Sophie Dugast, Julie Longis, Marine Anquetil, Benoit Piot, Pierre Corre, Jean‐François Huon, Hélios Bertin
Publication date 23-03-2023
Abstract This systematic review aimed to evaluate the surgical techniques used for orbital floor reconstruction after Brown class III maxillectomy for cancer. Three databases were searched from January 1990 to January 2022. Of the 614 studies identified, 20 were retained after eligibility assessment.
The surgical techniques were classified into four groups: free bone flaps (A), alloplastic implants (B), bone grafts (C), and soft-tissue reconstructions (D). Ectropion and diplopia concerned 42.6% and 6.6% of the patients, respectively. Soft tissue reconstruction was more likely to cause ectropion (17/27), followed by the reconstruction techniques of group B (34/79), group C (26/70), and group A (1/7). Postoperative enophthalmos was identified in 18 patients (9.6%), mostly in group D (5/35), followed by groups B (8/68), A (3/33), and C (2/52). Free bone flaps and alloplastic implants represent good reconstructive options in terms of postoperative ocular parameters.
Takumi Hasegawa, Yasumasa Kakei, Nobuhiro Yamakawa, Tadaaki Kirita, Masaya Okura, Tomofumi Naruse, Mitsunobu Otsuru, Shin‐ichi Yamada, Hiroshi Kurita, Eiji Hirai, Shin Rin, Michihiro Ueda, Masahiro Umeda, Masaya Akashi, Japan Oral Oncology Group (JOOG)
Publication date 23-03-2023
Abstract Background The purpose of this retrospective study was to investigate the prognosis of patients with oral cavity cancer with positive margin (PM) or close margin (CM) divided into pN− and pN+ groups.
Methods The evaluated endpoints were local control and disease-specific survival (DSS) rates.
Results Higher T classification, lymphovascular space invasion (LVSI), and older age were significant risk factors for DSS in the pN− groups. On the other hand, extranodal extension, multiple lymph node metastases, and LVSI were significant risk factors for DSS in the pN+ groups. Among the CM pN+ patients, no significant differences in the 3-year DSS were observed between the only surgery (51.9%) and adjuvant groups (53.2%).
Conclusions Higher T classification and LVSI are high-risk features more than PM or CM in the pN− groups for DSS. However, further prospective studies are needed to demonstrate the usefulness of adjuvant treatment in patients with PM or CM.
Daphne A. J. J. Driessen, Anne I. J. Arens, Tim Dijkema, Willem L. J. Weijs, Lisette C. Draaijer, Guido B. Broek, Robert P. Takes, Jimmie Honings, Johannes H. A. M. Kaanders
Publication date 21-03-2023
Abstract Background The aim of this study was to investigate the feasibility of flexible endoscopy-guided tracer injection for sentinel lymph node (SLN) identification in patients with laryngeal and pharyngeal carcinoma.
Methods Sixteen cT1-4N0-2M0 patients with laryngeal or pharyngeal carcinoma underwent intra- and peritumoral 99m Tc Tc-nanocolloid injections after topical anesthesia under endoscopic guidance. SPECT–CT scans were performed at two time points.
Results Tracer injection and visualization of SLNs was successful in 15/16 (94%) patients. Median number of tracer injections was 1 intratumoral and 3 peritumoral. The median duration of the endoscopic procedure including tracer injection after biopsy taking was 7 min (range 4–16 min). A total of 28 SLNs were identified which were all visualized on the early and late SPECT–CT. Most SLNs were visualized in neck levels II and III.
Conclusions Flexible endoscopy-guided tracer injection for SLN identification is a feasible and fast procedure in laryngeal and pharyngeal carcinoma patients.
Qiuju Wang, Yanzhen Zhao, Yan Chen, Yibo Chen, Xiaoyu Song, Li Zhang, Qiao He, Bo Ye, Lichun Wu, Xinyue Huang, Dongsheng Wang
Publication date 20-03-2023
Abstract Background This study aimed at exploring the correlation between T-cadherin and programmed death-ligand 1 (PD-L1), as well as their prognostic value in patients with human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC).
Methods Immunohistochemical staining was used to identify the protein expression of T-cadherin and PD-L1. Spearman linear correlation analysis was used to determine their association. Kaplan–Meier analysis was utilized to plot overall survival (OS) and disease-free survival (DFS) curves. Cox proportional hazards regression was used to conduct univariate and multivariate analysis.
Results The results showed a negative association between protein expression of T-cadherin and PD-L1 (r = −0.760, p < 0.001), positive expression of T-cadherin was associated with a better OS (p < 0.001) and DFS (p < 0.001), while positive PD-L1 expression was associated with a worse OS (p = 0.002) and DFS (p < 0.001). The expression of T-cadherin and PD-L1 were independent prognostic predictors for OS and DFS.
Conclusions In conclusion, expression of T-cadherin and PD-L1 were largely inversely correlated and independent prognostic factors for patients with HPV-negative HNSCC.
Jong‐Lyel Roh
Publication date 20-03-2023
Abstract Background This study compared the complete closure versus the exposure of remnant parotid parenchyma in sialocele formation.
Methods This study included 151 patients with benign parotid lesions who underwent partial parotidectomy plus the complete closure or exposure of remnant parotid parenchyma. Two surgical methods of closed or exposed parenchyma were alternatively allocated to consecutive patients without randomization and blinding processes.
Results Complete closure and exposure of the remnant parotid parenchyma were performed in 81 and 70 patients.
Early postoperative complications occurred with temporary events: transient facial weakness, 24 (16%); hematoma, 9 (6%); wound infection, 1 (0.7%) without statistical difference between the two groups (p > 0.1). Postoperative sialocele was more frequently found in the exposure group (n = 15) than the closure group (n = 4; p = 0.003).
Conclusions The complete closure of remnant parotid parenchyma is preferred over the exposure of injured parenchymal parenchyma to prevent postparotidectomy sialocele.
Kourtney L. Kostecki, Mari Iida, Anne L. Wiley, Stanley Kimani, Bridget Mehall, Kaitlin Tetreault, Roxana Alexandridis, Menggang Yu, Seungpyo Hong, Ravi Salgia, Justine Y. Bruce, Raymond B. Birge, Paul M. Harari, Deric L. Wheeler
Publication date 20-03-2023
Abstract Background The tyrosine kinase receptors Axl and MerTK are highly overexpressed in head and neck cancer (HNC) cells, where they are critical drivers of survival, proliferation, metastasis, and therapeutic resistance.
Methods We investigated the role of Axl and MerTK in creating an immunologically “cold” tumor immune microenvironment (TIME) by targeting both receptors simultaneously with a small molecule inhibitor of Axl and MerTK (INCB081776). Effects of INCB081776 and/or anti-PDL1 on mouse oral cancer (MOC) cell growth and on the TIME were evaluated.
Results Targeting Axl and MerTK can reduce M2 and induce M1 macrophage polarization. In vivo, INCB081776 treatment alone or with anti-PDL1 appears to slow MOC tumor growth, increase proinflammatory immune infiltration, and decrease anti-inflammatory immune infiltration.
Conclusions This data indicates that simultaneous targeting of Axl and MerTK with INCB081776, either alone or in combination with anti-PDL1, slows tumor growth and creates a proinflammatory TIME in mouse models of HNC.
Joshua D. Smith, Megan L. Ludwig, Apurva D. Bhangale, Collin Brummel, Paul L. Swiecicki, Francis P. Worden, Steven B. Chinn, Chaz L. Stucken, Andrew J. Rosko, Mark E. P. Prince, Kelly M. Malloy, Keith A. Casper, Carol R. Bradford, Douglas B. Chepeha, Jennifer Shah, Caitlin A. Schonewolf, Jonathon B. McHugh, Mukesh K. Nyati, Avraham Eisbruch, Michelle L. Mierzwa, Matthew E. Spector, J. Chad Brenner
Publication date 18-03-2023
Abstract Background We sought to characterize early changes in CD8+ tumor-infiltrating lymphocytes and tumor transcriptomes after induction cetuximab in a cohort with p16-positive oropharyngeal cancer on a phase II clinical de-escalation trial.
Methods Tumor biopsies were obtained before and 1 week after a single cetuximab loading dose in eight patients enrolled in a phase II trial of cetuximab and radiotherapy. Changes in CD8+ tumor-infiltrating lymphocytes and transcriptomes were assessed.
Results One week after cetuximab, five patients (62.5%) had an increase in CD8+ cell infiltration with a median (range) fold change of +5.8 (2.5–15.8). Three (37.5%) had unchanged CD8+ cells (median range fold change of −0.85 0.8–1.1). In two patients with evaluable RNA, cetuximab induced rapid tumor transcriptome changes in cellular type 1 interferon signaling and keratinization pathways.
Conclusions Within 1 week, cetuximab induced measurable changes in pro-cytotoxic T-cell signaling and immune content.
Michael J. C. Schachtel, Mitesh Gandhi, Mark J. Midwinter, Benedict J. Panizza
Publication date 16-03-2023
Abstract Background In our experience, the anterior carotid sheath forms an important plane of dissection when excising temporal bone region cancers. However, its anatomical composition, relationships, and radiological appearance remains unclear.
Methods Eight sides of cadaveric heads were dissected. Anatomical findings were correlated with a high-resolution baseline T1 MRI.
Results The anterior carotid sheath was formed by the tensor-vascular-styloid fascia, stylopharyngeal fascia, buccopharyngeal fascia (BPF), and longus capitis fascia (LCF), and appeared as a hypointense line on MRI. Not previously described, the glossopharyngeal nerve pierced the sheath 9.0 mm (SD 2.1 mm) below the skull base and traveled through its LCF and BPF layers to exit near the pharynx.
Conclusion Multiple fascial layers formed the anterior carotid sheath at the skull base, and this was radiologically identifiable. Further studies are required to validate findings and investigate the role this fascial plane has in forming an effective barrier to spread of malignancy.
Tomoya Yokota, Hiroki Yukino, Mihoko Doi, Hisatsugu Ohori
Publication date 16-03-2023
Abstract Background The efficacy of entrectinib, a potent inhibitor of tropomyosin receptor kinases, c-ros oncogene 1, and anaplastic lymphoma kinase has been demonstrated in neurotrophic receptor tyrosine kinase fusion-positive pediatric and adult solid tumors. However, real-world data on entrectinib therapy for salivary gland malignancies are limited.
Methods We describe a multicenter case series of four consecutive patients with ETV6-NTRK3 fusion-positive metastatic salivary secretory carcinoma (SSC) treated with entrectinib.
Results All patients had a prior history of systemic therapy with cytotoxic chemotherapy or immune checkpoint inhibitors. All patients achieved durable radiographic complete response. Adverse events included weight gain, dizziness, increase in creatine kinase level, and withdrawal pain, but were manageable by the interruption and dose reduction of entrectinib.
Conclusion Durable complete response was achieved with entrectinib in patients with ETV6-NTRK3 fusion-positive metastatic SSC. The clinical benefit of entrectinib supports the importance of routine screening for NTRK gene fusion in patients with SSC.
Panchali Saha, Sharada Sawant, Atul Deshmukh, Arti Hole, C. Murali Krishna
Publication date 15-03-2023
Abstract Background Loco-regional recurrences attributable to field cancerization and minimal residual cancer, remain prime causes of mortality in oral cancer (OC) subjects. The current study evaluates potential of serum Raman spectroscopy (SRS) to identify recurrence-prone OC subjects.
Methods Raman spectra of serum from eight healthy subjects (H) and 57 OC subjects (with-recurrence R, without-recurrence NR, and with suspicious-lesions S), before (BS) and after (AS) surgical excision of tumor were recorded. OC subjects were followed-up for 7-years.
ResultsDNA and protein alterations were observed in AS sera of all groups. 4-, 3-, and 2-model multivariate analyses were used to stratify BS and AS groups. H spectra were 100% distinguishable from all other groups. AS, R and NR were distinguished with high accuracy (84%) in all models. No stratification (~50%) was observed BS.
ConclusionSRS shows potential to identify recurrence prone subjects, post-surgery, using serum collected as early as 1 week after surgery.
Emily Marchiano, Lulia Kana, Emily Bellile, Joshua D. Smith, Keith A. Casper, Kelly M. Malloy, Steven B. Chinn, Chaz L. Stucken, Mark E. P. Prince, Douglas B. Chepeha, Andrew J. Rosko, Matthew E. Spector
Publication date 13-03-2023
Abstract Background We examined the effect of free tissue neurotization on speech and swallowing outcomes for patients undergoing reconstruction of hemiglossectomy defects with a radial forearm free flap (RFFF).
MethodsA retrospective study was performed in patients with oral cavity squamous cell carcinoma undergoing a hemiglossectomy and reconstruction with a RFFF. Functional outcomes including nutritional mode, range of liquids and solids, and speech understandability were analyzed 1-year post-treatment.
Results Eighty-four patients were included in this analysis, 41 of whom had neurotized flaps (49%). No significant differences in demographic or clinical variables were seen between the neurotized and non-neurotized groups. On multivariate analysis controlling for BMI, flap area, and N-classification, patients with neurotized flaps were significantly more likely to have normal range of liquids and solids and less likely to have a G-tube.
Conclusions Neurotization of RFFF reconstructing hemiglossectomy defects results in decreased G-tube dependence and improved range of liquids and solids.
Belinda Vangelov, Judith Bauer, Daniel Moses, Robert Smee
Publication date 13-03-2023
Abstract Background The cross-sectional area (CSA) of skeletal muscle (SM) at the third lumbar vertebra (L3) is used to determine computed tomography (CT)-defined sarcopenia. We investigated the feasibility of SM assessment at the second thoracic vertebra (T2) in patients with head and neck cancer (HNC).
Methods Diagnostic PET-CT scans were used to develop a prediction model for L3-CSA using T2-CSA. Effectiveness of the model and cancer-specific survival (CSS) were investigated.
Results Scans of 111 patients (85% male) were evaluated.
The predictive formula: L3-CSA (cm2) = 174.15 + 0.212 × T2-CSA (cm2) – 40.032 × sex – 0.928 × age (years) + 0.285 × weight (kg) had good correlation r = 0.796, ICC = 0.882 (p < 0.001). SM index (SMI) mean difference (bias) was −3.6% (SD 10.2, 95% CI −8.7% to 1.3%). Sensitivity (82.8%), specificity (78.2%), with moderate agreement (ƙ = 0.540, p < 0.001). Worse 5-year CSS with lower quartile T2-SMI (51%, p = 0.003).
ConclusionsSM at T2 can be effectively used for CT-defined sarcopenia evaluation in HNC.
Atsushi Taguchi, Tsuyoshi Kojima, Yusuke Okanoue, Hiroki Kagoshima, Koki Hasebe, Hirotaka Yamamoto, Ryusuke Hori
Publication date 13-03-2023
Abstract Background Enucleation has been reported as a minimally invasive surgery for Warthins tumor (WT). However, the definite indications for enucleation have not been clarified.
Methods Enucleation was indicated by the following findings: findings of WT, cystic fluid, or benign leukocytes by fine-needle aspiration cytology; a well-margined and homogeneous pattern on imaging; and a tumor location in the tail or preauricular area of the parotid gland. We reviewed 552 cases treated with parotid gland surgery in our hospital.
ResultsA total of 108 tumors were treated with enucleation and included no malignant solid tumors or pleomorphic adenoma. Enucleation demonstrated low invasiveness and complication rates. Revision surgery for WT reappearance after enucleation was rare and showed minimal scarring, with a lower risk of facial weakness.
Conclusions The indication criteria for enucleation were validated. Such enucleation is useful, as it is associated with minimal invasiveness, low complication rates, and safety in revision surgery.
Carleen M. E. M. Adriaansens, Rob Noorlag, Wouter P. Visscher, Remco Bree, Gerben E. Breimer, Robert J. J. Es
Publication date 13-03-2023
Abstract Background The adequate surgical margin for local control of buccal mucosa squamous cell carcinoma (BMSCC) is under debate. This study investigates surgical margins and other factors associated with local recurrence free survival (LRFS) in a large cohort of BMSCC patients.
Methods Multiple factors were evaluated retrospectively in 97 patients with BMSCC. Cox-regression and Kaplan–Meier curves were used for analysis.
Results The local recurrence rate was 23%. The tumor-free margin was <5.0 mm in 89% of the patients and the deep margin was significantly more often inadequate. Multivariate analysis associated pT3-classification, former smokers, tumor-free margin status, and postoperative (chemo)radiation (PO(ch)RT) with local recurrence. Re-resections did not improve LRFS in patients with <5.0 mm tumor-free margins.
Conclusions Adequate tumor-free margins are pivotal for LRFS of BMSCC. PO(ch)RT, not re-resection, can improve LRFS in patients with <5.0 mm tumor-free margins.
Patryk Ostrowski, Elżbieta Szczepanek, Kazimierz Niemczyk, Michał Bonczar, Mateusz Michalczak, Jakub Batko, Agata Krawczyk‐Ożóg, Wadim Wojciechowski, Jerzy Walocha, Mateusz Koziej
Publication date 13-03-2023
Abstract Background Knowledge about the anatomy of the lingual artery (LA) is of immense importance when performing procedures on the base of tongue (BOT).
MethodsA retrospective analysis was performed to establish morphometric data of the LA. The measurements were performed on 55 consecutive patients who underwent head and neck computed tomography angiographies (CTA).
ResultsA total of 96 LAs were analyzed. Additionally, a three-dimensional heat map (showing the oropharyngeal region from the lateral, anterior, and superior point of view) of the occurrence of the LA and its branches was created.
Conclusion The length of the main trunk of the LA was measured to be 31.94 ± 11.44 mm. This reported distance is thought to be a surgical safe zone when performing transoral robotic surgery (TORS) on the BOT because it represents the area where the LA does not give off any major branches.
Yukinori Takenaka, Atsuhiko Uno, Hidenori Tanaka, Norihiko Takemoto, Hidenori Inohara
Publication date 13-03-2023
Abstract Background Head and neck squamous cell carcinoma (HNSCC) with distant metastasis (DM) has poor prognosis. HNSCC has several histological variants with varying characteristics. We investigated the DM rates and prognoses of patients with DM among the HNSCC variants.
Methods We obtained data from 54 722 cases using the Surveillance, Epidemiology, and End Results database. Odds ratios (ORs) for DM and hazard ratios (HRs) for overall survival (OS) were estimated using a logistic regression model and a Cox proportional hazard model, respectively.
ResultsDM rate was the lowest in verrucous carcinoma and the highest in basaloid squamous cell carcinoma (BSCC) (0.2% and 9.4%, respectively). ORs for DM were 3.63 for adenosquamous carcinoma, 6.80 for BSCC, and 3.91 for spindle cell carcinoma (SpCC). SpCC was significantly associated with a poor OS (HR, 1.61).
ConclusionsDM rates differed among the HNSCC variants. The prognosis of metastatic SpCC is worse than that of other metastatic HNSCCs.
Shun‐Ji Wang, Bo Lin, Shi‐Yue Shen, Jian‐Lin Lin, Tian‐Wen Zhang, Hong‐Yu Yang
Publication date 13-03-2023
Abstract Background This study examined the postoperative follow-up attendance of oral squamous cell carcinoma (OSCC) patients, evaluated some of the factors associated with it, and assessed its relationship with early detection of postoperative disease progression.
Methods An exploratory retrospective cohort study of 430 OSCC patients was conducted. We examined associations of follow-up attendance within the first year after surgery with selected demographic and clinical factors, and with early detection of disease progression.
Results The mean number of follow-up visits within the first year after surgery was 3.9 out of the 12 recommended at our center; few patients were fully adherent. Age ≥70 years, unmarried status, high education level, and negative history of surgery for premalignant or malignant lesions from oral cavity or other sites were significantly associated with lower follow-up attendance. Greater follow-up attendance was significantly associated with early detection of disease progression during the first year after surgery (p = 0.025).
Conclusions Adherence to follow-up visits was poor. Several sociodemographic and clinical factors were related to follow-up attendance, greater follow-up attendance was significantly associated with early detection of disease progression, and these should be further explored in future research.
Matthew Beckett, Marc Gaudet, Jean‐Marc Bourque, Kristopher Dennis, May Abdel‐Wahab
Publication date 13-03-2023
Abstract Background Not all patients with locally advanced head and neck cancer (HNC) who are eligible for adjuvant radiotherapy (RT) following upfront surgery appear to receive it.
Methods Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Selected patients from 2009 to 2018 had locally advanced HNC, underwent upfront surgery, and were eligible for adjuvant RT. Multivariable logistic regression and chi-squared test were used to analyze available patient and tumor characteristics.
Results Of 12 549 patients, 84.5% underwent adjuvant RT, 15.5% did not. Characteristics associated with lowest adjuvant RT utilization included cancers of the larynx (p < 0.0001) and gingivae (p < 0.0001), age 80 and above (p < 0.0001), unpartnered status (p < 0.0001), and residence within a nonmetropolitan area (p < 0.0024).
Conclusions Tumor subsite, age, partnered status, and rural/urban residence correlate with omission of adjuvant RT in locally advanced HNC.
James C. Gates, Allison P. Clark, Elliot Cherkas, Aditya V. Shreenivas, Dennis Kraus, Natalie Danzinger, Richard S. P. Huang, Jennifer Johnson, Jeffrey S. Ross
Publication date 13-03-2023
Abstract Background Ameloblastoma may present a significant treatment challenge in the locally advanced, recurrent and metastatic setting. Comprehensive genomic profiling (CGP) can identify targetable genomic alterations to aid in treatment.
Methods Ameloblastoma samples were sequenced using hybrid-capture based sequencing. A systematic literature review was performed to examine outcomes in studies employing targeted treatment in ameloblastoma.
Results We reviewed 14 cases of Ameloblastoma using CGP. There were six patients with activating BRAF mutations, five with PIK3CA, five with SMO, four with FGFR2, one with EGFR, and one with ROS1. All cases were MSI stable and the median TMB was 2.5 mutations/Mb. A separate literature review of clinical outcomes in ameloblastoma showed a predominance of at least partial response to targeted treatment (7/12 cases).
ConclusionCGP is helpful in identifying specific driver mutations in patients with complex ameloblastoma. Targeted treatment has been employed with success in achieving treatment response.
Jun Ho Lee, Hee Jun Choi, Jung‐Woo Woo, Eun‐Jung Jung
Publication date 13-03-2023
Abstract Background This study compared the surgical outcomes of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) in papillary thyroid cancer (PTC).
Methods The TOETVA and TORT groups comprised 119 and 121 patients between November 2016 and May 2022. Clinico-surgical outcomes and operation times were retrospectively reviewed.
Results The TORT group showed a higher number of retrieved central compartment lymph nodes, shorter hospital stays, and lower pain score after 48 h than the TOETVA group. No significant difference was observed in the other postoperative complications, including permanent vocal cord palsy. Total operation, working space creation, and endoscopic or robotic surgery times of the TORT group were longer than those of the TOETVA group.
ConclusionsTORT and TOETVA are feasible and safe. TORT may have some advantages, such as central compartment node dissection, shorter hospital stays, and pain score after 48 h in PTC, despite a longer operative time.
Thanion Soopanit, Natthawadee Laokulrath, Veeruth Chayopasakul, Warut Pongsapich
Publication date 13-03-2023
Abstract Background Non-smokers, non-drinkers, and non-betel quid chewers (NSNDNBs) with oral squamous cell carcinoma (OSCC) have poor survival outcomes. Tumor microenvironment based on PD-L1/CD8+ T cell infiltrated lymphocyte (TIL) proportion is proposed as a prognostic indicator.
Methods Immunohistochemistry staining was performed on OSCC samples from 64 patients. The PD-L1/CD8+ TILs were scored and stratified into four groups. Disease-free survival (DFS) was analyzed using a Cox regression model.
ResultsOSCC in NSNDNB patients was associated with female sex, T1-2 classification, and PD-L1 positivity. Low CD8+ TILs correlated with perineural invasion. High CD8+ TILs correlated with improved DFS. PD-L1 positivity was not correlated with DFS. Type IV tumor microenvironment yielded the highest DFS (85%).
ConclusionNSNDNB status relates to PD-L1 expression regardless of CD8+ TILs infiltration. Type IV tumor microenvironment was associated with the best DFS. High CD8+ TILs resulted in better survival, while PD-L1 positivity alone was not correlated to DFS.
Shannon S. Wu, Hanna Hong, Michael Fritz, Jamie Ku, Brandon Prendes, Natalie Silver, Dane J. Genther, Peter Ciolek, Patrick Byrne, Philip Brauer, Chandana A. Reddy, Neil Woody, Shauna Campbell, Shlomo A. Koyfman, Eric D. Lamarre
Publication date 13-03-2023
Abstract Background Resected oral cavity carcinoma defects are often reconstructed with osteocutaneous or soft-tissue free flaps, but risk of osteoradionecrosis (ORN) is unknown.
Methods This retrospective study included oral cavity carcinoma treated with free-tissue reconstruction and postoperative IMRT between 2000 and 2019. Risk-regression assessed risk factors for grade ≥2 ORN.
Results One hundred fifty-five patients (51% male, 28% current smokers, mean age 62 ± 11 years) were included. Median follow-up was 32.6 months (range, 1.0–190.6). Thirty-eight (25%) patients had fibular free flap for mandibular reconstruction, whereas 117 (76%) had soft-tissue reconstruction. Grade ≥2 ORN occurred in 14 (9.0%) patients, at a median 9.8 months (range, 2.4–61.5) after IMRT. Post-radiation teeth extraction was significantly associated with ORN. One-year and 10-year ORN rates were 5.2% and 10%, respectively.
ConclusionsORN risk was comparable between osteocutaneous and soft-tissue reconstruction for resected oral cavity carcinoma. Osteocutaneous flaps can be safely performed with no excess concern for mandibular ORN.
Qian Liu, Lixin Lun, Meng Sun, Zekun Wang, Xiaodong Huang, Xuesong Chen, Jingbo Wang, Jianghu Zhang, Yuan Qu, Kai Wang, Runye Wu, Ye Zhang, Jianping Xiao, Junlin Yi, Jingwei Luo
Publication date 13-03-2023
Abstract Background The necessity of level III irradiation in patients with node-negative advanced sinonasal squamous cell carcinoma (SNSCC) is unclear.
Methods Seventy-eight patients with advanced SNSCC were included. Survival rates were estimated and compared between treatment groups.
Results Twenty-five patients received ipsilateral levels Ib and II irradiation (group 1) and 53 patients received ipsilateral levels Ib and II plus level III irradiation (group 2). The median follow-up time was 75.56 months. Five-year survival rates (regional relapse-free survival, overall survival, local relapse-free survival, and distant metastasis-free survival) were similar between groups 1 and 2 (all p > 0.05). Irradiation doses to the thyroid and larynx were significantly lower in group 1 than in group 2.
Conclusions Ipsilateral irradiation of levels Ib and II neck provides similar regional control and results as irradiation of these levels plus level III, with lower irradiation doses to normal neck tissue, in patients with node-negative advanced SNSCC.
Theofano Tikka, Mark Andrew Hall, Sarah Margaret Blieck, Malcolm Alexander Buchanan
Publication date 13-03-2023
Abstract Background Vertical closure of the pharynx after laryngectomy can result in an outpouch of the anterior wall of the neopharynx below the tongue base, called a pseudo-diverticulum. The prolapsed mucosa that separates the rest of the neopharynx from the pseudo-diverticulum is termed a pseudo-epiglottis.
Methods Prospective study of patients with pseudo-epiglottis. M. D. Anderson Dysphagia Inventory (MDADI) scores were used to assess swallowing outcomes pre- and post-pseudo-epiglottis division, including minimally clinically important difference (MCID) assessment.
Results Of 16 patients with a pseudo-epiglottis, 12 had dysphagia (75%). Symptomatic patients had significantly worse global MDADI and subscale scores. After division, the mean composite MDADI increased from 48.3 to 64.7 (p = 0.035), including a high MCID (16.4) with a similar improvement in the global question rating findings (31.1 vs. 60, p = 0.021). The MCID was significant for all MDADI subscales.
Conclusions Pseudo-epiglottis formation is associated with significantly worse global and subscale MDADI scores. A clinically- and statistically-significant improvement in the MDADI scores was found following surgical division.
Sudhir Bhandari, Bhavita Wadhwa Soni, Ankita Gupta, Sushmita Ghoshal
Publication date 13-03-2023
Abstract Background Prophylactic oral care (POC) before radiotherapy (RT) is an adjunct but an integral process toward preparing patients for RT, however, time to be invested in POC remains unexplored.
Methods Prospective treatment records were maintained in head and neck cancer patients, who received POC following a standardized protocol with definite timelines. Data collected for oral treatment time (OTT), interruption in RT due to oro-dental issues, future extraction(s), and incidence of osteoradionecrosis (ORN) up to 18 months after treatment were analyzed.
Results Three hundred thirty-three patients, 275 males and 58 females, mean age 52.45 ± 11.2 years were included. Mean OTT was 21.0 ± 6.2 days and was influenced significantly with the number of extractions (p < 0.00). There was no interruption in RT schedule due to oro-dental issues. Five patients were diagnosed with ORN.
Conclusion Performing POC as demonstrated aid in timely removal of nidus of infection(s), perform RT as scheduled, and maintain satisfactory oral health through the survivorship of patients.
Anna C. H. Willemsen, Walmari Pilz, Ann Hoeben, Frank J. P. Hoebers, Annemie M. W. J. Schols, Laura W. J. Baijens
Publication date 13-03-2023
Abstract Background This study aims to investigate the relationship between cancer cachexia and oropharyngeal dysphagia (OD) in patients with head and neck cancer (HNC) prior to chemoradiotherapy or bioradiotherapy (CRT/BRT).
MethodsA prospective cohort study with patients with HNC undergoing CRT/BRT (2018–2021) was conducted. Body composition and skeletal muscle function were evaluated using bioelectrical impedance analysis, handgrip strength, and the short physical performance battery (SPPB). The M. D. Anderson Dysphagia Inventory (MDADI), Eating Assessment Tool (EAT)-10 questionnaire, and patient characteristics were collected. A standardized videofluoroscopic swallowing study was offered to patients.
Results Sixty-six patients were included. Twenty-six patients scored EAT-10 ≥ 3 and seventeen were cachectic. ACE-27 score >1, cachexia, abnormal SPPB-derived repeated chair-stand test, lower MDADI scores, and higher overall stage grouping showed potential predictive value (p ≤ 0.10) for EAT-10 ≥ 3. Using multivariable regression analysis, only cachexia remained a significant predictor of EAT-10 ≥ 3 (HR 9.000 95%CI 2.483–32.619, p = 0.001).
Conclusion Cachexia independently predicted the presence of patient-reported OD.
Elizabeth C. Ward, Kelli Hancock, Jenni Boxall, Clare L. Burns, Ann‐Louise Spurgin, Belinda Lehn, Juliet Hoey, Rachelle Robinson, Adele Coleman
Publication date 13-03-2023
Abstract Background This study examined post-laryngectomy pulmonary and related symptom changes following establishment of an optimal day/night regimen (all day/night wear of devices with improved humidification) using a new generation range of heat and moisture exchanger (HME) devices.
Methods In Phase 1 (6 weeks), 42 post-laryngectomy HME users transitioned from their usual HME regime to equivalent new device/s (i.e., “like-for-like”). In Phase 2 (6 weeks) participants used the full range of HMEs to achieve an optimal day/night regimen. Pulmonary symptoms, device use, sleep, skin integrity, quality of life and satisfaction were examined at baseline, and weeks 2 and 6 of each Phase.
Results From baseline to end of Phase 2, cough symptoms and impact significantly improved, as did sputum symptoms, sputum impact, duration and types of HMEs used, reasons for HME replacement, involuntary coughs, and sleep.
Conclusion The new HME range supported improved HME use, with pulmonary and related symptom benefits.
Anirudh Yalamanchali, Kailin Yang, Logan Roof, Nerea Lopetegui‐Lia, Larisa M. Schwartzman, Shauna R. Campbell, Neil M. Woody, Natalie Silver, Shlomo Koyfman, Jessica L. Geiger, Emrullah Yilmaz
Publication date 13-03-2023
Abstract Objectives Evaluate outcomes of patients with recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy (IO).
Methods Among patients with R/M HNSCC treated with IO in this retrospective single-institution cohort, Cox regression was used to compare overall survival (OS) for those with platinum-refractory disease and those treated in the first-line setting with OS from KEYNOTE-040/048, respectively. Multivariable Cox regression was used to identify predictors of OS.
Results There was no significant OS difference for those treated in the platinum-refractory setting when compared to patients on KEYNOTE-040 (HR = 1.22, p = 0.27), nor for the first-line setting compared to KEYNOTE-048 (HR = 1.23, p = 0.19). ECOG-PS 1 (HR = 2.00, p = 0.02) and ECOG-PS 2 (HR = 3.13, p < 0.01) were associated with worse OS. Higher absolute lymphocyte count (ALC) was associated with improved OS (HR = 0.93 per 100 cells/μL, p = 0.03).
Conclusions Real-world outcomes of IO in R/M HNSCC are similar to outcomes in randomized control trials, with performance status and ALC correlating with OS.
Michael R. Papazian, Michael S. Chow, Adam S. Jacobson, Theresa Tran, Mark S. Persky, Michael J. Persky
Publication date 13-03-2023
Abstract Background There are several options for primary surgical treatment of early-stage supraglottic squamous cell carcinoma (SCC), including transoral robotic surgery (TORS). The purpose of this study was to compare outcomes of TORS to open partial laryngectomy and transoral laser microsurgery (TLM).
Methods Patients with clinical classification T1-2 supraglottic SCC diagnosed 2010–2019, treated with TORS, open partial laryngectomy, or TLM in the National Cancer Database were selected.
Results One thousand six hundred three patients were included: 17% TORS, 26.5% TLM, 56.5% open. TORS patients had the lowest rates of adjuvant treatment (28.4% vs.
TLM: 45.0%, open: 38.5%, p < 0.001), and lower positive margin rates than TLM (16.9% vs. 30.5%, p < 0.001). Thirty-day and ninety-day post-operative mortality did not differ between the approaches. Five-year survival was higher following TORS compared to open surgery (77.8% vs. 66.1%, p = 0.01); this difference persisted following matched-pair analysis.
ConclusionsTORS may be a safe and effective surgical approach for early-stage supraglottic SCC in appropriate patients.
Tianxiao Wang, Yehao Zhang, Jia Wu, Hongjie Feng, Ruixia Wang, Hua Yuan
Publication date 13-03-2023
Abstract Background Oral squamous cell carcinoma (OSCC) is the most common cancer in the oral cavity. The relationship between the genetic susceptibility of circCHST15 and OSCC remains unclear.
Methods Genetic variants of circCHST15 were screened using a genotyping analysis from 1044 patients with OSCC and 3199 healthy participants. The circCHST15 expression was detected in 32 pairs of OSCC tissues. The circular RNA quantitative trait locus analysis and the reporter gene assay were performed for verification.
Results The circCHST15 expression was upregulated in OSCC (Wilcoxon p < 1e−3). The genotyping analysis screened out 61 loci in circCHST15 associated with the risk of OSCC. After adjustment and annotation, rs28707473 (A > C, odds ratio = 1.21, 95% CI: 1.076–1.361, p = 1.453e−3) was selected. This genetic variation could elevate the circCHST15 expression level possibly by altering the structure of circular RNAs and affecting transcription factor binding.
Conclusions The results of this study suggested that genetic variants of circCHST15 may contribute to OSCC susceptibility.
Sebastian Regnery, Henrik Franke, Thomas Held, Thuy Trinh, Ariel Naveh, Yissachar Abraham, Juliane Hörner‐Rieber, Jochen Hess, Peter E. Huber, Jürgen Debus, Ramon Lopez Perez, Sebastian Adeberg
Publication date 13-03-2023
Abstract Background We aimed to demonstrate the effects of tumor treating fields (TTFields) in head and neck squamous cell carcinoma (HNSCC) cells when combined with radiotherapy (RT) and chemotherapy.
Methods Two human HNSCC cell lines (Cal27, Fa Du) received five different treatments: TTFields, RT +/− TTFields and RT + simultaneous cisplatin +/− TTFields. Effects were quantified using clonogenic assays and flow cytometric analyses of DAPI, caspase-3 activation and γH2AX foci.
Results Treatment with RT + TTFields decreased the clonogenic survival as strong as treatment with RT + simultaneous cisplatin. The triple combination of RT + simultaneous cisplatin + TTFields even further decreased the clonogenic survival. Accordingly, combination of TTFields with RT or RT + simultaneous cisplatin increased cellular apoptosis and DNA double-strand breaks.
ConclusionTTFields therapy seems a promising combination partner in the multimodal treatment of locally advanced HNSCC. It could be used to intensify chemoradiotherapy or as alternative to chemotherapy.
Chiara Mossinelli, Marta Tagliabue, Francesca Ruju, Giulio Cammarata, Stefania Volpe, Sara Raimondi, Mattia Zaffaroni, Johannes Lars Isaksson, Cristina Garibaldi, Marta Cremonesi, Federica Corso, Aurora Gaeta, Ilaria Emili, Stefano Zorzi, Daniela Alterio, Giulia Marvaso, Matteo Pepa, Elvio De Fiori, Fausto Maffini, Lorenzo Preda, Marco Benazzo, Barbara Alicja Jereczek‐Fossa, Mohssen Ansarin
Publication date 13-03-2023
Abstract Background Radiomics represents an emerging field of precision-medicine. Its application in head and neck is still at the beginning.
Methods Retrospective study about magnetic resonance imaging (MRI) based radiomics in oral tongue squamous cell carcinoma (OTSCC) surgically treated (2010–2019; 79 patients). All preoperative MRIs include different sequences (T1, T2, DWI, ADC). Tumor volume was manually segmented and exported to radiomic-software, to perform feature extraction. Statistically significant variables were included in multivariable analysis and related to survival endpoints. Predictive models were elaborated (clinical, radiomic, clinical-radiomic models) and compared using C-index.
Results In almost all clinical-radiomic models radiomic-score maintained statistical significance. In all cases C-index was higher in clinical-radiomic models than in clinical ones. ADC provided the best fit to the models (C-index 0.98, 0.86, 0.84 in loco-regional recurrence, cause-specific mortality, overall survival, respectively).
ConclusionMRI-based radiomics in OTSCC represents a promising noninvasive method of precision medicine, improving prognosis prediction before surgery.
Maartje Leemans, Maarten J. A. Alphen, Wim Vallenduuk, Richard Dirven, Michiel W. M. Brekel, Sara H. Muller
Publication date 13-03-2023
Abstract Background To improve the understanding of the thermodynamics and performance of small passive hygroscopic Heat and Moisture Exchangers (HMEs), a computer model simulating HME function is required.
Methods We developed a numerical HME model to calculate the HMEs water and heat exchange. The model was tuned and verified with experimental data and validated by applying it to HME design variations.
Results Verification of the models results to the experimental data shows that the tuned model yields reliable results. The mass of the core, which determines the HMEs total heat capacity, is the most important parameter influencing the performance of passive HMEs.
Conclusions Increasing the HMEs diameter is an effective way to improve an HME, as it yields higher performance and lowers breathing resistance. HMEs intended for use in warm or dry climates should contain more and those for use in cold humid climates should contain less hygroscopic salt.
Pengfei Diao, Rong Huang, Yawei Shi, Qin Yao, Yibin Dai, Hua Yuan, Yanling Wang, Jie Cheng
Publication date 13-03-2023
Abstract Background Enhancer RNAs (eRNAs) are increasingly recognized as prognostic biomarkers—across human cancers. Here, we sought to develop a novel eRNA-regulated genes (ERGs)-derived prognostic signature for head neck squamous cell carcinoma (HNSCC).
Methods Candidate ERGs were identified via co-expression between individual survival-related eRNAs and their putative targets by Spearmans correlation analyses. The ERG signature was developed by univariate Cox regression, Kaplan–Meier survival analysis and maximum AUC in 1000 iterations of LASSO-penalized multivariate Cox regression. An ERG nomogram incorporating ERG signature and selected clinicopathological parameters were constructed by multivariate Cox regression. Biological roles of eRNA of interest were further explored in vitro.
Results The ERG signature successfully stratified patients into subgroups with distinct survival in multiple cohorts. An ERG nomogram was developed with satisfactory performance in prognostication. Inhibition of ENSR00000165816 significantly reduced transcript level of SLC2A9 and impaired cell proliferation and invasion.
Conclusion Our results establish ERG signature and nomogram as powerful prognostic predictors for HNSCC.
Publication date 13-03-2023
Carleen M. E. M. Adriaansens, Klijs J. de Koning, Remco de Bree, Jan Willem Dankbaar, Gerben E. Breimer, Robert J. J. van Es, Rob Noorlag
Publication date 13-03-2023
Yu‐Hao Liao, Wei‐Yi Chou, Chun‐Wei Chang, Mei‐Chun Lin, Cheng‐Ping Wang, Pei‐Jen Lou, Tseng‐Cheng Chen
Publication date 13-03-2023
Abstract Background Oral cancer causes significant morbidity and mortality. Chemoprevention utilizes medication or natural compounds to reverse oral premalignant lesions and to prevent second primary tumors.
MethodsA comprehensive Pub Med database and Cochrane Library search from 1980 to 2021 was performed using the keywords “leukoplakia,” “oral premalignant lesion,” and “chemoprevention.”Results Chemopreventive agents included retinoids, carotenoids, cyclooxygenase inhibitor, herbal extracts, bleomycin, tyrosine kinase inhibitors, metformin, and immune checkpoint inhibitors. Although some agents demonstrated effect in reducing premalignant lesions and preventing second primary tumors, the results among different studies were highly variable.
Conclusions The results of different trials, albeit inconsistent, provided substantial information for future studies. In the era of personalized medicine, future studies will focus on identifying specific biomarkers and molecular profile to monitor and to prevent malignant transformation. Larger trials are warranted to validate the effect of chemopreventive agents.
Jennifer Dörfler, Maren Freuding, Christopher Zaiser, Jens Büntzel, Christian Keinki, Lukas Käsmann, Jutta Hübner
Publication date 13-03-2023
Abstract Acupuncture is a common part of complementary medicine. However, traditional Chinese acupuncture has been built on concepts which are not in accordance with science-based medicine. Our aim was to critically assess the evidence presented in systematic reviews (SRs) and meta-analyses (MAs) about the effectiveness of acupuncture on radiotherapy induced xerostomia. A systematic search was conducted in February 2022. We evaluated all SRs/MAs using the AMSTAR-2 instrument. Eight SRs, with 12 controlled studies were included. All SRs summarize that the methodological drawbacks do not allow to give a clear statement about the effectiveness of acupuncture. While objective assessments in most SRs/MAs reported no difference between real and sham acupuncture, some favorable effects on subjective xerostomia symptoms are found. No clinical meaningful effectiveness of acupuncture on xerostomia has been proven so far, but positive subjective findings need to be explored more. While most SRs recommend further studies, studies involving patients with a serious cancer diagnosis are ethically questionable.
Pubmed PDF WebHarleen K. Sethi, Christopher E. Fundakowski
Publication date 13-03-2023
Abstract The surgical approach to a parotid neoplasm has traditionally been taught through a modified-Blair incision. This approach results in a visible scar in the preauricular, retromandibular, and upper neck skin. Various modifications have been undertaken which aim to improve cosmesis either by decreasing overall incision length and/or relocation of the incision to the hairline via what is commonly described as a “facelift approach”. We describe a novel minimally invasive parotidectomy approach which utilizes a single retroauricular incision. This approach eliminates both the preauricular scar as well as the extended incision in the hairline and additional skin flap elevation which accompanies it. Sixteen patients underwent parotidectomy using this minimally invasive incision and the excellent clinical outcomes are reviewed. The minimally invasive retroauricular approach to parotidectomy provides excellent exposure with no visible incision/scar in appropriately selected patients.
Pubmed PDF WebLisa Tuomi, Julia Magnusson‐Sandkvist, Jonatan Fridolfsson, Daniel Arvidsson, Mats Börjesson, Caterina Finizia
Publication date 13-03-2023
Abstract Background Pre-treatment levels of physical activity (PA) in head and neck cancer (HNC) are rarely evaluated using accelerometry. This study aimed to investigate whether pre-treatment PA level in HNC predicts aspects of long-term health-related quality of life (HRQL) at 12 months after end of treatment.
Methods This pilot study included 48 patients diagnosed with HNC, 41 participants remaining at 12 months post-treatment. Pre-treatment PA was objectively assessed by an accelerometer. Self-perceived PA and HRQL were assessed pre-treatment and at 6- and 12-months post-treatment.
Results Patients with a higher pre-treatment PA level scored higher on physical function and role function and less fatigue and pain at the 12 months follow-up compared to patients with a lower pre-treatment PA. At 6 months the groups differed only on physical functioning. When comparing changes over time, there were statistically significant differences comparing high and low pre-treatment PA in the fatigue and pain domains between 6 and 12 months. Exploratory multiple regression analyses also indicated that higher pre-treatment PA levels were associated with greater favorable change in the four HRQL measures.
Conclusions Higher levels of PA assessed with accelerometer before oncologic treatment associated favorably with aspects of self-perceived HRQL and PA over time in patients with HNC.
Sarbani Ghosh Laskar, Shwetabh Sinha, Meetakshi Gupta, Shreyasee Karmakar, Meenakshi Nivedha J., Sadhana Kannan, Ashwini Budrukkar, Monali Swain, Anuj Kumar, Tejpal Gupta, Vedang Murthy, Devendra Chaukar, Prathamesh Pai, Pankaj Chaturvedi, Gouri Pantvaidya, Deepa Nair, Sudhir Nair, Shivakumar Thiagarajan, Anuja Deshmukh, Vanita Noronha, Vijay Patil, Amit Joshi, Kumar Prabhash, Jai Prakash Agarwal
Publication date 13-03-2023
Abstract Background To assess the efficacy of prophylactic versus reactive feeding strategy in oral cavity squamous cell carcinoma (OCSCC) patients receiving adjuvant radiation therapy (RT).
Methods This was a post hoc analysis of patients of OCSCC enrolled in a randomized trial comparing three adjuvant strategies. In this trial, till 2010, a prophylactic feeding approach was followed for all patients. Since January 2011, a reactive feeding approach was followed.
Results Two hundred and sixty-eight in each cohort (total n = 526) were eligible for analysis after propensity score matching. At 6 weeks post-RT completion, the median weight loss in the prophylactic versus reactive cohort was 5 versus 3 kg, p = 0.002. At all other time points until 1 year, the median weight loss was lesser in reactive than in the prophylactic cohort.
ConclusionsA reactive feeding tube approach should be preferred for OCSCC receiving adjuvant RT.
Gianluigi Napoli, Rocco Tritto, Marco Moscarelli, Cinzia Forleo, Maria Grazia Carmela La Marca, Lin Yang, Giuseppe Biondi‐Zoccai, Arturo Giordano, Yamume Tshomba, Martino Pepe
Publication date 10-03-2023
Abstract Background Pre-operative embolization prior to surgical resection of carotid body tumors was meant to decrease intraoperative blood loss and operative time. Yet, potential confounders such as different Shamblin classes have never been analyzed. Aim of our meta-analysis was to investigate effectiveness of a pre-operative embolization according to different Shamblin classes.
Methods Five studies comprising 245 patients were included. A random effects model meta-analysis was conducted, and the I2 statistic was used to assessment for heterogeneity.
Results Pre-operative embolization was associated with a significant reduction in blood loss (WM: 276.4 mL; 95% CI, 201.9–378.3, p < 0.01); an absolute mean reduction, though not statistically significant, was observed in both Shamblin 2 and 3 classes. No difference in operative time was found between the two strategies (WM: 192.0 min; 95% CI, 157.7–234.1, p = 1.0).
Conclusions Embolization proved an overall significant reduction in perioperative bleeding, which did not reach threshold for statistical significance when Shamblin classes were singularly considered.
Kurtis Young, Hannah Bulosan, Carley C. Kida, Arnaud F. Bewley, Marianne Abouyared, Andrew C. Birkeland
Publication date 09-03-2023
Abstract There are limited data supporting the commonly suggested 5 mm margin cutoff as the optimum value in defining clear margins in oral cancer. A database search of Pubmed/Medline, Web of Science, and EBSCOhost was performed from inception to June 2022. A random-effects model was chosen for this meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed throughout this study. Seven studies met study criteria (2215 patients). The risk ratio was significantly higher for margins <5 mm when compared to those ≥5 mm (2.09 (95%CI: 1.53–2.86, I2 = 0.47)). Subgroup analysis (I2 = 0.15) of margin distances of 0.0–0.9, 1.0–1.9, 2.0–2.9, 3.0–3.9, and 4.0–4.9 mm calculated risk ratios for local recurrence of 2.96, 2.01, 2.17, 1.8, and 0.98, respectively. Margins between 4.0 and 4.9 mm had similar risk ratios for local recurrence compared to ≥5 mm, while margins <4.0 were significantly higher.
Pubmed PDF WebKotaro Tamagawa, Hirotaka Shinomiya, Takuya Okada, Shun Tatehara, Masanori Teshima, Ryohei Sasaki, Ken‐ichi Nibu
Publication date 09-03-2023
Abstract Background Superselective cisplatin (CDDP) infusion via the external carotid artery system and concomitant radiotherapy (RADPLAT) provides favorable oncological and functional outcomes in patients with maxillary sinus cancer. However, targeted lesions are occasionally fed by the branch of the internal carotid artery.
Methods In RADPLAT for maxillary sinus cancer partly fed by the ophthalmic artery, the ethmoid arteries were ligated in two patients without medial orbital wall involvement. In four patients with that, CDDP was administered via the ophthalmic artery.
ResultsA complete response was obtained in all six patients. Locoregional recurrence was not observed in any cases. However, visual acuity was lost in four patients who received the ophthalmic artery infusion.
Conclusions Ligation of the ethmoid arteries is recommended in RADPLAT for maxillary sinus cancer with lesions fed by the ophthalmic artery. CDDP administered via the ophthalmic artery may be considered if a patient accepts the possibility of visual loss.
Vishwanatha M. Rao, Allen L. Feng, Daniel G. Deschler, Howard L. Kaufman, Derrick T. Lin, David Miller, Jeremy D. Richmon, Sophia Z. Shalhout, Mark A. Varvares, Kevin S. Emerick
Publication date 08-03-2023
Abstract Background Understanding the impact of surgical treatment on regionally metastatic cutaneous squamous cell carcinoma (cSCC).
Methods Retrospective series of 145 patients undergoing parotidectomy and neck dissection for regionally metastatic cSCC to the parotid. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) analyzed over 3 years. Multivariate analysis was completed using Cox proportional hazard models.
ResultsOS was 74.5%, DSS was 85.5% and DFS was 64.8%. On multivariate analysis, immune status (HR = 3.225OS, 5.119DSS, 2.071DFS) and lymphovascular invasion (HR = 2.380OS, 5.237DSS, 2.595DFS) were predictive for OS, DSS, and DFS. Margin status (HR = 2.296OS, 2.499DSS) and ≥18 resected nodes (HR = 0.242OS, 0.255DSS) were predictive of OS and DSS, while adjuvant therapy was predictive of DSS (p = 0.018).
Conclusions Immunosuppression and lymphovascular invasion portended worse outcomes in patients with metastatic cSCC to the parotid. Microscopically positive margins and <18 nodes resected are associated with worse OS and DSS, while patients receiving adjuvant therapy had improved DSS.
Kaitlynne Y. Pak, Spencer R. Anderson, Tyler L. Langenfeld, Kenneth Tan, Allison Slijepcevic, Sunishka Wimalawansa, Yadranko Ducic, Mark K. Wax, Sameep P. Kadakia
Publication date 08-03-2023
Abstract Background The utilization of an arteriovenous loop is an underreported technique that affords the creation of reliable vascular options. Understanding the efficacy and impacting variables of microvascular reconstruction with an arteriovenous loop can be critical to its use.
Methods Multi-institutional study of 36 patients who underwent vein grafting or AV loop with free tissue transfer.
Results58.3% of patients received prior radiation and 38.9% prior flap reconstruction. Flap success for vein grafting was 76% and AV loop was 100% (p = 0.16). Success for the radiated cohort was 90.5% and non-radiated 80% (p = 0.63). Flap success for the radiated, vein grafted patient was 83.3% and 100% flap success rate for radiated, AV loop patient (p = 0.49). Overall flap survival was 83.3% versus 97% overall success rate in the United States.
Conclusion The AV loop is a viable modality for vessel-depleted free tissue reconstruction. Radiation and previous surgery do not significantly impact flap success rates.
Markus Atula, Katri Aro, Heikki Irjala, Elina Halme, Anna Jouppila‐Mättö, Petri Koivunen, Tommy Wilkman, Henry Blomster, Antti Mäkitie, Timo Atula
Publication date 07-03-2023
Abstract Background Head and neck cancers (HNCs) are often diagnosed at an advanced stage. We investigated the lengths and factors associated with patient, primary health care (PHC), and specialist care (SC) delays in T3–T4 oral, oropharyngeal, and laryngeal cancer.
MethodsA nationwide prospective questionnaire-based study (n = 203) with the 3-year long data collection period.
Results The median patient, PHC and SC delays were 58, 13, and 43 days, respectively. Lower level of education, heavy alcohol use, hoarseness, difficulties breathing, and eventual palliative treatment associated with a longer patient delay. A lump on the neck or facial swelling associated with a shorter PHC delay. Conversely, if symptoms were treated as an infection, PHC delay was longer. The treatment modality and tumor site affected SC delay.
Conclusions Patient delay stands as the most notable factor contributing to delays before treatment. HNC symptom awareness thus remains especially important among HNC risk groups.
Na Wang, Yulan Lin, Fa Chen, Fengqiong Liu, Jing Wang, Bingju Gao, Yu Qiu, Lisong Lin, Bin Shi, Baochang He
Publication date 07-03-2023
Abstract Background To assess the prognostic role of gamma-glutamyl transpeptidase to lymphocyte count ratio (GLR) and develop a prognostic nomogram for patients with oral cancer.
MethodsA prospective cohort (n = 1011) was conducted during July 2002 to March 2021 in Southeastern China.
Results The median follow-up time was 3.5 years. Multivariate Cox regression (OS: HR = 1.51, 95% CI: 1.04, 2.18) and Fine–Gray model (DSS: HR = 1.68, 95% CI: 1.14, 2.49) both showed that high GLR could act as an indicator of poor prognosis. A nonlinear dose–response relationship was observed between continuous GLR and the risk of all-cause mortality (p for overall = 0.028, p for nonlinear = 0.048). Compare with TNM stage, time-dependent ROC curve proved that GLR-based nomogram model performs better in predicting prognosis (the area under curve for 1-, 3-, and 5-years mortality: 0.63, 0.65, and 0.64 vs. 0.76, 0.77, and 0.78, p < 0.001).
ConclusionGLR might be a useful tool in predicting prognosis for patients with oral cancer.
Juan Xu, Guang Yang, Wei An, Wei Wang, Fangfang Li, Yingtao Meng, Xingli Wang
Publication date 03-03-2023
Abstract Background This study aimed to investigate correlations of the severity of radiation-induced oral mucositis (RIOM) with epidermal growth factor (EGF) and inflammatory cytokines in patients with head and neck cancer (HNC).
Methods Levels of inflammatory cytokines and EGF in saliva of HNC patients were measured. Correlations of inflammatory cytokines and EGF levels with RIOM severity and pain degree, and their diagnostic values on RIOM severity were determined.
Results Elevated IFN-γ, TNF-α, IL-2, and IL-6 levels, and reduced IL-4, IL-10, and EGF levels were found in patients with severe RIOM. IFN-γ, TNF-α, IL-2, and IL-6 were positively correlated with RIOM severity, while IL-10, IL-4, and EGF were negatively correlated with it. All factors were effective in predicting the severity of RIOM.
ConclusionIFN-γ, TNF-α, IL-2, and IL-6 in saliva of patients with HNC are positively correlated with the severity of RIOM, and IL-4, IL-10, and EGF were negatively correlated with it.
Alice N. Weaver, Stephanie Lakritz, Divneet Mandair, Mark B. Ulanja, Daniel W. Bowles
Publication date 01-03-2023
Abstract Salivary gland carcinomas (SGC) are a rare and variable group of head and neck cancers with historically poor response to cytotoxic chemotherapy and immunotherapy in the recurrent, advanced, and metastatic settings. In the last decade, a number of targetable molecular alterations have been identified in SGCs including HER2 upregulation, androgen receptor overexpression, Notch receptor activation, NTRK gene fusions, and RET alterations which have dramatically improved treatment outcomes in this disease. Here, we review the landscape of precision therapy in SGC including current options for systemic management, ongoing clinical trials, and promising future directions.
Pubmed PDF WebShaurav Maulik, Paromita Roy, Indranil Mallick, Sriram Prasath, B. Arun, Sanjoy Chatterjee
Publication date 01-03-2023
Abstract Background The literature on modern-era outcomes of oropharyngeal squamous carcinoma (OPSCC) in India is limited.
Materials and Methods We analyzed records of consecutive patients with OPSCC treated using a curative SIB IMRT regimen of 66 Gy/30#/6 weeks.
Results One hundred fifteen patients from July 2011 to December 2018 were analyzed. Twenty of 69 patients tested positive for p16. In p16 positive patients, the K-M probability of being disease free and alive at 2 years, with at least one follow-up 3 months after treatment, was 83% (median not reached) compared with 48% if p16 was unknown/negative. Patients staged as IVB p16 negative had a 2-year DFS of 25%. Patients unfit for cisplatin and consequently received other agents had 2-year DFS estimated at 20%.
Conclusions Intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) and concurrent chemotherapy was feasible, with toxicity and disease control comparable to available literature. AJCC Stage IVB p16 negative disease had notably poor outcome.
Rushi Patel, Julia Nguyen, Hannaan S. Choudhry, Mehdi S. Lemdani, Richard Chan Woo Park
Publication date 01-03-2023
Abstract Background Opioids are commonly used to manage the pain of head and neck (HN) cancer patients.
Methods Retrospective cohort of graduates from American Head and Neck Society accredited fellowships from 1997 to 2018. The Center for Medicare and Medicaid Services Part D Provider Utilization and Payment database 2014–2019 was cross-referenced with provider names to identify opioid prescription trends.
Results From 2014 to 2019, there was no significant difference in the average number of opioid beneficiaries per provider (18.02 vs. 18.10, p = 0.586) or opioid claims per provider (28.06 vs. 26.73, p = 0.708). The average total opioid day supply per beneficiary declined from 11.09 to 7.05 days from 2014 to 2019 (p < 0.001). In 2019, providers in the Northeast had the lowest prescribed opioid day supply (3.67 days) compared to those from the South who had the highest (10.32 days).
Conclusions Opioid prescription length has significantly declined among HN surgeons, with variations across geographic regions.
Zichen Qiu, Feifei Lin, Zheng Wu, Taihua Wu, Mingli Wang, Jiang Hu, Dehuan Xie, Shaowen Lyu, Jun Ma, Yalan Tao, Yong Su
Publication date 01-03-2023
Abstract Background Most nasopharyngeal carcinoma (NPC) protocols define primary gross tumor volume (GTVnx) plus a range from 2 to 5 mm as the high-dose clinical target volume (hd-CTV). However, in China, hd-CTV is defined as GTVnx plus 0 mm.
MethodsA total of 40 patients with newly diagnosed nonmetastatic NPC (T1–T4 ten cases each) treated with IMRT were consecutively enrolled. Real and virtual treatment plans were designed according to the definitions of hd-CTV recommended by China and Radiation Therapy Oncology Group (RTOG), respectively.
Results The hd-CTV in China was significantly smaller than that of RTOG. Exposure doses to 5 mm subclinical involvement and OARs as well as NTCP in the China treatment plan were significantly lower than those of RTOG.
Conclusion It could be recommended to divide the hd-CTV into GTV and subclinical target volume and to prescribe different doses for the GTV and subclinical involvement in the IMRT plan of NPC.
Yanyan Chen, Quxia Zhang, Tianzhu Lu, Cairong Hu, Jingfeng Zong, Yun Xu, Wei Zheng, Lisha Chen, Senan Lin, Sufang Qiu, Luying Xu, Jianji Pan, Qiaojuan Guo, Shaojun Lin
Publication date 01-03-2023
Abstract Background In intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), priority is often given minimize dose to the critical organs at risk (OARs) to avoid potential morbid sequelae. However, in T4 NPC, dosimetric inadequacy enforced by dose constraints on OARs may significantly impact tumor control.
Methods This was a single-institute cohort that patients diagnosed between July 2005 and December 2010 with T4 NPC treated with IMRT. All patients were re-classification according to the 7th-AJCC stage.
Results Overall, the average doses such as Dmax, D1%, D2% and D1cc for various Central nervous system (CNS) OARs including brainstem, optic nerve, chiasm, temporal lobes and spinal cord were found to exceed published guidelines as RTOG0225. However, no clinical toxicities were seen during the follow-up period except for 13% patients with temporal lobe necrosis.
Conclusion Our retrospective review showed that its feasible to maximize gross tumor volume dose coverage while exceeding most CNS OAR constraint standards, with ideal local control and no obvious increase of craniocerebral toxicity.
Halil Cumhur Yildirim, Gulnihan Eren Kupik, Teuta Zoto Mustafayev, Tanju Berber, Berrin Yavuz, Oguz Cetinayak, Ozlem Akagunduz, Beyhan Ceylaner Bıcakcı, Suheyla Aytac Arslan, Ela Delikgoz Soykut, Mete Gundog, Metin Figen, Fatma Teke, Emine Canyilmaz, Sumerya Duru Birgi, Mursel Duzova, Sefik İgdem, Candan Demiroz Abakay, Beste Atasoy, Nuri Kaydihan, Murtaza Parvizi, Gonca Hanedan Uslu, Halil Saginc, Fadime Akman, Enis Ozyar
Publication date 28-02-2023
Abstract Background We aimed to evaluate patients with nasopharyngeal carcinoma (NPC) in a nonendemic population.
Methods In a national, retrospective, multicenteric study, 563 patients treated with intensity modulated radiotherapy at 22 centers between 2015 and 2020 were analyzed.
Results Median age was 48 (9–83), age distribution was bimodal, 74.1% were male, and 78.7% were stage III-IVA. Keratinizing and undifferentiated carcinoma rates were 3.9% and 81.2%. Patients were treated with concomitant chemoradiotherapy (48.9%), or radiotherapy combined with induction chemotherapy (25%) or adjuvant chemotherapy (19.5%). After 34 (6–78) months follow-up, 8.2% locoregional and 8% distant relapse were observed. Three-year overall survival was 89.5% and was lower in patients with age ≥50, male sex, keratinizing histology, T4, N3 and advanced stage (III-IVA).
Conclusions Patients with NPC in Turkey have mixed clinical features of both east and west. Survival outcomes are comparable to other reported series; however, the rate of distant metastases seems to be lower.
Matthew E. Witek, Christopher G. Morris, Gregory S. Alexander, Pragnya Dontu, Antony I. Koroulakis, William F. Regine, William M. Mendenhall
Publication date 28-02-2023
Abstract Background To evaluate disease control, toxicities, and variables associated with clinical outcomes for patients with head and neck squamous cell carcinoma and clinical N3 disease (HNSCC N3) treated with definitive chemoradiation therapy.
Methods We performed a retrospective review of patients with HNSCC N3 treated at two high-volume academic centers between 1996 and 2019.
Results We identified 85 patients with a median follow-up of 2.8 years. Five-year overall survival, regional control, and freedom from distant metastases rates were 38%, 80%, and 80%, respectively. Severe complications were identified in 19% of patients.
Conclusions Favorable regional control is achievable with definitive chemoradiation therapy for patients with HNSCC N3 disease. Distant metastases are a common pattern of failure and should be a focus of prospective study.
"Fanny Collette, Georges Lawson, Samantha Hassid, Gilles Delahaut, Vincent Bachy, Sébastien Van Der Vorst, Laurence Faugeras, Quentin Gilliaux, Lionel DHondt"
Publication date 25-02-2023
Abstract Background Recurrent respiratory papillomatosis (RRP) is a currently incurable benign neoplasm caused by human papilloma virus (HPV) infection. It usually reduces voice, respiratory, and general quality of life, and is sometimes life-threatening. Patients usually need repeated operations. The use of adjuvant bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A, has been described in several case reports, with a good efficacy and safety profile.
Methods We report the cases of five patients with aggressive RRP who were treated with adjuvant systemic bevacizumab in a single Belgian tertiary center.
ResultsA complete response was achieved in four patients after a median of 4.5 months, and a partial response in one. In all cases, the number of surgeries was drastically reduced, and quality of life improved. Toxicity was easily managed.
Conclusions Systemic bevacizumab seems to be an effective and safe adjuvant treatment for aggressive RRP.
Young Chul Kim, Seok Joon Lee, Hojin Park, Young Jun Choi, Woo Shik Jeong, Yoon Se Lee, Kyoung Hyo Choi, Tae Suk Oh, Jong Woo Choi
Publication date 25-02-2023
Abstract Background This study aimed to explore the outcomes of motor-innervated free flaps in hemi-tongue reconstruction by assessing the tongue mobility through midsagittal images from cine-magnetic resonance imaging.
Methods In this retrospective study, 47 patients who underwent tongue reconstruction following hemi-glossectomy and 10 control subjects without any surgical history were included.
Patients were classified into two groups: the motor and no-motor innervation group. Various spatial parameters related to tongue mobility that were acquired from midsagittal sections were compared during consecutive swallowing phases.
Results Overall, the motor group showed improved functional swallowing scale compared with the no-motor group. In case of tongue base resection, the motor group showed improved mobility of the tongue base during pharyngeal phase, whereas the no-motor group showed increased laryngeal elevation for compensatory movement.
Conclusion The tongue reconstruction with motor-innervated free flaps may facilitate swallowing capacity in patients with a hemi-tongue defect combined with tongue base resection.
Ariel E. Pollock, Danielle Arons, Gregory S. Alexander, David Alicia, Kayla M. Birkman, Jason K. Molitoris, Ranee Mehra, Kevin J. Cullen, Kyle M. Hatten, Rodney J. Taylor, Jeffrey S. Wolf, William F. Regine, Matthew E. Witek
Publication date 25-02-2023
Abstract Background To determine if the extent of high-dose gross tumor volume (GTV) to clinical target volume (CTV) expansion is associated with local control in patients with p16-positive oropharynx cancer (p16+ OPC) treated with definitive intensity modulated proton therapy (IMPT).
Methods We performed a retrospective analysis of patients with p16+ OPC treated with IMPT at a single institution between 2016 and 2021. Patients with a pre-treatment PET–CT and restaging PET–CT within 4 months following completion of IMPT were analyzed.
Results Sixty patients were included for analysis with a median follow-up of 17 months. The median GTV to CTV expansion was 5 mm (IQR: 2 mm). Thirty-three percent of patients (20 of 60) did not have a GTV to CTV expansion. There was one local failure within the expansion group (3%).
Conclusion Excellent local control was achieved using IMPT for p16+ OPC independent of GTV expansion. IMPT with minimal target expansions represent a potential harm-minimization technique for p16-positive oropharynx cancer.
Ciro Franzese, Sara Lillo, Luca Cozzi, Maria Ausilia Teriaca, Marco Badalamenti, Luciana Di Cristina, Veronica Vernier, Sara Stefanini, Damiano Dei, Stefano Pergolizzi, Armando De Virgilio, Giuseppe Mercante, Giuseppe Spriano, Pietro Mancosu, Stefano Tomatis, Marta Scorsetti
Publication date 23-02-2023
Abstract Background Prediction of survival and radiation therapy response is challenging in head and neck cancer with metastatic lymph nodes (LNs). Here we developed novel radiomics- and clinical-based predictive models.
Methods Volumes of interest of LNs were employed for radiomic features extraction. Radiomic and clinical features were investigated for their predictive value relatively to locoregional failure (LRF), progression-free survival (PFS), and overall survival (OS) and used to build multivariate models.
Results Hundred and six subjects were suitable for final analysis. Univariate analysis identified two radiomic features significantly predictive for LRF, and five radiomic features plus two clinical features significantly predictive for both PFS and OS. The area under the curve of receiver operating characteristic curve combining clinical and radiomic predictors for PFS and OS resulted 0.71 (95%CI: 0.60–0.83) and 0.77 (95%CI: 0.64–0.89).
Conclusions Radiomic and clinical features resulted to be independent predictive factors, but external independent validation is mandatory to support these findings.
Publication date 15-11-2020
Patrick Dubach, Thiago Oliveira–Santos, Stefan Weber, Nicolas Gerber, Andreas Dietz, Marco Caversaccio
Publication date 03-09-2018
ABSTRACTBackground Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT is increasingly used for the evaluation of regional or distant metastasis in head and neck oncology. However, positive PET findings lack specificity, which is especially challenging for localized disease at the skull base.
Methods An optically tracked navigation system for multimodal image-guided biopsies was tested to evaluate PET-positive skull base lesions between 2009 and 2013.
ResultsFDG-PET/CT navigated biopsies of patients with suspected persistence or recurrence of carcinoma (sinonasal, n = 3; nasopharyngeal, n = 1; adenocarcinoma, n = 2; and carcinoma of unknown primary origin, n = 1) have been safely performed. Histology confirmed local persistent or recurrent malignant disease (n = 5), radio-osteonecrosis (n = 1), and super-infection (n = 1).
Conclusion In the follow-up of patients with tumors, FDG-PET/CT-navigated biopsies are a valid tool to evaluate PET-positive skull base lesions. This is an especially useful technique if functional anomalous areas in FDG-PET/CT do not cause structural alterations in MRI/CT, and if endoscopic visualization is impossible because of posttreatment alterations. © 2014 Wiley Periodicals, Inc. Head Neck, 2014