 24 months. The 2-year Locoregional Control, Disease-Free Survival, and Overall Survival were 77.4%, 64.5%, and 79% respectively. Overall, there were 55 (38.5%) recurrences, of which 35 (24.5%) were either local, regional, or combined locoregional failures, 13 (9.1%) were distant failures alone, and 7 (4.9%) had both locoregional and distant failures. The elective nodal regions had 3 (2.1%) contralateral nodal failures.ConclusionThe entire flap need not be intentionally covered in the target volume. Contralateral ENI should be considered only for patients with heavy nodal burden at ipsilateral level Ia/Ib, in tumors crossing the midline, or in tumors having a high propensity for contralateral lymph nodal involvement.
Pubmed PDF Web\nJenny B. Xiao, \nNorbert Banyi, \nKhanh Linh Tran, \nEitan Prisman\n
Publicatie 31-12-2024
ABSTRACTBackgroundVirtual surgical planning (VSP) is an emerging method in head and neck reconstruction with demonstrated benefits, however, its economic viability is supported with mixed evidence.MethodsA structured search was performed in five electronic databases. Studies that performed an economic evaluation on VSP in head and neck reconstruction were included. Data regarding VSP workflow, costs, and variables influencing costs were recorded and synthesized.ResultsEighteen studies met the final inclusion criteria (n = 733). Fourteen out of 18 studies (78%) found that VSP either generated cost savings or was comparable to freehand surgery (FHS). The majority of cost savings were generated from reduced OR times and LOS/LOH. In addition, greater cost savings were associated with in-house VSP workflows compared to those that are outsourced.ConclusionVSP is potentially cost-beneficial compared to traditional unplanned surgery, however, substantial heterogeneity amongst methods and outcome measures impedes the generalizability of these findings.Trial Registration: PROSPERO: CRD42024504398
Pubmed PDF Web\nJong‐Lyel Roh\n
Publicatie 30-12-2024
ABSTRACTBackgroundThis study evaluates the outcomes of intracapsular enucleation using the retroauricular hairline incision (RAHI) approach for treating cervical vagal schwannomas.MethodsA longitudinal study was conducted on patients with cervical vagal schwannomas. Eleven patients who underwent RAHI-based enucleation were included. Preoperative imaging was performed using contrast-enhanced MRI. Postoperative evaluations assessed pain, neurological function, cosmetic outcomes, voice, and swallowing functions.ResultsEleven patients underwent surgery. The median tumor size was 4.6 cm. The median operation time was 42 min, with minimal bleeding. Common complications were earlobe numbness (45%) and temporary vocal cord paralysis (27%), which were resolved within a year. Cosmetic satisfaction was high, with median VAS scores of nine for scars and 10 for facial deformities. No significant dysphagia was found. No recurrences were observed over a median follow-up of 79 months.ConclusionsIntracapsular enucleation using the RAHI approach is a safe and effective method for treating cervical vagal schwannomas.
Pubmed PDF Web\nDaniel P. Lander, \nNikhil Vettikattu, \nTuleen Sawaf, \nNaomi Wang, \nMihir R. Patel, \nAzeem S. Kaka, \nAndrés M. Bur, \nRyan S. Jackson\n
Publicatie 30-12-2024
ABSTRACTBackgroundTo describe utilization and outcomes of submandibular gland flap (SGF) reconstruction after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC).MethodsA multi-institutional retrospective case series of patients who underwent TORS for OPSCC followed by SGF reconstruction with harvest via transcervical approach from 1/1/2016 to 4/1/2023.ResultsIn total, 14 patients underwent SGF reconstruction after TORS for OPSCC. All patients had HPV-positive disease, predominantly in early local (N = 10 with pT1/pT2 disease, 71%) and regional stages (N = 11 with pN0/pN1 disease, 79%). Most patients received adjuvant radiation treatment (N = 9, 64%). Median hospital LOS after surgery was 4 days (IQR 2 days) with median functional oral intake scale (FOIS) score of 5 (IQR 0.8) at 1–3 weeks after surgery.ConclusionsSGF reconstruction is a useful technique for closure of appropriately selected TORS defects requiring reconstruction beyond healing by secondary intention and mobilization of adjacent tissue but not large enough to warrant free flap reconstruction.
Pubmed PDF Web\nTeresa M. Cardesa‐Salzmann, \nMonika Sparber‐Sauer, \nPeter Hingst, \nAndreas Erbersdobler, \nBjoern Schneider, \nMaja Hühns, \nAndre Jakob, \nFriederike Terpe, \nChristian Spang, \nDorothea Stalmann, \nClaudia Bierwirth, \nChristina Hauenstein, \nStefanie Märzheuser, \nManfred Ballmann, \nCarl Friedrich Classen\n
Publicatie 30-12-2024
ABSTRACTBackgroundInfantile fibrosarcoma (IFS) is a rare pediatric tumor of intermediate malignancy with high local aggressiveness that typically presents in young infants. Its occurrence in the head and neck region is rare. Complete non-mutilating surgical resection is often not possible, requiring multimodal treatment. IFS frequently harbors neurotrophic receptor tyrosine kinase (NTRK) fusions. Targeted therapy with NTRK inhibitors is modifying treatment paradigms of IFS.MethodsHerein, we report the case of a neonate with a giant unresectable congenital ETV6::NTRK3 (+) IFS of the head and neck region without rapid response to chemotherapy who was treated with larotrectinib oral suspension.ResultsLarotrectinib was well tolerated and induced an impressive clinical and radiologic response.ConclusionsThis case illustrates an example of pediatric precision oncology in a neonate with an ETV6::NTRK3 (+) congenital IFS of the head and neck region and provides further reference for the use of larotrectinib in the neonatal period.
Pubmed PDF Web\nPraneet C. Kaki, \nAman M. Patel, \nJason A. Brant, \nSteven B. Cannady, \nKarthik Rajasekaran, \nRobert M. Brody, \nRyan M. Carey\n
Publicatie 30-12-2024
ABSTRACTBackgroundThe geriatric nutritional risk index (GNRI) is a tool to assess preoperative nutritional status that can be calculated simply based on height, weight, and serum albumin. This study assesses the utility of GNRI in predicting postoperative complications in patients undergoing major head and neck cancer (HNC) surgery.MethodsRetrospective review of the 2016–2020 National Surgical Quality Improvement Program database. Patients were categorized into GNRI > 98 (normal nutritional status), GNRI 92–98 (moderate malnutrition status), and GNRI < 92 (severe malnutrition status). Univariable and multivariable binary logistic regression analyses were performed.ResultsSixteen thousand seven hundred eight-nine patients undergoing HNC resection were included. On multivariable analysis, moderate and severe malnourishment based on GNRI remained significantly associated with any surgical complication, any medical complication, any complication, Clavien-Dindo grade IV complications, and 30-day mortality.ConclusionsGNRI may have utility as a potentially modifiable preoperative prognostic factor that can be optimized to improve complications and mortality following HNC resection.Level of EvidenceLevel 4.
Pubmed PDF Web\nSahil Goel, \nDelu Gunasekera, \nGiri Krishnan, \nSuren Krishnan, \nJohn‐Charles Hodge, \nLucylynn Lizarondo, \nAndrew Foreman\n
Publicatie 29-12-2024
ABSTRACTBackgroundResidual, recurrent, and second primary head and neck cancers are on the rise. This is largely driven by a younger age at diagnosis and increasingly targeted chemoradiotherapy options. Salvage surgery remains the only curative intent option in this cohort of patients. With transoral robotic surgery (TORS), achieving good oncological and functional outcomes in primary cancer cohorts, there remains a paucity of synthesized evidence on treating residual, recurrent, or second primary disease in previously irradiated fields.MethodsConducted in accordance with the JBIs methodology for systematic reviews of effectiveness, three databases were searched including PubMed, Embase, and Scopus. This study represents the largest systematic review till date finding 679 studies and including 15 after screening and critical appraisal. A meta-analysis of proportions and comparison was conducted using Freeman–Tukey arcsine transformation statistical method and the Mantel–Haenszel statistical method, respectively.ResultsData from 515 patients was analyzed with a median follow-up time up to 47 months and a mean hospital stay of 8.5 days. Two-year overall survival (OS) rate and disease-free survival (DFS) rate were 73.8% and 56.1%, respectively. Compared to primary head and neck cancer, risk ratios for OS and DFS were 0.35 (95% CI, 0.18–0.67) and 0.44 (95% CI, 0.22–0.88). Weighted mean for tracheostomy decannulation and nasogastric dependence was 9.7 and 12.8 days, respectively, with long term tracheostomy dependence in 0%–11.5% of patients. Positive surgical margins were obtained in 19.4% with a risk ratio of 1.08 (95% CI, 0.66–1.75) when compared to primary head and neck cancer. Recurrence rate was 36% (95% CI, 24–48.9). Pooled complication rate was 32.3% with 92% of complications being classed as Clavien Dindo grade 2 or 3.ConclusionTORS is an emerging technique for salvage in recurrent, residual, and second primary head and neck cancers in previously irradiated fields. Survival outcomes are encouraging with decreased morbidity and mortality rates when compared to traditional open surgical techniques. Future studies need to mandate collection of swallowing data as a key tool to evaluate functional outcomes, deploy longer follow-up times, and address confounding factors including HPV status and prior adjuvant therapy.
Pubmed PDF Web\nSkylar Trott, \nSara Yang, \nZoey Morton, \nMackenzie Sautter, \nGavin Young, \nAlexandra Hoffman, \nDaniel Petrisor, \nSrinivasa R. Chandra, \nMark K. Wax\n
Publicatie 27-12-2024
ABSTRACTObjectivesVirtual surgical planning (VSP) allows for optimal reconstruction of maxillary defects with fibula free flaps. Current data are limited regarding long-term complications of patient-specific plates (PSPs) in this setting. Our objective was to determine long-term complications of PSPs in maxillary reconstruction using fibula free flaps.MethodsA retrospective chart review was performed on patients undergoing maxillary reconstruction with a fibula free flap and PSP between January 2010 to July 2022. The primary outcomes were plate-related complications, which were defined as plate exposure, fracture, removal or evidence of loose screws. Secondary outcomes were wound infection, nonunion, or flap failure.ResultsA total of 39 patients underwent fibular reconstruction of maxillary defects using PSP. The average age was 56 years, with 56% of patients being female. There were 14 (35.8%) patients with plate-related complications, 10 (25.6%) underwent plate removal, 12 (30.8%) developed exposed hardware, 2 (5.1%) had loose screws, and none had a plate fracture. The average time to plate removal was 2.76 ± 1.94 years. With regard to age, sex, tobacco or alcohol use, diabetes, hypothyroidism, preoperative radiation therapy, number of fibula segments, type of cancer, postoperative radiation therapy, or whether the patient underwent orodental rehabilitation, there were no significant differences between patients who did and did not experience plate complications.ConclusionsVSP allows for patient-specific reconstruction of maxillary defects with a fibula free flap that remains stable in the majority of patients. In the long term, up to 25% of patients may require plate removal, but the reconstruction remains stable.Level of EvidenceLevel 4.
Pubmed PDF Web\nMasahiro Uchibori, \nKazuyoshi Hosomichi, \nYasutaka Hoshimoto, \nMasashi Sasaki, \nTakayuki Aoki, \nAtsushi Tajima, \nYoshihide Ota, \nMinoru Kimura\n
Publicatie 27-12-2024
ABSTRACTBackgroundThe use of liquid biopsy of total cell-free DNA (cfDNA) to identify otherwise undetectable cancers has attracted interest; however, its efficacy remains unknown. We explored whether analysis using total cfDNA is efficacious for Japanese patients with oral squamous cell carcinoma (OSCC).MethodsWe collected total cfDNA from nine patients with OSCC preoperatively, 1 month postoperatively, and every 3 months thereafter to analyze this association. We used a target DNA sequence for genetic mutation analysis of tumor tissues collected from 33 patients, including the aforementioned nine patients.ResultsPatients with good disease control showed negligible changes in preoperative and postoperative total cfDNA concentrations. A rapid increase in total cfDNA concentration was observed in patients who developed systemic metastases. Patients whose tumor tissue DNA showed genetic mutations had the same mutations in preoperative circulating tumor DNA.ConclusionsOur data suggested that analyzing total cfDNA is efficacious for patients with OSCC.
Pubmed PDF Web\nAndrew Williamson, \nAlison E. Lim, \nFreddie Green, \nYing Ki Lee, \nLucy Li, \nChristy Moen, \nRishi Vasanthan, \nOlivia Wharf, \nJeremy Wong, \nVinidh Paleri\n
Publicatie 27-12-2024
ABSTRACTBackgroundTo investigate the management of recurrent head and neck squamous cell carcinoma (rHNSCC) and describe survival outcomes.MethodsPost hoc subgroup analysis of a retrospective national observational cohort was conducted. All patients with rHNSCC who received a definitive treatment decision between September 1, 2021 and November 30, 2021 were included. Survival analysis was stratified according to subsite, primary versus recurrent disease, and surgical versus nonsurgical treatment.ResultsData from 202 rHNSCC patients were derived from a cohort of 1488 patients submitted by 50 UK centers. Median age was 66 years (IQR 58–74), and 142 (70.3%) were male. The most common recurrence subsites were oropharynx (20.5%), oral cavity (19.5%), larynx (16.4%), and hypopharynx (14.9%). Ninety-three (48.4%) were managed curatively. Surgery was the most common treatment for laryngeal (59.4%), oral cavity (60.5%), hypopharyngeal (44.8%), and oropharyngeal (37.5%) cancers. Two-year overall (OS), disease-free (DFS), disease-specific (DSS), and local recurrence free survival (LRFS) were 41.1%, 39.1%, 42.2%, and 39.3%, respectively. rHNSCC treated with surgery had improved OS (p = 0.0005), DFS (p = 0.012), DSS (p = 0.0003), and LRFS (p = 0.007), over nonsurgical treatments. Compared to primary cancers, rHNSCC presents with more advanced T stage (p < 0.001) and distant metastasis (p < 0.001), receives less curative treatment (p < 0.001), and has worse survival outcomes (all p < 0.001). On multivariate analysis, salvage surgery, radiotherapy, and p16 status were independent prognostic factors of all survival outcomes.ConclusionsRecurrent HNSCC is associated with high rates of incurable disease and worse survival than primary cancers. Surgery remains the most common curative treatment in rHNSCC, however future studies are necessary to improve patient selection and optimize outcomes following salvage treatment.
Pubmed PDF Web\nOscar Villarreal Espinosa, \nMusaddiq Awan, \nAbdullah A. Memon, \nAnne Frei, \nJamie Foeckler, \nRachel Kuehn, \nJennifer Bruening, \nBecky Massey, \nStuart Wong, \nMonica Shukla, \nJulia Kasprzak, \nAmit Joshi, \nMichael Dwinell, \nHeather A. Himburg, \nJoseph Zenga\n
Publicatie 26-12-2024
ABSTRACTBackgroundHead and neck squamous cell carcinoma (HNSCC) presents significant treatment challenges, particularly in cases unrelated to human papillomavirus (HPV). The chemokine receptor CXCR4, interacting with its ligand CXCL12, plays a crucial role in tumor proliferation, metastasis, and treatment resistance. This study explores the therapeutic potential of engineered monomeric and dimerized CXCL12 variants (CXCL121 and CXCL122, respectively) in HNSCC and evaluates potential additive effects when combined with radiation therapy.MethodsClinical HNSCC biopsies were evaluated for CXCR4 expression in both previously untreated and radiorecurrent disease. HNSCC cell lines were then treated with combinations of CXCL12 variants and radiotherapy and interrogated for proliferation, gene expression change, and underlying molecular mechanisms. In vivo studies evaluated the biodistribution of engineered CXCL12 and tested these treatments in humanized cell line-derived xenograft (CDX) models.ResultsCXCL122 significantly reduced HNSCC cell proliferation and enhanced the effects of radiotherapy, likely through biased agonism at the CXCR4 receptor and upregulation of the KISS1R pathway. In vivo, CXCL122 localized to tumor sites and augmented the effects of radiation to inhibit tumor growth.ConclusionsCXCL122, in combination with radiation, demonstrates potent anti-tumor effects in HNSCC. These findings support further clinical investigation of CXCL122 to enhance the effects of radiotherapy.
Pubmed PDF Web\nAdèle Rohée‐Traoré, \nPierre Gagnieur, \nArnaud Gleizal, \nMathieu Daurade\n
Publicatie 26-12-2024
\nLiang Zuo, \nZheng Jiang, \nJun Liu, \nHao Tian, \nShuiChao Gao, \nWeiLun Huang\n
Publicatie 24-12-2024
ABSTRACTBackgroundTo evaluate the effectiveness of trilobed forearm flaps in repairing postoperative defects in T2 stage oral cancer patients, while minimizing the impact on the donor site.Methods16 male patients with oral cancer were treated at two tertiary medical centers. Patients demographic characteristics, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and University of Washington Quality of Life Questionnaire (UW-QoL) were recorded.ResultsPostoperatively, all flaps survived with primary closure of donor site. One patient experienced neck wound edema, which healed after re-drainage. The quality-of-life evaluation shows a UW-QoL score indicating an excellent quality of life, with the mean score of 78.86 ± 4.26 and a mean DASH score of 23.29 ± 9.89, indicating good function preservation of the donor site.ConclusionThe trilobed forearm flap technique significantly improves the repair range for oral cancer defects while maintaining donor site integrity and is recommended for wider application.
Pubmed PDF Web\nPietro de Luca, \nLuca de Campora, \nOreste Gallo, \nMarco Radici, \nAngelo Camaioni, \nEnrico de Campora\n
Publicatie 24-12-2024
ABSTRACTObjectiveThe objective of this study is to provide a retrospective review of the 40-year experience of three oncology referral centers in the field of reconstructive laryngeal surgery.Materials and MethodsA multi-institutional retrospective analysis included adult patients who underwent reconstructive laryngeal surgery for cT2-T4a laryngeal cancer (LC) between 1 June 1987 and 1 July 2019. Patients were stratified according to the European Laryngological Society classification for open partial horizontal laryngectomy (OPHL).ResultsThe final study group included 805 patients (668 men and 137 women). 561 tumors were glottic, while 244 showed supraglottic origin; 644 were considered anterior and 161 posterior. Arytenoid motility was normal in 712 patients, while the motility of the vocal folds appeared to be impaired in 501 patients. All patients underwent OPHL, of which 20 patients underwent OPHL I, 636 patients underwent OPHL II, and 149 patients underwent type III OPHL. 257 patients underwent adjuvant RT based on multiple risk factors/pathological findings. The 5-year overall survival rate was 89.7% (95% CI 87.2–94). The 5-year disease-free survival rate was 78.4% (95% CI 76.8–84.9), and the 5-year disease-specific survival was 64.3% (95% CI 62.2–69.6). Complications were observed in 7.5% of patients, while long-term sequelae were observed in 21% of patients.ConclusionThe findings of this work reveal four decades of surgical evolution in the school of Enrico de Campora. Despite the retrospective analysis and the extremely long follow-up, our analysis shows how OPHLs play a crucial role in LC (even cT4a), with excellent results in terms of functional outcome and organ preservation.
Pubmed PDF Web\nAbigail C. Weiland, \nSandeep Samant, \nAlex E. Clain, \nBonnie Martin‐Harris\n
Publicatie 23-12-2024
ABSTRACTBackgroundDysphagia (difficulty swallowing) is a common morbidity resulting from the treatment of head-and-neck squamous-cell carcinoma (HNSCC) due to surgery and chemoradiation. Transoral robotic surgery (TORS) is a minimally invasive surgical technique for the management of HNSCC, which ideally avoids many of the known complications of open surgery. Research describing physiologic swallowing impairment after surgery using videofluoroscopy is lacking.MethodsWe evaluated videofluoroscopic swallowing studies of 37 patients who received TORS for head and neck cancer using a validated scoring tool, the Modified Barium Swallow Impairment Profile (MBSImP), at three time points including baseline.ResultsPatients had worsened physiologic impairments in the immediate post-operative and late post-operative periods, particularly in components related to airway protection. Many patients also had baseline swallowing impairment.ConclusionsFurther research is required to elucidate dysphagia at discrete time points before and after treatment as well as with different and evolving adjuvant therapy protocols.
Pubmed PDF Web\nHelen Hieu Nguyen, \nIshita Gupta, \nAshley Cellini, \nJohn C. Papadimitriou, \nRanee Mehra, \nDaria A. Gaykalova, \nMatthew E. Witek\n
Publicatie 23-12-2024
ABSTRACTBackgroundThe p16/CDKN2A protein is being explored as an independent prognostic marker in laryngeal cancer, with studies suggesting that p16-positive patients may have a better prognosis. While its role is well-established in oropharyngeal squamous cell carcinoma (OPSCC) related to HPV, ongoing research indicates its potential prognostic value in laryngeal cancer, even in HPV-negative cases.MethodsIn this study, we investigated the association between survival outcomes and p16 expression in a cohort of 310 laryngeal cancer patients from the Cancer Genome Atlas (TCGA) Program and the University of Maryland Medical Center (UMMC).ResultsIn the TCGA cohort, patients with high p16 protein expression had a significantly higher probability of disease-free survival (DFS) at 89%, compared to 51% in the low p16 protein group (p = 0.0266). Additionally, the mean relative p16 protein expression decreased significantly with advancing TNM stage, measured at 1.116 for stage II, 1.075 for stage III, and 0.6204 for stage IV (p = 0.7871 for stage II vs. stage III, p = 0.0065 for stage III vs. stage IV, p = 0.0031 for stage I vs. stage IV). Protein expression for p16 also correlated with CDKN2A retention/deletion status (p = 0.0077), where the DFS was higher in patients with retained CDKN2A than those with deleted CDKN2A (p = 0.0187). Multivariate analysis of the UMMC and TCGA cohorts revealed that both an increase in the patients age and higher T stage significantly increased the risk of mortality (p = 0.05, p = 0.01, respectively).ConclusionWhile this study observes trends suggesting that low p16 protein expression is associated with longer DFS and advanced TNM stage in laryngeal cancer, the multivariate analysis did not establish p16 as an independent prognostic factor. These findings suggest that while p16 may have a biological role in tumor progression, its utility as a standalone prognostic marker in clinical outcomes requires further validation.
Pubmed PDF Web\nVan Cuong Nguyen, \nJeong Seon Park, \nChang Myeon Song, \nYong Bae Ji, \nJin Hyeok Jeong, \nKyung Tae\n
Publicatie 23-12-2024
ABSTRACTBackgroundThis study aimed to evaluate the safety, efficacy, and oncologic outcomes of thermal ablation techniques, including radiofrequency, laser, and microwave ablation, in treating primary thyroid cancer compared with surgical resection.MethodWe conducted a systematic review and network meta-analysis, which included 21 comparative studies and 40 noncomparative studies.ResultsThe three thermal ablation techniques showed significant superiority over surgical resection in terms of operative time, pain, cost, quality of life, and complications. Three years after the procedure, the tumor volume reduction and complete disappearance rates for the three thermal ablation techniques were similar, at approximately 99% and 93%–95%, respectively. The recurrence rate remained comparable (approximately 2%–3%) among the three thermal ablation techniques and surgical resection during a follow-up period exceeding 3 years.ConclusionsThe safety, efficacy, and oncologic outcomes of thermal ablation techniques may be acceptable and comparable to surgical resection for selected cases of primary thyroid cancer.
Pubmed PDF Web\nAyman A. Amin, \nOmer M. Jamali, \nRamez Farid, \nMohamed H. Zedan, \nRomany Esshak Ghobrial, \nReem Zakka, \nMohammed A. Rifaat\n
Publicatie 23-12-2024
ABSTRACTBackgroundThe submental artery island flap (SIF) is a valid option for palatal reconstruction. However, the main limitation for its application for palatal defects is the arc of rotation. A novel modification for tunneling of the antegrade design of SIF that allows a compliant easy reach to the defect is described.MethodsEighteen patients with Brown class II maxillectomy defects were included. Reconstruction started using reversed flow SIF in five patients then shifted to the modified antegrade technique in the remaining patients. Speech, swallowing, chewing, other parameters, and oncological outcomes were assessed.ResultsThe reversed flow group has high complications. In the antegrade SIF group, all flaps survived. One developed marginal flap necrosis that healed spontaneously. The follow-up period ranged from 1 to 4.2 years with favorable functional outcome and with no evidence of recurrence.ConclusionThe modified SIF antegrade design is a reliable option for palate reconstruction that allows favorable functional and oncological outcome.
Pubmed PDF Web\nNicholas A. Rapoport, \nAndrew M. Peterson, \nSarah N. Chiang, \nDorina Kallogjeri, \nJason T. Rich\n
Publicatie 23-12-2024
ABSTRACTBackgroundHead and neck reconstruction after resection of cutaneous malignancies spans the entire reconstructive ladder. Local flaps, such as the bilobed flap, offer excellent versatility, negligible morbidity, and minimal hospitalization. However, there is sparse data regarding the bilobed flap for large defects of the head and neck.MethodsA retrospective case series identified patients undergoing head and neck reconstruction with a large bilobed flap for defect sizes ≥ 5 x 5 cm. Data collected included demographics, risk factors for impaired healing, operative variables, and complications.ResultsNineteen patients were included; 15 (79%) were male, and median age was 80 years (47–88). Twelve patients had pertinent comorbidities and risk factors, including diabetes mellitus, current smoker, prior radiation to the operative area, and immunosuppressive state. Ten (53%) patients experienced complications, including infection, necrosis, or hematoma. Eleven (58%) patients received adjuvant radiation. Eleven (58%) patients were discharged within 1 day.ConclusionThe large bilobed flap is an effective reconstructive technique for large head and neck cutaneous defects in properly selected patients. This flap can be a useful alternative to free tissue transfer in elderly patients.
Pubmed PDF Web\nSoraya Fereydooni, \nCaroline Valdez, \nLauren C. Williams, \nAvanti Verma, \nBenjamin Judson\n
Publicatie 23-12-2024
ABSTRACTObjectiveTo characterize the perioperative complications after ablative and reconstructive surgery in patients with head and neck cancer (HNC) based on race.MethodsWe conducted a retrospective study of the 2015–2020 National Surgical Quality Improvement Program Database. We compared the perioperative outcomes between White, Asian, Black, Native Hawaiian or Pacific Islander, and American Indian or Alaskan Native patients with bivariate analysis. Multivariate logistic regression assessed the independent association of race with perioperative complications.ResultsBlack patients experienced longer surgeries (aβ, 43; 95% CI, 33, 53), longer hospital stays (aβ, 1.6 95% CI, 1.1–2.1), and were less likely to be discharged home (aOR, 0.64; 95% CI, 0.54, 0.76). Black patients also had higher major complications risk (aOR, 1.38; 95% CI, 1.13–1.67) with the most common being reintubation/ventilation (Black, 4.4% vs. White 2.7%; p = 0.003) and sepsis/septic shock (Black, 3.4% vs. White 1.8%; p = < 0.001). Black patients had higher reoperation rates (aOR, 1.33; 95% CI, 1.12–1.56) with incision and drainage of abscess and hematoma, exploration of postoperative hemorrhage, thrombosis or infection, or surgical debridement being the top reasons for reoperation. Concordantly, they were at higher risk of postoperative transfusion (Black, 18%; White, 7.2%; p = < 0.001) and wound dehiscence (Black, 4.1%; White, 2.1%; p = < 0.001).ConclusionThere is evidence of racial disparities in HNC surgery perioperatively. Black patients face an increased risk of major complications, reoperation, extended hospital stay, and non-home discharge. Developing a comprehensive surgical database with more social determinants of health variables and using a socioecological framework of health can help us identify contributors to these disparities and design high-leverage solutions.
Pubmed PDF Web\nMaria Vlock, \nAnnu Singh, \nAnthony J. Farmer, \nKenneth Kronstadt, \nJoseph D. Randazzo, \nJerry Halpern, \nSteven Tunick, \nJoseph M. Huryn\n
Publicatie 20-12-2024
ABSTRACTBackgroundTo spare important anatomical structures from damage during treatment of cystic odontogenic lesions, decompression has become a conservative alternative to enucleation. Marsupialization, in combination with the use of a custom-made decompression prosthesis, is an effective method of inducing reduction and bony infill of cystic lesions of the jaw.MethodsIn this case series and review of the literature, we describe three patients with odontogenic cysts of the mandible who were treated with custom-made decompression obturator prostheses (DOP) at the Memorial Sloan Kettering Cancer Center Dental Service.ResultsAt the conclusion of treatment, all patients demonstrated complete resolution of their respective bony defects.ConclusionDOP provide effective means of keeping the cyst opening patent following marsupialization, which allows for adequate, if not complete, resolution of defects, often without need for subsequent enucleation.
Pubmed PDF Web\nOmar A. Karadaghy, \nAllen L. Feng\n
Publicatie 20-12-2024
ABSTRACTBackgroundComposite rhinectomy defects pose significant challenges due to the noses complex structure and role in facial esthetics and function. Traditional nasal reconstructions often require multiple stages to restore mucosal lining, structural support, and external skin.MethodsThis case series examines the use of a single-stage osteocutaneous radial forearm free flap (OCRFFF) for composite rhinectomy reconstruction. Three patients who underwent composite rhinectomy due to malignancy were treated using OCRFFF, which allows for simultaneous reconstruction of composite nasal defects by incorporating skin, bone, and fascial tissue.ResultsAll three cases achieved successful postoperative outcomes, demonstrating both cosmetic and functional success without significant long-term complications. The single-stage approach streamlined the reconstructive process, reducing patient recovery time and the need for additional surgeries.ConclusionsOCRFFF is an effective, transformative technique for single-stage nasal reconstruction for composite rhinectomy defects, providing reliable functional and esthetic outcomes, and contributing to advancements in complex nasal defect management.
Pubmed PDF Web"\nRotem Kimia, \nSamih J. Nassif Abudinen, \nCraig Hanna, \nChristian Jung, \nMiriam OLeary, \nLauren F. Tracy, \nJeremiah C. Tracy\n"
Publicatie 19-12-2024
ABSTRACTObjectiveTo identify current airway management practice patterns during free tissue transfer (FTT) reconstruction of head and neck defects.MethodsA 27-question survey distributed to American Head and Neck Society (AHNS) members. Correlation between surgeon and patient variables with likelihood to perform tracheotomy and tracheotomy technique were evaluated.ResultsOur survey yielded 151 respondents. The majority (69.5%) reported performing tracheotomy for “most”/“every” FTT case. There was higher likelihood (p < 0.05) toward tracheotomy for patients with poor preoperative pulmonary status, larger defect size, and reconstruction of glossectomy and oropharyngeal defects. Tracheotomy was less likely (p < 0.05) during reconstruction of maxillary or palatal defects. Surgeons in practice for > 10 years were less likely to perform tracheotomy following reconstruction of hemiglossectomy defects (OR 0.36, p = 0.018, 95% CI 0.18–0.72).ConclusionThis study identified practice patterns of airway management in patients undergoing head and neck FTT reconstruction. There is no current consensus regarding perioperative airway management in these patients.
Pubmed PDF Web\nLukas Anschuetz, \nSamuel Tschopp, \nMafalda Trippel, \nSören Huwendiek, \nRoman Trepp, \nMarco Caversaccio, \nMoritz von Werdt, \nUrs Borner\n
Publicatie 19-12-2024
ABSTRACTIntroductionThis study aims to improve the diagnostic yield of cervical fine-needle aspiration (FNA) through training on a novel liver model. Ultrasonography-guided fine-needle aspiration (US-FNA) is crucial for diagnosing head and neck lumps but requires meticulous execution. Limited resources often hinder systematic teaching, making practical models essential for training.MethodsFifteen otorhinolaryngology residents trained using a liver model with inserted Sensorium spheres to simulate cervical masses. The training involved viewing an instructional video, performing US-FNA on the model, and completing pre- and posttraining self-assessments. Performance was evaluated using visual analog scales (VAS), an adapted version of objective structured assessment of ultrasound skills (adapted OSAUS), and timing of procedures. Clinical impact was assessed by comparing diagnostic rates of US-FNA before and after training.ResultsParticipants reported increased comfort and proficiency in US-FNA techniques posttraining. Adapted OSAUS scores improved significantly for image recognition and both in-plane and out-of-plane techniques. The diagnostic yield of US-FNA in clinical practice increased from 71% to 85%. No significant influence of gender, preferred ultrasound orientation, age, or experience on the learning curve was found. However, male participants showed a more substantial benefit from the training.ConclusionThe liver model effectively enhances US-FNA skills, reflected in improved clinical diagnostic rates. Training on such models should be incorporated into medical education to reduce inconclusive punctures and enhance patient satisfaction. This study demonstrates the feasibility and effectiveness of a cost-efficient, reproducible model for US-FNA training, emphasizing the importance of practical training in medical education.
Pubmed PDF Web\nXiong Zhou, \nZheng Wu, \nZichen Qiu, \nMinchuan Lin, \nYalan Tao, \nYong Su\n
Publicatie 18-12-2024
ABSTRACTBackgroundIn this study, we aimed to analyze the efficacy and failure patterns of contouring target volume based on the residual tumor and decreasing the dose to the area of tumor regression after neoadjuvant therapy in locoregionally advanced head and neck squamous cell carcinoma (HNSCC).MethodsWe retrospectively analyzed the patients with locoregionally advanced HNSCC treated by our group from May 2011 to June 2023. All patients received neoadjuvant therapy followed by intensity-modulated radiation therapy. Gross tumor volumes for the primary tumor and metastatic lymph nodes were delineated according to postneoadjuvant extension. The tumor shrinkage after neoadjuvant therapy was included in the high-risk clinical target volume (CTV1) and prescribed a dose of 60 Gy. Kaplan–Meier analysis was employed to calculate local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), overall survival (OS), and distant metastasis-free survival (DMFS). Failure patterns were analyzed by mapping the location and extent of locoregional recurrence onto pretreatment planning CT.ResultsThis study included a total of 114 patients, with a median follow-up of 34 months. The 5-year LRFS, RRFS, OS, and DMFS rates were 70.2%, 70.7%, 74.8%, and 73.8%, respectively. Among the 14 patients with recurrences, there were 5 local failures, 6 regional recurrences, and 3 both local and regional recurrences. All local recurrences occurred within the 95% isodose line, classified as in-field failures. Only one regional recurrence was marginal failure. No out-of-field failure was observed.ConclusionReduction of target volume after neoadjuvant therapy and distribution of 60 Gy of dose to the tumor regression area may be feasible.
Pubmed PDF Web\nMaged Ali Al‐Aroomi, \nYe Liang, \nJie Chen, \nYiheng Feng, \nLiu Pei‐Xuan, \nCanhua Jiang\n
Publicatie 18-12-2024
ABSTRACTObjectivesThe choice of surgical access for resection and reconstruction of buccal squamous cell carcinoma (BSCC) with the lip-splitting incision is controversial. Thus, this study aimed to evaluate the clinical and functional outcomes of midline lip split with lazy-S incision (MLSI) against the lateral lip-splitting incision (LLSI).MethodsA retrospective review was conducted on 41 patients with primary BSCC who underwent resection and reconstruction using MLSI approach (n = 19) and LLSI approach (n = 22) between 2022 and 2024. Functional outcomes, including skin sensitivity testing, oral competency, lip movement, cold perception, and other relevant measures, were evaluated with appropriate scales. Functional satisfaction and Patient and Observer Scar Assessment Scale (POSAS) were analyzed.ResultsNone of the patients in either group demonstrated differences in sensation to light touch from baseline at 6 months postoperatively. Patients with MLSI approach reported higher lip function satisfaction (p = 0.037), and no patients in either group reported drooling. Besides, groove formation was significantly more common in the LLSI compared to the MLSI groups (50% vs. 15.8%, respectively; p = 0.046). A statistically significant difference was also observed in the self-assessment of mouth-opening movement among MLSI patients (p = 0.041). No significant differences were found in the mean POSAS scores, except that irregularity and surface area parameters were better in the MLSI group.ConclusionsObjective sensation deficits are reversible and do not impact long-term daily activities. The MLSI approach provides better postoperative outcomes and low disfigurement perception.
Pubmed PDF Web\nM. Ángeles Sánchez Roldán, \nDulce Moncho, \nMercedes Velasco, \nE. Madalina Petriman, \nHéctor Duque, \nRamón Vilallonga, \nManuel Armengol, \nÓscar González\n
Publicatie 18-12-2024
ABSTRACTBackgroundIntraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) aims to detect and prevent iatrogenic damage during thyroid surgery. Mechanisms of injury include traction, heat damage, and nerve transection. Continuous IONM (C-IONM) techniques detect impending damage due to traction and heat related when they are still reversible.MethodsWe present a 73-year-old woman who underwent a total thyroidectomy due to a goiter. The IONM included intermittent IONM (I-IONM) in combination with C-IONM using the laryngeal adductor reflex (LAR). The intraoperative neurophysiological signals recorded were correlated with the surgical maneuver and the postoperative evaluation.ResultsDuring surgery, a significant decrease in left LAR amplitude was observed, coinciding with the use of the harmonic. After some corrective maneuvers, the intraoperative signals recovered, and the postoperative examination showed adequate VF function.ConclusionsC-IONM of the RLN using the LAR can be a valuable tool for detecting and preventing thermal spread injury during thyroid surgery.
Pubmed PDF Web\nNausica Montalto, \nSimonetta Battocchio, \nGiacomo Contro, \nPiergiorgio Gaudioso, \nFrancesca Mularoni, \nAlessandra Ruaro, \nGiulia Ramacciotti, \nDiego Cazzador, \nGiacomo Spinato, \nAndrea Luigi Camillo Carobbio, \nStefano Taboni, \nElisabetta Zanoletti, \nCesare Piazza, \nPiero Nicolai, \nMarco Ferrari\n
Publicatie 17-12-2024
ABSTRACTIntroductionThe anatomy of the tongue is three-dimensionally complex and is thought to play a central role in the local growth of oral tongue squamous cell carcinoma (OTSCC). Understanding patterns of tumor extension could improve a multimodal therapeutic approach. Thus, the main aim of this study was to provide a histological and microanatomical analysis of surgical specimens after compartmental surgery for OTSCC.Materials and MethodsThe present prospective observational study included primary cT3 OTSCC (according to the eighth edition of the TNM classification) treated in an academic tertiary referral center with curative compartmental surgery, from July 2016 to July 2019. Analysis of histologic macrosections allowed assessment of standard pathologic parameters as well as a detailed analysis of the position of OTSCC cells from microanatomic and topographic standpoints.ResultsOf the 28 patients included, 71.4% were males, with a mean age of 64.9 years. Nine (32.1%) patients presented satellitosis, which was always located within the T-N tract. OTSCCs displaying satellitosis had a significantly higher median pathologic depth of invasion (DOI). A radiologic and pathological DOI > 15 mm significantly predicted the presence of satellites. There was a significant relationship between the presence of satellites and both positive lymph nodes and distant metastases.ConclusionApproximately one-third of cases of intermediate-to-advanced OTSCC are characterized by tumor satellites located in the T-N tract. DOI exceeding 15 mm and the presence of clinically appreciable nodal metastases best predict the presence of satellitosis. Satellite-bearing OTSCC behave more aggressively, with an increased risk of distant metastasis and reduced survival.
Pubmed PDF Web\nAdriana I. Báez Berríos, \nMathilda Monaghan, \nMargaret Brandwein‐Weber, \nMaaike van Gerwen\n
Publicatie 17-12-2024
ABSTRACTBackgroundHashimotos thyroiditis (HT) impact on the aggressive lymph node (ALN) status of papillary thyroid carcinoma (PTC) remains understudied.MethodsUnivariate and multivariate analyses assessed PTC aggressiveness markers, comparing PTC + HT to PTC alone from a single center retrospectively. ALN categorization included > 5 positive, ≥ 1 > 3 cm, and/or ≥ 4 with extranodal extension lymph nodes.ResultsOf 533 patients with PTC, 19.1% concurrently had HT. Compared to PTC alone, PTC + HT patients were predominantly female (p < 0.001), younger (p = 0.034), non-smokers (p = 0.035), and had more pN0 stage tumors (p < 0.001). PTC + HT was associated with lower odds of pN1 stage (ORadj, 0.50) and lymphatic invasion (ORadj, 0.53). No significant differences were observed in ALN status, pT stage, lymphatic and perineural invasion, gross ETE, margin, and focality.ConclusionALN status does not differ between PTC with or without HT.
Pubmed PDF Web\nShuqing Chen, \nJustin M. Pyne, \nYulun Liu, \nYoustina Abraham, \nZhuoyu Wen, \nDoreen Palsgrove, \nGuanghua Xiao, \nJohn Truelson, \nLarry Myers, \nBrittny Tillman, \nAndrew Day, \nEli Gordin, \nLenka Stankova, \nYang Xie, \nDavid Sher, \nJustin Bishop, \nJinming Gao, \nBaran D. Sumer\n
Publicatie 16-12-2024
ABSTRACTBackgroundLymph node count (LNC) from neck dissection has been associated with undernutrition and survival in head and neck squamous cell carcinoma (HNSCC). As local components of the immune system, cervical lymph nodes may reflect anti-tumor immune status. This study investigates the relationship between decreased LNC, formation of tertiary lymphoid structures (TLS), and primary tumor infiltration by lymphocytes in undernourished patients.MethodsA matched-cohort study was conducted in a tertiary medical center, where neck dissection quality was standardized for a total of 384 subjects that were evaluated. Six head and neck cancer patients that underwent primary surgery including neck dissection with low LNC and BMI (low BMI < 23, low LNC ≤ 5.6 per neck level) were matched by stage, p16 status, and subsite to 16 patients with normal BMI and high LNC. Multiplexed immunohistochemistry was used to evaluate the tumor-infiltrating lymphocytes and the number and quality of TLS within primary tumors. Whole primary cancers underwent automated analysis and counting of leukocytes after multiplexed immunohistochemistry staining of tumor slides. A head and neck pathologist blindly scored the number and maturity of TLS. Descriptive statistics were used to analyze outcomes.ResultsThe patients with low BMI and low LNC had significantly fewer CD3 (p = 0.0136), CD8 (p = 0.0003), and CD20 (p = 0.0334) cells in their primary tumors compared to patients with normal BMI and LNC. The low BMI low LNC patients also had fewer mature TLS (0.83/tumor) in their primary cancers compared to patients with normal BMI and high LNC (5.4/tumor) and also had greater than fourfold lower mature TLS density (TLS per μm2 mean) (6.34 × 10−9 vs. 2.82 × 10−8), with significantly worsened survival relative to patients with low BMI and normal LNC and patients with normal BMI.ConclusionLow LNC predicts worsened survival only in low BMI HNSCC patients with non-HPV related tumors and in these patients is associated with markers of immunosuppression such as fewer tumor-infiltrating CD8+ T-cells, CD20+ cells, and fewer TLS in primary cancers compared to matched normal BMI patients with high LNC.
Pubmed PDF Web\nCamila Mancera, \nTonya S. King, \nBrittany A. Long, \nTyler P. Tufano, \nRalph P. Tufano\n
Publicatie 16-12-2024
ABSTRACTBackgroundThis study evaluates the utility of PTeye autofluorescence (AF) technology in primary hyperparathyroidism (PHPT) surgery.MethodsA retrospective review analyzed 232 patients undergoing first-time parathyroid surgery between September 2021 and 2023. Of these, 92 underwent surgery consecutively without PTeye assistance, then 140 underwent PTeye-guided surgery consecutively.ResultsThe PTeye-guided surgery group showed significantly higher parathyroid gland identification rates (p < 0.001) and a 20.7 times greater likelihood of identifying all four glands compared to controls (3.3%). No cases of permanent hypoparathyroidism were reported, indicating the procedures safety.ConclusionsPTeye appears to be a safe and effective technology that can be used to improve parathyroid gland identification during first time surgery for PHPT. This is particularly beneficial for patient population with a high prevalence of multiglandular disease.
Pubmed PDF Web\nDiana S. Shaari, \nDanielle A. Kapustin, \nMichelle Yoon, \nSamuel J. Rubin, \nAzita Khorsandi, \nRicardo J. Ramirez, \nMichael Schiff, \nMark L. Urken\n
Publicatie 12-12-2024
ABSTRACTBackgroundRadiation therapy with or without chemotherapy is commonly used as an adjunct or alternative to surgery for treating head and neck cancer (HNC). In rare cases, radiation-induced side effects such as posterior pharyngeal wall necrosis, fistula formation, and osteoradionecrosis (ORN) can lead to dangerous complications of the cervical spine (C-spine).MethodsWe conducted a literature review on C-spine ORN in HNC, and we reported four additional cases following the treatment of oropharyngeal carcinoma.ResultsWe identified 26 reported cases of C-spine ORN following radiation for HNC. Of the four cases from our institution, two were treated with surgical management and two with conservative measures. Two patients were able to resume oral intake. The median time to diagnosis was 121.5 (range: 22–194) months after completion of radiation.ConclusionLate complications of radiation can be devastating, severely limiting functional status and quality of life. C-spine ORN is related to total radiation dose and should be discussed with patients as a rare but serious side-effect.
Pubmed PDF Web\nMichelle Yoon, \nRicardo Ramirez, \nJun Yun, \nChristina Wiedmer, \nMargaret Brandwein‐Weber, \nAzita S. Khorsandi, \nDaniel Buchbinder, \nMohemmed N. Khan\n
Publicatie 12-12-2024
ABSTRACTIntroductionBisphosphonates (BPs) are widely used for osteoporosis and cancer-induced bone diseases due to their antiresorptive properties, yet they pose risks such as medication-related osteonecrosis of the jaw (MRONJ).MethodsWe present a unique case of concurrent oral squamous cell carcinoma (SCC) and MRONJ in a 72-year-old female chronically treated with oral ibandronate for osteoporosis. Following a dental extraction, she developed a nonhealing wound in the maxilla. Following conservative treatment, the patient underwent a maxillectomy and extensive tissue reconstructions to control her infection and address suspicions of an underlying malignancy.ResultsHistopathological examinations confirmed simultaneous osteonecrosis and well-differentiated SCC in the maxillary sinus and surrounding tissues. Despite multiple surgeries, the patients disease progressed rapidly. Upon examining the literature for patients with a history of BP use diagnosed with MRONJ and/or SCC, a total of 16 cases report a diagnostic dilemma between MRONJ and locoregional SCC. Three of the 16 cases report a final diagnosis of concurrent MRONJ and SCC. This report is the fourth reported case of concurrency to date.ConclusionsThe patients complex clinical course underscores the diagnostic challenges and therapeutic dilemmas in managing concurrent MRONJ and SCC, highlighting the need for vigilant monitoring and interdisciplinary collaboration in similar cases.
Pubmed PDF WebPublicatie 12-12-2024
\nChristopher D. Goodman, \nFranco DeMonte, \nTheresa P. Nguyen, \nAdam S. Garden, \nCatherine He Wang, \nXin A. Wang, \nKevin Diao, \nAnna Lee, \nJay Reddy, \nAmy Moreno, \nMichael Spiotto, \nClifton D. Fuller, \nDavid Rosenthal, \nRenata Ferrarotto, \nShaan M. Raza, \nShirley Y. Su, \nAndrew Warner, \nEhab Hanna, \nJack Phan\n
Publicatie 12-12-2024
The cover image is based on the article A prospective cohort study on stereotactic radiotherapy in the management of dural recurrence of olfactory neuroblastoma by Christopher D. Goodman MD et al., https://doi.org/10.1002/hed.27887.The cover image is based on the article A prospective cohort study on stereotactic radiotherapy in the management of dural recurrence of olfactory neuroblastoma by Christopher D. Goodman MD et al., https://doi.org/10.1002/hed.27887.
Pubmed PDF WebPublicatie 12-12-2024
Publicatie 12-12-2024
Publicatie 12-12-2024
\nAdebayo Alade, \nMelissa Persad, \nGeorge Bitar, \nAlina Dragan, \nNicos Fotiadis, \nJoshua Shur, \nKee Howe Wong, \nBrian Ng‐Cheng‐Hin, \nVinidh Paleri, \nKevin Harrington, \nDerfel Ap Dafydd\n
Publicatie 12-12-2024
ABSTRACTBackgroundTraditional head and neck cancer treatment involves open surgery, cytotoxic chemotherapy, and conventional radiotherapy planning. Emerging techniques aim to improve precision and reduce associated toxicity and functional impairment in current practice. This review article describes four such adaptations in image guidance, tailored to next generation therapies.MethodsThis is a review of current literature, including feasibility studies from our cancer center, relating to: saline-aided intra-oral ultrasound-guided retropharyngeal biopsy; intra-oral ultrasound guided trans-oral robotic surgery (TORS); ultrasound-guided injection of “directly injected therapies”; and magnetic resonance imaging-guided radiotherapy.ResultsPresented within the context of the wider literature, initial local experience and data indicate good technical outcomes and patient tolerance, and low technical complications in all four image guidance techniques.ConclusionInitial findings suggest a potentially important future role for these four image guidance techniques, on which next generation therapies are reliant. The broader implications on cross-disciplinary collaboration are also explored herein.
Pubmed PDF Web\nJin‐Hui Rao, \nCheng‐Peng Zha, \nWen‐Da Zhang, \nLiu‐Han Cheng, \nQian Lei, \nTao Xie, \nWen Peng, \nPei‐Jing Ye, \nMin‐Yue Zhang, \nYu‐Jie Xing, \nChuan‐Zheng Sun, \nLei Li\n
Publicatie 12-12-2024
ABSTRACTObjectiveTo investigate the clinicopathological features of individuals who have cervical lymph node metastasis (CLNM) from non-head and neck primary carcinomas.MethodsThe data of 1448 patients diagnosed with CLNM from non-head and neck primary carcinomas at the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, China, from January 2013 to December 2023 were collected. The patients general information, imaging data, and pathological information were retrospectively analyzed.ResultsThere were 780 men and 668 women among the 1448 patients, for a male-to-female ratio of 1.17:1. The median age was 56 years (range 21–81 years). The most prevalent primary sites in males were the lung (n = 508, 65.1%) and, in females, the breast (n = 276, 41.3%). The most prevalent pathological kind (n = 949), or 65.5% of cases, was adenocarcinoma. There was a significant difference in the proportion of adenocarcinoma between males (n = 385, 49.4%) and females (n = 564, 84.4%). The common sites of CLNM from non-head and neck primary carcinomas were level V (1,236 cases, 85.4%). In a subgroup of 1133 patients with primary cancer located in symmetrical or unilateral organs, 60.3% exhibited ipsilateral lymph node metastasis, 27.6% had bilateral lymph node metastasis, and 12.1% showed contralateral lymph node metastasis exclusively.ConclusionFor patients with CLNM, especially those with metastasis to cervical areas IV-V and those with adenocarcinoma pathology, it is particularly important to screen for primary foci in the lungs, breast, urogenital system, and digestive system after excluding head and neck primary cancers.
Pubmed PDF Web\nYusuf Ilhan, \nKadriye Bir Yucel, \nMuhammet Bekir Hacıoglu\n
Publicatie 12-12-2024
\nJames R. Janopaul‐Naylor, \nNancy Lee, \nSean McBride\n
Publicatie 12-12-2024
\nXinni Xu, \nBingcheng Wu, \nKwok Seng Loh, \nWei Sian Lim, \nCharmaine Si Min Tan, \nTerese Huiying Low, \nYew Kwang Ong, \nJeng Swan Tan, \nDonovan Kum Chuen Eu\n
Publicatie 12-12-2024
AbstractBackgroundSWI/SNF complex-deficient sinonasal carcinomas are rare, genetically distinct, and aggressive entities.MethodsSMARCB1 and SMARCA4 immunohistochemistry was retrospectively performed on a cohort of undifferentiated, poorly differentiated, and poorly defined sinonasal carcinomas. Survival outcomes were compared between SMARCB1/SMARCA4 (SWI/SNF complex)-deficient and -retained groups.ResultsEight SWI/SNF complex-deficient (six SMARCB1-deficient, two SMARCA4-deficient) cases were identified among 47 patients over 12 years. Triple-modality treatment was more frequently utilized in SWI/SNF complex-deficient carcinomas than in SWI/SNF complex-retained carcinomas (71.4% vs. 11.8%, p = 0.001). After a median follow-up of 21.3 (IQR 9.9–56.0) months, SWI/SNF complex-deficient sinonasal carcinomas showed comparable recurrence rates (57.1% vs. 52.9%, p = 0.839), time-to-recurrence (7.3 IQR 6.6–8.3 vs. 9.1 IQR 3.9–17.4 months, p = 0.531), and overall survival (17.7 IQR 11.8–67.0 vs. 21.6 IQR 8.9–56.0 months, p = 0.835) compared to SWI/SNF complex-retained sinonasal carcinomas.ConclusionTriple-modality treatment may improve survival in SWI/SNF complex-deficient sinonasal carcinomas.
Pubmed PDF Web\nLisa Nachtsheim, \nL. Jansen, \nS. Shabli, \nC. Arolt, \nA. Quaas, \nJ. P. Klussmann, \nM. Mayer, \nP. Wolber\n
Publicatie 12-12-2024
AbstractBackgroundPrimary 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.MethodsThis 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%.ConclusionTumor recurrence in SGC occurred in one out of five patients. In highly aggressive entities and patients with risk factors, treatment intensification should be considered.
Pubmed PDF Web\nChristopher D. Goodman, \nFranco DeMonte, \nTheresa P. Nguyen, \nAdam S. Garden, \nCatherine He Wang, \nXin A. Wang, \nKevin Diao, \nAnna Lee, \nJay Reddy, \nAmy Moreno, \nMichael Spiotto, \nClifton D. Fuller, \nDavid Rosenthal, \nRenata Ferrarotto, \nShaan M. Raza, \nShirley Y. Su, \nAndrew Warner, \nEhab Hanna, \nJack Phan\n
Publicatie 12-12-2024
AbstractBackgroundTreatment 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.ResultsFourteen 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.ConclusionIn this largest study of SBRT reirradiation for ONB dural recurrence to date, high local control rates with minimal toxicity were attainable.
Pubmed PDF Web\nTyler G. Chan, \nJaime Wicks, \nIla Sethi, \nJennifer Becker, \nDavid Brandon, \nNicole C. Schmitt, \nAzeem Kaka, \nBrian Boyce, \nHarry Michael Baddour, \nMark W. El‐Deiry, \nMihir R. Patel, \nJennifer H. Gross\n
Publicatie 12-12-2024
AbstractIntroductionOccult 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.ResultsAmong 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.ConclusionsOn 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.
Pubmed PDF Web\nCatherine H. Frenkel, \nErin E. Donahue, \nAllyson Cochran, \nDaniel Brickman, \nSteven Hong, \nMatthew C. Ward, \nBenjamin J. Moeller, \nDaniel R. Carrizosa, \nZvonimir L. Milas\n
Publicatie 12-12-2024
AbstractObjectiveThe 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.MethodsPatients 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.ResultsThirty-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.
Pubmed PDF Web\nSamuel Doty, \nAmanda Goslawski, \nClaudia I. Cabrera, \nEve Tranchito, \nNicole Fowler, \nShawn Li, \nJason E. Thuener, \nTheodoros N. Teknos, \nRod P. Rezaee, \nCyrus C. Rabbani, \nAkina Tamaki\n
Publicatie 12-12-2024
AbstractBackgroundFacial 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.ResultsThere 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.ConclusionsThese 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.
Pubmed PDF Web\nQifeng Jin, \nYonghong Hua, \nTing Jin, \nLei Wang, \nChangjuan Tao, \nShuang Huang, \nWeifeng Qin, \nXiaozhong Chen\n
Publicatie 12-12-2024
AbstractBackgroundInduction 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.ResultsThe 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.ConclusionMecapegfilgrastim effectively reduced the incidence of chemotherapy-induced neutropenia and FN in patients with locally advanced nasopharyngeal carcinoma.
Pubmed PDF Web\nNicole E. Schaen‐Heacock, \nLinda M. Rowe, \nMichelle R. Ciucci, \nJohn A. Russell\n
Publicatie 12-12-2024
AbstractBackgroundCommon 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.MethodsPre- 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.ResultsBoth treatments impacted outcome measures; the addition of exercise intervention showed benefit for some measures, particularly in rats treated with radiation, vs. chemoradiation.ConclusionsRadiation 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.
Pubmed PDF Web\nAngela A. Colback, \nDaniel V. Arkfeld, \nAlireza Paydar, \nOsama Raslan, \nDaniel J. Cates, \nMarianne Abouyared\n
Publicatie 12-12-2024
AbstractBackgroundMalnutrition 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.MethodsThis 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.ResultsHundred 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).ConclusionsDefining 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.
Pubmed PDF Web\nAnouk W. M. A. Schaeffers, \nAnouk V. M. Burger, \nCharlotte W. Duinkerken, \nKlaske E. van Sluis, \nJan Paul de Boer, \nLisette van der Molen, \nAlex E. Hoetink, \nAbrahim Al‐Mamgani, \nKatarzyna Jóźwiak, \nLot A. Devriese, \nRemco de Bree, \nCharlotte L. Zuur\n
Publicatie 12-12-2024
AbstractIntroductionPatients 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.ResultsThis 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 kHz) (p = 0.048).ConclusionsHNSCC patients with low LSMI suffer increased treatment-related SNHL upon cisplatin-based CRT.
Pubmed PDF Web\nAllen M. Chen, \nJeremy P. Harris, \nTjoson Tjoa, \nYarah Haidar, \nWilliam B. Armstrong\n
Publicatie 12-12-2024
AbstractPurposeTo 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.ResultsThe 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.ConclusionHypofractionated 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.
Pubmed PDF Web\nSamuel M. Vorbach, \nThomas Seppi, \nManuel P. Sarcletti, \nSiegfried Kollotzek, \nJulian Mangesius, \nJens Lehmann, \nDavid Riedl, \nMartin J. Pointner, \nMatthias Santer, \nDaniel Dejaco, \nMeinhard Nevinny‐Stickel, \nUte Ganswindt\n
Publicatie 12-12-2024
AbstractBackgroundWe 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).MethodsIn 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.ResultsPrognostic 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.ConclusionThe 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.
Pubmed PDF Web\nZhuowei Yao, \nJingshuo Wang, \nYongquan Jiang, \nYi Zhang, \nJun Liu, \nLi Dai, \nSilin Shen, \nXiang Zhou, \nQiang Liu, \nLuying Zheng, \nMinfei Qian, \nJiping Li\n
Publicatie 12-12-2024
AbstractPurposeHead 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.MethodsPatients with HNSCC underwent radical surgery and complete cervical lymph node dissection following neoadjuvant immunochemotherapy at RenJi 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.FindingsTwenty-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.ConclusionPembrolizumab 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.
Pubmed PDF Web\nZikun Yu, \nQin Wang, \nZimeng Wang, \nSihan Liu, \nTianliang Xia, \nChongyang Duan, \nYouping Liu, \nXi Ding, \nSiyuan Chen, \nTao Yu, \nRui You, \nMingyuan Chen, \nPeiyu Huang\n
Publicatie 12-12-2024
AbstractBackgroundEffective 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.MethodsWe 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.ResultsOur 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.ConclusionsHigh abundance of Lachnoclostridium predicts poor prognosis in patients with NPC receiving immunotherapy.
Pubmed PDF Web\nEinav G. Levin, \nAmit Ritter, \nGideon Bachar, \nAviram Mizrachi, \nHagit Shoffel‐Havakuk, \nNoga Kurman, \nAron Popovtzer, \nYaniv Hamzany\n
Publicatie 12-12-2024
AbstractBackgroundLaryngeal 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).MethodsWe 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.ResultsOf 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.
Pubmed PDF Web\nSaikrishna Ananthapadmanabhan, \nEugene Wong, \nLydia Natsis, \nAnand Suruliraj, \nNiranjan Sritharan, \nMark Smith, \nCarsten E. Palme, \nFaruque Riffat\n
Publicatie 12-12-2024
AbstractBackgroundThe 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.ResultsOf 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.ConclusionThe 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.
Pubmed PDF Web\nShuyong Zhang, \nRong Xie, \nLiuhuan Wang, \nGuoxue Fu, \nChenxi Zhang, \nYang Zhang, \nJichun Yu\n
Publicatie 12-12-2024
AbstractBackgroundPapillary 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.MethodsQuantitative 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.ResultsOur 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.ConclusionOur study elucidates that TMEM252 suppresses PTC progression by modulating the Notch pathway. These findings underscore TMEM252 is a potential therapeutic target in managing PTC.
Pubmed PDF Web\nNikhil Bellamkonda, \nEvan L. Tooker, \nAnne Naumer, \nLuke O. Buchmann, \nWendy Kohlmann, \nHilary C. McCrary, \nNeil S. Patel, \nMana Espahbodi\n
Publicatie 12-12-2024
AbstractBackgroundBilateral head and neck paragangliomas (HNPGLs) require nuanced management to balance tumor control with functional preservation.MethodsAll 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.ResultsThere 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).ConclusionsYounger 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.
Pubmed PDF Web\nKerstin Petersson, \nCaterina Finizia, \nNina Pauli, \nLisa Tuomi\n
Publicatie 12-12-2024
AbstractBackgroundRadiation-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.MethodsEighty-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.ResultsSwallowing 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.ConclusionsPreventive exercises did not improve short-term swallowing function and mouth opening after radiotherapy.
Pubmed PDF Web\nShaghauyegh S. Azar, \nCourtney B. Shires, \nKaruna Dewan, \nDinesh K. Chhetri\n
Publicatie 12-12-2024
AbstractObjectivesTracheoesophageal 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 designScoping review using PubMed of all English language articles from 1990 to 2020 addressing causes of TEP failure.MethodsThis 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 PubMeds MeSH subject headings and keywords was created. Causes and rates of failure were reviewed.ResultsAmong 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%).ConclusionCommon 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.
Pubmed PDF Web\nArdalan Ebrahimi, \nRuta Gupta, \nLachlan McDowell, \nMatthew J. R. Magarey, \nPaul N. Smith, \nKlaus‐Martin Schulte, \nDiana M. Perriman, \nMichael Veness, \nSandro Porceddu, \nTsu‐Hui Hubert Low, \nAllan Fowler, \nJonathan R. Clark\n
Publicatie 12-12-2024
AbstractBackgroundWe 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.MethodsPredictors of DMR were identified using Cox regression in a multicenter study of 1151 patients.ResultsThe 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).ConclusionsThe 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.
Pubmed PDF Web\nXin Zhao, \nZiqi Pei, \nXiang Song, \nGang Jin\n
Publicatie 12-12-2024
AbstractBackgroundSinonasal 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.MethodsRetrospective analysis of survival trends of 410 SNUC patients between 1973 and 2015.ResultsThe 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.ConclusionsRadiotherapy plays a key role in improving SNUC survival rates. No significant difference in survival rates was observed in preoperative and postoperative RT treatment.
Pubmed PDF Web\nOmar A. Karadaghy, \nAndrew M. Peterson, \nTuleen Sawaf, \nBryan Renslo, \nBrevin Miller, \nCelina Virgen, \nKevin J. Sykes, \nMichelle M. Doering, \nChristopher J. Moran, \nHenrik Ullman, \nJeremy Peterson, \nPatrik Pipkorn, \nAndrés M. Bur\n
Publicatie 12-12-2024
AbstractBackgroundThe 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.ResultsThe 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.ConclusionsAcute 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.
Pubmed PDF Web\nDan P. Zandberg, \nSerafettin Zenkin, \nMurat Ak, \nPriyadarshini Mamindla, \nVishal Peddagangireddy, \nRonan Hsieh, \nJennifer L. Anderson, \nGreg M. Delgoffe, \nAshely Menk, \nHeath D. Skinner, \nUmamaheswar Duvvuri, \nRobert L. Ferris, \nRivka R. Colen\n
Publicatie 12-12-2024
AbstractBackgroundWe retrospectively evaluated radiomics as a predictor of the tumor microenvironment (TME) and efficacy with anti-PD-1 mAb (IO) in R/M HNSCC.MethodsRadiomic 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.ResultsRadiomics 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.ConclusionRadiomics accurately predicted the efficacy of IO and features of the TME in R/M HNSCC. Further study in a larger patient population is warranted.
Pubmed PDF Web\nFaye G. Zhang, \nShankar Viswanathan, \nChenxin Zhang, \nRichard V. Smith, \nBradley A. Schiff, \nThomas J. Ow, \nMadhur K. Garg, \nRafi Kabarriti, \nVikas Mehta\n
Publicatie 12-12-2024
AbstractBackgroundDelay 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.MethodsThis 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.ResultsAmong 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.
Pubmed PDF Web\nFilippo Marchi, \nAndrea Iandelli, \nGian Marco Pace, \nElisa Bellini, \nAlessandro Tirrito, \nAndrea Costantino, \nLuca Cerri, \nAntonio Greco, \nAntonella Polimeni, \nGiampiero Parrinello, \nGiorgio Peretti, \nArmando De Virgilio\n
Publicatie 12-12-2024
AbstractObjectiveThis 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).ResultsThe 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).ConclusionThe 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.
Pubmed PDF Web\nZhichao Zuo, \nJie Ma, \nMi Yan, \nWu Ge, \nTing Yao, \nLu Zhou, \nYing Zeng, \nYang Liu\n
Publicatie 12-12-2024
AbstractBackgroundEarly 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.ResultsThe 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.
Pubmed PDF Web\nAmanda J. Bastien, \nLuv Amin, \nMissael Vasquez, \nIris Cong, \nMichael Luu, \nMeghan Laszlo, \nSaori Yen, \nHeather Thompson, \nElana L. Teitelbaum, \nJulie K. Jang, \nAlain C. Mita, \nKevin S. Scher, \nJustin Moyers, \nJon Mallen‐St. Clair, \nEvan S. Walgama, \nZachary S. Zumsteg, \nAllen S. Ho\n
Publicatie 12-12-2024
AbstractBackgroundAs 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.MethodsRetrospective 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.ResultsAltogether, 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.
Pubmed PDF Web\nLuca Canali, \nMarika D. Russell, \nAnthea Sistovaris, \nAmr H. Abdelhamid Ahmed, \nMichael Otremba, \nHien T. Tierney, \nFrédéric Triponez, \nFares Benmiloud, \nGiuseppe Spriano, \nGiuseppe Mercante, \nGregory W. Randolph\n
Publicatie 12-12-2024
AbstractBackgroundHypocalcemia 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.ResultsSeven 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).ConclusionsWe 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.
Pubmed PDF Web\nKwang Hyun Yoon, \nJong Cheol Lee, \nYong Jin Song, \nWon Jun Kim, \nMyoung Sook Shim, \nHa Young Kim, \nJin Yub Kim, \nByeong‐Joo Noh, \nDong Gyu Na\n
Publicatie 12-12-2024
AbstractBackgroundAccurate 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.MethodsThe 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.ResultsIn 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%.ConclusionsPreoperative 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.
Pubmed PDF Web\nShreya Sriram, \nDeborah Xie, \nRebecca A. Gersten, \nChristine G. Gourin\n
Publicatie 12-12-2024
AbstractBackgroundThe 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 PubMed, Embase, and Web of Science from 1980 to 2022.ResultsOf 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.ConclusionsComparison 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.
Pubmed PDF Web\nBeatriz Cirauqui Cirauqui, \nAdrià Bernat Peguera, \nAriadna Quer Pi‐Sunyer, \nAngelica Ferrando‐Díez, \nJose Luis Ramírez Serrano, \nMarta Domenech Viñolas, \nIris Teruel García, \nVanesa Quiroga García, \nImane Chaib Oukadour, \nAndrea González Valencia, \nPilar Hernández Vergara, \nItziar de Aguirre Egaña, \nCristina Queralt Herrero, \nOscar Mesía Carbonell, \nAssumpció López Paradís, \nAnna Esteve, \nMireia Margelí Vila, \nRafael Rosell, \nAnna Martínez‐Cardús, \nRicard Mesía\n
Publicatie 12-12-2024
AbstractBackgroundSquamous 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 methodsBetween 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.ConclusionsAlthough 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.
Pubmed PDF Web\nClaudio Sampieri, \nEleonora Cioccoloni, \nAndrea Costantino, \nDahee Kim, \nKyuin Lee, \nGiuseppe Meccariello, \nGiovanni Cammaroto, \nClaudio Vicini, \nSe‐Heon Kim\n
Publicatie 12-12-2024
AbstractBackgroundTransoral 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.ResultsAmong 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.
Pubmed PDF Web\nGiacomo Bertazzoni, \nAlessandro Vinciguerra, \nDomitille Camous, \nMarco Ferrari, \nDavide Mattavelli, \nMario Turri‐Zanoni, \nAlberto Schreiber, \nStefano Taboni, \nVittorio Rampinelli, \nAlberto Daniele Arosio, \nBenjamin Verillaud, \nCesare Piazza, \nPaolo Battaglia, \nMaurizio Bignami, \nAlberto Deganello, \nPaolo Castelnuovo, \nPiero Nicolai, \nPhilippe Herman\n
Publicatie 12-12-2024
AbstractIntroductionIn 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.MethodsAll 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.ResultsNine 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).ConclusionOur 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.
Pubmed PDF Web\nPelin Güneri, \nGaye Bolukbasi, \nBetul Ilhan, \nJoel B. Epstein, \nSaman Warnakulasuriya\n
Publicatie 12-12-2024
ABSTRACTOral epithelial dysplasia (OED) is the primary histological marker for assessing the progression of oral potentially malignant disorders (OPMDs) to cancer. Despite challenges in grading and low inter-pathologist reproducibility, OED severity remains the key predictor of malignant transformation. However, globally accepted guidelines for OED monitoring are lacking, despite calls for individualized management based on host and lesion characteristics. The proposed research protocol involves acquiring high-quality intraoral images, assessing oral hygiene and periodontal status, eliminating chronic mechanical irritation and Candida infections, and applying adjunctive diagnostic methods like toluidine blue staining, optical evaluation, and brush cytology. Tailored follow-up regimens based on individual risk assessments are emphasized, with frequent monitoring for high-grade dysplasia or patients at higher risk of progression. Therefore, effective OED management should consider the patients immune status, dietary habits, and oral microbiota, aiming to develop personalized treatment strategies that optimize patient-centered care.
Pubmed PDF Web\nScott A. Roof, \nMichael H. Berger, \nAustin S. Lam\n
Publicatie 09-12-2024
ABSTRACTBackgroundThe reverse flow technique describes flap revascularization via anastomoses at the distal pedicle. The technique has been described for various indications but rarely as a means of flap salvage. To our knowledge, there are no previously reported cases where the reverse flow concept was utilized as a means of salvage of an osteocutaneous fibula free flap with severe atherosclerosis of the proximal peroneal artery.MethodsWe describe the use of reverse flow to salvage the case of a 71-year-old male with significant atherosclerosis of the proximal peroneal artery preventing adequate microvascular anastomosis and inflow, despite multiple attempts.ResultsWe were able to establish arterial perfusion of the flap using a reverse flow technique, with perfusion through the distal peroneal artery via the contralateral facial artery.ConclusionThis case describes the first reported use of the reverse flow technique for salvage of an osteocutaneous fibula free flap when severe atherosclerosis prevented antegrade arterial inflow. The technique appears to be a viable option for free flap salvage in similar instances.
Pubmed PDF Web\nWaranyu Ueangphairot, \nPooriwat Muangwong, \nPhimchat Suwannaphong, \nSirida Youngchim, \nPatcharin Thammasit, \nKittikun Kittidachanan, \nImjai Chitapanarux\n
Publicatie 09-12-2024
ABSTRACTBackgroundThis study evaluated the efficacy of fluconazole prophylaxis in reducing radiation-induced oral mucositis (RIOM) and Candida carriage in head and neck cancer (HNC) patients undergoing concurrent chemoradiotherapy (CCRT).MethodsA prospective, double-blinded, randomized controlled trial was conducted with 78 HNC patients receiving either fluconazole (100 mg daily) or placebo during CCRT. The primary outcome was the incidence of grade 2 or higher RIOM. Secondary outcomes included positive Candida cultures and colony-forming units (CFUs). Mixed-effects ordinal logistic regression and logistic regression were used for analysis.ResultsFluconazole significantly reduced the incidence of grade 2 or higher RIOM at week 7 (p = 0.039), positive Candida carriage at week 4 (p = 0.024) and week 7 (p = 0.029), and median CFUs at week 7 (p = 0.050).ConclusionsFluconazole significantly reduces RIOM severity and Candida colonization in HNC patients undergoing CCRT, suggesting its efficacy as a prophylactic treatment.
Pubmed PDF Web"\nPatrick Sheahan, \nDeirdre Callanan, \nNadia van den Berg, \nJustin Hintze, \nDavid Brinkman, \nHadeel Jawad, \nRyan OSullivan, \nRoss OShea, \nAndrew Dias, \nLinda Feeley\n"
Publicatie 09-12-2024
ABSTRACTBackgroundThe prognostic significance of close margins in oral squamous cell carcinoma (OSCC) is controversial. We wished to investigate the impact of close margins on the risk of local recurrence (LR) in OSCC according to the oral subsite.MethodsA retrospective cohort study of 342 OSCC patients undergoing primary surgical treatment was conducted. Surgical margins were based on the main specimen and defined as positive (SCC at margins), close (< 5 mm), or clear (≥ 5 mm).ResultsAmong tongue SCC cases, both positive (hazard ratio 13.48, 95% CI 2.03, 32.91) and close margins (hazard ratio 3.87, 95% CI 1.31, 11.34) were significantly associated with LR. Tongue margins < 4 mm were associated with higher LR. Among non-tongue SCC cases, only positive margins (hazard ratio 4.10, 95% CI 1.19, 14.21) were associated with LR. Close margins were not significant (hazard ratio 1.59, 95% CI 0.46, 5.42).ConclusionsClose margins appear to have a differential impact on LR in OSCC according to the oral subsite.
Pubmed PDF Web\nDaniel Paixão Pequeno, \nJuliana Carron, \nKarla Cristina Gaspar, \nCarmen Silvia Passos Lima, \nClarissa Rosalmeida de Dantas, \nGustavo Jacob Lourenço\n
Publicatie 09-12-2024
ABSTRACTBackgroundThis study aimed to assess the occurrence of post-traumatic stress symptoms (PTSS) in head and neck cancer (HNC) patients. The goal also was to explore potential associations between PTSS, demographic factors, psychological variables, and specific genetic variants.MethodsThis study included a total of 155 HNC patients, divided into pre-pandemic (n = 76) and COVID-19 pandemic (n = 79) groups. PTSS assessments were conducted using a standardized questionnaire. The assessment of adverse childhood experiences (ACEs) involved specific questionnaire items. Genetic variants were identified via RT-PCR. Statistical analysis employed linear multivariate regression, while mediation analysis examined gene–environment interactions.ResultsIn the pre-pandemic, higher PTSS scores were found to be associated with younger age (p = 0.02) and a history of cumulative ACEs (p = 0.001). Mediation analysis revealed that ACEs had a direct impact on PTSS scores, with the FKBP5 CC genotype (rs1360780, C>T) mediating this association by 29%. In the pandemic, elevated PTSS scores were correlated with a history of depression (p = 0.001), the negative impact of the pandemic (p = 0.007), and undergoing palliative treatment (p = 0.02).ConclusionsOur findings provide insights into the psychosocial and genetic factors contributing to PTSS in HNC patients, considering the additional stressors introduced by the COVID-19 pandemic.
Pubmed PDF Web\nYoungjun Cho, \nGeorge Spirou, \nSummer J. Decker, \nJonathan M. Ford, \nMatthew Mifsud, \nEric Sommers, \nYael Bensoussan\n
Publicatie 05-12-2024
ABSTRACTObjectiveWe hypothesized that a method to segment human airways from clinical cases and import them into a case presentation environment in Virtual Reality (VR) could be developed to model and visualize complex airway stenosis for efficient surgical planning.MethodsOne normal and two pathological airways modeled from CT scans at a slice thickness of 0.625 mm were processed. A multidisciplinary team composed of airway surgeons, VR engineers, educators, and radiologists collaborated to create a clinically relevant VR rendering and explanatory Narrations of the three clinical cases. Segmentation and postprocessing were completed in the Mimics Innovation Suite v24 from Materialize. Structures were segmented from the level of bifurcation of common carotid arteries to the level of bifurcation of the main bronchi, including cartilaginous and bony airway structures, vessels, and soft tissues. They were then postprocessed into 3D image volumes and imported into syGlass (IstoVisio Inc.), a VR software.ResultsDirect visualization and free manipulation of these 3D airway models within the VR environment provided improved geometrical and anatomical details compared to traditional two-dimensional (2D) CT. Then, specialized presentation and active learning tools developed for scientific communication using the VR environment permitted the creation of VR Narrations to explain pathological cases.ConclusionThe method to segment human airways from clinical cases used in this paper, combined with intuitive VR tools to overlay segmentation and image data in an active learning environment, shows potential in the use of 3D airway modeling and VR in clinical practice for the description and surgical planning of complex airways. Further work is needed to validate the use of these models in clinical practice and patient education.Level of EvidenceLevel 4.
Pubmed PDF Web\nLing‐Ying Wei, \nYi‐Wen Cheng, \nWei‐Yih Chiu, \nSang‐Heng Kok, \nHao‐Hong Chang, \nShih‐Jung Cheng, \nJang‐Jaer Lee\n
Publicatie 29-11-2024
ABSTRACTAimAntiresorptive therapy (ART) is commonly used in osteoporotic patients to prevent bone loss. This retrospective cohort study aimed to identify the risk factors associated with medication-related osteonecrosis of the jaw (MRONJ) in osteoporotic patients receiving dental extraction during ART.Materials and MethodsData were collected from 937 patients with 1067 dental extractions conducted between January 2003 and May 2022, including 519 patients on oral alendronate, 276 on denosumab, and 172 on zoledronate. Multivariate logistic regression analysis was employed to assess potential risk factors.ResultsRegression model analysis revealed older age (AOR 1.09 per year; 95% CI, 1.06–1.12) and drug treatment exceeding 24 months (AOR 2.07; 95% CI, 1.29–3.30) as significant risk factors. A drug interruption of 3 or more months prior to tooth extraction lowered MRONJ risk (AOR 0.11; 95% CI, 0.07–0.17). Stratified by drug type, denosumab users had significantly lower risk of MRONJ after extraction (AOR 0.14; 95% CI, 0.07–0.27) compared to those on other medications. Factors of drug duration ≥ 24 months, < 3 months of interruption, and posterior mandibular tooth extraction posed the highest synergistic MRONJ risk (AOR 80.29; 95% CI, 33.05–195.09).ConclusionOur results suggest an association between a three-month ART interruption prior to tooth extraction and reduced MRONJ risk, especially in long-term ART patients undergoing posterior mandibular extractions. However, these findings require validation through prospective randomized controlled trials.Clinical RelevanceScientific Rationale for Study: The study fills crucial knowledge gaps regarding MRONJ risks in osteoporotic patients undergoing dental extraction during antiresorptive therapy (ART), providing a foundation for informed clinical decisions.Principal Findings: Noteworthy findings include elevated MRONJ risk with older age and prolonged ART, the protective effect of a 3-month ART interruption, and denosumab users showing significantly reduced postextraction MRONJ risk.Practical Implications: Implementing a 3-month ART interruption before dental extraction is recommended to reduce MRONJ occurrences.
Pubmed PDF Web\nJulie Nadjmi, \nOlivier Peetermans, \nSimon Nicolay, \nPatrick Lauwers, \nGilles Van Haesendonck\n
Publicatie 29-11-2024
ABSTRACTBackgroundTotal laryngectomy is an essential surgical intervention in the management of advanced laryngeal carcinoma. However, anatomical variations such as the bovine arch can complicate this procedure. The atypical branching pattern of the bovine arch may position major vessels closer to the tracheostomy site, increasing the risk of tracheo-arterial fistulization.MethodsWe present the case of a 71-year-old woman with bovine arch anatomy who underwent total laryngectomy. Preoperative assessment revealed an aberrant right common carotid artery (RCCA) located close to the tracheostomy site. Intraoperatively, the “strap-flap technique” was employed, positioning the strap muscles between the RCCA and the trachea to minimize friction and reduce the risk of tracheo-arterial fistula formation.ResultsThe laryngectomy was performed successfully without any bleeding complications.ConclusionPreoperative assessment of aortic arch anatomy is essential for guiding surgical planning. Surgical modifications, such as the use of strap muscles or pectoralis muscle flaps, are crucial in preventing postoperative complications.
Pubmed PDF Web\nBin Zhang, \nYu‐Zhong Qiu, \nLei‐Ming Cao, \nZi‐Zhan Li, \nGuang‐Rui Wang, \nYao Xiao, \nHan‐Yue Luo, \nBing Liu, \nYi‐Feng Ni, \nZhi‐Li Zhao, \nLin‐Lin Bu\n
Publicatie 29-11-2024
ABSTRACTBackgroundSince its first application in 1978, the vascularized free iliac flap (VFIF) has gradually become a mainstay for tissue defect reconstruction. However, the complications associated with harvesting the bone flap and its corresponding reconstruction surgery cannot be overlooked.MethodsWe conducted a narrative review through literature search to identify the types, incidence, influencing factors, measurement methods, and treatment approaches of complications related to DCIA-related VFIF.ResultsWe propose the “LIP” rule (Loss, Injury, Postoperative) for classifying donor site complications. For the four most common recipient sites, mandible, maxilla, extremities, and hip joint, we list the common and rare complications that may occur. Additionally, we provide a summary of the methods and advances in preventing these complications.ConclusionsWe comprehensively describe the complications observed in the application of DCIA-related VFIF and introduce the “LIP” principle and other strategies to minimize or avoid adverse outcomes.
Pubmed PDF Web\nKaho Momiyama, \nShohei Tsutsumi, \nYasutaka Sakurai, \nSachiyo Mogi, \nShunsuke Miyamoto, \nYoshiki Murakumo, \nTaku Yamashita\n
Publicatie 28-11-2024
ABSTRACTBackgroundREV7 is a multifunctional protein involved in various biological processes, including DNA damage response. REV7 expression in human cancer cells influences sensitivity to DNA-damaging agents, and its high expression level is reportedly associated with a poor prognosis in many carcinomas. However, the significance of REV7 expression in human papillomavirus 16–negative oropharyngeal squamous cell carcinoma (OPSCC) remains unclear.MethodsREV7 expression was assessed by immunohistochemical analysis in 79 patients with HPV16-negative OPSCC. We evaluated the effects of inhibiting REV7 expression on the proliferation and cisplatin sensitivity of FaDu, an HPV16-negative pharyngeal SCC cell line.ResultsIn patients with p16-negative OPSCC, the high-REV7-expression group experienced significantly shorter overall survival than the low-REV7-expression group (p = 0.03) in the Cox regression analysis. Furthermore, REV7-deficient FaDu cells showed suppressed cell growth and enhanced sensitivity to cisplatin in vitro.ConclusionsREV7 expression is associated with a poor prognosis in HPV16-negative OPSCC.
Pubmed PDF Web\nSijia Yan, \nPuhua Zhang, \nShuai Tan, \nHaiyun Mo, \nYanlin Yang\n
Publicatie 27-11-2024
ABSTRACTBackgroundCisplatin (DDP) is one of the commonly used chemotherapeutic drugs for nasopharyngeal carcinoma (NPC) patients, and the resistance of tumor cells to cisplatin is main obstacle for NPC treatment. This study explored effect and possible mechanism of lncRNA small nucleolar RNA host gene 14 (SNHG14) on drug resistance of NPC cells to cisplatin.MethodsLevels of SNHG14 and Notch2 in NPC tissues and cells were confirmed using RT-qPCR. Western blot detected Notch2 and ABCB1 expression in NPC cells. IC50 of cisplatin-treated NPC cells was tested utilizing 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). Cell proliferation and apoptosis were evaluated utilizing colony formation experiment and flow cytometry, respectively. RNA immunoprecipitation (RIP) assay was utilized to validate the target genes of U2AF2. Notch2 mRNA stability was tested using actinomycin D.ResultsSNHG14 level was increased in both cisplatin-resistant NPC tissues and cell lines. SNHG14 silencing in HNE1/DDP cells resulted in inhibition of chemoresistance to cisplatin. Conversely, upregulation of SNHG14 in HNE1 cells enhanced their resistance to cisplatin. SNHG14 exhibited an interaction with U2AF2, leading to stabilization of Notch2 mRNA. Finally, Notch2 was involved in SNHG14-mediated cisplatin resistance in NPC cells.ConclusionOur findings demonstrate SNHG14 plays a significant role in promoting chemoresistance of NPC cells to cisplatin through U2AF2/Notch2 axis. These results highlight potential therapeutic targets for NPC treatment.
Pubmed PDF Web\nShimrit Sharav, \nJoshua D. Horton, \nZachary Theodossiou, \nJohn Turner, \nDavid Neskey, \nTerry Day\n
Publicatie 27-11-2024
ABSTRACTBackgroundThere is limited understanding of head and neck second primary tumors (SPTs) in HPV-associated squamous cell carcinoma (SCC). Analogous to the concept of field cancerization of the upper airway known to contribute to the development of smoking-related head and neck SPTs, this case series reports four cases of HPV-associated SPTs.MethodsWe reviewed the charts of four patients diagnosed with HPV-associated oropharyngeal SCC who subsequently developed HPV-associated SPTs. Clinical data was collected, including demographics, tumor characteristics, time elapsed between the two diagnoses, and treatment type.ResultsThe average age of the patients was 68 years. All of the patients were non-smokers, and none reported heavy alcohol use. All patients had the first cancer in the oropharynx. The time between the first and second diagnoses ranged from 3 and 12 years.ConclusionHPV has not been previously identified as a risk factor for head and neck SPTs. Given the long period between the first and second cancers and the lack of other risk factors for head and neck cancer, our case series demonstrates HPV-associated head and neck SPTs.
Pubmed PDF Web\nE. Ansari, \nN. Carrillo Minulina, \nM. A. van Beers, \nR. J. J. van Es, \nF. J. Dieleman, \nA. J. W. P. Rosenberg, \nL. M. Janssen, \nW. W. Braunius, \nE. M. Van Cann, \nR. de Bree\n
Publicatie 27-11-2024
ABSTRACTBackgroundLow skeletal muscle mass (SMM) is a predictive factor for complications in patients undergoing major head and neck cancer surgery. This study aims to identify the predictive value of low SMM for postoperative complications in patients who underwent free forearm flap (FAFF) reconstructions after oral cancer resections.MethodsA retrospective study was performed with all patients who underwent FFAF between 2003 and 2020 for an oral cavity reconstruction after cancer ablation. Free flap related, any postoperative complications and hospital stay were investigated.ResultsLow SMM was associated with an increased risk of free flap associated complications (OR 2.14; 95% CI 1.02–4.39, p = 0.029). Low SMM was associated with severe complications (Clavien–Dindo ≥ III) (OR 1.46; 95% CI 1.20–2.09, p = 0.02).ConclusionsLow SMM is a strong predictive factor for free flap related surgical complications in patients undergoing FAFF reconstruction after resection of oral cancer.
Pubmed PDF Web\nOm S. Chitnis, \nSabrina K. Wagner, \nJ. Joseph Caraway, \nNora L. Watson, \nRhonda J. Allard, \nMichael I. Orestes\n
Publicatie 27-11-2024
ABSTRACTBackgroundThere is currently a lack of consensus regarding neuropsychiatric symptoms as an indication for parathyroidectomy in primary hyperparathyroidism (pHPT). The purpose of this study is to perform a systematic review and meta-analyses of pre- and postoperative Beck Depression Inventory-II (BDI-II) scores in patients with pHPT undergoing parathyroidectomy.MethodsA search of the literature was performed using Embase, PubMed, Web of Science, PsycINFO, and OvidAll EBM Reviews. Studies were included if they evaluated BDI-II scores in pHPT patients before and after parathyroidectomy.ResultsThe literature search returned 1554 studies, of which nine articles met criteria for inclusion. Baseline BDI-II scores were significantly higher in pHPT patients compared to control patients. pHPT patients experienced a statistically significant decrease in BDI-II scores at ≤ 1 and 6 months postoperatively.ConclusionsBased on the results of this study, a BDI-II score ≥ 14 could potentially advocate for parathyroidectomy in patients with pHPT.
Pubmed PDF Web\nJenny B. Xiao, \nAbhiram Cherukupalli, \nKhanh Linh Tran, \nEitan Prisman\n
Publicatie 25-11-2024
ABSTRACTBackgroundMalnutrition is a major problem in head and neck cancer (HNC) with up to half of patients requiring gastrostomy tube (G-tube) placement. Predicting this need remains complex given mixed evidence surrounding its usage.MethodsA comprehensive search was performed to identify studies examining risk factors associated with G-tube placement following radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) in HNC patients.ResultsSixteen retrospective studies were included (n = 11 015). The overall prevalence of G-tube placement was 44% with 76% of patients receiving reactive G-tube placement. Pretreatment dysphagia, pretreatment BMI < 18.5, and tumors in the hypopharynx were significant predictive factors for prophylactic G-tube placement. Type of chemotherapy regimen, tumors in the nasopharynx, and cytokine changes were significant predictive factors for reactive G-tube placement.ConclusionSeveral factors were identified that contribute to increased risk of G-tube placement and may guide current decision-making algorithms.
Pubmed PDF Web\nKyu‐Il Lee, \nYe‐Won Choi, \nSeung‐Kyu Han, \nSeong‐Ho Jeong, \nEun‐Sang Dhong\n
Publicatie 25-11-2024
ABSTRACTBackgroundThis study aimed to compare the degree of scar contracture following artificial dermis grafting after excision of basal cell carcinoma on the nose categorized by defect location into three nasal subunits.MethodsAnthropometric analysis was conducted on seven parameters using patients photographs to compare changes between preoperative and postoperative measurements based on nasal subunits. Defect locations were classified as: (1) dorsum and sidewalls (D zone), (2) tip (T zone), and (3) alar lobule (A zone).ResultsThe greatest change in alar height asymmetry was observed in zone A. Changes in nasal tip projection ratio and nasofrontal angle were the most significant in zone T. No other measurements showed statistically significant differences among the three zones.ConclusionsCareful consideration is recommended when applying artificial dermis grafting in zones A and T. Conversely, zone D appears to be the most suitable for artificial dermis grafting.
Pubmed PDF Web"\nVivian Lin, \nMichael Zhang, \nRuta Gupta, \nMichael S. Elliott, \nJonathan R. Clark, \nJames J. Wykes, \nSydney Chng, \nKerwin F. Shannon, \nCarsten E. Palme, \nTsu‐Hui Low\n"
Publicatie 25-11-2024
ABSTRACTBackgroundCutaneous squamous cell carcinomas (cSCC) metastasizing to the parotid gland can cause facial nerve (FN) dysfunction secondary to direct invasion, perineural spread, or surgical ablation. This study aims to characterize the prevalence of preoperative FN involvement in metastatic cSCC to the parotid and identify risk factors resulting in FN sacrifice.MethodsPatients with parotid metastases from cSCC, treated surgically with parotidectomy with curative intent were identified through a retrospective cohort analysis of a prospectively maintained Sydney Head and Neck database from 1992 to 2021.ResultsOf 408 patients identified, 39 (10%) were found to have preoperative FN weakness, of which 41% underwent concurrent temporal bone resection compared to 9.1% for the overall cohort. All patients with preoperative FN weakness underwent FN sacrifice. FN sacrifice occurred in n = 145 (36%), of which 88 (61%) required sacrifice of a trunk or division. The 5-year disease free survival and disease specific survival was worse for patients requiring sacrifice of the FN trunk compared to no sacrifice, however there was no difference in survival for patients requiring sacrifice of the FN division or branch. We found those with > 23.5 mm parotid deposits had an odds ratio of 9.9 for FN sacrifice (95% CI 3.0–32.8, p < 0.001).ConclusionsPreoperative FN weakness was present in 10% of patients and 36% had some part of the FN sacrificed. There was no significant difference in outcomes for patients with and without preoperative FN weakness. Patients who undergo sacrifice of the FN trunk have worse survival compared to those not requiring FN sacrifice, however similar outcomes were observed in those requiring lessor degrees of FN sacrifice. The likelihood FN sacrifice rises with increasing parotid deposit size.
Pubmed PDF Web\nJames C. Gates, \nMarianne Abouyared, \nYelizaveta Shnayder, \nD. Gregory Farwell, \nAndrew Day, \nFaizan Alawi, \nMichael Moore, \nAndrew J. Holcomb, \nAndrew Birkeland, \nJoel Epstein\n
Publicatie 25-11-2024
ABSTRACTBackgroundOral potentially malignant disorders (OPMDs) occur in up to 4%–5% of the population, of which oral leukoplakia (OL) is the most common subtype. Predicting high-risk OL remains a challenge. Early diagnosis and effective treatment are thought to be of paramount importance to improve outcomes.MethodsWe searched PubMed and Clinicaltrials.gov data for updates in the clinical management of OL from 2015 to current.ResultsRecent publication of large cohorts of patients with OL aids in counseling patients regarding risk of malignant transformation. Management for OL includes surveillance, excision, and laser surgery, as well as local and systemic approaches to chemoprevention. Several new entities show promise regarding candidate biomarkers, chemoprevention agents, and diagnostic adjuncts, though all require further validation.ConclusionThis update serves to further inform clinical management of OL and provide impetus for future investigations.Trial RegistrationNCT00099021, NCT00951379, NCT05727761, NCT05727761
Pubmed PDF Web\nCameron McCann, \nRhona Hurley, \nJosh McGovern, \nKatrina Knight, \nNicholas J. W. Rattray, \nCatriona M. Douglas\n
Publicatie 22-11-2024
ABSTRACTBackgroundFrailty increases the risk of mortality in the head and neck cancer population. This study examines the association between frailty and survival outcomes in patients with laryngeal squamous cell cancer (LSCC).MethodRetrospective data collection from patients in the West of Scotland diagnosed with LSCC between 2014 and 2020. The Modified Five Item Frailty Index (mFI-5) measures frailty and categorizes patients according to their level of frailty. Statistical tests used were the Mann–Whitney U-test or ANOVA for differences in means and survival analyses for overall survival time.ResultsThere were 867 patients included. Seventy-eight percent (n = 676) of patients were deemed frail. Median survival for “not frail” patients was 78 months and “severely frail” was 23 months. The palliative treatment group had worse overall survival outcomes compared to curative (hazard ratio (HR) of 7.96, p < 0.001).ConclusionThis study demonstrates frailty is common in patients with LSCC and leads to worse mortality and survival outcomes.
Pubmed PDF Web\nYeonsu Jeong, \nMin‐Seok Rha, \nChang‐Hoon Kim, \nHyung‐Ju Cho\n
Publicatie 22-11-2024
ABSTRACTBackgroundThis first prospective study evaluates the efficacy and safety of single-port transoral robotic surgery (SP TORS) for tongue base resection (TBR) in obstructive sleep apnea (OSA) patients.MethodsA single-center, single-surgeon clinical investigation enrolled 25 subjects from April 2021 to September 2022. Pre- and postsurgery polysomnography reports and standardized sleep quality assessments were collected. Surgical parameters and complications were documented.ResultsAccording to Shers success criteria (50% reduction in AHI and AHI < 20), the success rate was 76% (19/25 patients). Preoperative AHI decreased from 58.56 ± 26.40 to 18.19 ± 22.02 postsurgery. Symptoms such as foreign body sensation and taste dysfunction improved within 3 months. Major complications, including hemorrhage, occurred in two patients (8%).ConclusionsSP TORS TBR effectively manages OSA, significantly improving AHI outcomes and safety. Its precision and targeted tissue removal highlight its advantages over traditional methods, warranting further clinical investigation.Traial Registration:ClinicalTrials.gov identifier: NCT04795817.
Pubmed PDF Web\nJacob Hauser, \nTraeden Wilson, \nChelsea Huang, \nPaul Walker\n
Publicatie 22-11-2024
ABSTRACTBackgroundTopical vitamin E is commonly used for its antioxidant properties in a rapidly expanding anti-aging market. Cutaneous reaction to vitamin E is rare and can present a difficult diagnosis.MethodsWe report a unique case of a 46-year-old female who developed a severe cutaneous inflammatory chin lesion after topical use of vitamin E oil with a micro-spike roller. Clinical examination found a friable and fungating mass which prompted biopsy due to suspected malignancy. Pathology ruled out malignancy and revealed chronic inflammation with xanthogranulomatous-like features.ResultsThe lesion was significantly improved with Kenalog injection treatment over 18 months. A scar excision procedure further enhanced the lesion cosmetically.ConclusionsThis case highlights the rarity and clinical diversity of vitamin E skin reactions, and their potential to mimic malignancies.
Pubmed PDF Web\nSegado‐Guillot Salvador, \nGarcía‐Anaya María Jesús, \nToledo‐Serrano María Dolores, \nCalvo‐Tudela Ángel, \nPrieto‐Granados Patricia, \nTorres‐Tabanera María Dolores, \nMedina‐Carmona José Antonio, \nGómez‐Millán Jaime\n
Publicatie 22-11-2024
ABSTRACTBackgroundRadiotherapy combined with chemotherapy is the treatment of choice for locally advanced non-metastatic head and neck cancer. Elderly and frail patients cannot always tolerate this therapy and no clear guidelines exist for their treatment. This retrospective study aims to analyze the efficacy and safety of hypofractionated radiotherapy for these patients.MethodsA retrospective analysis of 65 patients treated with hypofractionated radiotherapy, using a regimen of 57.5 Gy in 23 fractions of 2.5 Gy.ResultsMost patients completed the prescribed treatment. Overall survival at 2 and 5 years was 55% and 33%. Locoregional control at 2 and 5 years was 76% and 51%, respectively. Performance status was an independent prognostic factor (p = 0.05).ConclusionsThis radiotherapy schedule was well tolerated, showing a high rate of locoregional control and shortening the overall treatment time. Prospective studies are necessary to establish the most effective treatment for frail patients.
Pubmed PDF Web\nCarl Stöcker, \nJens Greve, \nMeinrad Beer, \nBeate Hosch, \nThomas F. E. Barth, \nThomas K. Hoffmann, \nAdrian von Witzleben\n
Publicatie 19-11-2024
ABSTRACTBackgroundMost challenging treatment needs are in recurrent or persisting head and neck squamous cell carcinoma (HNSCC) patients after (((chemo-)radiotherapy) (C)RT).Materials and MethodsThis 10-year retrospective study included 100 patients, who initially received (C)RT followed by neck dissection (ND). The results of computed tomography (CT) and sonography were evaluated for residual/recurrent cervical lymph nodes and compared to the histopathology. On this basis we calculate the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV).ResultsA total of 144 ND specimens were analyzed. The combination of CT and sonography (n = 103) reached values 97% sensitivity, 71% specificity, 98% NPV, 66% PPV, and 81% overall accuracy.For patients who received as primary treatment CRT the values for the combined imaging were: 100.0%, 73.5%, 100.0%, 66.7% and 82.7% respectively.ConclusionOur study demonstrates that the combined use of CT and sonography reliably detects lymph node metastases, particularly in patients previously treated with CRT, even after a long time after treatment.
Pubmed PDF Web\nPo‐Wen Chuang, \nWen‐Yu Chuang, \nTa‐Jen Lee, \nPo‐Hung Chang, \nYi‐Wei Chen, \nChia‐Hsiang Fu\n
Publicatie 18-11-2024
ABSTRACTIntroductionSolitary extramedullary plasmacytomas (SEP) of the head and neck are rare and pose unique challenges. This study aimed to explore the clinical spectrum and treatment outcomes of these neoplasms using multimodal management.MethodsA retrospective review of 13 patients with SEP of the head and neck. Data on demographics, clinical presentation, diagnostics, treatment, and survival outcomes were analyzed.ResultsOne patient refused the treatment and was lost to follow-up. Another one received operation alone. The other 11 patients underwent surgical resection when feasible and showed favorable responses to radiation. Two of them (16.7%) experienced local recurrence, and another two patients (16.7%) progressed to multiple myeloma (MM) within the first 2 years following the initial treatment. Tumor > 2.6 cm significantly affected the post-radiation prognosis.ConclusionAlthough radiotherapy yields favorable immediate outcomes in our limited case series, a subset of cases progresses to MM within the initial 2 years. Despite all tumors being categorized as Stage I, tumor size may still influence prognosis.
Pubmed PDF Web\nKevin Yu‐Ting Chen, \nAngela Chien‐Yu Chen, \nChung‐Kan Tsao, \nShao‐Yu Hung, \nDavid Chon‐Fok Cheong, \nHuang‐Kai Kao\n
Publicatie 18-11-2024
ABSTRACTBackgroundThe primary objective of this study was to ascertain the risk factors associated with hardware complications following segmental mandibular reconstruction in head and neck cancer patients. Additionally, we sought to develop a nomogram model that enables accurate risk prediction.MethodsPatients who underwent segmental mandibulectomy with immediate free or local regional tissue transfer between January 2016 and December 2020 were reviewed. Hardware complications were defined. Patient demographics and perioperative parameters were analyzed.ResultsA total of 510 patients were analyzed. Postoperative radiation therapy (OR = 2.296, 95% CI = 1.339–3.938, p = 0.003), postoperative wound infection (OR = 2.367, 95% CI = 1.472–3.806, p < 0.001), and debridement for flap-related complications (OR = 5.484, 95% CI = 3.269–9.199, p < 0.001) were identified as independent risk factors. The nomogram model demonstrated good discriminatory ability.ConclusionThis comprehensive analysis identified three independent risk factors, and the nomogram provides a valuable tool for predicting the risks. Further research is needed to validate these findings and explore preventive strategies.
Pubmed PDF Web\nReineke A. Schoot, \nPieter Taselaar, \nGiovanni Scarzello, \nFrederic Kolb, \nBeatrice Coppadoro, \nSimone ter Horst, \nHenry Mandeville, \nAndrea Ferrari, \nRaquel Hladun, \nSylvie Helfre, \nSima Ferman, \nAnna Kelsey, \nMarinka L. F. Hol, \nChristine Devalck, \nMyriam Ben‐Arush, \nDaniel Orbach, \nJulia Chisholm, \nMeriel Jenney, \nVeronique Minard‐Colin, \nGianni Bisogno, \nJohannes H. M. Merks\n
Publicatie 15-11-2024
ABSTRACTBackgroundParameningeal (PM) site is an unfavorable characteristic in rhabdomyosarcoma (RMS). We described the treatment and outcome for patients with PM RMS and investigated the prognostic value of risk factors. We scored PM site by originating site and by highest risk extension.MethodsPatients with PM RMS were treated within the European pediatric Soft tissue sarcoma Study Group (EpSSG) RMS 2005 study with risk-adapted, multi-modal treatment.ResultsThree-hundred-eighty-one patients with PM RMS were included. Radiotherapy was administered in 359 patients (77 with surgery). After a median follow-up of 75 months, 5-year event-free survival was 60% (95% confidence interval (CI) 55%–65%), 5-year overall survival was 65% (95% CI 60%–70%).ConclusionsThe outcome for patients with PM RMS has not improved in comparison to previous historical studies, despite the more rigorous application of radiotherapy (94% of patients). Signs of meningeal involvement, PM site, and age at diagnosis remained prognostic risk factors.Trial RegistrationEudraCT number 2005-000217-35
Pubmed PDF Web\nJessica W. Gregor, \nBrent Chang, \nNandita Keole, \nAlyssa McGary, \nSamir Patel\n
Publicatie 12-11-2024
ABSTRACTBackgroundExternal and internal head and neck cancer related lymphedema (HNCRL) is a common consequence of radiation treatment (RT). Currently, internal HNCRL can be clinically assessed endoscopically using a visuoperceptual, ordinal rating scale. Use of fluoroscopy to identify and measure internal HNCRL has been explored but is not widely used in clinical practice. Advanced Pneumatic Compression (APC) has shown external HNCRL reduction after a single treatment, whereas internal HNCRL reduction has not yet been assessed.MethodsFluoroscopic lateral scouts and TIMS Review software (TIMS Medical) were used to assess immediate internal HNCRL measures of 30 HNC patients with RT history following a single APC treatment. Pre and post external measures were also obtained. Paired t-test was used to assess changes in pre and post measures. A post-treatment survey was completed.ResultsAll 30 patients had both immediate external and internal HNCRL reductions, and all reductions were statistically significant. All reported positive benefit.ConclusionsA single, external APC treatment immediately impacted the extent of pharyngeal and laryngeal edema in post-radiated HNC survivors. Fluoroscopy can be a clinically useful and complementary modality to detect, surveil, and measure internal HNCRL.
Pubmed PDF Web