Jose Granell, Raimundo Gutierrez-Fonseca
Publication date 18-11-2024
Gayathri Rengasamy, Vishnu Priya Veeraraghavan
Publication date 13-11-2024
Pitchaipillai Sankar Ganesh, Naji Naseef Pathoor, Rajesh Kanna Gopal
Publication date 13-11-2024
The study finds no significant difference in the timing of radiation therapy initiation between bleeding and non-bleeding cohorts, ensuring that timely adjuvant care is achievable without compromising survival. Feeding tube dependency and dysphagia outcomes are also explored to enhance understanding of post-surgical morbidity and quality of life. With a multi-institutional design, the study strengthens the generalizability of its findings and addresses limitations inherent in retrospective data collection. Future research could use validated patient-reported outcomes to refine swallowing assessments and investigate novel hemostatic techniques as alternatives to transcervical arterial ligation. Additionally, exploring HPV-related prognostic subgroups will provide further clarity on oncological outcomes. This study paves the way for optimizing TORS protocols to improve patient care and long-term survival.
Pubmed PDF WebSuellen Hornos Vieira, André Alexis Corazza Vidoris, Leandro Luongo Matos
Publication date 13-11-2024
Adenoid cystic carcinoma (ACC) of the parotid gland is a relatively rare neoplasm, accounting for 10-15 % of all salivary gland tumors. Metastasis to the uveal region, particularly to the ciliary body and iris, is extremely uncommon, with the first case reported in 2011. This case report describes a 32-year-old woman with a history of ACC of the parotid gland. Despite radical surgery, radiotherapy, and facial nerve reconstruction, the patient developed metastasis to the ciliary body and iris one year after treatment. Ultrasonography revealed a solid iridociliary mass, and radiotherapy was administered. The patient later developed meningeal, hepatic, and bone metastases, leading to her death four years after diagnosis. This report highlights the rarity of uveal metastasis from ACC and the importance of considering metastatic disease in oncology patients presenting with ocular symptoms, as early diagnosis and intervention may improve outcomes and quality of life.
Pubmed PDF WebBhargav Ram, Josephine Joy, Shelly sharma, Shalini Thakur, Anand Subash, Vishal U S Rao
Publication date 06-11-2024
Erkan Topkan, Efsun Somay, Duriye Ozturk, Ugur Selek
Publication date 06-11-2024
John Lennon Silva Cunha
Publication date 06-11-2024
Himani
Publication date 03-11-2024
Yoshiyasu Takefuji
Publication date 03-11-2024
Yuan et al. developed a predictive model for early response using sub-regional radiomic features from multi-sequence MRI alongside clinical factors. However, biases in feature selection and assessment may lead to misleading conclusions regarding feature importance. This paper elucidates the biases induced by machine learning models and advocates for a robust methodology utilizing statistical techniques, such as Chi-squared tests and p-values, to uncover true associations. By emphasizing the vital distinction between true and model-specific associations, we promote a comprehensive approach that integrates multiple modeling techniques. This strategy enhances the reliability of predictive models in medical imaging, ensuring that outcomes are based on objective relationships and ultimately improving patient care.
Pubmed PDF WebDiego de Sena Costa de Oliveira, John Lennon Silva Cunha
Publication date 03-11-2024
S. Muthamizh, S. Balachandran, Elangovan Dilipan
Publication date 02-11-2024
Dhivya Viswanathan, Rajakumar Govindasamy
Publication date 21-10-2024
Micah K. Harris, Sophia Dang, Joshua D. Smith, Steven Chinn, Shaum S. Sridharan, Kevin J. Contrera, Matthew E. Spector
Publication date 16-10-2024
Microvascular free flap surgery permits single-stage reconstruction of complex head and neck ablative defects. Venous congestion can occur in the early postoperative period, risking partial or total flap loss. While prompt surgical re-exploration is often required, a number of adjunct medical treatments have been explored. Recently, there has been an anecdotal rise in the use of the anticoagulant bivalirudin, a recombinant derivative of hirudin. However, there has only been one case series report on the use of bivalirudin in head and neck free flap venous congestion. Here, we describe our team's experience with bivalirudin through a series of 7 patients.
Pubmed PDF WebRex H. Lee, Cara Evans, Yousef Alqasieer, P. Daniel Knott, Andrea M. Park
Publication date 11-10-2024
Wei-Zhen Tang, Wei-Ze Xu, Tai-Hang Liu
Publication date 06-10-2024
Haosen Lian, Yufei Hua, Grace Paka Lubamba, Gaowei Zhang, Mingzhe Bao, Guanru Wang, Guile Zhao, Ning Gao, Bing Yan, Chunjie Li
Publication date 30-09-2024
The complexity of lip anatomy and the roles played by the lip make the reconstruction of lip defects more challenging. Adequate reconstruction of lip defects requires adaptation of mucosa, vermilion, and skin features in lip as well as its specific function. A 59-year-old male with left lower lip cancer underwent en-bloc resection and left selective neck dissection (SND), followed by immediate reconstruction using Facial Artery Myomucosal Island Flap (FAMMIF) with external Skin Complex Tissue. The use of chimeric flap based on FAMMIF and its external skin tissue allowed minimizing the postoperative problem of combination of both aesthetic and functional impairments. The FAMMIF is suitable for the reconstruction of lip mucosa and lip vermilion, while the external skin tissue can be use to replace the external lip skin defect. The patient was satisfied with the treatment outcomes. He is undergoing follow-up without any evidence of recurrence. FAMMIF with external skin complex tissue, as a reconstructive approach selected in our case of lip defect secondary to lip cancer resection, combined the reconstruction of both aesthetics and functions of the lower lip. The technique was found feasible and provided satisfactory postoperative outcomes.
Pubmed PDF WebSiva Dharshini Rajathirajan
Publication date 29-09-2024
Prithviraj
Publication date 27-09-2024
R. Dineshkumar
Publication date 26-09-2024
Nai-Si Huang, Jia-Ying Chen, Yan Meng, Qiu-Li Li, Qing-Hai Ji, Yu Wang
Publication date 23-09-2024
5-10% of thyroid cancers are at locally advanced stage. Neoadjuvant targeted therapy will likely create surgical opportunities for these patients with unresectable or borderline resectable tumors. Pralsetinib, a RET inhibitor, has been approved for advanced or metastatic RET-altered thyroid cancer. However, there is no evidence on the efficacy of pralsetinib as neoadjuvant therapy in locally advanced RET-altered thyroid cancer. Two patients with locally advanced pappilary thyroid carcinoma (PTC) were treated with pralsetinib (400 mg daily) to reduce tumor size and increase the chance of R0 resection. Both PTCs, characterized by RET-fusion, underwent successful R0 resection without major surgical complications after 4-months neoadjuvant pralsetinib. There is a potential for pralsetinib as a neoadjuvant treatment in PTC with RET-fusion.
Pubmed PDF WebGayathri Rengasamy, Vishnu Priya Veeraraghavan
Publication date 18-09-2024
C.M.E.M. Adriaansens, K.J. de Koning, R. Noorlag, R. de Bree, R.J.J. van Es
Publication date 19-09-2024
Siva Dharshini Rajathirajan
Publication date 16-09-2024
Siva Dharshini Rajathirajan
Publication date 16-09-2024
Grace Paka Lubamba, Yufei Hua, Mingzhe Bao, Gaowei Zhang, Wei Liu, Diya Wang, Guile Zhao, Guiquan Zhu, Longjiang Li, Ning Gao, Chunjie Li
Publication date 14-09-2024
The internal jugular vein (IJV) plays a major role in collecting venous blood from the cranium, face, and neck. Preserving or reconstructing at least one IJV during bilateral radical neck dissection (RND) allows preventing severe complications. The aim of this report was to present a variant of IJV reconstruction in bilateral radical neck dissection. A 55-year-old male complained for a gingival mass for about 2 months, which was approximately 4 × 2 cm in size with a surface ulceration, located in the anterior mandibular area. There were bilateral cervical adenopathy. The computed tomography (CT) scan revealed mandibular bone destruction with surrounding soft tissue masse, multiple enlarged lymph nodes around bilateral submandibular space and bilateral carotid sheath, with obvious necrosis in the center. The preoperative diagnosis was mandibular gingiva squamous cell carcinoma (SCC), staged T4aN2bM0. Under general anesthesia, the patient underwent bilateral RND with sacrifice of right IJV and reconstruction of left IJV by anastomosis of IJV to the ipsilateral EJV using the common facial vein as a communicating way, followed by an expanded resection of mandibular gingiva SCC via marginal mandibulectomy, left anterolateral thigh (ALT) free flap reconstruction of the resulting defects, and tracheotomy. The patient's post-operative course was uneventfully. In our case report, the immediate IJV reconstruction by the W method was performed without compromising oncologic principles and was found feasible, safe and effective to prevent the occurrence of severe postoperative complications related to bilateral RND with sacrifice of both IJV.
Pubmed PDF WebJeffrey P. Graves, Ghazal S. Daher, Megan M.J. Bauman, Eric J. Moore, Kendall K. Tasche, Daniel L. Price, Kathryn M. Van Abel
Publication date 12-09-2024
Breno Amaral Rocha, Mateus Costa Lima, Lucianne Maia Costa, Mayra Mendes Soares Teixeira, Angel da Silva Martinez, Carlos Antônio Lopes Junior, Martinho Campolina Rebello Horta
Publication date 11-09-2024
Sathish Sankar
Publication date 09-09-2024
Sesuraj Balasamy, Jayalakshmi Somasundaram, Ashok K. Sundramoorthy
Publication date 09-09-2024
T. Prithviraj
Publication date 09-09-2024
Elizabeth Gensterblum-Miller, Apurva Bhangale, Dana Al Majid, Victor Murcia Pienkowski, Malgorzata Rydzanicz, Joanna Janiszewska, Magdalena Kostrzewska-Poczekaj, Clifford Chang, Collin Brummel, Nicole L. Michmerhuizen, Jiayu Wang, Erin Sandford, Muneesh Tewari, Malgorzata Wierzbicka, Andrew C. Birkeland, Jonathan B. McHugh, Matthew E. Spector, Maciej Giefing, Malgorzata Jarmuz-Szymczak, Molly E. Heft Neal
Publication date 17-11-2024
Mucoepidermoid Carcinoma (MEC) is a common salivary malignant neoplasm. Approximately 60 % of MECs harbor translocations between CRTC1 or CRTC3 and MAML2, which are thought to drive disease pathogenesis. However, the precise structural mechanism driving this rearrangement remains uncharacterized. Here, we performed multi-omic and long read genomic sequencing, discovering a chain of alterations that created the CRTC1::MAML2 fusion, but also an unexpected MAML2 to MYBL1 rearrangement, suggesting that MYBL1 may play a larger role in salivary gland cancers than previously recognized. Furthermore, we discovered and validated recurrent TERT rearrangements and amplifications in MEC models. 5/5 MEC cell lines and 36/39 (92 %) primary MEC tumors harbored a TERT rearrangement or copy number amplification. Custom sequencing of the TERT locus confirmed translocation breakpoints in 13/33 (39 %) MECs, while exome sequencing confirmed frequent TERT amplifications. Critically, TERT knockdown in NCI-H292, a cell line with TERT promoter rearrangement, reduced clonogenic cell survival, supporting a critical role of this gene in MEC tumorigenesis. Overall, our data suggest that complex chromothripsis rearrangement mechanisms drive the formation of structural variation in CRTC1::MAML2 fusion positive and negative tumors and reveal highly recurrent structural variation driving TERT rearrangement in MEC.
Pubmed PDF WebAdrian von Witzleben, Ayla Grages, Jaya Thomas, Jasmin Ezić, Cornelia Brunner, Patrick J. Schuler, Johann M. Kraus, Hans A. Kestler, Julius M. Vahl, Johannes Doescher, Emma V. King, Christian H. Ottensmeier, Thomas K. Hoffmann, Simon Laban
Publication date 17-11-2024
A substantial proportion of head and neck squamous cell carcinoma (HNSCC), particularly oropharyngeal squamous cell carcinoma (OPSCC), is associated with human papillomavirus (HPV), resulting in distinct molecular phenotypes. In this study, we investigated differential immune checkpoint molecule (ICM) expression by HPV status using RNA sequencing data to identify additional ICM targets that may complement anti-PD1 antibodies. RNA sequencing was performed on 51 OPSCC cases and validated using the TCGA HNSCC dataset. Unsupervised clustering and differential gene expression analyses in R were conducted based on HPV status. Additionally, a published single-cell RNA sequencing (scRNA) dataset of tumor-infiltrating lymphocytes (TIL) and peripheral immune cells (PBMC) (GSE139324) was analyzed with a Seurat pipeline grouped by HPV status. Our study identified a significant upregulation of all examined ICM in HPV-positive OPSCC through bulk RNA sequencing, validated by the TCGA cohort. Unsupervised clustering revealed a strong association between HPV-positive/-negative and high/low ICM expression cases respectively, indicating overlap between ICM and HPV status. In scRNA analysis, CD27, PD-1, OX-40, and BTLA were significantly more highly expressed on TILs of HPV-positive OPSCC. Conversely, VSIR was increased in PBMC and TILs of HPV-negative OPSCC, while LAG3 expression on PBMC was reduced in HPV-negative OPSCC. Our study unveils the intricate interplay of ICMs in OPSCC, emphasizing the necessity for personalized therapeutic approaches based on HPV status and immune profiles. The identified ICMs, including PD1, CD27, and CTLA4, are promising candidates for further investigation and may enhance immunotherapeutic interventions in the HPV-dependent treatment strategies for OPSCC.
Pubmed PDF WebShuai Li, TingTing Zhao, NengMing Liu, YueTao Li, HaiMei Chen, Chan Tang, Yi Wei, HaoYu Lu, XuanPing Huang
Publication date 14-11-2024
Oral cancer refers to a group of malignancies. The disease's complexity requires a multidisciplinary approach, encompassing oncology, dentistry, epidemiology, molecular biology, and other fields. Given this multifaceted nature, bibliometrics has emerged as a crucial tool to navigate the vast array of academic literature surrounding oral cancer. 82 highly cited publications on oral cancer were collected based on the Web of Science Core Collection. For bibliometric visualization and analysis, VOSviewer and R software (4.3.0 version) were used to explore publication trends, collaboration networks, core journals, research hotspots and authors in the field of oral cancer. This study analyzed 82 publications published over the past 11 years, including 46 published in the United States, 17 in China, 17 in UK, 12 in Canada and 10 in India. Quynh-Thu Le had the most publications (4 publications). Burtness B was the most cited author with 1,926 citations. University of Texas MD Anderson Cancer Center was the most active institution by contributing 7 publications. The most productive journal was journal of clinical oncology. Cluster Analysis of Co-occurrence Keywords revealed that top 10 highest number of core words were squamous-cell carcinoma, cancer, human-papillomavirus, survival, united-states, oropharyngeal cancer, risk, epidemiology, head and risk-factors. Over the past 11 years, studies of oral cancer are increasingly. This bibliometric study may aid researchers in the understanding of the knowledge base and research frontiers associated with oral cancer. Emerging hotspots for research can be used as the subjects of future studies.
Pubmed PDF WebBowen Yang, Xiaobo Dai, Zhixin Li, Zhenxin Wu, Shuai Chen, Chunjie Li, Bing Yan
Publication date 13-11-2024
Head and neck squamous cell carcinoma poses a formidable treatment challenge owing to its complex anatomy and essential functions of the organs involved. Neoadjuvant immunotherapies, particularly PD-1 inhibitors, have shown promise in improving patient outcomes. Nevertheless, the ability to accurately predict which patients will benefit from neoadjuvant immunotherapy continues to be a significant hurdle. We investigated 46 patients diagnosed with head and neck squamous cell carcinoma. Combined positive score was assessed before treatment. Serum samples were collected both before and after neoadjuvant immunotherapy, and subsequently analyzed utilizing surface-enhanced Raman spectroscopy. Significant differences in Raman spectral peaks were observed between the partial response and stable disease groups before treatment, particularly in the regions of 516-525 cm Surface-enhanced Raman spectroscopy offers significant potential to surpass the conventional combined positive score in predicting responses to neoadjuvant immunotherapy.
Pubmed PDF WebYi-Chan Lee, Li-Jen Hsin, Wan-Ni Lin, Tuan-Jen Fang, Yao-Te Tsai, Ming-Shao Tsai, Cheng-Ming Luo, Shih-Wei Yang
Publication date 13-11-2024
Advances in technology have enabled neck dissection techniques that reduce aesthetic impact while maintaining oncological safety. This study compares perioperative outcomes between robotic neck dissection via retroauricular/modified facelift incision (RNDRM) and conventional neck dissection via anterolateral cervical incision (CND). Studies were selected from Pub Med, Embase, and Cochrane Library. Data from studies comparing RNDRM and CND were extracted and analyzed using a random-effects model. The meta-analysis included eight studies with 421 cases. The RNDRM group had a longer operative time (mean difference [MD], 69.11; 95 % confidence interval [CI] 37.92 to 100.30) and higher cosmetic satisfaction (MD, 2.03; 95 % CI, 1.48 to 2.57), along with a higher risk of marginal mandibular nerve injury (risk difference [RD], 0.08; 95 % CI 0.01 to 0.15). No significant differences were found in operative blood loss (MD, 15.35; 95 % CI - 7.39 to 38.10), days of drain placement (MD, 0.49; 95 % CI, -0.02 to 1.00), drainage volume (MD, 15.29; 95 % CI, -45.22 to 75.79), overall lymph node yield (MD, -1.09; 95 % CI, -3.18 to 1.00), positive lymph node yield (MD, -0.61; 95 % CI, -2.20 to 0.98), length of hospital stay (MD, 1.07; 95 % CI -0.06 to 2.20), or regional recurrence (RD, 0.00; 95 % CI -0.05 to 0.05), with similar rates of other complications. RNDRM offers better cosmetic outcomes but requires longer operative time and has a higher risk of marginal mandibular nerve injury than CND. It may be an alternative for selected patients, with surgery choice needing discussion between patient and surgeon.
Pubmed PDF WebHui Peng, Li Y. Zhang, Wei Z. Zhu, Yu Zhou
Publication date 13-11-2024
The purpose of this study is to present a novel method of reconstructing oral and maxillofacial defects using the Radial Artery Retrograde Proximal Forearm Flap (RARPFF) and to evaluate the efficacy and safety of the forearm flap for direct closure of the donor site and its effect on hand function in the donor area. A prospective study of 30 patients who underwent oral and maxillofacial reconstruction with RARPFF between June 2021 and April 2024 was conducted to evaluate the safety and efficacy of the flap and its influence on hand function in the donor area. Flap survival was 93.3 %. The donor site defect in 28 out of 30 patients healed primarily. All donor sites were directly closed without complications such as splitting, tendon exposure, or numbness in the thumb or thenar region. Statistically significant differences were observed in grip strength (MD = 4.56, p < 0.001) and elbow extension (MD = 2.78, p < 0.001) at 3 months, as well as in grip strength (MD = 2.20, p < 0.001) and elbow extension (MD = 1.67, p < 0.001) at 1 year, compared to the contralateral hand. Wrist flexion, extension, radial deviation, ulnar deviation, elbow flexion, pronation, and supination did not exhibit statistically significant differences from the contralateral hand at both 3 months and 1 year. The Michigan Hand Questionnaire (MHQ) revealed a statistically significant difference in aesthetics compared to the contralateral hand (p < 0.001), along with satisfactory overall hand function, activities of daily living (ADL), work performance, pain levels, and patient satisfaction with hand function. The reverse radial artery proximal forearm flap is a dependable and secure technique for head and neck reconstruction. This method can effectively reduce donor site complications while preserving hand function.
Pubmed PDF WebXiangjun Wang, Xingyu Chen, Zi Mei
Publication date 06-11-2024
In primary oral squamous cell carcinoma (OSCC), the tumor microenvironment (TME) constitutes a highly intricate ecosystem comprised of cellular and acellular elements. The tumor immune microenvironment (TIME) is characterized by the presence of a broad of immune cells, while there is a scarcity of cytotoxic lymphocytes (CTLs) intratumorally. Consequently, the recruitment of a larger cohort of CTLs to infiltrate the tumor core has emerged as a pressing scientific challenge. Gasdermin E (GSDME), as a pivotal effector protein in pyroptosis, plays a significant role in anti-tumor therapy. Here, primary OSCC was induced by Gsdme knockout (KO) mice and wild type (WT) mice of the same strain respectively, using the chemical mutagen 4-Nitroquinoline N-oxide (4-NQO). Through comparative analysis of immune function between the two kinds of mice, intriguing observations have been elucidated, the presence of GSDME was instrumental in augmenting the infiltration of lymphocytes towards the neoplastic site, effectively ameliorating the TIME. Our findings elucidated that the absence of GSDME promotes the development of primary OSCC, accompanied by a notable increase in malignancy. Furthermore, our data delineated a positive inter-relationship between the presence of GSDME and the host organism's immunological reactivity, which enhances the TIME in primary OSCC.
Pubmed PDF WebKai Shang, Taotao Li, Yue Chen, Xunyan Luo, Huajing Wu, Yu Zhou, Jiayu Song, Weili Wu, Yuanyuan Li, Xiuling Luo, Xiaoxiao Chen, Xiuyun Gong, Chaofen Zhao, Zhuoling Li, Lina Liu, Qianyong He, Jinhua Long, Feng Jin
Publication date 04-11-2024
This prospective clinical trial aims to compare the efficacy and safety of gemcitabine plus cisplatin (GP) versus docetaxel plus cisplatin and fluorouracil (TPF) as induction chemotherapy combined with locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma (dmNPC). 146 dmNPC patients were randomly assigned in a 1:1 ratio to receive 4-6 cycles of GP (GP group) or TPF induction chemotherapy (TPF group) followed by locoregional radiotherapy (LRRT). The primary endpoint was overall survival (OS). Secondary endpoints consisted of progression-free survival（PFS）, objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (AEs). As of data cutoff (May 31, 2024), the median follow-up time was 60.0 months (IQR 40.3-68.1). There is no significant difference in median OS (35.4 vs. 34.8 months, p = 0.2609) and PFS (15.8 vs. 14.3 months, p = 0.2318) between the GP and TPF groups. No significant differences in ORR (65.8 % vs. 71.2 %, p = 0.476) and DCR (79.5 % vs. 82.2 %, p = 0.674) were observed between GP and TPF group too. Furthermore, the 5-year OS was 40.1 % (95 % CI, 29.6 %-54.2 %) in the GP group, compared with 27.2 % (95 % CI, 17.9 %-41.3 %) in the TPF group（HR = 0.79, 95 % CI, 0.53-1.20). However, the TPF group had higher incidences of grade 3-4 AEs such as neutropenia, leukopenia, nausea, and diarrhea. The study indicates that 4-6 cycles of TPF induction chemotherapy combined with LRRT achieves a therapeutic effect comparable to the GP regimen with controllable safety.
Pubmed PDF WebHanpon Klibngern, Chung-Jan Kang, Li-Yu Lee, Shu-Hang Ng, Chien-Yu Lin, Kang-Hsing Fan, Wen-Cheng Chen, Jin-Ching Lin, Yao-Te Tsai, Shu-Ru Lee, Chih-Yen Chien, Chun-Hung Hua, Cheng-Ping Wang, Tsung-Ming Chen, Shyuang-Der Terng, Chi-Ying Tsai, Hung-Ming Wang, Chia-Hsun Hsieh, Chih-Hua Yeh, Chih-Hung Lin
Publication date 04-11-2024
The prognostic significance of margin-to-depth ratio (MDR) in oral cavity squamous cell carcinoma (OCSCC) remains unclear, particularly in comparison to traditional margin status. We aimed to examine the association between MDR and clinical outcomes in a large Taiwanese cohort. A total of 18,324 patients with first primary OCSCC were categorized by margin status: positive (1013), <5 mm (8371), and ≥ 5 mm (8940). Disease-specific survival (DSS) and overall survival (OS) served as the main outcome measures. After excluding patients with positive margins (MDR = 0), the optimal MDR cutoff value for DSS and OS was 0.6. Patients with MDR > 0.6 showed significantly better 5-year DSS and OS rates (87 %, 81 %) compared to those with MDR ≤ 0.6 (71 %, 63 %) and MDR = 0 (53 %, 43 %). Multivariable analysis identified MDR ≤ 0.6 as independently associated with both DSS and OS in the entire cohort (hazard ratio [HR] = 1.34/1.32). This finding was consistent in the subgroups with surgical margins < 5 mm (HR = 1.39 for DSS and 1.38 for OS) and margins ≥ 5 mm (HR = 1.21 for both DSS and OS). In subgroups with surgical margins < 5 mm and ≥ 5 mm, an MDR > 0.6 was associated with better survival outcomes. An MDR (cutoff: 0.6) is independently associated with prognosis in OCSCC, offering improved risk stratification compared to margin status alone. While MDR may guide surgical margin modification, further research is needed to determine whether MDR could serve as a postoperative indicator for adjuvant therapy in patients with close or clear margins.
Pubmed PDF WebSigne Bergliot Nielsen, Mikkel Hjordt Holm Larsen, Hani Ibrahim Channir, Katalin Kiss, Benedicte Parm Ulhøi, Christian Godballe, Jesper Grau Eriksen, Niclas Rubek, Thomas Kjaergaard, Christian von Buchwald
Publication date 31-10-2024
Squamous cell carcinoma of unknown primary in the head and neck (HNSCCUP) remains a diagnostic challenge. Tongue base mucosectomy by transoral robotic surgery (TORS-TBM) can increase the diagnostic yield and de-intensify treatment. However, the added value of TORS-TBM as an adjunct to work-up programs for HNSCCUP is unclear. Furthermore, the optimal extent of the procedure and selection criteria remain to be established. The primary aim of the present study was to assess the diagnostic yield of TORS-TBM as a supplement to a standardized work-up program, using the Danish national guidelines as an example. Secondary aims include predictive values of HPV-testing and PET/CT. This was a national multicenter observational cohort study including all patients diagnosed with HNSCCUP from January 2013 to December 2019, who subsequently underwent TORS-TBM. In most cases HPV status was based on dual testing (p16 and HPV-DNA). Predictive values of PET/CT and HPV status were calculated. A total of 100 consecutive patients underwent TORS-TBM; 93 total TBMs and 7 unilateral TBMs. The primary tumor was detected in 49 % (49/100) of patients. The detection rate was 58 % (47/81) in patients with HPV-associated disease (PPV of HPV status) and 11 % (2/19) in patients with HPV-independent disease. The NPV of HPV status was 89 %. The PPV and NPV of PET/CT was 53 % and 52 %, respectively. Adding total TORS-TBM to the current Danish guideline-based work-up program on HNCCCUP patients with HPV-associated disease significantly improved the diagnostic yield.
Pubmed PDF WebAgathe Villarmé, Nathalie Ebran, Tanguy Pace-Loscos, Renaud Schiappa, Audrey Mignot, Alexandre Bozec, Anne Sudaka-Bahadoran, Esma Saada-Bouzid, Dorian Culié
Publication date 29-10-2024
The incidence of HPV-induced oropharyngeal squamous cell carcinoma (OSCC) is constantly increasing. Although HPV-related OSCC carry a better prognosis, the majority of patients with an HPV-positive OSCC have other prognostic factors such as tobacco smoking, making therapeutic de-escalating approaches less precise. In this context, our study aims to evaluate the prognostic impact of intra-tumoral HPV-16 viral load (VL) in OSCC. We conducted a retrospective analysis of p16-positive OSCC samples from patients treated between 2012 and 2019. Viral load (VL) was determined using digital droplet Polymerase Chain Reaction (ddPCR) and described according to 3 subgroups: low (<0.9 copies/cell), medium (0.9-85 copies/cell), and high (>85 copies/cell). We assessed the correlation between VL and recurrence-free survival (RFS), specific survival (SS), and overall survival (OS) using the Kaplan-Meier method. In total, 192 patients were included; 148 (77 %) were male. The mean age was 65. HPV-16 was detected in 189/192 samples (98 %). T3-4-stage (p = 0.002), metastasis (p = 0.007), and tobacco consumption (p = 0.01) predicted lower OS. High VL was associated with higher RFS (HR = 0.2, p = 0.01), SS (HR = 0.32, p = 0.02), and OS (HR = 0.39, p = 0.03). After adjusting for tobacco consumption and tumor stage, high VL remained associated with higher RFS (HR = 0.1, 95 %CI [0.04-0.7], p = 0.01) and SS (HR = 0.20, 95 %CI [0.05-0.75], p = 0.01). In our study, high intra-tumoral HPV VL was independently associated with survival. Subject to further validation in independent and prospective cohorts, our findings suggest that HPV VL could help to refine the prognosis of HPV positive OSCC patients.
Pubmed PDF WebLucas M. Ritschl, Valeriya Sackerer, Katharina Pippich, Jakob K. Zink, Hannes Singer, Alex Grabenhorst, Dennis M. Hedderich, Markus H. Wirth, Klaus-Dietrich Wolff, Andreas M. Fichter, Alexandra V. Behr
Publication date 04-11-2024
The aim of this study was to determine the influence of intraoral reconstructions following oral squamous cell carcinoma (OSCC) resection with a free microvascular flap on the posterior airway space (PAS) and to correlate these results with the potential risk of developing an obstructive sleep apnea syndrome (OSAS). Only primary OSCC cases of the tongue or floor of the mouth which were operated and reconstructed. The PAS displayed in computed tomography (CT) scans at three time points were analyzed: t MinCSA increased from t Posterior airway space PAS values became higher than preoperatively. In particular, flap type had a significant influence on the three PAS parameters.
Pubmed PDF WebHector F. Pelaez-Prestel, Fernando Gonzalez-Martin, Alvaro Ras-Carmona, Almudena Rocha, Carlos Cabañas, Esther M. Lafuente, Pedro A. Reche
Publication date 23-10-2024
Tumor-associated macrophages (TAMs) are major cellular components in the tumor microenvironment of oral squamous cell carcinomas (OSCCs). Most of these TAMs derive from circulating monocytes that differentiate in situ. In this work, we show that cell culture media (CM) derived from two OSCC cell lines, H413 and TR146, promote monocyte differentiation into M2 macrophages, characterized by a high expression of CD163, CD206 and a low expression of CD11c, CD86 and HLA-DR. Monocyte-derived macrophages (moMΦ) differentiated by CM from H413 cells (H413-CM) were also unable to activate allogeneic T cells, and inhibited T cell activation and proliferation induced by CD3/CD28 stimulation. By culturing monocytes with fractionated H413-CM, we found that soluble proteins mediated CD163
Pubmed PDF WebValentine Poissonnet, Emilien Chabrillac, Emmanuelle Uro-Coste, Virginie Woisard, Antoine Moya-Plana, Florent Espitalier, Joel Castelli, Thibault Dedieu, Sébastien Salas, Renaud Garrel, Robin Baudouin, Gilles Poissonnet, Claire Castain, Jonathan Barbut, Haitham Mirghani, Diane Evrard, Olivier Bouchain, Jean Paul Marie, Hélène Orliac, Philippe Ceruse
Publication date 22-10-2024
Salivary carcinomas of the tongue represent a therapeutic challenge as their radical excision is particularly mutilating. We aimed to study the oncologic and functional outcomes of advanced stages salivary carcinomas of the tongue. This retrospective multicentric study, based on the French national network on rare head and neck cancers (REFCOR), included all patients with a T3-T4 salivary carcinoma of the tongue, diagnosed between January 2009 and December 2018. In total, 47 patients were included, of which 44.7 % underwent surgery. Histologies were mostly adenoid cystic carcinomas (61.7 %), followed by other adenocarcinomas (27.7 %) and mucoepidermoid carcinomas (10.6 %). Median follow-up duration was 63.9 months. In multivariable analysis, surgery was significantly associated with better Recurrence-Free Survival (HR = 0.23, 95 %CI [0.09;0.55]) and Local/Regional Recurrence-Free Survival (HR = 0.31, 95 %CI [0.10;0.95]). The rate of distant metastasis at the end of follow-up was 61.9 % in the surgical group and 57.7 % in the non-surgical group. The Distant Metastasis Free Survival was 54.9 % [38.3;68.7], without statistical difference between both groups. There were similar rates of definitive gastrostomies but the rate of normal oral diet at the last follow-up seemed higher in the surgery group (38.1 % vs 15.4 %). Radical surgery in that population mainly aims to improve local/regional control, which may result in better long-term swallowing functions. About half of these tumors may be associated with occult distant metastasis at initial presentation. More studies are warranted to establish the role of postoperative RT and non-surgical treatment with concurrent CRT.
Pubmed PDF WebNorihisa Ichimura, Yusuke Urata, Takeru Kobayashi, Ryo Ebata, Hiroya Matsumoto, Hideharu Hibi
Publication date 22-10-2024
Oral squamous cell carcinoma (OSCC) is the most common subtype of head and neck squamous cell carcinoma (HNSCC). Treatment options for OSCC are currently limited owing to the lack of identified therapeutic targets. In this study, we aimed to analyze the genomic profiles of Japanese patients with OSCC and compare them to those of patients with HNSCC to identify potential therapeutic targets. We extracted the clinical and genomic information of patients with OSCC (n = 242) and those with other HNSCC (n = 402) who underwent comprehensive genomic profiling tests under the National Health Insurance between June 2019 and April 2024 from the Center for Cancer Genomics and Therapeutics database. The most frequent genomic alterations identified in OSCC were TP53 (85.5 %), followed by TERT (62.4 %), CDKN2A (41.3 %), FGF19 (24.9 %), and CCND1 (23.6 %). FGF19 and CCND1 were co-amplified, and CDKN2A and CDKN2B were co-deleted. The frequencies of TERT, HRAS, and CASP8 alterations were the highest in OSCC among all HNSCC subtypes. The frequency of EGFR alterations was substantially higher in adolescent and young adults than older patients with OSCC. Genes associated with genomic integrity and the RTK-RAS pathway were frequently altered in OSCC. This study analyzed the genomic profiles of patients with OSCC in Japan and the genetic differences between OSCC and other HNSCC subtypes. This analysis offers insights into the development of personalized therapeutics for OSCC.
Pubmed PDF WebMichael J. De Biasio, Ravi Mohan, Aaron Hendler, C. Jillian Tsai, Andrew McPartlin, Ali Hosni, Mirko M. Kolarski, David P. Goldstein, John R. de Almeida, Christopher M.K.L. Yao
Publication date 20-10-2024
Lymphatic mapping is an established technique to map drainage patterns in oral cancer. Its utility in patients who have undergone prior radiation or neck dissection is not well studied. Patients presenting to a single tertiary cancer center between 2021-2023 for a recurrent/second oral cancer that underwent lymphatic mapping were considered. All patients had a history of a head and neck cancer treated with either radiation or neck dissection. We further conducted a scoping review in MEDLINE, Embase, and Web of Science of lymphatic mapping in oral cancer patients with previous neck treatment. In our single center review, a total of 11 patients were included. 73 % received prior radiotherapy and 55 % underwent prior neck dissections for a head and neck cancer. Lymphoscintigraphy-directed neck dissections identified sentinel nodes in 9/11 patients, with only one patient who had positive sentinel node disease. There were no reports of regional recurrence at a median of 10 months follow-up. Our scoping review of 980 studies identified 151 additional patients who underwent sentinel node biopsy for a second oral cancer after previous neck treatment. Overall, the negative predictive value of lymphatic mapping in all studies was 96.7 %. Lymphatic mapping is feasible in secondary or recurrent oral cavity cancers even in patients with prior radiation or surgical management of the neck. The literature to date demonstrates a negative predictive value of ∼ 97 % for sentinel node mapping and warrants further consideration in the management of salvage oral cancer.
Pubmed PDF WebSearan Karamchandani, Axel Sahovaler, Elizabeth Crosbie-Jones, Mark McGurk, Selvam Thavaraj, Mustansir Alibhai, Simon Wan, Martin D Forster, Isabel Sassoon, Clare Schilling
Publication date 20-10-2024
Wen-Bin Wu, Le Xia, Zheng-Kai Feng, Jiong-Lin Liang, Xi Ding, Si-Yuan Chen, Rui You, Ming-Yuan Chen, You-Ping Liu
Publication date 19-10-2024
To analyze the risk factors and explore effective treatments for epistaxis in nasopharyngeal carcinoma (NPC) patients. From March 2006 to February 2020, 351 epistaxis patients visited our center and 195 patients meeting the inclusion criteria were enrolled in the study. Characteristics and treatments, including step-up hemostatic treatment (including medication, anterior ± posterior nostril packing, or further surgical hemostasis) and the CTPI emergency hemostasis method (including common carotid artery compression, tracheotomy / intubation, packing of nasal and nasopharynx, and interventional treatment), were analyzed. The median total bleeding volume was 100.0 ml (range 20-4430 ml). 126 (64.6 %) and 69 (35.4 %) patients suffered from non-massive epistaxis and massive epistaxis. The 1-year overall survival (OS) rate was 60.1 % for patients with massive epistaxis and 97.3 % for those with non-massive epistaxis treated with step-up hemostatic treatment. Among patients with massive epistaxis, the 1-year OS rate was 80.0 % for those who received CTPI and 13.3 % for those who received step-up hemostatic treatment. ICA exposure and hemostasis failure was adverse prognostic factors for OS in NPC patients with epistaxis. The step-up hemostatic treatment is effective for controlling non-massive epistaxis. The CTPI emergency method might be an effective hemostasis treatment for NPC patients with massive epistaxis, especially those with PRNN and ICA exposure.
Pubmed PDF WebDaniel Li, Andrea Lopez, Nitisha Shrivastava, Wesley Chan, Carlos Thomas, Robert Burk, Jeff Segall, Stelby Augustine, Gregory Rosenblatt, Vikas Mehta, Bradley A. Schiff, Richard V. Smith, Michael B. Prystowsky, Nicolas F. Schlecht, Chandan Guha, Evripidis Gavathiotis, Thomas J. Ow
Publication date 19-10-2024
Evasion of apoptosis promotes tumor survival and contributes to resistance to cancer therapeutics in head and neck squamous cell carcinoma (HNSCC). Our recent work has demonstrated that HNSCC's highly express pro-survival anti-apoptotic proteins Bcl-xL and Mcl-1. Nevertheless, the mechanism of HNSCC to evade apoptosis is still not well understood. We used BH3 profiling, a functional assay which measures mitochondrial depolarization in response to the introduction of BH3 peptides, to evaluate apoptosis competency and dependency upon BCL-2 family anti-apoptotic proteins in a panel of immortalized and patient-derived HNSCC lines. We assessed response to BH3 mimetics including ABT-263 (navitoclax), an inhibitor of Bcl-2/Bcl-xL/Bcl-w, and S63845, an inhibitor of Mcl-1, both as single agents and in combination. We demonstrate that apoptosis signaling appears to be intact in the majority of HNSCC cells, and they are co-dependent upon Bcl-xL and Mcl-1 for survival. We found the combination to be highly synergistic in 2D culture and in 3D organoid models of HHNSCC. Given our findings that co-dependency on Bcl-xL and Mcl-1 is common, and co-inhibition of these molecules is synergistic for growth suppression in HNSCC cells, these results elucidate the therapeutic potential of BCL-xL and MCL-1 inhibition in HNSCC.
Pubmed PDF WebYiqing Zang, Yi Lu, Jiaxi Yu, Qiuping Dong, Yue Shi, Guoguang Ying, Zheng Liang
Publication date 17-10-2024
Hippo signalling is involved in the coordination of extracellular signals that control tissue homeostasis and organ size. Yes-associated protein 1 (YAP1) is regulated primarily by Hippo signalling through coactivation of transcription factors with GATA domains called TEADs. However, small-molecule orthosteric inhibitors of YAP1 are difficult to develop due to its tight binding to TEAD4 via a flat interface. Previous studies have shown that chlorpromazine (CPZ) can inhibit YAP1 expression. MTT, colony formation, wound healing, Transwell migration and Western blot assays were performed to explore how CPZ affects nasopharyngeal carcinoma (NPC) cells through FOXP3. In addition, immunofluorescence and live-cell imaging were used to detect YAP1 intracellular localization after CPZ administration. Through the HDOCK website, we predicted protein binding regions between FOXP3 and TEAD4. Western blot and co-IP experiments were used to verify the relationship between FOXP3 and YAP1. The UCSC Xena database, Linked Omics database and KM plotter website were used to assess the prognostic value of FOXP3 in head and neck squamous cell carcinoma (HNSCC). Age, sex, pathological tumour-node-metastasis (pTMN) stage, grade, smoking status and FOXP3 expression were included in an overall survival nomogram model. Our findings revealed that FOXP3 has the ability to competitively interacts competitively with TEAD4 to inhibit YAP1 expression. By increasing FOXP3 expression, CPZ induces YAP1 nuclear export and phosphorylation, consequently suppressing NPC cell proliferation and migration. Collectively, our findings indicate that FOXP3 competitively binds TEAD4 to regulate YAP1 localization in the nucleus and cytoplasm to suppress NPC progression. Consequently, FOXP3 may be a prognostic indicator for HNSCC.
Pubmed PDF WebChunhao Liu, Hao Zhao, Ying Lu, Yu Xia, Ziwen Liu, Ge Chen, Yuewu Liu, Shuzhou Liu, Luying Gao, Xiaoyi Li
Publication date 16-10-2024
No significant difference in disease-specific survival and recurrence-free survival exists between papillary thyroid cancer (PTC) patients with high-risk features subjected to lobectomy and thyroidectomy. However, it is unclear which type of patients with unilateral PTC combined with ipsilateral clinical involved lymph nodes (cN1) can receive a less aggressive treatment. We collected the medical records of 631 patients diagnosed with unilateral PTC and ipsilateral cN1. These patients initially underwent total thyroidectomy and bilateral central lymph node dissection (LND), with or without lateral LND. We conducted an analysis to investigate the associations between contralateral occult central lymph node metastasis (CLNM) and clinicopathologic factors. The proportion of contralateral occult CLNM was 38.9 %. Age ≤45 years, tumor diameter >1 cm, obesity, and involvement of lymph node regions ≥2 were independent risk factors for contralateral occult CLNM. Multifocality and ipsilateral neck high-volume lymph node metastases were independent risk factors among the postoperative pathological factors. A predicting model was developed to quantify the risk of each factor, which revealed that patients without any of the risk factors mentioned above had a 20-30 % probability of contralateral occult CLNM, whereas the probability was greater than 60 % when all factors were present. Based on the predictive nomograms, we proposed a risk stratification scheme based on different nomogram scores. In the debate about prophylactic central LND among contralateral central lymph node in unilateral PTC with ipsilateral clinical LNM, our nomograms provide the balance to avoid overtreatment and undertreatment through personal risk assessment.
Pubmed PDF WebHasmithaa Balaji, Venkataraja U. Aithal, Janet Jaison Varghese, K. Devaraja, A.N. Naveena Kumar
Publication date 16-10-2024
To find the agreement between clinician-rated and patient-reported speech and swallowing outcomes in post-operative oral cavity cancer patients. In this prospective observational study, a total of 53 post-operative oral cavity cancer patients were recruited. The Speech Handicap Index - Kannada (SHI-K) and the Dysphagia Handicap Index - Kannada (DHI-K) were used as the patient-reported outcome measures (PROMs), and the Mann Assessment of Swallowing Ability-Cancer (MASA-C) and Ali Yavar Jung National Institute of Speech & Hearing Disabilities (DIVYANGJAN) AYJNISHD(D)'s speech intelligibility rating scale were used as the clinician-rated scales to evaluate speech and swallowing status. Intraclass correlation coefficient (ICC) was poor, with a value of 0.480 between clinician-rated speech AYJNISHD(D)'s scale and patient-reported SHI-K scale. ICC was poor, with a value of 0.471 between clinician-rated swallowing MASA-C and patient-reported swallowing DHI-K. In our study, there was no agreement between patient-reported and clinician-rated speech and swallowing outcomes in post-operative oral cavity cancer patients. Incorporating PROMs into routine clinical practice is advisable, and clinicians need to balance PROMs with clinical and instrumental speech and swallowing assessments to ensure comprehensive care.
Pubmed PDF WebMartin Garset-Zamani, Anne Fog Lomholt, Birgitte Wittenborg Charabi, Rikke Norling, Danijela Dejanovic, Johanna Maria Hall, Fatemeh Makouei, Tina Klitmøller Agander, Annette Kjær Ersbøll, Christian von Buchwald, Tobias Todsen
Publication date 16-10-2024
Squamous cell carcinomas of unknown primary (SCCUP) are often Human Papillomavirus (HPV)-positive. Due to their small size, extensive surgical workup is required to locate the primary tumors. High-frequency transoral ultrasound (US) may provide improved visualization of these small tumors. Our study aimed to explore whether surgeon-performed intraoperative transoral US for patients with HPV-positiveSCCUP could improve primary tumor detection during panendoscopy.
This was a single-center, prospective diagnostic study including patients undergoing panendoscopy under general anesthesia with HPV-positive SCCUP. Preoperative MRIs, PET/CTs, and HPV DNA-testing of lymph node metastases were performed in all patients. Intraoperative transoral US was performed prior to panendoscopy. Frozen section biopsies were performed unblinded to US results, and transoral US-guided biopsies were attempted if initial biopsies were negative. Final histopathology was obtained with palatine- and/or lingual tonsillectomy if frozen section was negative. The main outcome was the primary tumor detection rate with intraoperative transoral US and panendoscopy.
Thirty patients were included: 24 (80 %) were men, and the median age was 60 years [range 35-79 years]. Twenty-nine primary tumors (97 %) were confirmed; 18 (62 %) and 10 (34 %) in the lingual- and palatine tonsils, respectively, and one (3 %) in the posterior oropharynx. Transoral US had a significantly higher sensitivity than panendoscopy to locate the primary tumor (93 % vs 76 %, p = 0.02), and significantly higher than pre-operative PET/CT (62 %, p = 0.002), CT (45 %, p < 0.001), and MRI (28 %, p < 0.001).
Intraoperative transoral US during panendoscopy is a promising diagnostic tool that may improve the detection of HPV-positive SCCUP.
Yuntao Song, Yabing Zhang, Yanhua Bai, Tianxiao Wang, Guohui Xu, Xiao Ma, Kuangyu Fei, Bin Zhang
Publication date 13-10-2024
Anaplastic thyroid carcinoma (ATC) is rare but has a very poor prognosis. New therapeutic options such as multikinase inhibitors and selective tyrosine kinase inhibitors have revolutionized the treatment of ATC, with immunotherapy also showing encouraging effects. This study evaluated the efficacy and safety of kinase inhibitors combined with an anti-PD-1 inhibitor as first-line treatment, as well as in the neoadjuvant setting for patients with unresectable ATC. This retrospective single-center study recruited consecutive patients with stage IVB and IVC ATC who received first-line kinase inhibitors plus immunotherapy between June 2021 and June 2023. The patients were treated with either selective or multi-kinase inhibitors (dabrafenib/trametinib, lenvatinib, or anlotinib) in combination with one immune checkpoint inhibitor (pembrolizumab, sintilimab, or camrelizumab). The endpoints included overall survival (OS), progression-free survival (PFS), response evaluation, and feasibility of R0/R1 resection. Eighteen patients were included in this analysis. The median OS (mOS) was 14.0 months and the 12-month survival rate was 55.6 %. The mOS in BRAF V600E mutated ATC was not reached, significantly longer than non-BRAF V600E mutated ATC (4.0 months [95 %CI, 1.1-6.9], p = 0.049). Among evaluable patients, 5 achieved a complete response (CR) and 6 patients achieved partial response (PR). The best ORR was 61.1 %. Surgical resection was feasible in 7/18 (38.9 %) patients. One grade 5 adverse event (AE) occurred. Most AEs were well tolerated. Combination kinase inhibitors with immunotherapy as first-line therapy are safe and effective for the treatment of unresectable ATC, especially with BRAF V600E mutation.
Pubmed PDF WebShui-Qing He, Guo-Ying Liu, Ya-Hui Yu, Lin Wang, Guo-Yi Zhang, Ding-Sheng Peng, Wei-Xin Bei, Chun-Lan Chen, Shu-Hui Lv, Ze-Yu Zhao, Ying Huang, Yan-Qun Xiang
Publication date 12-10-2024
This study aims to better manage de novo metastatic nasopharyngeal carcinoma (NPC) patients receiving palliative immuno-chemotherapy (PICT), thereby easily determining individual survival outcomes. Patients with de novo metastatic NPC from four centers who received first-line PICT were included. We developed a nomogram for the pretherapy overall survival (OS) prediction using a logistic regression model in the training cohort (n = 296). We assessed the performance of this nomogram in a validation cohort. A total of 592 patients were included. The median follow-up time was 29.83 months. Bone metastasis (HR, 2.46; 95 % CI, 1.01-6.21; p = 0.049) and the number of metastatic lesions > 3 (HR, 2.78; 95 % CI, 1.24-6.24; p = 0.013) were independent prognostic indicators. A new two-category M1 subdivision was generated: M1a, defined by the absence of co-existing bone metastasis and the presence of more than three metastatic lesions; and M1b, characterized by the presence of co-existing bone metastasis and the presence of more than three metastatic lesions. The 3-year OS rates of patients with M1a vs. M1b were 87.1 % vs. 60.3 % (p < 0.001). The C-indexes were 0.652 and 0.581 in the training and validation cohorts. The 1-, 2-, and 3-year areas under the curve (AUC) were 0.69, 0.68, 0.68 in the training cohort and 0.64, 0.6, 0.6 in the validation cohort. DCA curves also indicated that the nomogram has good clinical utility. The proposed M1 subdivision provides good OS segregation for patients receiving PICT.
Pubmed PDF WebMolly E. Heft Neal, Joshua D. Smith, Teresa H. Lyden, Eric J.P. Chanowski, Robert J. Morrison, Kevin Contrera, Shaum Sridharan, Steven B. Chinn, Douglas B. Chepeha, Matthew E. Spector
Publication date 09-10-2024
The primary goal for reconstruction of oral tongue defects is to improve speech and swallowing. The purpose of this study is to present a new reconstructive metric that uses volume displacement to measure oral cavity obliteration and correlate this metric to outcomes of speech and swallowing. 47 patients underwent resection and primary closure or free-tissue reconstruction of oral tongue defects. Oral cavity obliteration was measured using a novel oral volume assessment test (OVAT). Briefly, a latex balloon filled with pudding was placed on the patient's tongue and patients performed mouth closure to expel the pudding. Residual volumes represented dead space in the oral cavity and was measured by water displacement. These results were correlated with the Speech and Swallowing Assessment and Assessment of Intelligibility of Dysarthric Speech (AIDS) instruments. The mean residual volume was 7.4 cc (range 3 - 20 cc; sd 4.5 cc). There was a correlation with lower residual volumes (better obliteration) with increasing AIDS efficiency ratio (R = 0.72, p < 0.001). A receiver operator curve was used to identify 10 cc of residual volume as the optimal cutoff point. Binary logistic regression using this cut point showed that residual volume significantly predicts normal nutritional mode (p < 0.001), ability to tolerate all liquids (p = 0.007), range of solids (p = 0.004), eating in public (p = 0.007), understandability (p < 0.001), and speaking in public (p = 0.01). Oral volume assessment test (OVAT) is a novel measure of residual volume (obliteration) that correlates with improved speech efficiency, intelligibility, speaking in public and swallowing outcomes.
Pubmed PDF WebLogesvar Balaguru, Krishna S. Hanubal, Zhanna Galochkina, Ji-Hyun Lee, Linda Chow, Dustin Conrad, Peter T. Dziegielewski
Publication date 06-10-2024
Salvage oropharyngeal surgery with free-flap reconstruction after failed radiation therapy (RT) presents unique challenges and complications. The aim of this retrospective review is to examine surgical complications and functional outcomes in patients who received salvage surgery for recurrent or persistent oropharyngeal cancer following RT. Patients diagnosed with oropharyngeal cancer and underwent salvage oropharyngectomy at the University of Florida between 2016-2021 were identified from inpatient and outpatient records of the Head and Neck Oncology Team. Outcomes measured were tracheostomy dependence, tube-feed dependence, and intact oral intake status. Survival outcomes using Kaplan-Meier product limit method were calculated. Twenty-six patients were included in the analysis. Average age was 63.7 years. Fourteen (53.8 %) oropharyngectomies used a transmandibular approach, ten (38.5 %) through a combined transoral and transcervical approach, and two (7.7 %) through a transcervical approach. Average time to tracheostomy decannulation was 25.1 days. At 6 months, twenty (83.3 %) patients were gastric tube independent with twelve (54.2 %) patients tolerating any oral intake. At 12 months, gastric tube independent feeds decreased to nine (60 %) patients with thirteen (92.9 %) patients tolerating oral intake. The median overall survival was 27 months with local cancer recurrence being the most common cause of death. Patients undergoing salvage oropharyngectomy for recurrent disease continue to face prolonged tracheostomy and tube dependent feedings. Despite intact swallowing function, patients preferred to use gastric tube feedings, likely for speed, ease, and convenience. Further studies are needed to analyze factors influencing these conflicting functional outcomes and predictive factors impacting survival.
Pubmed PDF WebAlzina Koric, Chun-Pin Chang, Siqi Hu, John Snyder, Vikrant G. Deshmukh, Michael G. Newman, Ankita P. Date, Marcus M. Monroe, Mia Hashibe
Publication date 03-10-2024
The incidence of oropharyngeal cancer continues to rise in the United States, yet studies on the quality of life (QoL) of oropharyngeal cancer patients are limited. The objective of this pilot study was to assess the impact of oral health on the QoL in oropharyngeal cancer survivors. Oropharyngeal cancer survivors with a confirmed cancer diagnosis from 1996 to 2016 were sampled from the Utah Cancer Registry. The Oral Health Impact Profile-14 (OHIP-14) questionnaire was administrated between January and May of 2019. The impact of oral health on QoL was evaluated using simple linear regression (β-coefficient). Among the 260 oropharyngeal cancer survivors, the majority were male (84.6 %) and ≥ 60 years of age at the time of cancer diagnosis (74.0 %). The most frequently reported symptoms of OHIP-14 were discomfort while eating any foods (19.2 %) and worsening sense of taste (16.0 %). The overall OHIP-14 mean score was 13.3. Significantly worse OHIP-14 scores were observed for females (β = 12.85, p = 0.01), chemotherapy recipients (β = 6.60, p = 0.02), and past smokers (β = 5.25, p = 0.04). Better OHIP-14 scores (better oral QoL) were observed in patients with distant cancer stage (β = -7.66, p = 0.01), higher income (β = -2.50, p = 0.05), and older age at cancer diagnosis (β = -0.35, p = 0.03). The oral health-related quality of life scores observed in this pilot study suggest a need for improvement in patient symptom management over time.
Pubmed PDF WebAlice Dawson, Amir Hossein Karimi, Mushfiq H. Shaikh, Walid Gazala, Peter Y.F. Zeng, Sarah E.B. Ryan, Harrison Pan, Halema Khan, Matthew Cecchini, Adrian Mendez, David A. Palma, Joe S. Mymryk, John W. Barrett, Anthony C. Nichols
Publication date 03-10-2024
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer type worldwide. In recent years, there has been an increase in the rate of HNSCC cases attributed to the infection of the oropharynx by the human papillomavirus (HPV). Given the significant treatment-related toxicities of the current standard of care for HPV-positive HNSCC, there is an urgent need for the development of precision patient stratification and treatment strategies to improve patients' quality of life while maintaining excellent survival rates. We have previously carried out whole genome sequencing of HPV+ HNSCC tumors that failed concurrent cisplatin and radiation treatment and discovered that MACROD2 deletion is enriched among these tumors. In the current study, we sought to investigate the mechanistic role of MACROD2 in HPV+ HNSCC treatment resistance. Our results indicate that MACROD2 depletion in HNSCC cell lines leads to increased cell viability and colony formation capacity. Interestingly, MACROD2 depletion did not alter cisplatin sensitivity but led to an increase in radiation resistance of HPV+ HNSCC cell lines. RNA sequencing and immunofluorescence microscopy demonstrated that MACROD2-depleted HPV+ HNSCC cells displayed elevated levels of hypoxia and an altered DNA damage response. Taken together, this study establishes and characterizes the role of MACROD2 in HPV+ HNSCC radioresistance. Further work is needed to validate MACROD2 as a biomarker of treatment failure and to understand how to overcome the identified molecular mechanisms of resistance.
Pubmed PDF WebAkashanand, Quazi Syed Zahiruddin, Diptismita Jena, Suhas Ballal, Sanjay Kumar, Mahakshit Bhat, Shilpa Sharma, M. Ravi Kumar, Sarvesh Rustagi, Abhay M. Gaidhane, Lara Jain, Sanjit Sah, Muhammed Shabil
Publication date 03-10-2024
Oral cancer is the sixth most prevalent cancer globally, posing a significant health concern, especially in India, where it accounts for one-third of the global cases. Despite high incidence and mortality rates, comprehensive national and regional data on risk factors and trends are scarce. This study analyzed data from the Global Burden of Disease (GBD) 2021 report, focusing on the age-standardized incidence rate (ASIR), mortality rate (ASMR), disability-adjusted life years (ASDR), and prevalence rate (ASPR) of oral cancer in India from 1990 to 2021. Joinpoint regression analysis was used to assess trends, and ARIMA models were applied to forecast future trends from 2022 to 2031. From 1990 to 2021, India experienced a moderate increase in oral cancer mortality, with ASMR rising from 5.32 to 5.92, reflecting an annual percentage change (APC) of 11.18 %. ASDR increased from 152.94 to 163.61 (APC of 6.98 %), and ASPR showed a marked rise from 15.71 to 25.46 (APC of 62.06 %). The burden varied significantly across states. Gender disparities were observed, with males consistently exhibiting higher incidence and mortality rates. ARIMA forecasts projected an upward trend in oral cancer metrics from 2022 to 2031, with ASIR expected to reach 10.15 per 100,000 and ASPR 29.38 per 100,000 by 2031. The study reveals a persistent and growing burden of oral cancer in India, highlighting the influence of lifestyle and socioeconomic factors. Targeted strategies to mitigate risk behaviors, improve early detection, and address disparities are urgently needed to reduce the disease's impact.
Pubmed PDF WebKatherine Keefe, Hilary C. McCrary, Mei Wei, Bayarmaa Mark, Sarah Drejet, Richard B. Cannon, Luke O. Buchmann, Jason P. Hunt, Mark Dodson, Vikrant Deshmukh, Michael Newman, Marcus M. Monroe, Mia Hashibe
Publication date 01-10-2024
In the United States, approximately 63,000 Americans develop head and neck cancer (HNC) annually. Our study aims were to investigate cardiovascular complications and risk factors for development of CVD among HNC survivors. Utilizing the Utah Populations Database, a total of 1,901 HNC patients diagnosed and 7,796 birth year, sex, and birth state matched individuals from the general population were identified. Multivariate Cox proportional hazard models were used. Within the first two years after cancer diagnosis, HNC survivors had a higher likelihood of developing cardiovascular disease (CVD). High Charleston Comorbidity Index (CCI) score at baseline (Hazard Ratio (HR) 1.67, 95 % 1.28-2.17), stage II and IV disease (HR 1.80, 95 % 1.29-2.51), age >=65 years old (HR 2.31, 95 % 1.85-2.88), chemotherapy (HR 1.47, 95 % 1.15-1.88) were associated with increased CVD risk. Compared to the general population, HNC survivors were more likely to develop cardiovascular diseases, particularly if they had the following risk factors: older age, stage II or IV cancer, high baseline CCI score, and chemotherapy were risk factors for development of CVD.
Pubmed PDF WebJun Young Kim, Younghac Kim, Eun Hye Kim, Man Ki Chung, Han-Sin Jeong, Chung-Hwan Baek, Young-Ik Son, Nayeon Choi
Publication date 29-09-2024
In cases of positive resection margin (RM), re-resection is generally recommended. There has been controversy about the oncologic impact of revised negative RMs after re-resection. The aim of this study was to investigate the oncologic impact of revised negative RM in patients who underwent surgery without adjuvant therapy for early-stage (pT1-2/N0) oral tongue squamous cell carcinoma (OSCC). We retrospectively analyzed patients with pT1-2 N0 OSCC who did not receive adjuvant therapy (N=441). These patients were classified into an initial negative RM (R0, n = 380) group and a revised negative RM (R1-R0, n = 61) group. Demographic and clinical data (T stage, tumor length, depth of invasion [DOI], lymphovascular invasion [LVI], perineural invasion [PNI], and recurrence) were compared between the R0 and R1-R0 groups. Age, sex, T stage, DOI, LVI, PNI, and SUVmax were not significantly different between the two groups. Local recurrence was more frequent (P=0.045) in the R1-R0 group (13.1 %) than in the R0 group (5.5 %). Local recurrence-free survival was better in the R0 group than in the R1-R0 group (P=0.046). There was no significant difference in overall recurrence or overall survival. On multivariate analysis, initial positive RM was the independent significant risk factor (hazard ratio, 2.249; 95 % confidence interval, 1.025-4.935; P=0.043) for local recurrence. A revised clear RM after initial cut-through margin is a risk factor for local recurrence in early-stage OSCC. Cautious should be considered in early-stage OSCC patients with revised clear RM.
Pubmed PDF WebWenjiao Lyu, Jing Gong, Lin Zhu, Tingting Xu, Shenglin Huang, Chunying Shen, Cuihong Wang, Xiayun He, Hongmei Ying, Chaosu Hu, Yu Wang, Qinghai Ji, Yajia Gu, Xin Zhou, Xueguan Lu
Publication date 29-09-2024
Accurate prediction of neoadjuvant chemotherapy (NAC) response allows for NAC-guided personalized treatment de-intensification in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). In this study, we aimed to apply baseline MR radiomic features to predict NAC response to help select NAC-guided de-intensification candidates, and to explore biological underpinnings of response-oriented radiomics. Pre-treatment MR images and clinical data of 131 patients with HPV-positive OPSCC were retrieved from Fudan University Shanghai Cancer Center. Patients were divided into training cohort (n = 47), validation cohort 1 (n = 49) from NAC response-adapted de-intensification trial (IChoice-01, NCT04012502) and real-world validation cohort 2 (n = 35). NAC prediction model using linear support vector machine (SVM) was built and validated. Subsequent nomograms combined radiomics and clinical characteristics were established to predict survival outcomes. RNA-seq and proteomic data were compared to interpret the molecular features underlying radiomic signatures with differential NAC response. For NAC response prediction, the fusion model with both oropharyngeal and nodal signatures achieved encouraging performance to predict good responders in the training cohort (AUC 0·89, 95% CI, 0·79-0·95) and validation cohort 1 (AUC 0·71, 95% CI, 0·59-0·83). For prognosis prediction, radiomics-based nomograms exhibited satisfactory discriminative ability between low-risk and high-risk patients (PFS, C-index 0·85, 0·76 and 0·83; OS, C-index 0·79, 0·76 and 0·87, respectively) in three cohorts. Expression analysis unveiled NAC poor responders had predominantly enhanced keratinization while good responders were featured by upregulated immune response and oxidative stress. The MR-based radiomic models and prognostic models efficiently discriminate among patients with different NAC response and survival risk, which help candidate selection in HPV-positive OPSCC with regard to personalized treatment de-intensification.
Pubmed PDF WebMaria Eduarda Pérez-de-Oliveira, Vivian Petersen Wagner, Colin D. Bingle, Pablo Agustin Vargas, Lynne Bingle
Publication date 28-09-2024
Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumour with around 50 % of cases carrying the CRTC1-MAML2 translocation. The CREB pathway has been associated with the transforming activity of this translocation. The aim of this study was to determine the effects of CREB inhibition on MEC cell behaviour in vitro. Two translocation-positive (UM-HMC-2 and H292) and one translocation-negative (H253) MEC cell lines were treated with 666.15, a CREB inhibitor. Drug IC50 doses were determined for each cell line. Clonogenic and spheroid assays were used to assess survival, including percentage of cancer stem cells, and transwell and scratch assays evaluated invasive and migratory capacities, respectively. Immunofluorescence staining was used to determine E-cadherin expression. CREB inhibition significantly reduced the number of surviving colonies and spheroids and delayed cell invasion in all cell lines, but this was more significant in the fusion positive, UM-HMC-2 cells. The expression of E-cadherin was significantly higher in treated UM-HMC-2 and H292 cells. CREB inhibition with 666.15 impaired key MEC oncogenic behaviours associated with metastasis and drug resistance, including cell invasion and survival.
Pubmed PDF WebAyham Al Afif, Philip Rosen, Jae Gardella, Timothy G. Norwood, Adam Abbas, Lindsay S. Moore, Jessica W. Grayson, Kristine E. Day, Andrew C. Prince, Benjamin J. Greene, William R. Carroll, Sejong Bae
Publication date 28-09-2024
To compare the efficacy of the Modified Frailty Index and Modified Surgical Apgar scores in predicting postoperative outcomes in head and neck cancer patients. We retrospectively reviewed patients who underwent major head and neck surgery between 2012 and 2015. Modified Surgical Apgar, and Frailty Index, scores were calculated on 723 patients. The primary outcome was 30-day complication and/or mortality. The mean Modified Frailty Index was 0.11 ± 0.12, and mean Modified Surgical Apgar score was 6.15 ± 1.67. Both scores were significantly associated with 30-day complication (P<0.05). The Modified Surgical Apgar score was superior to the Modified Frailty Index in predicting complications (Area Under the Curve (AUC) = 0.76; 95 % Confidence Interval (CI), 0.722-0.793; and AUC=0.59; 95 % CI, 0.548-0.633, respectively). Concurrent use of both scoring systems (AUC=0.77) was not superior to individual use. An increase in the mFI from 0.27 to 0.36 was associated with an increase in the risk of complication postoperatively (Odds Ratio (OR) = 3.67; 95 % CI, 1.30-10.34, P=.014). A reduction in the mSAS from 7 to 6 increased the risk of complication following surgery (OR=2.64; 95 % CI, 1.45-4.80; P=.002). Both scores are useful in risk stratifying head and neck cancer patients. The Modified Surgical Apgar score was superior at predicting complications; concurrent use of both scores added minimal benefit.
Pubmed PDF WebKajal Mahto, Gaurav Kumar Goldar, Akash Varshney, Manu Malhotra, Madhu Priya, Amit Kumar, Bhinyaram, Ashok Singh, Abhishek Bhardwaj, G. Vetrivel, Subrata Nag, Amit Kumar Tyagi
Publication date 27-09-2024
In India, oral cavity cancer rates are the highest, largely due to tobacco and areca nut use. The primary goal of oncologic surgery is complete tumor resection with adequate margins, yet no accepted guidelines exist margin identification. NBI enhances mucosal lesion detection and may improve margin assessment in OSCC. This study aims to evaluate the proportion of negative superficial resection margins using NBI and to compare these results with margins assessed using white light (WL) examination. The study at AIIMS, Rishikesh, included 38 patients with T1-T3 biopsy-proven OSCC. Surgical margins were marked using WL and NBI. Histopathology classified margins as clear (>5mm), close (1-5 mm), or involved. Sensitivity, specificity, and predictive values of NBI were calculated. The average NBI examination duration was 227 s. Negative margins were achieved in 68.42 % (>5mm) and 78.94 % (>3mm) of NBI cases, compared to 71.05 % and 84.21 % for WL. NBI had a sensitivity of 12.50 %, specificity of 96.67 %, and overall accuracy of 78.95 %. NBI showed high specificity but low sensitivity. This could be due to the smaller number of patients in NBI positive group. In the present study, the single positive margin identified with NBI could also have been detected with the combined approach of white light and palpation, ensuring that no positive margins were missed. NBI can complement WL for margin assessment in oral SCC but requires a long learning curve and a dedicated team. Integrating NBI into standard protocols could improve surgical outcomes and reduce recurrence.
Pubmed PDF WebAlexander Valcenko, Anabel Zwick, Lissy Schneider, Maximilian Linxweiler, Stefan Lohse
Publication date 23-09-2024
Neutrophils play a crucial role in the tumor microenvironment (TME) of head and neck squamous cell carcinomas (HNSCC) and significantly influence treatment outcomes. Phenotypic and functional properties of neutrophils adapt to the TME with distinct subsets modulating disease progression and therapeutic interventions. Here, we evaluated phenotypic and functional differences of neutrophils derived from HNSCC patients and healthy donors. We observed significant phenotypic differences between neutrophils from healthy donors and HNSCC patient-derived neutrophils. Gender and tumor stage influenced neutrophil phenotypes and their ability to lyse tumor cells through antibody-dependent cell-mediated cytotoxicity (ADCC). Patients with advanced HNSCC and males may benefit less from neutrophil-centered immunotherapy. An engineered IgA2 antibody specific for the epidermal growth factor receptor (EGFR) demonstrated superior efficacy in activating neutrophils for ADCC compared to Panitumumab using healthy and patient-derived neutrophils, underscoring the potential of the IgA isotype as a therapeutic alternative. The distinct behavior and antibody-isotype dependent ADCC competence of CD177+/- neutrophils of healthy but not HNSCC donors warrants further exploration. Our study emphasizes the importance of personalized immunotherapy treatments that consider the characteristics of neutrophils, patient demographics, and the type of antibody to improve ADCC and ultimately enhance treatment outcomes for HNSCC.
Pubmed PDF WebKelly E. Daniels, Daniel R. Awad, Shirley X. Liu, Joseph Mocharnuk, Mark Kubik, Seungwon Kim, Robert L. Ferris, Umamaheswar Duvvuri, Shaum S. Sridharan
Publication date 22-09-2024
Transoral robotic surgery (TORS) for the treatment for oropharyngeal squamous cell carcinoma (SCC) carries a risk of post-operative hemorrhage. Increased time from surgery to completion of adjuvant therapy has been associated with decreased survival. Our objective was to assess for adjuvant treatments delays in patients with post-operative bleeding. Secondarily, to assess post-operative swallowing outcomes.
Retrospective chart review of all patients who underwent TORS from 2014 to 2021 at a tertiary care center. Patient demographics, adjuvant therapy course, treatment-related dysphagia outcomes, incidence and severity of post-operative bleeding were reviewed.
221 patients underwent TORS, 160 (72%) of which were recommended to undergo adjuvant treatment. 33 patients developed post-operative bleeding, of which 22 patients underwent at least partial radiation therapy (RT) where there was an average of 53.0 ± 12 days elapsed from surgery to the initiation of RT. In the control group, 124 completed at least partial adjuvant treatment and there was an average of 55.3 ± 23 days from surgery to start of adjuvant RT. Time to start of RT was not significantly different between the cohorts (p=0.47). 9.1% of patients with bleeding and 23.7% of those without bleeding started radiation therapy within 6 weeks. The odds ratio of requiring a feeding tube during treatment in patients with post-operative bleeding compared to those without was 1.3 (95% C.
I. 0.54-3.13).
Patients with post-operative bleeding following TORS with TAL were not found to have a significantly higher risk of treatment delays or dysphagia burden, independent of hemorrhage severity.
Yu Min, Xiaoxia Liu, Zhigong Wei, Ge Song, Yuantai Li, Kun Gao, Zheran Liu, Yiyan Pei, Huilin Li, Junyou Ge, Yan Qing, Youneng Wei, Xingchen Peng
Publication date 20-09-2024
Immune-related biomarkers are linked to the outcomes of cancer immunotherapy. This study evaluates the baseline and longitudinal association between the lung immune prognostic index (LIPI) and immune checkpoint inhibitor outcomes in previously treated recurrent or metastatic (R/M) nasopharyngeal carcinoma (NPC) patients.
Data from 153 R/M NPC patients (median age = 49.00 years old) enrolled in a multicenter, single-arm, phase 2 study (NCT03848286) were analyzed. Pretreatment LIPI was classified into good and intermediate/poor (inter/poor) groups. Longitudinal LIPI variations were categorized into "Stable good", "Trend to increase", "Trend to decrease", and "Stable inter/poor". Primary and secondary outcomes were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR).
Pretreatment LIPI was significantly associated with OS (inter/poor vs.
good: HR = 2.54, 95 % CI: 1.60-4.04, P < 0.001), PFS [inter/poor vs.
good: hazard ratio (HR) = 2.18, 95 % CI: 1.47-3.23, P < 0.001], and DCR [inter/poor vs.
good: odd ratio (OR) = 0.26, 95 % CI: 0.12-0.58, P < 0.001)]. Patients with persistently inter/poor LIPI status showed worse OS (HR = 3.25, 95 % CI: 1.84-5.74, P < 0.001), PFS (HR = 2.96, 95 % CI: 1.85-4.74, P < 0.001), and ORR (OR = 0.21, 95 % CI: 0.08-0.56, P < 0.001) compared to the persistently good subgroup.
Pretreatment LIPI and its longitudinal variations may serve as potential biomarkers for predicting immune checkpoint inhibitor outcomes in R/M NPC patients.
Lorne Green, Lachlan McDowell, Fiona Ip, Mario Tapia, Meiling Zhou, Michael T. Fahey, Benjamin Dixon, Matthew Magarey
Publication date 18-09-2024
The aims of this study were to investigate the rate and time to return to work (RTW) after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) and to explore the impact of disease or work-related factors leading to variations in RTW outcomes.
Cross-sectional survey of disease, socioeconomic, work-related and health-related quality of life (HR-QOL). Qualitative analysis of responses for facilitators and barriers to RTW.
A total of 47 participants employed at diagnosis were included in the study, with an average age 56 years. Median survey time 3.2 years. 22 participants underwent TORS only with 25 undergoing TORS with adjuvant therapy. 93.6 % had stage 1 disease. 95.7 % of participants RTW after TORS with a mean time of 13.6 weeks. Patients returned earlier after TORS alone compared to those requiring adjuvant treatment (10 weeks vs. 17 weeks; p = 0.13) Overall high HR-QOL metrics for all patients, with those undergoing adjuvant having significantly poorer outcomes for the dry mouth/sticky saliva (9.1 vs 41.3, p=<0.001) items.
Qualitative analysis of free text responses showed facilitators and barriers to RTW fell under four main categories: physical, phycological/emotional, financial and workplace.
High rate of RTW amongst patients after TORS, which is the highest reported amongst head and neck cancer literature to date. Participants returned earlier after surgery only compared to adjuvant treatment, but both groups reported high HR-QOL metrics. Physical effects of treatment, including fatigue and oral dysfunction were some of the main barriers to RTW; whereas flexible working arrangements and support from employer/colleagues were major facilitators.
Yen-Ting Lu, Chiao-Wen Lin, Shih-Chi Su, Yu-Ting Ho, Fang-Ling Yeh, Chung-Han Hsin, Shun-Fa Yang
Publication date 17-09-2024
Metastatic disease is a major issue of treatment failure in nasopharyngeal carcinoma (NPC) patients and often linked to high mortality. L48H37, a synthetic analog of curcumin with augmented bioavailability over its parent compound, has demonstrated several oncostatic characteristics. This study was aimed to explore the anti-metastatic effect of L48H37 on NPC cancer cells and its underlying mechanism. Cell viability was evaluated using MTT assay. Regulation of signaling pathways was elucidated by immunoblotting, and specific kinase inhibitors. In this study, we showed that L48H37 suppressed TPA-stimulated invasive and migratory capacities of NPC cell lines and gave rise to very little cytotoxic responses. Such anti-cancer effect of L48H37 was accompanied with attenuated expression levels and enzymatic activities of matrix metalloproteinase-9 (MMP-9), a pivotal mediator of metastatic processes. In addition, L48H37 interfered with TPA-induced JNK activation, and the treatment of L48H37 combined with a JNK antagonist demonstrated a synergistic effect on restraining TPA-stimulated MMP-9 activity and migration events in NPC cells. Our results revealed that L48H37 impeded the invasive potential of NPC cells via impairment of MMP-9 function and abundance, highlighting possible complementary therapies using curcumin or its effective analogs to manage NPC dissemination.
Pubmed PDF WebPhillip Staibano, Michael Au, Michael Xie, Michael K. Gupta, James Edward Massey (Ted) Young, Han Zhang
Publication date 16-09-2024
Treatment de-intensification, including transoral robotic surgery (TORS), may outcomes in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). Early return to work (RTW) improves quality of life in oncology patients. Our objective was to compare the RTW time in OPSCC patients undergoing primary TORS or chemoradiotherapy (CRT). We investigated the role of treatment modality on self-reported swallowing function. All patients were adults diagnosed with early-stage (T1-2, N0-2) OPSCC and treated via primary TORS or CRT. We performed 1:1 exact case matching based on tumor stage and subsite. We collected RTW outcomes for all patients. We also reported MD Anderson Dysphagia Index (MDADI) scores up to 24 months from the end of treatment. We performed statistical analyses and comparison of RTW and MDADI outcomes based on treatment group. Overall, 26 patients undergoing primary TORS and 25 undergoing primary CRT were included. We found a significant improvement in RTW in TORS patients compared to CRT (TORS: 54 days (1.8 months), IQR: 30.8; CRT: 164 days (5.4 months), IQR: 109; W=587, p = 9.28e-08) independent of HPV status, tonsillar subsite, and radiotherapy alone. Primary TORS had a 16.2-fold (95 % CI: 5.78-45.5) higher likelihood of returning to work than primary CRT patients. Primary TORS also had better MDADI scores within two years of treatment. In OPSCC, primary TORS accelerated RTW and improved swallowing when compared to primary CRT. The potential economic advantage of returning to work sooner should be discussed when reviewing treatment options with patients.
Pubmed PDF WebChris P. Verschoor, Stacey A. Santi, Ravi Singh, Sujeenthar Tharmalingam, Christopher Thome, Deborah P. Saunders
Publication date 14-09-2024
Oral mucositis is a painful and debilitating condition that occurs in the majority of head and neck cancer patients receiving radiation and/or chemotherapy. While some patient and treatment related factors are known to contribute to the incidence and severity of disease, reliable biomarkers remain elusive. In the following study, we investigated the association of salivary DNA methylation derived biological aging, cellular frequency and protein concentration measures with the severity of oral mucositis and overall survival in a cohort of head and neck cancer (HNC) patients (n = 103). DNA methylation profiling was performed on saliva samples obtained prior to treatment. Biological aging measures included Horvath2, Pheno Age, Fit Age and Grim Age, and cellular frequency included epithelial and specific immune cell populations. Severe mucositis (i.e. grade 3 or 4) occurred in nearly half of patients. For malignant HNC patients (n = 84), every 1-SD increase in Grim Age was associated with 2.62-times risk of severe mucositis (95 % CI: 1.38, 5.57), while a 1-SD increase in monocyte frequency was associated with a decreased risk (OR [95 %CI]: 0.40 [0.18, 0.80]). Over a median follow-up of 53 months, 39 of 103 participants died. Six protein scores (TNFSF14, GCSF, MATN3, GDF8, nCDase, TNF-β) were associated with survival at q < 0.15. We provide evidence that the risk-related biological aging measure Grim Age may be a useful predictor of mucositis severity in HNC patients. Salivary monocyte frequency may be protective against mucositis, and this measure could be used as a predictive biomarker while also providing clues into the pathobiology of the disease.
Pubmed PDF WebAn Wang, He Xia, Jin Li, Pengfei Diao, Jie Cheng
Publication date 09-09-2024
Dysregulated super-enhancer (SE) results in aberrant transcription that drives cancer initiation and progression. SEs have been demonstrated as novel promising diagnostic/prognostic biomarkers and therapeutic targets across multiple human cancers. Here, we sought to develop a novel prognostic signature derived from SE-associated genes for head and neck squamous cell carcinoma (HNSCC). SE was identified from H3K27ac ChIP-seq datasets in HNSCC cell lines by ROSE algorithm and SE-associated genes were further mapped and functionally annotated. A total number of 133 SE-associated genes with mRNA upregulation and prognostic significance was screened via differentially-expressed genes (DEGs) and Cox regression analyses. These candidates were subjected for prognostic model constructions by machine learning approaches using three independent HNSCC cohorts (TCGA-HNSC dataset as training cohort, GSE41613 and GSE42743 as validation cohorts). Among dozens of prognostic models, the random survival forest algorithm (RSF) stood out with the best performance as evidenced by the highest average concordance index (C-index). A prognostic nomogram integrating this SE-associated gene signature (SEAGS) plus tumor size demonstrated satisfactory predictive power and excellent calibration and discrimination. Moreover, WNT7A from SEARG was validated as a putative oncogene with transcriptional activation by SE to promote malignant phenotypes. Pharmacological disruption of SE functions by BRD4 or EP300 inhibitor significantly impaired tumor growth and diminished WNT7A expression in a HNSCC patient-derived xenograft model. Taken together, our results establish a novel, robust SE-derived prognostic model for HNSCC and suggest the translational potentials of SEs as promising therapeutic targets for HNSCC.
Pubmed PDF WebEoin F. Cleere, Justin M. Hintze, Claire Doherty, Conrad V.I. Timon, John Kinsella, Paul Lennon, Conall W.R. Fitzgerald
Publication date 09-09-2024
Frailty refers to a state of reduced physiological reserve and functional decline. We sought to analyse whether frailty, assessed using the 5-item modified frailty index (5mFI), was associated with increased morbidity and mortality following major mucosal head and neck surgery. We performed a retrospective study of patients undergoing major mucosal head and neck surgical resection over a 2-year period. Potential confounding variables were controlled by way of multivariable regression analysis. There were 310 patients included with 77 (24.8 %) classified as frail. Most patients were male (219/310, 70.7 %), had a history of smoking (246/310, 79.4 %) and 151 patients (48.7 %) were older than 65 at time of surgery. Most surgeries related to oral cavity or oropharyngeal subsites (227/310, 73.2 %) and 150 patients (48.4 %) underwent microvascular free tissue reconstruction. On multivariable analysis, frail patients were more likely to suffer adverse outcomes such as a return to theatre (OR 3.47, 95 % CI 1.82-6.62, p < 0.001), a Clavien-Dindo grade IV complication (OR 6.23, 95 % CI 2.55-15.20, p < 0.001) or medical complications, such as respiratory complications (OR 2.61, 95 % CI 1.45-4.69; p = 0.001) or delirium (OR 5.05, 95 % CI 2.46-10.33; p < 0.001). Additionally, hospital length of stay was increased among frail patients (ß 16.46 days, 95 % CI 9.85-23.07 days; p < 0.001). Neither 90-day nor 1-year post-operative mortality was increased in frail patients. Frailty assessed using the 5mFI was associated with greater post-operative morbidity, but not mortality following major mucosal head and neck surgery.
Pubmed PDF WebPai Pang, Xiaomeng Xue, Zhongfei Xu, Weiyi Duan, Fayu Liu, Xuexin Tan, Enjiao Zhang, Zhongzheng Qi, Changfu Sun
Publication date 18-11-2024
The lip is a crucial structure in the oral and maxillofacial region, serving vital physiological functions such as speech, swallowing, chewing, and expression. Due to the complexity of lip anatomy, function, and the various types of defects, the functional restoration and reconstruction of lip defects remain complex and challenging tasks. In this article, we summarize several methods for functional restoration and reconstruction of lip defects using local flaps that carry the depressor anguli oris muscle, as well as some free flaps. We also introduce methods for repairing extensive defects in the oral and maxillofacial region that are accompanied by lip defects using combinations of various tissue flaps.
Pubmed PDF WebFariba Esperouz, Vito Carlo Alberto Caponio, Andrea Santarelli, Andrea Ballini, Lorenzo Lo Muzio, Domenico Ciavarella, Lucio Lo Russo
Publication date 18-11-2024
To investigate the accuracy of ultrasound in the quantification of tumor thickness (TT) and depth of invasion (DOI) of oral potentially malignant disorders and oral squamous cell carcinoma. A systematic review search was conducted in Pub Med, Scopus, and Web of Science to answer the PICO question: "What is the correlation and the mean difference between ultrasound and histopathological assessment of tumor thickness and depth of invasion in patients with oral squamous cell carcinoma and oral potentially malignant disorders? The risk of bias was assessed, meta-analysis and trial sequential analysis was conducted on the available quantitative data, followed by trial sequential analysis. Of 2089 results, 48 studies were considered suitable for inclusion. Meta-analysis showed a low heterogeneity for tumor thickness mean difference (I There were no statistically significant differences between the results of ultrasound and histological examination, the clinical use of this device cannot yet be confirmed.
Pubmed PDF WebR. Mishra, A. Kapur, VP. Mathur, D. Sardana
Publication date 14-11-2024
The purpose of the present systematic review and meta-analyses was to appraise the case-control studies that have evaluated late adverse effects of chemotherapy for treating hematological malignancies in pediatric patients. Five electronic databases along with grey literature were searched using broad keywords and MeSH terms for the articles that could meet the eligibility criteria. The Newcastle-Ottawa Scale was employed for quality assessment. Der Simonian and Laird random effects model using the (Restricted Maximum Likelihood) REML approach was used for meta-analyses to calculate the pooled Odds Ratios (ORs) for binary outcomes and Standardized Mean Difference (SMD) for continuous outcomes. The GRADE approach was used to synthesize the certainty of evidence utilizing GRADEpro® GDT software. 8,052 records were obtained from the searches. After duplicate removal and initial screening of titles and abstracts, 109 articles were subjected to full-text reading but only 5 could be included. The pooled ORs of having root malformation, microdontia, tooth agenesis, taurodontism, and enamel defects in patients who have undergone treatment were 7.68, 5.39, 3.74, 2.00, and 1.84 compared to controls, respectively. The SMD for dental caries was also significant among the groups (p= 0.03) and indicated an SMD of 0.27 (95% CI: 0.03, 0.51) indicating higher pooled mean DMFT in the cases than controls. Root malformations are associated with treatment for childhood hematological cancers with a moderate certainty of assessment. Tooth agenesis and microdontia are associated with low certainty of evidence, while taurodontism, enamel defects, and caries were associated with very low certainty of evidence. Future studies on larger sample sizes are needed to validate the findings as the number of studies included in our review was small.
Pubmed PDF WebJanis Morgenthaler, Maike Trommer, Richard Khor, Morikatsu Wada, Houda Bahig, Adam S. Garden, Alesha Thai, Hui Gan, Emmanouil Fokas, Sweet Ping Ng
Publication date 13-11-2024
Oropharyngeal carcinomas linked to high-risk types of human papillomavirus (HPV
Pubmed PDF WebJihane Lehyanti, Caroline Even, Etienne Fessart, Cyriaque Wagner-Ballon, Aurélie Moreira, Aline Houessinon
Publication date 02-11-2024
Head and neck squamous cell carcinoma (HNSCC) is the seventh most common type of cancer worldwide. It is mainly discovered in a locally advanced stage, but it is estimated that 40% of recurrences after the treatment of the primary disease will be in a metastatic form, with one third being oligometastatic. There is no clear consensus regarding the treatment of oligometastatic HNSCC, whether it being local treatment, systemic treatment or a combination of both. We put together a systematic review using the Preferred Reporting Item for Systematic review and Meta-Analysis (PRISMA) method to gather all pertinent articles approaching the therapeutic management of oligometastatic HNSCC, especially in the metachronous setting. Out of 344 articles, 21 articles fit our inclusion criteria and were deemed pertinent to help answer the question of our review. Eight studies included only head and neck cancers (HNC) and the other 13 tackled multiple histologies including HNC. Stereotactic body radiotherapy (SBRT) was the treatment of choice for oligometastatic HNSCC with good local control rates and manageable toxicity. Most included studies were retrospective and not randomized. The association of local treatment and systemic treatment was difficult to assess as treatment protocols were not always standardized. There is crucial need for more prospective randomized trials that compare all treatments and sequences as some patients with a high risk of developing polymetastatic disease could derive benefit form a more intensified approach.
Pubmed PDF WebMarina Aweeda, Kelsey Richard, Ethan H. Arnaud, Vasu Divi, Neerav Goyal, Michael C. Topf
Publication date 12-10-2024
In head and neck cancer surgery, several studies have demonstrated the prognostic significance of lymph node yield (LNY). To our knowledge, no review has evaluated both the contributing factors to LNY and its impact on survival outcomes across all head and neck squamous cell carcinoma (HNSCC) subsites. A scoping review of LNY in HNSCC was conducted according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework to answer the following research questions: 1) Which surgeon, pathologist, and patient characteristics influence LNY? 2) Which anatomic subsites does LNY impact survival? Surgeon experience and variation in pathology protocols and personnel can impact LNY. Extent of nodal dissection, advanced tumor characteristics, and treatment at an academic facility are associated with increased LNY. Patient characteristics such as age <40, male gender, and BMI > 30 are associated with increased LNY. In the oral cavity, LNY > 18 is an independent predictor of improved overall survival (OS), disease free survival (DFS), and disease-specific survival (DSS). In the oropharynx, published studies show mixed results with regards to the impact of LNY on OS, DFS, and DSS. LNY has not been associated with OS or DFS in the larynx, irrespective of nodal threshold. Provider and patient characteristics may impact LNY. LNY ≥ 18 is associated with a survival benefit in the oral cavity and HNSCC overall. Further investigation of LNY particularly in prospective clinical trials is required prior to its adoption as a quality metric in HNSCC.
Pubmed PDF WebBrian Y. Zhao, Shun Hirayama, Deborah Goss, Yan Zhao, Daniel L. Faden
Publication date 10-10-2024
Human papillomavirus (HPV) is known to affect head and neck sites beyond the oropharynx, including the nasopharynx. Unlike HPV-associated oropharyngeal squamous cell carcinoma (HPV+OPSCC), HPV-associated nasopharyngeal carcinoma (HPV+NPC) is not well characterized and the true prevalence in non-endemic regions is poorly described. Here, we sought to obtain a global point prevalence of HPV in NPC, stratified by geographic region. EMBASE, OVID Medline, and Web of Science were systematically searched for available evidence on September 21, 2022 for articles published between January 1, 1990 and September 21, 2022. We reviewed the literature for all studies examining NPC and HPV status in adult patients that provided a quantitative HPV prevalence. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Main outcome and measures included HPV+NPC prevalence estimates stratified by geographic region, along with other clinical and demographic features. Of the 1567 citations retrieved, 46 studies encompassing 6314 NPC patients were eligible for statistical analysis. The global prevalence of HPV+NPC was 0.18 (95% CI 0.14-0.23). When stratified by geographic region, prevalence was highest in North America (0.25, 95% CI 0.17-0.36), which is a non-endemic region for NPC and also has highest prevalence for HPV+OPSCC. Asia, an endemic area, had the lowest HPV prevalence estimate (0.13, 95% CI 0.08-0.22). HPV 16 (44%) and 18 (33%) were the predominant genotypes in HPV+NPC, dissimilar to HPV+OPSCC. This systematic review and meta-analysis provides a global point prevalence of HPV+NPC stratified by geographic region and suggests that HPV is a significant etiological factor of NPC in North America.
Pubmed PDF WebIrini Yacoub, Joshua Y. Qian, Kareem Nashed, Mary Youssef, Mikayla Khalil, Daniel Kallini, Nancy Y. Lee
Publication date 06-10-2024
Gulpembe Bozkurt, Mario Turri Zanoni, Marco Ferrari, Alessandro Ioppi, Sinem Kara Peker, Hasan Elhassan, Melis Ece Arkan Anarat, Yetkin Zeki Yilmaz, Stefano Taboni, Alessandra Ruaro, Vittorio Rampinelli, Davide Mattavelli, Alberto Schreiber, Alessandro Vinciguerra, Benjamin Verillaud, Paolo Battaglia, Cesare Piazza, Philippe Herman, Paolo Castelnuovo, Piero Nicolai
Publication date 03-10-2024
This systematic review evaluates the efficacy and morbidity of transnasal endoscopic nasopharyngectomy as a salvage treatment for advanced-stage recurrent nasopharyngeal carcinoma (rNPC). Following PRISMA guidelines, we conducted a systematic search in Medline, Scopus, and Pub Med, identifying studies on transnasal endoscopic nasopharyngectomy for rNPC. Inclusion criteria encompassed histologically confirmed rT3 and rT4 NPC patients previously treated with radiotherapy or chemoradiotherapy. Data on overall survival (OS), disease-free survival (DFS), and complications were extracted and analyzed. Nine studies, including a total of 429 patients, met the inclusion criteria. Five studies reported 2-year overall survival (OS) rates ranging from 34.6 % to 88.7 %. Three studies reported 3-year OS rates between 50 % and 63.5 %. Long-term 5-year survival varied widely from 0 % to 100 % across three studies. One study detailed 1-year disease-free survival (DFS) and OS at 93 % and 98 %, respectively. The pooled analysis included 429 patients with a median follow-up of 26.1 months. Complications were predominantly minor and transient. Major complications included necrosis, hemorrhage, cranial nerve palsy, and death. Advanced surgical techniques and pre-treatment measures, such as internal carotid artery embolization, improved resection outcomes and reduced complication rates. Transnasal endoscopic nasopharyngectomy emerges as a viable salvage option for advanced rNPC, offering favorable survival outcomes and manageable complication profiles. Future research should focus on refining surgical techniques and improving patient selection criteria to further enhance treatment efficacy.
Pubmed PDF WebJérôme R. Lechien
Publication date 01-10-2024
This systematic review investigated the surgical, functional, and oncological outcomes of transoral robotic supraglottic laryngectomy (TORS-SGL) for cT1-T3 laryngeal squamous cell carcinoma (LSCC). Two investigators conducted an updated Pub Med, Scopus, and Cochrane Library systematic review for studies investigating the surgical, functional, and oncological outcomes of TORS-SGL using the PRISMA statements. The bias analysis was conducted with the MINORS. Twenty-one studies were included, accounting for 896 patients. TORS-SGL was primarily performed for cT1 (39.1 %), cT2 (46.9 %), and some selected cT3 (7.7 %) LSCCs. Surgical margins were positive in 10.8 % of cases. The mean hospital stay was 8.6 days. Hemorrhage (6.3 %), pneumonia (5.5 %), and aspiration (1.7 %) are the primary complications. The surgical margins were positive in 10.6 % of cases. Feeding tubes, temporary tracheotomy, and definitive percutaneous gastrostomy are found in 65.6 %, 19.7 %, and 5.2 % of patients, respectively. The oral diet is restarted after a mean of 7.2 days. The 5-year OS and DFS of TORS-SGL were estimated to be 78.3 %, and 91.7 %, with 5-year local-relapse-free survival and nodal-relapse-free survival of 90.8 %, and 86.6 %, respectively. The TORS-SGL is a safe, and effective surgical approach for cT1-T3 SGL. The functional and surgical outcomes appear comparable with TOLM-SGL. The oncological outcomes of TORS-SGL could be better than TOLM and open SGLs, but further large cohort-controlled studies are needed to draw reliable conclusions.
Pubmed PDF WebLinjie Ma, Chao Li
Publication date 27-09-2024
Resection of deep lobe benign tumors of parotid requires the preservation of facial nerve and other important structures, which is closely related to the refinement of surgical operations and the aesthetics of facial incisions. The Da Vinci robotic surgical operating system is more conducive to improving treatment effects. Combined with the hairline incision behind the ear, the surgical method can be explored for both aesthetic and curative effect. A case of a child with deep lobe benign tumor of parotid, who undergo tumor resection via the retroauricular hairline approach with the assistance of Da Vinci robot. The child successfully completed the operation. During postoperative follow-up, the patient showed no facial palsy manifestations such as crooked mouth, the incision healed well. It is feasible to remove the benign tumor of deep lobe of parotid with Da Vinci robot-assisted combined with via retroauricular hairline approach, which has clinical exploration value.
Pubmed PDF WebJingzhu Zhao, Xianhui Ruan, Songfeng Wei, Xiangqian Zheng, Ming Gao
Publication date 02-09-2024
Prithviraj T
Publication date 28-08-2024
Andrea Costantino, Bruce Haughey, Uthman Alamoudi, Jeffery Scott Magnuson
Publication date 26-08-2024
Helene Knap Rabjerg, Jesper Grau Eriksen, Sebastian Søby
Publication date 26-08-2024
Reydson Alcides de Lima-Souza, Iara Vieira Ferreira, Carlos Takahiro Chone, Erika Said Abu Egal, Alena Skálová, Albina Altemani, Fernanda Viviane Mariano
Publication date 24-08-2024
A 56-year-old female was referred to our service for management of a malignant salivary gland neoplasm with compromised margins that had been biopsied previously at another service. The patient reported a twenty-year history of a lesion in the oral cavity with progressive and exuberant growth over the past two years, associated with local pain and dyspnea. Physical examination revealed an erythematous, ulcerated, and hemorrhagic lesion measuring approximately 3 cm on the left soft palate and tonsillar pillar. Computed tomography revealed an expansile lesion in the topography of the left soft palate, growing predominantly toward the lumen of the nasopharynx and partially invading the left wall of this region. The patient underwent surgery and histopathologic examination revealed an infiltrative and aggressive epithelial neoplasia with large vacuolated and eosinophilic cytoplasm, vesicular nuclei, and prominent nucleoli. The neoplastic cells were arranged in a solid, microcystic, tubular, and follicular pattern with eosinophilic luminal secretion. Mitotic figures were frequent and all margins were affected by the neoplasia. Morphologic and immunohistochemical features supported the diagnosis of secretory carcinoma, and the patient is currently being followed for further therapeutic intervention.
Pubmed PDF WebKarl Payne, Harini Suriyanarayanan, Jill Brooks, Hisham Mehanna, Paul Nankivell, Deena Gendoo
Publication date 06-09-2024
Liquid biopsy profiling is gaining increasing promise towards biomarker-led identification and disease stratification of tumours, particularly for tumours displaying significant intra-tumoural heterogeneity (ITH). For head and neck squamous cell carcinoma (HNSCC), which display high levels of genetic ITH, identification of epigenetic modifications and methylation signatures has shown multiple uses in stratification of HNSCC for prognosis, treatment, and HPV status. In this study, we investigated the potential of liquid biopsy methylomics and genomic copy number to profile HNSCC. We conducted multi-region sampling of tumour core, tumour margin and normal adjacent mucosa, as well as plasma cell-free DNA (cfDNA) across 9 HNSCC patients. Collectively, our work highlights the prevalence of methylomic ITH in HNSCC, and demonstrates the potential of cfDNA methylation as a tool for ITH assessment and serial sampling.
Pubmed PDF WebJi Xiaoyu, Pan Baihong, Li Yaozhen, Chen Shen, Sheng Chang, Liu Tinghua, Ouyang Yang
Publication date 06-09-2024
To investigate effects of preoperative protective carotid artery (CA) stenting in complex head and neck cancer (HNC) resection. HNC that encases the CA is complex. Fifty-five patients diagnosed with complex HNC from 2018 to 2021 were enrolled, and were divided into Control group (general complex cases) and carotid artery stent (CAS) group (severe complex cases). All patients underwent standard tumor resection, while patients in the CAS group also underwent preoperative covered CA stenting. Medical information was retrospectively analyzed. CA stenting and tumor resection were successfully performed. Baseline demographics were recorded. CAS and Control groups had similar results for complete tumor resection rate, operation time, and intraoperative blood loss, although the CA was obviously more involved in CAS group than in Control group. However, recurrence rate in the CAS group was significantly lower than Control group, indicating that preoperative CA stent implantation facilitates complete tumor removal. Furthermore, perioperative CA-associated complications including common/internal CA ligation were more frequent in Control group. Overall survival and disease-free survival rate in CAS group and Control group was 87.5% and 69.2%, respectively. Disease-free survival rate in CAS group and Control group was 87.5% and 42.3%, respectively. No postoperative cerebral infarction was observed in either group. Overall hospitalization cost was recorded. Preoperative protective CA stenting facilitates more thorough tumor removal while better preserving the CA during complex HNC resection, reducing the surgical difficulty. Preoperative CA stenting may be a safe and effective therapeutic option for resection of HNC encasing the CA.
Pubmed PDF WebXushi ZHANG, Wanjia ZHENG, Sijuan HUANG, Haojiang LI, Zhisheng BI, Xin YANG
Publication date 04-09-2024
This study aimed to integrate radiomics and dosiomics features to develop a predictive model for xerostomia (XM) in nasopharyngeal carcinoma after radiotherapy. It explores the influence of distinct feature extraction methods and dose ranges on the performance. Data from 363 patients with nasopharyngeal carcinoma were retrospectively analyzed. We pioneered a dose-segmentation strategy, where the overall dose distribution (OD) was divided into four segmental dose distributions (SDs) at intervals of 15 Gy. Features were extracted using manual definition and deep learning, applying OD or SD and integrating radiomics and dosiomics, yielding corresponding feature scores (manually defined radiomics, MDR; manually defined dosiomics, MDD; deep learning-based radiomics, DLR; deep learning-based dosiomics, DLD). Subsequently, 18 models were developed by combining features and model types (random forest and support vector machine). Under OD, O(DLR_DLD) demonstrated exceptional performance, with an optimal area under the curve (AUC) of 0.81 and an average AUC of 0.71. Within SD, S(DLR_DLD) surpassed the other models, achieving an optimal AUC of 0.90 and an average AUC of 0.85. Therefore, the integration of dosiomics into radiomics can augment predictive efficacy. The dose-segmentation strategy can facilitate the extraction of more profound information. This indicates that ScoreDLR and ScoreMDR were negatively associated with XM, whereas ScoreDLD, derived from SD exceeding 15 Gy, displayed a positive association with XM. For feature extraction, deep learning was superior to manual definition.
Pubmed PDF WebWen-Jing Yin, Wu Mao, Fang Yang, Meng-Yao Wang, Jin-Quan Liu, Dong-Ping Chen, Li-Ping Zhou, Si-Da Chen, Xi-Zhen Jiang, Yu-Meng Ou, Zheng Wu, Bin Qi
Publication date 01-09-2024
To identify the failure patterns and prognostic factors of nonmetastatic nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era. Data on 847 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2012 and 2016 were retrospectively reviewed. Survival outcome, failure patterns and prognosis factors were analyzed. The 5-year local relapse-free survival, nodal relapse-free survival, distant metastasis-free survival, disease-free survival, and overall survival rates were 94.3%, 95.3%, 84.8%, 76.5% and 85.7%, respectively. The major local recurrence sites were the nasopharynx (91.5%, 43/47) and skull base (68.1%, 32/47); 39 patients had in-field failures, four had marginal failures, and four had out-field failures. Level IIb (62.2%, 23/37) was the most frequent regional recurrence site, followed by IIa (35.1%, 13/37) and retropharyngeal region (32.4%, 12/37); 35 cases had in-field failure alone, one had out-field failure alone, and one had both in- and out-field failure. TNM stage was the most significant factor for prognosis prediction. 402 (47.5%) patients had acute adverse events of grade 3 or 4; leukopenia (31.5%) and mucositis (26.7%) was the most common hematological and non-hematological event, respectively. Late complications were slight or moderate damages; xerostomia (647/847, 76.4%) and hearing impairment (422/847, 49.8%) remained the most troublesome. NPC patients treated with IMRT obtained satisfactory survival outcomes. The key failure pattern was distant metastasis. The main pattern of local-regional failure was in-field failure. Screening high risk patients with distant metastases and optimizing radiotherapy targets should be studied.
Pubmed PDF WebYizhi Ge, Haitao Liu, Wenxuan Huang, Huanfeng Zhu, Dan Zong, Xia He
Publication date 31-08-2024
Regulatory B (Breg) cells is a type of immune cell that exhibit immunosuppressive behavior within the tumor microenvironment. However, the differentiation and regulatory mechanisms of these Breg cells remain unexplored. Single-cell transcriptome sequencing analysis of human nasopharyngeal carcinoma (NPC) revealed a significant enrichment of B cell subset characterized by high expression of EGR1 and EGR3 in the tumor microenvironment. Notably, in the hypoxic microenvironment, these B cells induce MAPK pathway activation, subsequently triggering the activation of transcription factors EGR1 and EGR3, which further modulate the expression of immunosuppressive factors like TGFB1 and IL10. In transplant experiments using primary B cells induced under hypoxia and co-transplanted with cancer cells, a significant increase in tumor growth was observed. Mechanism experiments demonstrated that EGR1
Pubmed PDF WebXiate Zhou, Tianchi Shao, Haijian Jia, Liqiao Hou, Xingni Tang, Changhui Yu, Chao Zhou, Suna Zhou, Haihua Yang
Publication date 26-08-2024
Patients with nasopharyngeal carcinoma often experience weight loss and tumor regression during the course of radiotherapy that lasts for up to 6-7 weeks. Adaptive radiotherapy is a systematic feedback control approach based on image-guided technology that adjusts these changes and optimizes the radiotherapy plans according to new imaging findings during treatment. There is growing evidence that adaptive radiotherapy can reduce side effects, improve the quality of life, and enhance disease control. However, the routine application of adaptive radiotherapy for nasopharyngeal remains relatively limited. This review discusses the necessity, clinical benefits, and limitations of adaptive radiotherapy, and presents the current state, challenges, and future perspective of adaptive radiotherapy strategies for nasopharyngeal carcinoma.
Pubmed PDF WebFenglei Du, Kainan Shao, Yiwei Yang, Xue Bai, Yonghong Hua, Guoping Shan
Publication date 24-08-2024
Radiotherapy (RT) is the main treatment for patients with nasopharyngeal carcinoma (NPC). NPC patients at different stages have varying levels of damage to normal brain tissue after RT. No study has yet thoroughly analyzed the variations in radiation dosages in the brain for different stages of NPC patients treated with RT. This study aims to examine these variations. 1446 NPC patients' CT and RTdose data were retrospectively reviewed. Analysis of the radiation dosage was executed on these 803 patients. The RTdose images for several patient groups were averaged after registering each patient's RTdose data to the CT brain template created in our earlier study. The voxel-based (VB) analysis was used to examine the dose variations in the brains of three groups of NPC patients: the early-stage group, the stage III group, and the stage IV group. As the disease progresses from early to advanced stages, the intensity and volume of radiation in the brain increase. The normal brain tissue accepted a substantially larger dosage in more advanced NPC patients. Differences in brain regions between stage III and early-stage patients were minimal compared to any other two groups. Brain regions exhibited substantial variations between the stage IV group and all other patient groups were broadly distributed. Our findings highlight the critical role of NPC staging in the therapeutic strategy, emphasizing the heterogeneity of radiation-induced tissue damage across disease stages and implying the need to develop stage-specific RT plans.
Pubmed PDF WebSulaiman Alsheikh, Jie Su, Brian O’Sullivan, Jolie Ringash, John N Waldron, Scott V Bratman, John Cho, Enrique Sanz Garcia, Anna Spreafico, John de Almeida, Ezra Hahn, Andrew Hope, Ali Hosni, John Kim, Andrew McPartlin, Jillian Tsai, Tong Li, Wei Xu, Eugene Yu, Shao Hui Huang
Publication date 23-08-2024
Clinical extranodal extension (cENE) is a cN modifier in TNM-8 for laryngo-hypopharygeal carcinoma (LHC). We hypothesize that image-detected ENE (iENE) can provide additional prognostic value over cENE in LHC. Baseline CTs/MRIs of cN+ LHC patients treated with definitive (chemo-)radiotherapy between 2010-2019 were re-reviewed by a neuroradiologist using internationally accepted criteria for iENE-positive/negative (iENE+/iENE-). Overall survival (OS) was compared by iENE status. Multivariable analysis (MVA) was performed to confirm the prognostic value of iENE, adjusted for known potential confounders. A total of 232 LHC patients were identified, including 154 iENE-/cENE-, 60 iENE+/cENE-, and 18 iENE+/cENE+. A higher proportion of iENE+ (vs iENE-) patients had lymph node (LN) size > 3 cm [53 (67 %) vs 4 (3 %)], >=5 LNs [51 (65 %) vs 33 (21 %)], and retropharyngeal LN [12 (15 %) vs 6 (4 %)] (all p < 0.01). Median follow-up was 4.8 years. iENE+/cENE- and iENE+/cENE+patients had similarly low 5-year OS [28 % (18-44) and 29 % (13-63)] vs iENE-/cENE- [53 % (45-62)] (p < 0.001). On MVA, mortality risk was higher with iENE+vs iENE- [hazard ratio (HR) 2.22 (95 % CI 1.47-3.36)]. The prognostic value of iENE remained with MVA in larynx (n = 124) (HR 2.51 [1.35-4.68], p = 0.004] or hypopharynx (n = 108) (HR 1.87 [1.02-3.43], p = 0.04) patients, separately. Our study confirms the independent prognostic importance of iENE for LHC following definitive (chemo-)radiotherapy beyond TNM-8 cN status that already contains the cENE parameter. Further research is needed to explore whether iENE could replace cENE for future cN classification.
Pubmed PDF WebYizhuo Wei, Liu Xiao, Lina Liu, Lei Shi, Yu Wang, Bin Liu
Publication date 23-08-2024
To investigate whether lymph node (LN) yield influences clinical outcomes for pediatric patients with laterocervical lymph node metastasis (N1b) from papillary thyroid cancer (PTC). Conducted from January 1, 2008, to December 31, 2022, this was a cohort study of pediatric patients (aged ≤ 18 years) with N1b PTC who underwent total thyroidectomy and therapeutic LN dissection in the central and lateral compartments at 3 hospitals in southwest China in 2008-2021, with follow-up until 2022. Patients with distant metastasis were excluded. Univariate and multivariate Cox proportional hazards regression analyses were used to identify factors associated with persistent/recurrent diseases. A total of 102 pediatric patients (median [range] age, 16 [6-18] years) were analyzed: 36 patients (35 %) with T1; 27 patients (26 %), T2; 18 patients (18 %), T3; and 21 patients (21 %), T4. During a median follow-up of 50 months (range, 12-154 months), persistent diseases occurred in 40 (39 %) patients. Receiver operating characteristic analysis identified LN yield cut-off (<42 LNs) to predict persistent diseases. Multivariate analysis revealed that a less-extensive lymphadenectomy (<42 LNs) was an independent risk factor for persistent diseases (hazard ratio, 2.4; 95 % confidence intervals, 1.09-5.29; P=.029). Our study highlights that a higher LN yield may favorably influence prognosis in pediatric patients with N1b PTC.
Pubmed PDF Web