Magdalena Fay, Paul E. Clavijo, Clint T. Allen
Publication date 15-04-2024
Abstract Background Neutrophilic cells are among the most abundant immune populations within the head and neck tumor microenvironment (TME) and harbor multiple mechanisms of immunosuppression. Despite these important features, neutrophilic cells may be underrepresented in contemporary studies that aim to comprehensively characterize the immune landscape of the TME due to discrepancies in tissue processing and analysis techniques. Here, we review the role of pathologically activated neutrophilic cells within the TME and pitfalls of various approaches used to study their frequency and function in clinical samples.
Methods The literature was identified by searching Pub Med for “immune landscape” and “tumor immune microenvironment” in combination with keywords describing solid tumor malignancies. Key publications that assessed the immune composition of solid tumors derived from human specimens were included. The tumor and blood processing methodologies in each study were reviewed in depth and correlated with the reported abundance of neutrophilic cells.
Results Neutrophilic cells do not survive cryopreservation, and many studies fail to identify and study neutrophilic cell populations due to cryopreservation of clinical samples for practical reasons. Additional single-cell transcriptomic studies filter out neutrophilic cells due to low transcriptional counts.
Conclusions This report can help readers critically interpret studies aiming to comprehensively study the immune TME that fail to identify and characterize neutrophilic cells.
Qing Sun, Xing Li, Zhihui Zhu, Xiting Xiang, Shu Zhang, Xiaowei Liu, Xiao Long, Tao Zhang
Publication date 15-04-2024
Abstract Background Trigeminal trophic syndrome (TTS) is a rare condition caused by damage to the trigeminal nervous system, resulting in sensory disturbances and ulcers on the face. Treating TTS is complex and often requires medical or surgical intervention like flap reconstruction. However, there is limited research on surgical treatments for TTS ulcers.
Methods We report the case of a 19-year-old man with TTS. We employed an innovative surgical technique involving dual cross-face nerve grafts. In the initial procedure, corneal neuralization was accomplished using supraorbital and cross-face infraorbital nerve graft. The subsequent operation utilized auricular composite tissue flap transplantation repair and cross-face mental nerve graft.
Results This procedure led to rapid and sustained healing, as well as aesthetic improvement.
Conclusion Cross-face nerve grafts is a promising tool in the treatment of refractory ulcers caused by diseases such as TTS.
Arjun Singh, Richard Sullivan, Manasi Bavaskar, Rathan Shetty, Poonam Joshi, Sudhir Nair, Sudeep Gupta, Pankaj Chaturvedi, Rajendra Badwe
Publication date 15-04-2024
Abstract Introduction India contributes two-thirds of the global mortality due to oral cancer and has a younger population at risk. The societal costs of this premature mortality are barely discussed.
Methods Using the human capital approach, we aimed to estimate the productivity lost due to premature mortality, valued using individual socioeconomic data, related to oral cancer in India. A bottom-up approach was used to prospectively collect data of 100 consecutive patients with oral cancer treated between 2019 and 2020, with a follow-up of 36 months.
Results The disease-specific survival for early and advanced stage was 85% and 70%, with a median age of 47 years. With 671 years lost prematurely, the loss of productivity was $41 900/early and $96 044/advanced stage. Based on population level rates, the total cost of premature mortality was $5.6 billion, representing 0.18% of GDP.
Conclusion India needs to implement tailored strategies to reduce the economic burden from premature mortality.
Allen S. Zhou, Elliana K. DeVore, Amy F. Juliano, Jeremy D. Richmon
Publication date 12-04-2024
Abstract Background Anatomic landmarks such as the tympanomastoid suture line, posterior belly of the digastric muscle, tragal pointer, and styloid process can assist the parotid surgeon in identifying and preserving the facial nerve. Vascular structures such as the posterior auricular artery and its branch, the stylomastoid artery, lay in close proximity to the facial nerve and have been proposed as landmarks for the identification of the facial nerve. In this case report, we describe an anatomic variation in which the stylomastoid artery has fenestrated the main trunk of the facial nerve, dividing it in two.
Methods Two patients underwent parotidectomy (one for a pleomorphic adenoma, the second for a parotid cyst) through a standard anterograde approach with identification of the usual facial nerve landmarks.
Results The appearance of the main trunk of the facial nerve was unusual in both patients due to its being fenestrated by the stylomastoid artery. The stylomastoid artery was divided, and the remainder of the facial nerve dissection was performed uneventfully with subsequent resection of the parotid mass in both patients.
Conclusions In rare instances, the stylomastoid artery can penetrate through the common trunk of the facial nerve. This is an important anatomic variant for the parotid surgeon to be aware of, as it can increase the difficulty of facial nerve dissection.
Jonathan C. Garneau, Rod Rezaee
Publication date 12-04-2024
Abstract Background The concept of reserve flow perfusion for free flap reconstruction has been demonstrated in various applications in the literature. As it relates to the anterolateral thigh (ALT) free flap, the reserve flow principle has been primarily described to either augment or “supercharge” a large ALT to optimize skin perforator supply or lengthen the vascular pedicle.
Methods We report a case of a 77-year old male with chronic renal failure who had extensive atherosclerosis of the proximal descending lateral circumflex femoral artery (LCFA) where arterial anastomosis was unable to be performed.
Results We were able to circumvent this limitation by establishing reserve flow perfusion solely through the distal end of the descending LCFA. We describe our technique within the context of current literature on the topic of reverse flow perfusion in free flap reconstruction.
Conclusion This report uniquely describes applying the distally based, reverse arterial flow principle in an ALT flap to circumvent an atherosclerotic proximal pedicle.
Praneet C. Kaki, Doreen Lam, Neel R. Sangal, Karthik Rajasekaran, Ara C. Chalian, Robert M. Brody, Gregory S. Weinstein, Steven B. Cannady
Publication date 10-04-2024
Abstract Background Transoral robotic surgery (TORS) for oropharyngeal malignancy optimizes oncologic outcomes while preserving functionality. This study identifies patterns of functional recovery after TORS with free flap reconstruction (FFR).
Methods Retrospective cohort study at a tertiary care center of patients with primary oropharyngeal tumors treated with TORS with FFR between 2010 and 2022.
Patients were categorized into: adjuvant chemoradiation or radiation, or no adjuvant therapy (NAT). Functional outcomes were measured by functional oral intake scale (FOIS).
Results241 patients were included. FOIS declined at first postoperative appointment (median = 7.0 to 2.0, IQR = 7.0, 7.0, 2.0, 4.0), and progressively improved to 6.0 (5.0, 6.0) after 1 year, with NAT having the highest FOIS (7.0, p < 0.05). Predictors of poor long-term FOIS included RT and hypoglossal nerve (CN XII) involvement (p < 0.05).
ConclusionsTORS with FFR leads to good long-term function with minimal intake restrictions. Radiation therapy and CN XII involvement increase risk of worse functional outcomes.
Johannes N. van der Lely, Niek J. Nieuwdorp, Ineke C. A. W. Smits, Floris V. W. J. van Zijl, Eveline M. L. Corten, Marc A. M. Mureau
Publication date 10-04-2024
Abstract Background Facial palsy profoundly affects patients quality of life (QoL). We evaluated the effect of various surgical procedures on QoL using patient-reported outcome measures (PROMs) to provide evidence-based recommendations for improved care.
Methods Embase, Medline, Web of Science, Cochrane, and CINAHL were searched for studies on QoL in patients with facial palsy who had undergone reconstructive surgery with preoperative and postoperative data from validated PROMs. After conducting the quality assessment, data were subtracted from the articles. Meta-analyses of subgroups were performed when study outcomes where compatible.
Results Incorporating 24 studies (522 patients), our systematic review revealed consistent and significant QoL improvements following diverse reconstructive surgical procedures.
Conclusions Our systematic review and meta-analysis showed the positive effects of different reconstructive surgical procedures on QoL of patients with facial palsy. These results support clinicians to better inform patients about their potential outcomes, optimizing informed and shared decision-making and ultimately improving overall QoL in patients with facial palsy.
Hilary C. McCrary, Janice L. Farlow, John Alexander, Catherine T. Haring, Stephen Y. Kang, Matthew O. Old, Nolan B. Seim
Publication date 10-04-2024
Abstract The osteocutaneous radial forearm free flap (OCRFFF) is a versatile flap with the ability to reconstruct complex defects. We detail the techniques necessary to harvest an OCRFFF, including an outline on making 90-degree osteotomies to maximize bone harvest. In this pictorial essay, we provide illustrations of the anatomy and surgical techniques necessary for OCRFFF harvest. Detailed discussion is provided on how to protect the perforators to the bone and the approach to making osteotomies in a 90-degree fashion. The approach for prophylactic plating of the radius to prevent radius fractures is outlined. A case presentation on the real-life utilization of this flap is included. The OCRFFF is an excellent head and neck reconstructive option. While there are limitations to its use for patients requiring dental rehabilitation or long/anterior mandibular defects, for the right patient and indication it has shown great success in reconstructive efforts.
Pubmed PDF WebXavier Liem, Thierry de Baère, Omar I. Vivar, Tanguy Y. Seiwert, Colette Shen, Zsuzsanna Pápai, Victor Moreno, Zoltán Takácsi‐Nagy, Frigyes Helfferich, Juliette Thariat, Zhen Gooi, Sue S. Yom, Paolo Bossi, Robert L. Ferris, Trevor G. Hackman, Christophe Le Tourneau, Joseph Rodriguez, Caroline Hoffmann
Publication date 10-04-2024
Abstract Background An international multidisciplinary panel of experts aimed to provide consensus guidelines describing the optimal intratumoral and intranodal injection of NBTXR3 hafnium oxide nanoparticles in head and neck squamous cell carcinoma (HNSCC) of the oral cavity, oropharynx, and cervical lymph nodes and to review data concerning safety, feasibility, and procedural aspects of administration.
Methods The Delphi method was used to determine consensus. A 4-member steering committee and a 10-member monitoring committee wrote and revised the guidelines, divided into eight sections. An independent 3-member reading committee reviewed the recommendations.
Results After two rounds of voting, strong consensus was obtained on all recommendations. Intratumoral and intranodal injection was deemed feasible. NBTXR3 volume calculation, choice of patients, preparation and injection procedure, potential side effects, post injection, and post treatment follow-up were described in detail.
Conclusions Best practices for the injection of NBTXR3 were defined, thus enabling international standardization of intratumoral nanoparticle injection.
Anne‐Sophie Becker, Jenny Merkel, Inci Bozkurt, Daniel Fabian Strüder, Claudia Maletzki, Maja Hühns, Annette Helene Zimpfer
Publication date 09-04-2024
Abstract Background Human papillomavirus (HPV) is an increasing risk factor for cancer. HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable outcome. Blockstaining for p16 is a surrogate marker for HPV+ OPSCC. In oral and laryngeal squamous cell carcinoma (OSCC/LSCC), the relevance of p16 immunohistochemistry, alone or in combination with other cell cycle-related proteins, to identify HPV-driven non-OPSCC is less well understood.
Methods We stained for p16, p Rb, cyclin D1, and p53 in 327 HNSCC. In 310 OPSCC, HPV-status was assessed by HPV DNA PCR. In 119 non-OPSCC, RNA in situ hybridization was additionally performed. HPV-status was correlated with staining patterns, p53 and clinical data.
Results The OPSCC showed blockstaining for p16 in 36%, 8% were equivocal. Of these, HPV-testing was performed in 57%, and 53% were positive for HPV DNA. HPV-association correlated with absence of p Rb and cyclin D1 and favorable outcome. In non-OPSCC, 18% showed p16-blockstaining, and 13% showed E6/E7 RNA. Six of seven HPV+ OSCC and 8/8 LSCC lost p Rb and cyclin D1. Compared to HPV-negative counterparts, patients with HPV+ cancers had lower rates of alcohol consumption and keratinizing morphology. HPV-positive OSCC had a longer overall survival (p < 0.05). HPV subtype 16 was the most common.
Conclusions We conclude that HPV-positive non-OPSCC are associated with p16 overexpression and low levels of p Rb and cyclin D1. High expression of p Rb and cyclin D1 indicates HPV-negativity.
Leyu Li, Lixiao Fan, Zheng Jiang, Xin Yang, Dejuan Wang, Fei Chen, Deying Gu, Jun Liu
Publication date 09-04-2024
Abstract Background Preserving laryngeal function and reconstructing the hypopharynx in advanced hypopharyngeal cancer pose significant challenges for head and neck surgeons.
MethodsA 48-year-old male patient was diagnosed with advanced hypopharyngeal cancer originating from the left pyriform sinus. The tumor extended into the hypopharynx, left vocal cord, ventricular fold, partial aryepiglottic fold, and a segment of the cervical esophagus. A curative tumor resection was performed, and a well-thought-out strategy was employed for hypopharyngeal repair and laryngeal reconstruction.
Results Following the surgery, the patient demonstrated exceptional flap survival, and the tracheostomy tube was removed at the 6-month mark. No surgery-related complications were observed, and both swallowing and vocal functions exhibited a robust recovery.
Conclusion Our reconstruction strategy proves effective in preserving laryngeal function among patients with advanced hypopharyngeal cancer.
Sohta Matsumura, Takeo Sato, Satoshi Matsushima, Tatsushi Kokubu, Tadashi Umehara, Teppei Komatsu, Kenichiro Sakai, Hidetaka Mitsumura, Yasuyuki Iguchi
Publication date 09-04-2024
Abstract BackgroundA case of retropharyngeal abscess complicated by both artery and nerve injury has rarely been reported.
MethodsA 36-year-old woman suddenly presented with right eye visual loss, dilated pupil, reduced direct light reflex, ptosis and ocular motility disorder on the side of inflammation progression, and was diagnosed with retropharyngeal abscess due to Fusobacterium necrophorum. The patient was treated only with antibiotics and, no further surgery was necessary but tracheotomy. Four months later, MRA showed right ICA occlusion and left ICA stenosis. MRI revealed continuous spread of inflammation due to the abscess from the retropharyngeal to the intracranial space.
Results These severe complications would be attributed to an endothelial damage to the arterial wall and an ischemic neuropathy caused by inflammation and thrombogenesis due to Fusobacterium necrophorum.
Conclusions This case should provide a better understanding of the mechanism of vascular and cranial nerve injury due to retropharyngeal infections, and highlights the need for early antibiotic therapy and repeated vascular evaluation.
Publication date 09-04-2024
Yu Zhang, Yiqiao Wang, Yu Zhu, Hongwei Wan
Publication date 09-04-2024
Abstract The diagnostic efficacy of the water swallow test (WST) is relatively robust for patients with neurogenic dysphagia; however, its diagnostic performance in identifying dysphagia among patients with HNC varies across studies. Our study aims to assess the diagnostic value of the WST for detecting dysphagia in patients with HNC. Systematic retrieval of studies on the use of WST for screening dysphagia in patients with HNC from databases up to August 1, 2023. Quality assessment of the included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the screening ability of WST for dysphagia. A total of seven articles, encompassing eight study groups, were included, involving the analysis of 691 patients. The meta-analysis results demonstrate that the WST has a combined sensitivity, specificity, positive LR, negative LR, DOR, and AUC for diagnosing dysphagia in patients with HNC of 0.82 (95% CI 0.64, 0.92), 0.79 (95% CI 0.70, 0.86), 4.00 (95% CI 2.51, 6.36), 0.22 (95% CI 0.10, 0.50), 17.94 (95% CI 5.56, 57.92), and 0.86 (95% CI 0.83, 0.89), respectively. Significant heterogeneity was observed among the included studies. Meta-regression analysis showed that the pooled sensitivity of tumor sites and treatment was closely related, while the pooled specificity of treatment and version was closely related. The subgroup analysis showed that the WSTs pooled sensitivity for diagnosing dysphagia in patients with nasopharyngeal cancer was 0.40 (95% CI 0.26, 0.56), with an AUC of 0.50, lower than in other HNC sites. The WST performed better in surgical patients than in those undergoing radiotherapy (RT) or chemoradiotherapy (CRT), with lower sensitivity, specificity, and AUC values of 0.49 (95% CI 0.36, 0.61), 0.66 (95% CI 0.59, 0.72), and 0.64, respectively, for RT or CRT patients. The modified WST version showed different specificity values of 0.82 (95% CI 0.75, 0.87), compared to the regular version of 0.68 (95% CI 0.61, 0.74). Additionally, Deeks test indicated the absence of publication bias in this study (p = 0.32). The WST demonstrates favorable sensitivity and specificity in detecting dysphagia among patients with HNC. However, the diagnostic value may vary depending on factors such as tumor sites, treatment, and the specific version of the WST used.
Pubmed PDF WebYi‐Jun Dong, Hong‐Hui Zhang, Jia‐Qiao Liang, Ya‐Ya Gao, Ming Xiong, Hui Yang
Publication date 09-04-2024
Abstract Laryngeal paraganglioma (LP) is an exceptionally rare neuroendocrine tumor, underscoring importance of accurate identification to preclude misdiagnoses. In this review, we presented two typical misdiagnosed LPs, and offered reviews of LP cases reported over the preceding decade and all documented misdiagnosed LP cases. Furthermore, we systematically investigated the underlying causes of misdiagnosis and elucidated key points for effective differentiation. A retrospective analysis of 28 LP cases revealed a predominant occurrence in middle-aged women, with an average history of 25.1 months. Through an analysis of all misdiagnosed cases (n = 37), supraglottic LPs were frequently misidentified as laryngeal carcinomas and vascular tumors, while subglottic LPs were often misdiagnosed as thyroid cancers. And the occurrence of misdiagnosis resulted in delayed and inappropriate treatments, contributing to the deterioration of LP patients (14 cases, 37.8%). In conclusion, this review endeavored to heighten awareness of LPs, with the ultimate goal of advancing diagnostic precision and enhancing patient outcomes.
Pubmed PDF WebJoshua Barlow, Zara Sragi, Nina Rodriguez, Mathilda Alsen, Catharine Kappauf, Rocco Ferrandino, Susmita Chennareddy, Tamar Kotz, Diana N. Kirke, Marita S. Teng, Eric M. Genden, Mohemmed N. Khan, Scott A. Roof
Publication date 09-04-2024
Abstract Background Traditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6–14 days post-operatively due to concern for orocutaneous fistula development.
Methods Multiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed- and random-effects meta-analyses were used.
Results One randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = −0.02, p = 0.06) or free flap failure (RD = −0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference days = −2.43, p < 0.01).
Conclusions While further prospective trials are necessary, initiation of oral intake before post-operative day 5 may be appropriate in properly selected patients following oral reconstruction.
Olivier Gaiffe, Joackim Mahdjoub, Emmanuel Ramasso, Olivier Mauvais, Thomas Lihoreau, Lionel Pazart, Bruno Wacogne, Laurent Tavernier
Publication date 09-04-2024
Abstract Background Autofluorescence spectroscopy is effective for noninvasive detection but underutilized in tissue with various pathology analyses. This study evaluates whether AFS can be used to discriminate between different types of laryngeal lesions in view of assisting in vocal fold surgery and preoperative investigations.
MethodsA total of 1308 spectra were recorded from 29 vocal fold samples obtained from 23 patients. Multiclass analysis was performed on the spectral data, categorizing lesions into normal, benign, dysplastic, or carcinoma.
Results Through an appropriate selection of spectral components and a cascading classification approach based on artificial neural networks, a classification rate of 97% was achieved for each lesion class, compared to 52% using autofluorescence intensity.
Conclusions The ex vivo study demonstrates the effectiveness of AFS combined with multivariate analysis for accurate classification of vocal fold lesions. Comprehensive analysis of spectral data significantly improves classification accuracy, such as distinguishing malignant from precancerous or benign lesions.
Jake J. Lee, Nicholas A. Rapoport, Patrik Pipkorn, Sidharth V. Puram, Ryan S. Jackson
Publication date 09-04-2024
Abstract Objectives To assess airway, safety, and resource utilization outcomes between transoral base of tongue (BOT) surgery with staged versus concurrent bilateral neck dissections (BND).
MethodsA retrospective cohort study of patients with human papilloma virus (HPV)-related BOT cancer who underwent transoral surgery and BND from January 2015 through June 2022 was conducted. Free flap patients were excluded.
Results Of 126 patients (46 37% staged and 80 63% concurrent BND), there were no significant differences in rates of postoperative intubation, tracheostomy, intensive care admission, operative takebacks, gastrostomy, and 30-day readmission. Total operative time (median difference 1.4 95% CI 0.9–1.8 hours), length of stay (1.0 1.0–1.0 day), and time between primary surgery and adjuvant therapy initiation (4.0 0.0–8.0 days) were lower in the concurrent BND cohort.
Conclusion Concurrent BND alongside transoral BOT resection is safe with similar airway outcomes and lower total operative time, length of stay, and time to adjuvant therapy initiation compared to staged BND.
Heather M. Starmer, Joanne Patterson, Bridget Young, Jason Fleming, Mary Gemma Cherry
Publication date 09-04-2024
Abstract Purpose To develop a head and neck lymphoedema (HNL) specific quality of life (QoL) instrument to assess physical, functional, and social/emotional impacts of HNL.
Methods Instrument candidate items were reviewed by patients with HNL and clinicians and rated for importance, clarity, and invasiveness. The Content Validity Ratio was applied for item reduction. Three-step cognitive interviews were conducted with HNL patients to validate the items, survey format, and instructions.
Results Initially, 130 candidate questions were developed. Following item reduction, 52 items progressed to three-step cognitive interviews. Following cognitive interviews, the Comprehensive Assessment of Lymphoedema Impact in Head and Neck (CALI-HaN) included 33 items; 1 global, 10 physical, 7 functional, and 15 emotional.
Conclusions Physical, functional, and socioemotional effects need to be considered when measuring QoL in patients with HNL. This study describes initial development of the CALI-HaN, an instrument that shows promise for clinical and research applications following future validation.
Ayla Tabaksert, Tobias James, Christopher Rusius, Holt Walters, Shane Lester
Publication date 09-04-2024
Abstract Objective Lateral neck dissection (LND) is performed for staging/treatment of head and neck lesions. This traditionally includes placement of a drain and inpatient admission. Drainless, day-case head and neck surgery is attractive due to cost-effectiveness and reduced length of stay, but evidence is lacking in LND. We aim to investigate Artiss™ as an alternative to drain placement, facilitating day-case LND.
MethodsA prospective review was conducted of patients who underwent LND in a UK hospital over a 22-month period.
Results Thirty-nine patients were identified (27 Artiss™ only; 12 Artiss™ with a drain). Eight Artiss™ only patients were day-case. All drains were removed by post-operative day 2. There was no statistically significant difference in the number of complications between the two groups.
Conclusion This observational study demonstrates that for selected patients, Artiss™ could facilitate drainless, day-case LND. Further controlled studies with matched groups and larger numbers are required to validate this.
Si‐Ying Lin, Meng‐Yao Li, Chi‐Peng Zhou, Wei Ao, Wen‐Yu Huang, Si‐Si Wang, Jia‐Fan Yu, Zi‐Han Tang, Amr H. Abdelhamid Ahmed, Ting‐Yi Wang, Zhi‐hong Wang, Surong Hua, Gregory W. Randolph, Wen‐Xin Zhao, Bo Wang
Publication date 09-04-2024
Abstract Objective To enhance the accuracy in predicting lymph node metastasis (LNM) preoperatively in patients with papillary thyroid microcarcinoma (PTMC), refining the “low-risk” classification for tailored treatment strategies.
Methods This study involves the development and validation of a predictive model using a cohort of 1004 patients with PTMC undergoing thyroidectomy along with central neck dissection. The data was divided into a training cohort (n = 702) and a validation cohort (n = 302). Multivariate logistic regression identified independent LNM predictors in PTMC, leading to the construction of a predictive nomogram model. The models performance was assessed through ROC analysis, calibration curve analysis, and decision curve analysis.
Results Identified LNM predictors in PTMC included age, tumor maximum diameter, nodule-capsule distance, capsular contact length, bilateral suspicious lesions, absence of the lymphatic hilum, microcalcification, and sex. Especially, tumors larger than 7 mm, nodules closer to the capsule (less than 3 mm), and longer capsular contact lengths (more than 1 mm) showed higher LNM rates. The model exhibited AUCs of 0.733 and 0.771 in the training and validation cohorts respectively, alongside superior calibration and clinical utility.
Conclusion This study proposes and substantiates a preoperative predictive model for LNM in patients with PTMC, honing the precision of “low-risk” categorization. This model furnishes clinicians with an invaluable tool for individualized treatment approach, ensuring better management of patients who might be proposed observation or ablative options in the absence of such predictive information.
Vikash Kansal, Brendan L. C. Kinney, Nicole C. Schmitt
Publication date 09-04-2024
Abstract Background Preclinical models are invaluable for studies of head and neck cancer. There is growing interest in the use of orthotopic syngeneic models, wherein cell lines are injected into the oral cavity of immunocompetent mice. In this brief report, we describe injection of mouse oral cancer 1 (MOC1) cells into the buccal mucosa and illustrate the tumor growth pattern, lymph node response, and changes in the tumor immune microenvironment over time.
MethodsMOC1 cells were injected into the buccal mucosa of C57BL6 mice. Animals were sacrificed at 7, 14, 21, or 27 days. Tumors and lymph nodes were analyzed by flow cytometry.
Results All mice developed tumors by day 7 and required euthanasia for tumor burden and/or weight loss by day 27. Lymph node mapping showed that these tumors reliably drain to a submandibular lymph node. The proportion of intratumoral CD8+ T cells decreased over time, while neutrophilic myeloid cells increased dramatically. Growth of orthotopic MOC2 and MOC22 also showed similar growth patterns versus published data in flank tumors.
Conclusions When used orthotopically in the buccal mucosa, the MOC1 model induces a robust lymph node response and distinct pattern of immune cell infiltration, with peak immune infiltration by day 14.
Azin Tabari, Sevil Nasirmohtaram, Hassan Reza Mohammadi, Mehdi Zeinalizadeh, Seyed Mousa Sadrehosseini
Publication date 09-04-2024
Abstract Background Anterior endoscopic access to middle cranial base lesions becomes feasible in the presence of infratemporal fossa (ITF) involvement. Various approaches, including endoscopic endonasal, transoral sublabial, and transorbital methods, have been described for accessing the ITF through a transmaxillary corridor. Among these approaches, endonasal access is the most commonly preferred, while the transorbital approach is a novel technique gaining popularity. The transoral sublabial approach is considered suitable for selected lesions.
Methods Patients who underwent the anterior endoscopic transoral/sublabial transmaxillary approach to middle cranial base lesions at a single institute from 2016 to 2023 were included in this retrospective study. Malignant lesions were excluded from the study. The sublabial approach was exclusively performed in all cases, with the exception of one patient who required a combined approach.
Results The anterior endoscopic transoral sublabial transmaxillary approach to the infratemporal fossa, upper parapharyngeal space, and middle cranial fossa was performed on 14 patients.
The underlying conditions for these patients were as follows: trigeminal schwannomas (n = 8), meningiomas (n = 2), juvenile nasopharyngeal angiofibroma, osteochondroma, arachnoid cyst and encephalocele (n = 1 each). Gross total resection was achieved in 11 cases. The most common complication was numbness in the territory of the maxillary and mandibular nerves (n = 4). Two patients needed endoscopic maxillary antrostomy for persistent suppuration. No wound problems or CSF rhinorrhea occurred. The average follow-up time was 26.6 months.
Conclusion The endoscopic sublabial transmaxillary approach provides direct access to the infratemporal fossa and middle cranial base, enhancing the surgical range of maneuverability while sparing the sinonasal cavity. This procedure is safe, less invasive, and could be used as an efficient corridor for the resection of selected infratemporal fossa lesions with or without extension to the middle cranial base and parapharyngeal space.
Hilary C. McCrary, Mitchell F. Dunklebarger, Brett J. Fechter, Sarah M. Drejet, Marcus M. Monroe, Luke O. Buchmann, Jason P. Hunt, Richard B. Cannon
Publication date 09-04-2024
Abstract Background Fibula free flaps (FFF) are one of the most common bony flaps utilized. This paper describes a quality improvement project aimed at increasing early ambulation.
MethodsA review of FFF patients at an academic hospital was completed (2014–2023). In 2018, an institutional change to encourage early ambulation without placement of a boot was made. Changes in hospital disposition and physical therapy outcomes were evaluated.
ResultsA total of 168 patients underwent FFF reconstruction. There was a statistically significant lower length of stay in Group 2 (early ambulation, no boot) (8.1 vs. 9.4; p = 0.04). A higher rate of discharge to a skilled nursing facility was noted in Group 1 (delayed ambulation with boot) (21.3% vs. 11.9%; p = 0.009). A higher proportion of patients in Group 2 demonstrated independence during bed mobility, transfers, and gait (p < 0.05).
Conclusions Early ambulation without boot placement after FFF is associated with decreased length of hospital stay, improved disposition to home and physical therapy outcomes.
Kavita Prasad, Nathaniel Peterson, David Nolen, Chege Macharia, Kyle Mannion, Sarah Rohde, Robert Sinard
Publication date 09-04-2024
Abstract Background We present a sustainable complex reconstructive program built through 12 years of surgical outreach work at Kijabe Hospital in Kenya.
Methods Retrospective chart review and anecdotal experiences.
Results In 2011, surgeons from a US-medical center performed Kijabe Hospitals first 3 successful free flap surgeries. Since then, they have returned 7 times, performing a total of 31 tumor excisions with microvascular reconstruction. One flap failure occurred that was reconstructed on a subsequent trip. In 2013, a US-trained missionary surgeon and a Kenyan-trained general surgeon began working with the visiting team with the goal of performing these surgeries independently. In 2016 they performed their first independent free flap reconstruction and have since performed 32 independent cases with only three flap losses. Establishing infrastructure, staff education, selective patient criteria, and continuous communication are the factors that enabled the success of this program.
Conclusions Establishing a successful microvascular reconstruction program in a resource-limited setting is feasible.
Faye G. Zhang, Thomas J. Ow, Juan Lin, Richard V. Smith, Bradley A. Schiff, Carolyn A. DeBiase, John C. McAuliffe, Noah Bloomgarden, Vikas Mehta
Publication date 09-04-2024
Abstract Background Total thyroidectomy for hyperthyroidism is typically followed by overnight admission to monitor for complications including thyrotoxicosis. Outpatient thyroid surgery is increasingly common, but its safety in patients with hyperthyroidism has not been well studied.
Methods This retrospective study reviewed 183 patients with hyperthyroidism who underwent total thyroidectomy from 2015 to 2022 at one urban, academic center. The main outcomes were rates of thyroid storm, surgical complications, and 30-day ED visits and readmissions.
Results Among 183 patients with hyperthyroidism (mean age, 45 ± 14.5 years; 82.5% female), there were no cases of thyroid storm and complications included recurrent laryngeal nerve (RLN) palsy (7.0%), symptomatic hypocalcemia (4.4%), and hematoma (1.6%). ED visits were present in 1.1% and no patients were readmitted.
Conclusion Total thyroidectomy was not associated with thyroid storm and <6% of patients required inpatient management. Ambulatory total thyroidectomy for hyperthyroidism warrants further consideration through identification of predictive factors for postoperative complications.
Shahaf Shilo, Nidal Muhanna, Dan M. Fliss, Gilad Horowitz, Anton Warshavsky, Jobran Mansour, Clariel Ianculovici, Ehud Fliss, Yoav Barnea, Arik Zaretski, Ravit Yanko
Publication date 09-04-2024
Abstract Background This study compares early outcomes of osteofascial fibula free flap (OF-FFF) with donor-site primary closure and osteocutaneous (OC) FFF with donor-site skin grafting in segmental mandibular reconstruction.
MethodsA retrospective chart review of FFF mandibular reconstruction patients (2006–2022) divided into OF-FFF and OC-FFF groups. Clinical data, operative parameters, and early postoperative outcomes (≤ 90 days) were analyzed.
Results The study included 67 patients (39 OF-FFF, 28 OC-FFF). OF-FFF had significantly lower donor-site complications (12.8% vs. 53.6%, p < 0.001) and revision surgeries (7.7% vs. 35.7%, p = 0.004) compared to OC-FFF. Recipient-site (28.2% vs. 25%, p = 0.77) and flap (15.4% vs. 17.9%, p > 0.99) complications were comparable.
ConclusionsOF-FFF mandibular reconstruction with donor-site primary closure is a safe and reliable technique associated with superior donor-site and comparable flap and recipient-site outcomes to OC-FFF, thus may be considered as a viable alternative to OC-FFF for selected patients.
Yuan Feng, Kai Qian, Kai Guo, Yuan Shi, Jiaqing Zhou, Zhuoying Wang
Publication date 09-04-2024
Abstract Objective To investigate the effectiveness of radiotherapy and its association with second primary malignancies (SPMs) risk in major salivary gland carcinomas (MSGCs) patients.
Methods Cohort 1 included 7274 surgically treated MSGC patients from the Surveillance, Epidemiology, and End Results database, assessing the effectiveness of radiotherapy. Cohort 2 (n = 4213) comprised patients with ≥5-year survival in Cohort 1 to study SPMs.
Results Radiotherapy decreased overall survival in MSGCs patients, but improved it in high-grade MSGCs. Cumulative SPMs incidences at 25 years were 16.5% in the radiotherapy (RT) group compared to 14.5% in the non-radiotherapy (NRT) group. For second head and neck carcinomas (SHNCs), incidences were 3.4% in RT versus 1.6% in NRT. Radiotherapy increased the relative risks of tumors, particularly SHNCs (RR = 1.78). The 10-year OS rates of SHNCs after radiotherapy were significantly lower.
Conclusion Radiotherapy improves survival in advanced-stage MSGCs but increases the risk of developing SPMs, particularly SHNCs.
Max L. Jiam, Kevin Z. Xin, Patrick K. Ha, Nicole T. Jiam
Publication date 09-04-2024
Abstract Background New patient referrals are often processed by practice coordinators with little-to-no medical background. Treatment delays due to incorrect referral processing, however, have detrimental consequences. Identifying variables that are associated with a higher likelihood of surgical oncological resection may improve patient referral processing and expedite the time to treatment. The study objective is to develop a supervised machine learning (ML) platform that identifies relevant variables associated with head and neck surgical resection.
MethodsA retrospective cohort study was conducted on 64 222 patient datapoints from the SEER database.
Results The random forest ML model correctly classified patients who were offered head and neck surgery with an 81% accuracy rate. The sensitivity and specificity rates were 86% and 71%. The positive and negative predictive values were 85% and 73%.
ConclusionsML modeling accurately predicts head and neck cancer surgery recommendations based on patient and cancer information from a large population-based dataset. ML adjuncts for referral processing may decrease the time to treatment for patients with cancer.
Kui‐Xuan Zhu, Ting Ding, Yi‐Min E, Hong‐Wei Yang, Rui‐Ping Wu, Run‐Jia Liu, Ling‐Li Zhou, Wen‐Jie Fu, Mei‐Ping Jiang, Xiao‐Li Wang
Publication date 09-04-2024
Abstract Background The effect of radiotherapy waiting time after last induction chemotherapy (IC-RT) on prognosis of patients with locally advanced nasopharyngeal carcinoma (LANPC) needs further discussion.
Methods Three hundred and six patients with LANPC diagnosed pathologically by induction chemotherapy (IC) and radiotherapy (RT) from 2013 to 2018 were selected for this study.
Results The IC-RT was a risk factor for the post-treatment progression of LANPC (OR = 1.017 95%CI: 1.003–1.031), For patients with LANPC, the IC-RT > 40 days significantly reduced 5-year PFS (70% vs. 55%; p = 0.0012), 5-year OS (84% vs. 73%; p = 0.028), 5-year DMFS (80% vs. 66%; p = 0.003), 5-year LRFS (77% vs. 67%; p = 0.012). Indicating that patients with stage IVa who IC-RT > 40 days were found to be a significant predictor of aggravated PFS (HR = 2.69; 95%CI: 1.57–4.6), OS (HR = 2.55; 95%CI: 1.29–5.03), DMFS (HR = 3.07; 95%CI: 1.64–5.76) and LRFS (HR = 2.26; 95%CI: 1.21–4.21).
Conclusion The prognosis of patients will be adversely affected if the IC-RT exceeds 40 days, especially for stage IVa patients.
Hsueh‐Ju Lu, Meng‐Che Hsieh, Hung‐Ming Wang, Jason Chia‐Hsun Hsieh, Chia‐Jui Yen, Shang‐Yin Wu, Huai‐Cheng Huang, Hui‐Ching Wang, Pen‐Yuan Chu, Tien‐Hua Chen, Chih‐Yen Chien, Tai‐Lin Huang, Yi‐Fang Chang, Chun‐Hung Hua, Ming‐Yu Lien, Jo‐Pai Chen, Wei‐Chen Lu, Jin‐Ching Lin, Chen‐Chi Wang, Yi‐Chun Liu, Muh‐Hwa Yang, Pei‐Jen Lou
Publication date 09-04-2024
Abstract Background For R/M HNSCC, the differences in prognosis and treatment options between distant metastasis (DM) and locoregional recurrence, especially in the DM group, remain unclear.
Methods From the Taiwan Head Neck Society registry database, patients who were diagnosed with R/M HNSCC and received cetuximab-based frontline therapy were collected for analysis.
Results Among the enrolled patients, 59.3% (491/827) belonged to the DM group. The DM group had less primary site of oral cavity, less betel nut chewing, higher lactate dehydrogenase (LDH) levels, and higher LDH/albumin ratio compared with the non-DM group. For the patients with primary site of oral cavity and current smokers, DM coexisted with poorer outcomes. In the DM group, EXTREME-like regimen was more suitable for older patients, those with elevated LDH, and those with higher LDH/albumin ratio than TPExtreme-like regimen.
ConclusionDM coexisted with poorer prognosis in certain groups. LDH-associated biomarkers may aid treatment options for DM patients.
An Wang, Na Xiao, Hong Wang, Qin Yao, Jin Li, Yaping Wu, Han Ge, Pengfei Diao
Publication date 09-04-2024
Abstract Background Cellular senescence significantly associates with tumor initiation, progression, and therapeutic response across multiple cancers. Here, we sought to develop a novel senescence-related genes (SRGs)-derived signature for oral squamous cell carcinoma (OSCC) prognostication and therapeutic response prediction.
MethodsOSCC-specific SRG prognostic signature was established with univariate Cox regression, Kaplan–Meier survival, and LASSO-penalized multivariate Cox regression analyses. A SRG nomogram integrating this signature and selected clinicopathological parameters were constructed by multivariate Cox regression. SiRNA-mediated gene knockdown was exploited to validate its function in vitro. The utilities of SRG signature in predicting immune status and chemotherapeutic sensitivities were analyzed.
Results The prognostic performance of SRG signature/nomogram was satisfactory in multiple independent cohorts. CDK1 knockdown induced senescence phenotype in vitro. Moreover, SRG signature scores negatively correlated with tumor-infiltrating immune cells and associated with multiple chemotherapeutic drug sensitivities.
Conclusions Our results established SRG-derived signature/nomogram as powerful predictors for prognosis and chemotherapeutic response for OSCC.
Talita de Carvalho Kimura, João Figueira Scarini, Luccas Lavareze, Luiz Paulo Kowalski, Cláudia Malheiros Coutinho‐Camillo, Ana Cristina Victorino Krepischi, Erika Said Abu Egal, Albina Altemani, Fernanda Viviane Mariano
Publication date 09-04-2024
Abstract Objective This study used array comparative genomic hybridization to assess copy number alterations (CNAs) involving miRNA genes in pleomorphic adenoma (PA), recurrent pleomorphic adenoma (RPA), residual PA, and carcinoma ex pleomorphic adenoma (CXPA).
Materials and Methods We analyzed 13 PA, 4 RPA, 29 CXPA, and 14 residual PA using Nexus Copy Number Discovery software. The miRNAs genes affected by CNAs were evaluated based on their expression patterns and subjected to pathway enrichment analysis.
Results Across the groups, we found 216 CNAs affecting 2261 miRNA genes, with 117 in PA, 59 in RPA, 846 in residual PA, and 2555 in CXPA. The chromosome 8 showed higher involvement in altered miRNAs in PAs and CXPA patients. Six miRNA genes were shared among all groups. Additionally, miR-21, miR-455-3p, miR-140, miR-320a, miR-383, miR-598, and miR-486 were prominent CNAs found and is implicated in carcinogenesis of several malignant tumors. These miRNAs regulate critical signaling pathways such as aerobic glycolysis, fatty acid biosynthesis, and cancer-related pathways.
Conclusion This study was the first to explore CNAs in miRNA-encoding genes in the PA-CXPA sequence. The findings suggest the involvement of numerous miRNA genes in CXPA development and progression by regulating oncogenic signaling pathways.
Jipei Liao, Zejia Yang, Shirin Azarbarzin, Kevin J. Cullen, Hancai Dan
Publication date 09-04-2024
Abstract Purpose To find a new strategy to treat cisplatin-resistant head and neck squamous cell carcinoma (HNSCC), we investigated the effects of EGFR inhibitors on the PI3K/Akt/mTOR pathway and determined the efficacy of EGFR inhibitors in combination with PI3K inhibitors to suppress cell proliferation in cisplatin-resistant-HNSCC.
Methods The cisplatin-resistant HNSCC cell lines were treated with four FDA approved EGFR inhibitors, which included Gefitinb or Erlotinib alone, or in combination with the pan-PI3K inhibitor, BKM120. Phosphorylation and total protein levels of cells were assessed by Western blot analysis. Cell proliferation was examined by MTS assay. Apoptosis was analyzed by flow cytometry.
Results Cisplatin-resistant HNSCC cells were also resistant to EGFR inhibitors. However, a combination of EGFR inhibitors with PI3K inhibitor BKM120 dramatically improved the efficacy of EGFR inhibitors to inhibit cell proliferation and induce apoptosis. Furthermore, treatment with EGFR inhibitors differentially affected the phosphorylation of Akt and mTOR, which included partial inhibition, no inhibition, and induction. A combination of EGFR inhibitors and BKM120 completely blocked phosphorylation of EGFR, Akt, and S6K (an mTOR target).
Conclusion Our data provided a rationale for EGFR inhibitors in combination with PI3K inhibitors to treat cisplatin-resistant HNSCC.
Seiichiro Makihara, Yoshihiro Otani, Kensuke Uraguchi, Aiko Shimizu, Aya Murai, Takaya Higaki, Naoki Akisada, Shohei Fujimoto, Takuma Makino, Joji Ishida, Kentaro Fujii, Takao Yasuhara, Tomoyuki Ota, Hiroshi Matsumoto, Mizuo Ando
Publication date 09-04-2024
Abstract Background Advanced surgical interventions are required to treat malignancies in the anterior skull base (ASB). This study investigates the utility of endoscopic endonasal and transcranial surgery (EETS) using a high-definition three-dimensional exoscope as an alternative to traditional microscopy.
Methods Six patients with carcinomas of varying histopathologies underwent surgery employing the EETS maneuver, which synchronized three distinct surgical modalities: harvesting of the anterolateral thigh flap, initiation of the transnasal technique, and initiation of the transcranial procedure.
Results The innovative strategy enabled successful tumor resection and skull base reconstruction without postoperative local neoplastic recurrence, cerebrospinal fluid leakage, or neurological deficits.
Conclusion The integration of the exoscope and EETS is a novel therapeutic approach for ASB malignancies. This strategy demonstrates the potential of the exoscope in augmenting surgical visualization, enhancing ergonomics, and achieving seamless alignment of multiple surgical interventions. This technique represents a progressive shift in the management of these complex oncological challenges.
"Julie E. Bauman, Sana D. Karam, Cathy OBrien, Gabriel Mak, Byoung Chul Cho"
Publication date 09-04-2024
Abstract Background The Phase 1 CLOVER study (NCT03509012) assessed durvalumab in combination with concurrent chemoradiotherapy (cCRT) in patients with advanced solid tumors; we report results from the head and neck squamous cell carcinoma (HNSCC) cohort.
Methods Patients with histologically/cytologically confirmed locally advanced HNSCC, eligible for definitive cCRT and not considered for primary surgery, received durvalumab plus cisplatin and concurrent external beam radiation. Objectives were to assess safety/tolerability and preliminary efficacy.
Results Eight patients were enrolled. The most frequent any-cause adverse events (AEs) were nausea and radiation skin injury (each n = 5); most frequent grade 3/4 AEs were lymphopenia and stomatitis (each n = 3). No patients had dose-limiting toxicities. Objective response rate was 71.4% (5/7 patients; four complete responses, one partial response); disease control rate was 85.7% at 18 weeks and 83.3% at 48 weeks.
Conclusions Durvalumab plus cCRT was tolerable and active in patients with unresected, locally advanced HNSCC.
Scott A. Hong, Austin T. Armstrong, Katherine Snow, Ronald J. Walker, Sean T. Massa
Publication date 09-04-2024
Abstract Background Postoperative radiotherapy radiation therapy (PORT) for early-stage human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) with positive lymphovascular invasion (LVI) has an unclear association with overall survival (OS).
Methods This retrospective cohort study queried the National Cancer Database for surgically treated, T1-2, N0-1 HPV+ OPSCC from 2010 to 2019. Primary exposures were LVI and PORT, and the main outcome was 5-year OS. Odds ratios and hazard ratios (HR) with 95% confidence intervals (CIs) were generated using multivariable models and Cox proportional hazard models, respectively.
Results Of 2768 patients, average age was 59.3 years, 2207 (79.7%) were male, and 386 (13.9%) had LVI. Of patients with LVI as their sole adverse pathologic feature, 220 (57.0%) received PORT, which was not associated with 5-year OS (HR, 1.13; CI, 0.65–1.19).
Conclusions Patients with surgically treated, early-stage HPV+ OPSCC and positive LVI as their only pathologic adverse feature may not require PORT.
Paul R. Wistermayer, Adam E. Brown, Taylor B. Cave, Brent A. Chang, Michael L. Hinni, Richard E. Hayden, Laura E. Klusovsky, Alyssa McGary, Thomas H. Nagel
Publication date 09-04-2024
Abstract Background Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery (TOS) for oropharyngeal HPV-mediated squamous cell carcinoma. Controversy exists regarding adequate resection margins for balancing functional and oncologic outcomes.
Methods This retrospective study was exempted by the IRB. Patients who underwent TOS from January 2017 to October 2022 were included. Patient characteristics, treatment details, and oncologic and functional outcomes were evaluated.
Results Fifty-five patients were included. Mean and median follow-up was 34 months. 98% of patients were AJCC stage I/II. Recurrence-free survival was 96% with no local recurrences.
Univariate analysis demonstrated an association between VPI and pT stage (p = 0.035), medial pterygoid resection (p = 0.049), and palatal attachment sacrifice (p < 0.001). Multivariate analysis showed sacrifice of the palatal attachments remained a significant risk for VPI (p = 0.009).
Conclusion Loss of soft palate pharyngeal attachments is an independent risk factor for VPI. When oncologically appropriate, the palatal attachments to the pharynx may be preserved.
Ann‐Kristin Struckmeier, Mayte Buchbender, Rainer Lutz, Abbas Agaimy, Marco Kesting
Publication date 09-04-2024
Abstract Background The aim of this study was to assess the prognostic significance of lymph node yield (LNY), lymph node ratio (LNR), and the number of lymph node metastases (LNMs) in patients affected by oral squamous cell carcinoma (OSCC).
Methods The study included patients who underwent surgical treatment for primary OSCC. Receiver operating characteristic curves were generated to determine the optimal threshold values. Kaplan–Meier curves were employed, along with the log-rank test, for the analysis of survival. To compare the performance in terms of model fit, we computed Akaikes information criterion (AIC).
Results This study enrolled 429 patients. Prognostic thresholds were determined at 22 for LNY, 6.6% for LNR, and 3 for the number of LNMs. The log-rank test revealed a significant improvement in both overall survival and progression-free survival for patients with a LNR of ≤6.6% or a number of LNMs of ≤3 (p < 0.05). Interestingly, LNY did not demonstrate prognostic significance. The AIC analyses indicated that the number of LNMs is a superior prognostic indicator compared to LNY and LNR.
Conclusions Incorporating LNR or the number of LNMs into the TNM classification has the potential to improve the prognostic value, as in other types of cancers. Particularly, the inclusion of the number of LNMs should be contemplated for future N staging.
Yujiao Li, Xiyin Guan, Xing Xing, Chaosu Hu
Publication date 09-04-2024
Abstract Objectives To compare survival outcomes and toxic effects among patients with newly diagnosed nonmetastatic nasopharyngeal carcinoma (NPC) when treated with intensity-modulated radiotherapy (IMRT) versus IMRT + carbon-ion radiotherapy (CIRT).
Methods We performed a retrospective propensity score matching analysis (1:1) of patients treated with IMRT and IMRT + CIRT. Descriptive statistics were used to examine the baseline characteristics of the patients. Survival was estimated using the Kaplan–Meier method. Univariate and multivariable logistic regression analysis were used to identify the independent predictors of survival. We examined the association between risk factors and adverse events (AEs) using chi-square tests. Cox model and logistic regression were used to analyze AEs.
Results Hundred and nine patients who received IMRT + CIRT were included and the median follow-up time was 20.6 months (range: 4.6–82 months). There were no statistically significant differences in locoregional failure–free survival, distant metastasis–free survival, disease-free survival, or overall survival between the two groups, but potentially better in IMRT + CIRT group (p > 0.05, respectively). Nodal boost was the only significant factor associated with LRFS and DFS on multivariable analysis. Thirty-seven patients (34.0%) developed grade 3 acute OMs and no grade 4 acute OMs were observed in IMRT + CIRT group. All patients in IMRT + CIRT group developed grade 1 dermatitis; while in the match group, 76 patients developed grade 1 dermatitis, 27 patients developed grade 2 dermatitis, 5 patients developed grade 3 dermatitis, 1 patient developed grade 4 dermatitis. IMRT + CIRT treatment was associated with a significant trend of lower grades of OM and dermatitis (p < 0.05, respectively). Any severe (i.e., grade 3) chronic AEs, such as xerostomia, skin fibrosis, temporal lobe necrosis, osteoradionecrosis, or radiation-induced optic neuropathy, was not observed.
Conclusions In this study, IMRT + CIRT was associated with significantly reduced acute toxicity burden compared with full course of IMRT, with excellent survival outcomes. Patients with persistent disease after treatment and treated with nodal boost had a worse outcome. More accurate assessments of IMRT + CIRT to primary nonmetastatic NPC patients will be imperative.
Francesco Chiari, Giuseppe Di Martino, Claudio Donadio Caporale, Gabriele Molteni, Livio Presutti, Pierre Guarino
Publication date 09-04-2024
Abstract The aim of this systematic review is to analyze epidemiology, clinical presentation, histopathological features, treatment and oncological outcomes in laryngeal mucoepidermoid cancer (MEC) in order to improve the knowledge on the management of such a rare malignant neoplasm. Specifically, authors highlight patients and tumors features about local, regional, and distant recurrence of disease. PRISMA 2020 guidelines were applied in this systematic literature review. A computerized search was performed using the Embase/Pubmed, Scopus, and Cochrane databases, for articles published from 1971 to December 2023. A descriptive and univariate analysis including selected papers with low or intermediate risk of bias was performed. Twenty-seven papers (11 case series and 16 case reports) were included in this review. Fifty-six patients were included in the analyses, with a mean age of 56.7 years; 84% of them were males. Most patients (86%) underwent a primary surgical approach.
Clinical stage was reported as follows: early stage (26 patients) and locally advance and advanced stage (19 patients). Overall survival (OS) and disease-free survival (DFS) at 2 years was 80% and 78%, respectively. The mean time to local recurrence was 18.7 months (range 8–36 months). The survival after recurrence is about 85% and 70% at 5 years, respectively. The mean time of lymph node recurrence was 14.7 months (range 7–19 months). Finally, the mean time of distant recurrence was 15 months (range 7–36 months) with a poor prognosis: all patients died due to the disease in a range of 0–7 months after metastasis evidence. Laryngeal MEC is a rare neoplasm of minor salivary glands in the larynx. No guidelines or indications about the management of this neoplasm are reported in the literature. The lower incidence of regional recurrence of the disease and the better OS and DFS underline how the prognosis of MEC is more favorable respect to other malignant histotypes.
Martin Jurlina, Matija Mamic, Jure Pupic‐Bakrac, Lovro Matoc, Hrvoje Jednacak, Ivica Luksic, Marica Zizic
Publication date 08-04-2024
Abstract Background Data from patients with post-ablative dural defects reconstructed using a free temporalis muscle fascia graft (FTFG) after resection of anterior or central skull base tumors were retrospectively analyzed.
Methods The primary predictor and outcome variables were the reconstructive methods for dural repair and postoperative cerebrospinal fluid (CSF) leakage rate, respectively.
Results Eighty patients were included, and 94 postoperative dural reconstructions were performed using FTFG. The postoperative CSF leakage rate was 3.19%. The postoperative CSF leakage rates did not significantly differ between open and endonasal endoscopic surgeries (1.92% vs. 4.88%; p > 0.05). In cases completed using the endonasal endoscopic approach, the postoperative CSF leakage rate was significantly associated with the intraoperative CSF leak flow (p < 0.05).
Conclusions Post-ablative dural defect reconstruction using FTFG resulted in low postoperative CSF leakage and complication rates comparable to those of free fascia lata graft from available literature.
Jacob Harris, Vinayak Ahluwalia, Katherine Xu, Dominic Romeo, Christian Fritz, Karthik Rajasekaran
Publication date 04-04-2024
Abstract Background The National Surgical Quality Improvement Program surgical risk calculator (SRC) estimates the risk for postoperative complications. This meta-analysis assesses the efficacy of the SRC in the field of head and neck surgery.
MethodsA systematic review identified studies comparing the SRCs predictions to observed outcomes following head and neck surgeries. Predictive accuracy was assessed using receiver operating characteristic curves (AUCs) and Brier scoring.
Results Nine studies totaling 1774 patients were included. The SRC underpredicted the risk of all outcomes (including any complication observed (ob) = 35.9%, predicted (pr) = 21.8% and serious complication ob = 28.7%, pr = 17.0%) except mortality (ob = 0.37%, pr = 1.55%). The observed length of stay was more than twice the predicted length (p < 0.02). Discrimination was acceptable for postoperative pneumonia (AUC = 0.778) and urinary tract infection (AUC = 0.782) only. Predictive accuracy was low for all outcomes (Brier scores ≥0.01) and comparable for patients with and without free-flap reconstructions.
Conclusion The SRC is an ineffective instrument for predicting outcomes in head and neck surgery.
Barbara M. Ebersole, Mark Zafereo, Katherine A. Hutcheson
Publication date 04-04-2024
Abstract We report the case of a laryngectomized patient with an enlarged tracheoesophageal puncture (TEP) that is refractory to standard treatments and culminating in life-threatening recurrent dislodgement and aspiration of custom fabricated dual extra-large flange voice prostheses (VP). The fabrication and use of a novel intraluminal prosthetic device to prevent dislodgement, lessen aspiration, and preserve TE voice is described. A custom device insetting a commercial VP into the posterior wall of a Lary Tube (coined “inset-VP”) was devised with the primary goal of eliminating chronic VP dislodgement and lessening aspiration while maintaining TE voice. Tools required to fabricate the device included a commercial laryngectomy tube, standard-flanged commercial indwelling voice prosthesis, felt-tip marker, 6 mm biopsy punch, and silk suture. After 7 months of using an inset-VP Lary Tube device, the patient has experienced zero episodes of VP aspiration. Thin liquid aspiration control is equivalent or better than prior management with custom 24–30 mm dual collar prostheses. TEP voice is fluent and functional with device in place. Novel strategies are needed to manage the rare but devastating effects of a severely enlarged TEP. Solutions to manage symptoms need to be patient-specific, aligning with their anatomy, physiology, psychosocial needs, and goals. The inset-VP device described in this report may offer improved prosthetic retention in select patients with enlarged TE puncture and frequent VP dislodgements.
Pubmed PDF WebKun Zhang, Xinyi Wang, Tao Wei, Zhihui Li, Jingqiang Zhu, Ya‐Wen Chen
Publication date 04-04-2024
Abstract Background Oncocytic carcinoma of the thyroid (OCA) is an independent type of thyroid cancer. Radioactive iodine (RAI) therapy was frequently administered to OCA patients, but its contribution to improving survival is indefinite.
Methods4641 OCA patients from 2000 to 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazard regression and competing risk analysis were applied.
Results Tumor size, SEER stage, primary surgery, and neck dissection were prognostic factors for cancer-specific survival. The results of competing risk analysis demonstrated that age over 55 years dramatically increased non-OCA death risks. Treatments that improve non-OCA survival (including total thyroidectomy, RAI therapy, and systemic therapy) should be recommended in OCA patients older than 55 years of age. Neck lymphadenectomy should not be recommended for OCA, since the metastatic lymph node ratio was low (about 3%).
ConclusionsRAI therapy can improve survival in OCA by reducing noncancer death risks.
Lorenzo Azzi, Francesca Magnoli, Diana Krepysheva, Federico Fontana, Andrea Coppola, Antonella Cappelli, Marta Dani, Paolo Battaglia, Dimitri Rabbiosi
Publication date 03-04-2024
Abstract This study aimed to review the lesser-known intraoral manifestations of immunoglobulin G4-related disease (IgG4-RD). In this paper we report an unprecedented case of oral IgG4-RD mimicking angiolymphoid hyperplasia with eosinophilia (ALHE), and another case presenting as plasma cell gingivitis. We then performed a scoping review of published cases of IgG4-RD involving the oral cavity.
The following data were collected for each case: age, sex, intraoral site(s) involved, clinical appearance, imaging features, serum IgG4 values, histopathology, treatment, and follow-up duration. Fifty-one cases of oral IgG4-RD were published in literature. The hard palate and jaw bones were the two main locations reported, while the histological identification of a IgG4/IgG plasma cells ratio ≥40% was fundamental for diagnosis. Conversely, the pathological features of storiform fibrosis and obliterative phlebitis were not common. Future reports regarding oral IgG4-RD should report clear adherence to the recognized international diagnostic criteria of the disease.
Yukimi Shibuya, Koichi Hirano, Makoto Miyamoto, Tomoya Mitsuma, Yoko Nakazato, Noritsugu Matsutani, Ryota Tanaka, Haruhiko Machida, Haruhiko Kondo
Publication date 01-04-2024
Abstract Background Although flexible laryngoscopy (FL) is the reference modality for diagnosing vocal cord paralysis (VCP), FL involves patient discomfort and insertion intolerance. Dynamic digital radiography (DDR) with high spatial and temporal resolution is easier to use and less invasive when evaluating VCP.
Methods Seventy-eight patients underwent FL and DDR before and after neck surgery. Qualitative and quantitative vocal cord movement (VCM) evaluations were conducted. Patients with postoperative VCP were followed-up regularly.
ResultsDDR exhibited diagnostic performance with 67% sensitivity and 100% specificity. The cutoff for VCM was 2.4 mm, with DDR exhibiting 100% sensitivity and 78% specificity. All cords with transient VCP had positive VCM at both 3 weeks and 2 months. Additionally, 50% and 75% of cords with permanent VCP had negative VCM at 3 weeks and 2 months, respectively.
ConclusionsDDR is promising for the diagnosis of postoperative VCP and early prediction of permanent postoperative VCP.
Douglas B. Chepeha, Carly E. A. Barbon, Alex O. Esemezie, Majd Al Mardini, Justine Philteos, Matthew E. Spector, Tim Bressmann, Rosemary Martino, Scott V. Bratman, John B. C. Cho, Andrew J. Hope, Ali Abdalati Hosni, John J. H. Kim, Jolie G. Ringash, John N. Waldron, Dale H. Brown, John R. de Almeida, Ralph W. Gilbert, David P. Goldstein, Patrick J. Gullane, Jonathan C. Irish, Eric A. Monteiro, Christopher M. K. L. Yao
Publication date 01-04-2024
Abstract Background To address the rehabilitative barriers to frequency and precision of care, we conducted a pilot study of a biofeedback electropalatography (EPG) device paired with telemedicine for patients who underwent primary surgery +/− adjuvant radiation for oral cavity carcinoma. We hypothesized that lingual optimization followed by telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER) would further improve speech and swallowing outcomes after “standard-of-care” SOC rehabilitation.
Method Pilot prospective 8-week (TEBER) program following 8 weeks of (SOC) rehabilitation.
Results Twenty-seven patients were included and 11 completed the protocol. When examining the benefit of TEBER independent of standard of care, “range-of-liquids” improved by +0.36 95% CI, 0.02–0.70, p = 0.05 and “range-of-solids” improved by +0.73 95% CI, 0.12–1.34, p = 0.03. There was a positive trend toward better oral cavity obliteration; residual volume decreased by −1.2 95% CI, −2.45 to 0.053, p = 0.06, and “nutritional-mode” increased by +0.55 95% CI, −0.15 to 1.24, p = 0.08.
Conclusion This pilot suggests that TEBER bolsters oral rehabilitation after 8 weeks of SOC lingual range of motion.
Masoud MiriMoghaddam, Babak Bohlouli, Hollis Lai, Seema Ganatra, Maryam Amin
Publication date 01-04-2024
Abstract Introduction This study aimed to determine trends in the healthcare utilization by Oral Cavity and Oropharyngeal cancer patients across emergency department (ED) and outpatient settings in Alberta and examine the predictors of ED visits.
Methods This is a retrospective, population-based, cohort study using administrative data collected by all healthcare facilities between 2010 and 2019 in Alberta, Canada. Trend of visits to different facilities, patients primary diagnosis, and predictors of ED visits were analyzed.
Results In total, 34% of patients had at least one cancer-related ED visit. With a rise of 31% in cancer incidence, there was a notable upswing in visits to outpatient clinics and community offices, while ED visits decreased. Cancer stage, rural residence, high material deprivation score, and treatments were found as predictors of ED visits.
Conclusion Improved symptom management and better care access for disadvantaged and rural oral cancer patients may decrease avoidable ED visits.
Farahna Sabiq, Abhiram Cherukupalli, Mohammad Khalil, Linh K. Tran, Jamie J. Y. Kwon, Thomas Milner, James S. Durham, Eitan Prisman
Publication date 28-03-2024
Abstract Objectives Virtual surgical planning (VSP) has gained acceptance because of its benefits in obtaining adequate resection, achieving cephalometric accuracy, and reducing operative time. The aim of this study is to compare the rate of union between VSP and free-hand surgery (FHS), identify predictors of non-union and evaluate the difference in operative time.
Methods Post-operative CT were retrospectively reviewed for 123 patients who underwent maxillary or mandibular reconstruction between 2014 and 2021 using either VSP or FHS. Each apposition was graded as complete, partial or non-union. The rate of union, risk difference and inter-rater reliability were calculated. The difference in operative time was assessed. Predictors of non-union were identified using logistic regression.
ResultsA total of 326 appositions were graded (VSP n = 150; FHS n = 176). The rates of complete and partial union were higher with VSP than FHS (74.7% vs. 65.3%; 18% vs. 15.9%, respectively, p = 0.01). Non-union was found at a higher rate with FHS than with VSP (18.7% vs. 7.3%). The non-union risk difference was 11.4. FHS, major complications and apposition at the native bone were predictors of non-union (OR 2.9, p = 0.02; OR 3.4, p = 0.01; OR 2.5, p = 0.05, respectively). The mean surgical time was shorter with VSP than with FHS (265.3 vs. 381.5 min, p < 0.001). The inter-rater agreement was high (k = 0.85; ICC = 0.86).
ConclusionVSP demonstrated significantly higher bony union rates and shorter operative time. FHS, development of major complications and apposition with native bone correlated with non-union.
Chao Luo, Wenjie Huang, Shuqi Li, Haojiang Li, Guangying Ruan, Gui Fu, Lizhi Liu
Publication date 28-03-2024
Abstract Background We aimed to establish the most suitable threshold for objective response (OR) in the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 in patients with nasopharyngeal carcinoma (NPC).
Methods According to RECIST 1.1, we retrospectively evaluated MR images of NPC lesions in patients before and after induction chemotherapy (IC). Restricted cubic spline and maximally selected rank statistics were used to determine the cut-off value. Survival rates and differences between groups were compared with Kaplan–Meier curves and log-rank tests.
Results Of 1126 patients, 365 cases who received IC treatment were suitable for RECIST 1.1 evaluation. The 20% cut-off value maximized between-group differences according to maximally selected rank statistics. No difference in distant metastasis-free survival between OR and non-response groups was shown using the primary threshold of OR (30%), while it differed when 20% was employed.
Conclusions With an optimal cut-off value of 20%, RECIST may assist clinicians to accurately evaluate disease response in NPC patients.
Mallory McKeon, Anna Zhou, Alice L. Tang
Publication date 28-03-2024
Abstract Background Gender inequity exists across national speakers at American Head and Neck Society (AHNS) conferences. This qualitative study explores potential causes of this disparity by surveying women invited to speak at AHNS between 2007 and 2019 and examining advice, resources, and meaningful actions from “those who made it.”Methods An internet search for contact information for the 131 female AHNS was performed. An electronic survey was distributed via email. Deidentified qualitative responses were coded by two independent researchers into themes. Themes characterize barriers that female head and neck (HN) surgeons face and describe ways to mitigate the impact of these for the next generation.
Results Contact information for 73/131 female AHNS speakers was obtained via internet search. Email responses were received from 22/73 (30%). Of those, respondents specialized in otolaryngology (n = 17), medical oncology (n = 2), palliative care (n = 1), vascular surgery (n = 1), and thoracic surgical oncology (n = 1). All speakers worked in academic settings at varying stages of their career with 81.8% (18/22) of respondents fellowship-trained (primarily HN surgery).
Concerns about gender disparity in ENT were grouped into the following themes: (1) recruiting women to ENT, (2) removing barriers to career advancement, (3) diversifying ENTs national presence, and (4) improving the broader culture of HN surgery. Respondents emphasized a need for diversifying leadership, early exposure to otolaryngology in medical school, and connecting students with female role models. Outstanding research, involvement at annual meetings, and committee membership were consistently deemed important for establishing a national presence in the field. Implicit bias, “boys clubs” culture, and burdensome childcare responsibilities were described as barriers to career advancement.
Conclusions While encouraging more women to enter otolaryngology residencies, increasing the number female role models and establishing strong mentoring networks may help to mitigate challenges. Meaningful progress requires the efforts of both male and female allies within the specialty. Simple solutions, such as educating on implicit bias, removing demographics from applications, and eliminating hidden penalties for maternity leave, may help improve diversity and mitigate barriers to career progression for underrepresented groups within ENT.
Mario F. Scaglioni, Matteo Meroni, Patrick E. Tomasetti, Gunesh P. Rajan
Publication date 27-03-2024
Abstract Background Head and neck tissue defects after ablative surgery often require complex and composite reconstructions. The superficial circumflex iliac artery perforator (SCIP) flap is an extremely versatile perforator-based flap with minimal donor site morbidity, which may represent the optimal procedure in this setting. Over the last 5 years, we collected a large base of experience, including both simple and chimeric SCIP-based reconstruction, making this flap our first choice for head and neck reconstructions.
Patients and Methods Seventy-three patients undergoing ablative head and neck surgery for oncologic pathologies were treated by means of a SCIP flap reconstruction. Patients mean age was 67 years old (range 37–89), 51 were males and 22 were females. Fifty-eight flaps were simple and 15 were chimeric reconstruction patterns. Indocyanine green perfusion imaging was performed in all cases.
Results All the patients were successfully treated with no flap losses were encountered.
Twelve patients encountered postoperative complications: in four cases revision surgery was required for venous congestion, while the remaining cases were managed conservatively (four wound dehiscence and three infections). No patients showed donor site complications. The mean follow-up period was 11 months (range 3–24).
Conclusions Our case series demonstrates the reliability and versatility of the SCIP flap for different kinds of head and neck reconstructions. The chimeric options combined with bone, double skin paddle, and muscle offer a broad variety of functional reconstructive solutions for complex head and neck surgeries. Intraoperative indocyanine green perfusion examination provides a valuable tool to assess and ascertain proper vascularization and post-anastomosis vessel patency in complex microvascular flap-based reconstructions.
Julie Kjems, Jacob Kinggaard Lilja‐Fischer, Jeppe Friborg, Trine Tramm, Jens Overgaard
Publication date 25-03-2024
Abstract Background In head and neck squamous cell carcinomas (HNSCC), there is no clinically available method to separate distant metastases (DMs) from SCC secondary primary tumors. The study aimed to assess the genetic relationship in paired tumor samples.
Methods Patients with pairs of solid biopsies from the primary HNSCC and suspected DMs were identified (2007–2017). Targeted next-generation sequencing of 22 genes was applied, including TP53, supplemented with human papillomavirus (HPV) genotyping.
Results Of 55 pairs obtained, 33 were successfully analyzed. Distant biopsies included lung, liver, and bone. A genetic match was found in 23/33 (70%) patients, primarily with identical TP53 mutations or HPV genotypes. In 10/33 patients (30%), the genetic relationship was absent, all with lung involvement. In patients with no lung involvement, 8/8 had a match.
Conclusions One-third of patients with DMs in HNSCC lack a genetic relationship with the primary tumors. The risk of misclassification is most prominent for patients with lung involvement.
Saheli Saha, Indranil Mallick, Prattusha Mukherjee, Santam Chakraborty, Tapesh Bhattacharyya, Moses Arunsingh S, Rimpa Basu Achari, Sanjoy Chatterjee
Publication date 25-03-2024
Abstract Background This study assessed a palliative radiotherapy regimen using daily radiation over 4 days for three courses in inoperable head and neck cancers, emphasizing oral primary cancers.
Methods Retrospective data of 116 patients treated with a daily dose of 3.6–3.7 Gy in four fractions over 4 days to a total of three courses, with a 2-week gap after every course, were analyzed for survival outcomes. A subgroup analysis was done for oral cancer.
Results Ninety-nine (85%) completed three courses. Overall subjective response rate was 77%. Median overall survival and progression-free survival were 12 months (95% confidence interval CI: 8–20) and 8 months (95% CI: 6–10), with numerically higher overall survival in oral cancer. The treatment was well tolerated, with no on-treatment hospitalization or grade 3–4 toxicities.
Conclusion The modified QUAD SHOT regimen is practical for palliation in head and neck cancers.
Qian Zhang, Yao Feng, Ying‐Hui Zhou, Yi‐Fan Yang, Yun‐Zhi Feng, Yue Guo
Publication date 25-03-2024
Abstract Objectives The Gothenburg Trismus Questionnaire (GTQ) is a comprehensive scale for screening and assessing trismus in head and neck (H&N) cancer and temporomandibular joint disorders (TMD) patients. This study aimed to translate and cross-culturally adapt the GTQ in China, and to test its measurement invariance.
Methods This study comprised 278 H&N cancer, 245 TMD, and 507 control patients. Internal consistency and test–retest reliability were tested to assess the GTQs reliability. The validity was evaluated through composite reliability (CR), average variance extracted (AVE), and correlation tests. Multi-group confirmatory factor analysis (CFA) was used to investigate the GTQs measurement invariance across clinical status and gender. T tests were employed to compare score differences across clinical status and gender.
Results The Chinese version of GTQ scale shows excellent internal consistency and test–retest reliability. The CR, AVE, and correlation values demonstrate the good validity of GTQ. The multi-group CFA supported configural invariance across clinical status but not metric invariance, while it supported strict invariance across gender. Additionally, t tests revealed that patients with H&N cancer and TMD scored higher than the control group, while males scored higher than females.
Conclusions The Chinese version of GTQ serves as an effective tool for screening and assessing trismus.
Yi Liu, Yisha Liu, Ying Li, Tong Wang, Bolong Li, Xianchen Kong, Changyi Li
Publication date 24-03-2024
Abstract Objective The aim was to research ACTL6As role in oral squamous cell carcinoma (OSCC).
MethodsOSCC and normal samples were obtained from patients and public databases. GSEA was performed. CIBERSORT was utilized to analyze immune landscape. Kaplan–Meier survival analysis and multivariate Cox regression analysis were conducted. After knocking down ACTL6A, we performed MTT assay, transwell assays, and flow cytometry to detect the impact of knockdown.
ResultsACTL6A expressed higher in OSCC samples than normal samples. The CNV and mutation rate of TP53 was higher in ACTL6A high-expression group. TFs E2F7 and TP63 and miRNA hsa-mir-381 were significantly related to ACTL6A. ACTL6A could influence immune microenvironment of OSCC. Knockdown of ACTL6A inhibited OSCC cells proliferation, migration, and invasion. ACTL6A was able to predict OSCC prognosis independently.
ConclusionACTL6A expressed higher in OSCC than normal samples and it could be used as an independent prognostic marker in OSCC patients.
Nauman H. Malik, Mackenzie Montero, Jie Jane Chen, Sumi Sinha, Sue S. Yom, Jason W. Chan
Publication date 22-03-2024
Abstract Background Neighborhood socioeconomic deprivation impacts outcomes in various cancers. We examined this association in nasopharyngeal carcinoma (NPC) patients using the area deprivation index (ADI).
Methods We conducted a single-institution retrospective cohort study on NPC patients treated with definitive radiotherapy from 1980 to 2023. ADI was used as the primary exposure measure. Higher ADI indicates higher levels of socioeconomic deprivation.
Results Of 561 patients, those with higher ADI (6–10 vs. 1–5) presented more commonly with AJCC stage III/IV compared to I/II (87% vs. 76%, p = 0.03). Increasing ADI decile score correlated with poorer overall survival (HR 1.14, 95% CI 1.01–1.28, p = 0.04). Local control was worse in patients from the most deprived quartile in the cohort ADI 5–10 (HR 2.11, 95% CI 1.01–4.41, p = 0.05).
ConclusionsNPC patients from more disadvantaged neighborhoods undergoing radiotherapy had worse local control and survival outcomes. Interventions to address structural determinants of health and neighborhood disparities may improve these outcomes.
Lise J. van de Velde, W. F. Julius Scheurleer, W. Weibel Braunius, Lot A. Devriese, Mischa de Ridder, Remco de Bree, Gerben E. Breimer, Boukje A. van Dijk, Johannes A. Rijken
Publication date 21-03-2024
Abstract Background Squamous cell carcinoma of the nasal vestibule (SCCNV) is a rare disease, distinctly different in presentation, treatment, and outcome from squamous cell carcinoma (SCC) of the nasal cavity and paranasal sinuses. However, these are often not analyzed separately.
Methods The Netherlands Cancer Registry (NCR) and pathology reports from the Dutch Nationwide Pathology Databank (PALGA) were used to identify all newly diagnosed SCCNV cases in the Netherlands between 2008 and 2021.
ResultsA total of 763 patients were included. The yearly incidence rate displayed a significant downward trend with an annual percentage change (APC) of −3.9%. The 5-year overall survival (OS) and disease-free survival were 69.0% and 77.2%, respectively. The 5-year relative survival was 77.9% and improved slightly over the inclusion period. OS for patients who were staged cT3 appeared to be worse than those staged cT4a, calling the applicability of the TNM-classification into question.
ConclusionSCC of the nasal vestibule is rare, with declining incidence rates. Introducing a specific topography code for SCCNV is recommended to enhance registration accuracy. The TNM classification seems poorly applicable to SCCNV, suggesting the need to explore alternative staging methods.
Caitlin McMullen, Alexandra Kejner, Elizabeth Nicolli, Marianne Abouyared, Orly Coblens, Katie Fedder, Punam Thakkar, Rusha Patel
Publication date 21-03-2024
Abstract Background The availability of paid parental leave is an important factor for retention and wellness. The experiences of head and neck surgeons with parental leave have never been reported.
MethodsA survey was electronically distributed to head and neck subspecialty surgeons in the United States. Responses were collected and analyzed.
Results Male surgeons had more children and took significantly less parental leave than women. Thirty percent of respondents reported that parental leave negatively impacted compensation, and 14% reported a delay in promotion due to leave, which impacted women more than men. The vast majority reported they are happy or neutral about covering those on leave. Most respondents utilized paid childcare, and approximately one quarter of respondents spending 11%–20% of their income on childcare.
Conclusions This study illuminates the current disparities regarding parental leave-taking within the subspecialty of head and neck surgery in the United States. Women surgeons are more likely to be impacted professionally and financially.
Jia Kang, Ping Ma, Hanbing Xu, Minghui Mao, Zhengxue Han
Publication date 20-03-2024
Abstract Objectives Reconstruction of large lower lip defects remains challenging in terms of aesthetics, function and safety. The aim of this study is to explore a modified nasolabial flap to repair large lower lip defects.
Methods The full-thickness nasolabial facial artery flap was used for reconstruction of defects in lip squamous cell carcinoma (LSCC) patients after tumor ablation. The postoperative recovery of patients was obtained through clinical review and follow-up in the first and sixth month.
Results There were four LSCC patients who received tumor ablation at the Beijing Stomatological Hospital of Capital Medical University from November 2022 to March 2023, were included in our study. All patients did not suffer from postoperative infection, orocutaneous fistula, flap necrosis, and flap loss. One patient had the trapdoor deformity. These patients achieved better lip closure function. One patient developed cervical lymph node metastasis 2 months after surgery.
Conclusions The modified nasolabial flap could achieve good outcomes in terms of aesthetics, function, and safety. It provided a supplementary strategy for the using of nasolabial flap in larger defects of lower lip.
Sagar Kansara, Evrim Oral, Indrani Sarkar, Vlad Sandulache, Rula Mualla, Rohan R. Walvekar, William Ryan, Patrick Ha
Publication date 18-03-2024
Abstract Objectives The rate of occult metastasis in lip cancer is poorly studied. Management of the regional nodal basin in lip cancer is thus controversial. This study sought to understand the true rate of micrometastasis in lip cancer.
Materials and Methods Systematic review and meta-analysis was conducted of English language studies reporting lip cancer sentinel node biopsy results. Studies were obtained from the Pub Med database between the years 2000 and 2023 using the search terms “sentinel node biopsy” and “squamous cell carcinoma.” Random effect and fixed effect meta-analyses were performed.
Results Thirteen studies met inclusion criteria. Low heterogeneity was noted among the studies, as indicated by the I2 inconsistency test (I2 = 0%). The rate of occult metastasis ranged between 0 and 33% (mean 9%). A total of 189 lip sentinel node biopsies had been performed. Of these, 21 revealed occult nodal metastasis (11.1%, 95% CI 7.36%–16.44%). One step, generalized linear mixed modeling revealed the true rate of occult nodal metastasis to be 10% (95% CI (0.0504, 0.1746), p < 0.0001).
Conclusion The rate of occult metastasis in lip cancer approaches the threshold for elective management of the regional nodal basin. Sentinel node biopsy is optimally suited for management of high-risk early T stage lip cancer.
Huai‐Pao Lee, Chia‐Jung Li, Ching‐Chih Lee
Publication date 18-03-2024
Abstract Background The prevalence of HPV-negative oropharyngeal cancer (OPC) is higher in Asian countries. Patients with HPV-negative OPC suffer poor outcomes. Multi-omics analysis could provide researchers and clinicians with more treatment targets for this high-risk group. We aimed to explore the prognostic significance of EGFR overexpression and macrophage infiltration in OPC, especially HPV-negative OPC in this study.
MethodsEGFR alternation was evaluated with TCGA, Pan Cancer Atlas through c Bio Protal. EGFR mRNA expression in HPV-negative head and neck squamous cell carcinoma was analyzed using the Tumor Immune Estimation Resource (TIMER 2.0). We also examined EGFR/STAT6/MRC1 expression in paraffin-embedded tissues from a p16-negative OPC cohort. The correlation between EGFR expression and macrophage activation was explored using Persons correlation coefficient. The impact of biomarkers or macrophage infiltration on 5-year overall survival and recurrence-free survival were analyzed using Kaplan–Meier survival curves.
ResultsEGFR alteration rate was 15%, 13%, and 0% for HPV-negative HNSCC (excluding OPC), HPV-negative OPC, and HPV-positive OPC. High EGFR expression was associated with increased tumor infiltration of immune cells, such as macrophages. We observed positive correlations between EGFR, STAT6, and MRC1 expression in p16-negative OPC. Higher MRC1 expression was associated with poorer survival rates.
Conclusions There is strong correlation between EGFR overexpression and M2 polarization in patients with p16-negative OPC. Immunotherapy with or without EGFR inhibitor could be considered in these high-risk patients.
Vusala Snyder, Brandon Smith, Seungwon Kim, Matthew E. Spector, Umamaheswar Duvvuri
Publication date 15-03-2024
Abstract Background Robot-assisted neck dissection (RAND) for the management of the regional lymphatic basin offers the potential for improved cosmesis and reduced lymphedema. While RAND has been previously described, functional outcome and oncologic control rates need further elucidation.
MethodsA retrospective, matched cohort study of neck dissections completed at UPMC from 2017 to 2021 was conducted. RAND was identified and matched to open neck dissections (open) in a 1:2 ratio. Matching characteristics included primary cancer site, pre-operative clinical N-stage, age at time of surgery, HPV status, and previous chemoradiation treatment (salvage vs. nonsalvage procedure). Additional information was collected on patient demographics, surgery characteristics, and outcomes. Comparisons were made using t-test, chi-square test, Fishers exact test, and Kaplan–Meier Wilcoxon (KMW) test with p < 0.05 indicating significance.
Results Overall, RAND and open groups had similar distributions of age, gender, BMI, primary site of cancer, HPV status, clinical N-stage, clinical T-stage, known neck disease prior to procedure, prior chemoradiation therapy, and level(s) of neck dissection. Surgically, RAND procedures yielded less drainage on average (124 mL in RAND vs. 220 mL in open approaches; p = 0.01). There was no difference in the rates of complications, estimated blood loss, or number of lymph nodes obtained. There were also no differences in the rates of adjuvant therapy. Long term, there were no differences in the rates of local, locoregional, and distant recurrence of primary disease between RAND and open procedures. There were also no differences in postprocedure disease-free survival time (KMW p-value = 0.32; HR of RAND compared with open = 0.62). Similarly, there were no statistical differences in the overall survival of RAND patients when compared with the open group (75 vs. 58.9 months; HR = 0.11, p = 0.87).
Conclusion This study is the first to report the long-term effectiveness of robot-assisted surgery compared with the traditional, open approach. In addition to well-known cosmetic benefits, robot-assisted surgery may also offer patients a reduction in uncomfortable drains and improved effects from lymphedema. Overall, this study provides initial data that the RAND may be considered as an alternative approach to open surgery.
Joshua K. Kim, Karen Tawk, Jonathan M. Kim, Hady Shahbaz, Joshua A. Lipton, Yarah M. Haidar, Tjoson Tjoa, Mehdi Abouzari
Publication date 15-03-2024
Abstract Background We analyzed online rating scores and comments of head and neck surgeons to understand factors that contribute to higher ratings.
Methods Numerical ratings and comments for American Head and Neck Society physicians were extracted from Healthgrades, Vitals, RateMDs, and Yelp, with narrative comments categorized based on content. Physician practice location, education, and residency training were also compiled.
Results Patient ratings were significantly higher with supportive staff and affable physician demeanor but showed significant drops with longer wait times and difficulties scheduling appointments or follow-ups. Physician education and postgraduate training did not significantly affect ratings.
Conclusion Online ratings and comments correlated to modifiable factors in clinical practice and may be informative in understanding patient needs.
Marika Russell, Matti L. Gild, Lori J. Wirth, Bruce Robinson, Amanda Silver Karcioglu, Ayaka Iwata, Tejas S. Athni, Amr H. Abdelhamid Ahmed, Gregory W. Randolph
Publication date 15-03-2024
Abstract Background Experience with targeted neoadjuvant treatment for locoregionally advanced thyroid cancer is nascent.
Methods Multicenter retrospective case series examining targeted neoadjuvant treatment for locoregionally advanced thyroid cancer. The primary outcome was change in surgical morbidity as measured by two metrics developed for use in clinical trials to characterize surgical complexity and morbidity. Secondary outcomes included percentage of patients proceeding to surgery and percentage receiving an R0/R1 resection.
Results Seventeen patients with varied molecular alterations, pathologies, and treatment regimens were included. Mean surgical complexity scores decreased between time points for baseline and postneoadjuvant treatment, postneoadjuvant treatment and surgery, and between baseline and surgery. Eleven patients (64.7%) underwent surgical resection, with 10 (58.8%) receiving an R0/R1 resection.
Conclusions Neoadjuvant treatment of advanced thyroid cancer improves resectability and decreases the morbidity of required surgical procedures. However, treatment is not uniformly effective.
Han Lei, Yu Lin, Weixiong Chen, Tianrun Liu, Jin Ye, Qian Cai, Fei Ye, Long He, Xingqiang Xie, Guoping Xiong, Wenxiang Gao, Wenbin Lei
Publication date 15-03-2024
Abstract BackgroundsA deep neck space abscess (DNSA) is a critical condition resulting from infection of deep neck fascia and soft issue, leading to high morbidity and mortality. Therefore, intensive care can be very significant for patients with DNSA. This study aimed to develop models to predict the need for postoperative intensive care in patients with DNSA.
Methods We retrospectively analyzed the records of 332 patients with DNSA who received drainage operation between 2015 and 2020. Multivariate logistic regression analysis and the e Xtrem Gradient Boosting (XGBoost) algorithm were used to develop predictive models.
Results We developed two predictive models, the nomogram and the XGBoost model. The area under the curve (AUC) of the nomogram was 0.911 and of the XGBoost model was 0.935.
Conclusion We developed two predictive models for guiding clinical decision making for postoperative ICU admission for DNSA patients, which may help improve prognosis and optimize intensive care resource allocation.
Shivee Gilja, Vikram Vasan, Arvind Kumar, Scott A. Roof, Eric M. Genden, Diana N. Kirke
Publication date 14-03-2024
Abstract Background In 2018, the National Comprehensive Cancer Network treatment guidelines began recommending the use of neck dissection during surgical management of stage I-II supraglottic laryngeal squamous cell carcinoma (LSCC).
Methods Trends and factors associated with the use of neck dissection during larynx-preserving surgery for patients with cT1-2, N0, M0 supraglottic LSCC in the National Cancer Database (2004–2020) were evaluated using multivariable-adjusted logistic regression.
Results Of the 2080 patients who satisfied study eligibility criteria, 633 (30.4%) underwent neck dissection. Between 2018 and 2020, the rate of neck dissection was 39.0% (114/292). After multivariable adjustment, academic facility type, undergoing biopsy prior to surgery, and more radical surgery were significant predictors of receiving neck dissection.
Conclusions The results of this national analysis suggest that the utilization of guideline-concordant neck dissection for management of stage I-II supraglottic LSCC remains low and highlight the need to promote the practice of neck dissection for this patient population.
Frederick G. Durrant, Jorge A. Gutierrez III, Shaun A. Nguyen, Cherie‐Ann O. Nathan, Jason G. Newman
Publication date 13-03-2024
Abstract Background Increased sexual activity is associated with higher human papillomavirus (HPV) rates; however, there is a lack of analysis comparing the sexual history of patients with HPV positive and HPV negative oropharyngeal cancer (OPC).
Methods In this meta-analysis, Pub Med, Scopus, and CINAHL were searched for articles that included patients with OPC and reported information regarding HPV status and either history of oral sex, number of sexual partners, or sexually transmitted infections (STI).
ResultsA total of 11 studies were included with 3296 patients with OPC. Patients with HPV positive OPC were more likely than patients with HPV negative OPC to report a history of oral sex (92%, 95% CI: 87.0–97.0 vs. 74.5%, 95% CI: 50.6–98.4, p < 0.0001), higher mean number of sexual partners (18.4 partners, 95% CI: 1.5–35.4 vs. 7.2 partners, 95% CI: 1.0–13.4, p < 0.0001), and more frequent history of STI (23.7%, 95% CI: 18.4–29.0 vs. 8.8%, 95% CI: 4.7–12.8, p = 0.0001).
Conclusions Compared to patients with HPV negative OPC, our analysis shows a larger proportion of patients with HPV positive OPC had participated in oral sex, had a higher number of sexual partners, and had a higher proportion of STI history.
Mohammad Altawil, Isabella Stanisz, Nadia H. Van Den Berg, Patrick Sheahan
Publication date 13-03-2024
Abstract Background Selective neck dissection (SND) has traditionally been applied to clinically negative (cN0) necks in mucosal squamous cell carcinoma (SCC). We aimed to examine the oncological safety and patterns of regional recurrence (RR) of SND in clinically positive (cN+) necks.
Methods Retrospective review of prospective cohort of 206 patients with mucosal SCC undergoing neck dissection. RR was classified as occurring within previously dissected levels, within ipsilateral undissected levels, within unusual locations of ipsilateral neck, or contralateral neck.
Results Seven of seventy-seven (9.1%) cN+ patients undergoing SND developed isolated RR, versus 16.2% after MRND, and 8.7% after SND for cN0 disease. RR was rarely seen within undissected levels of the ipsilateral neck. RR and survival rates were not associated with ND extent (SND vs. MRND) among either cN+ or pN+ patients.
ConclusionSND can be safely performed in most patients with cN+ SCC, who do not have gross sternocleidomastoid infiltration or level V metastases.
Gian Marco Pace, Carolina Morales‐Olavarría, Andrea Costantino, Bianca Maria Festa, Elena Russo, Giannicola Iannella, Claudio Carnevale, Pasquale Di Maio, Claudio Sampieri, Remo Accorona, Armando De Virgilio
Publication date 12-03-2024
Abstract Objective The aim of this study is to analyze oncologic outcomes and complications rate after common or internal carotid artery (CCA/ICA) resection for head and neck squamous cell carcinoma (HNSCC).
Methods This study was conducted in conformity with the PRISMA statement. A systematic review and pooled analysis was performed for overall survival (OS), disease specific survival (DSS) (primary outcomes), and perioperative death rate (secondary outcome).
ResultsA total of 276 patients (males: 76.7%, n = 191/249) with a median age of 59 years (n = 239/276; 95% CI 55.0–61.7) who underwent CCA/ICA resection for HNSCC were included. The median follow-up time was 11 months (n = 276). Estimated pooled OS rates (95% CI) at 1 and 2 years were 52.7% (46.9–59.2) and 29.8% (24.3–36.5), respectively. The median OS (95% CI) was 14 months (12–17). Estimated pooled DSS rates (95% CI) at 1 and 2 years were 58.6% (52.7–65.2) and 34.6% (28.5–41.9), respectively. The median DSS (95% CI) was 16 months (14–19). The perioperative death rate was 6.9% (n = 19/276).
ConclusionsCCA/ICA resection should be considered as a treatment option for accurately selected patients. Multicentric prospective studies are recommended to develop a predictive score guiding the decision-making process.
Yu‐Jing Weng, Kristine J. S. Kwan, De‐Biao Chen, Ben‐ling Hu, Jiang Jiang, Lei Min, Qing Ai, Wei‐chun Chen, Zhi‐Heng Huang
Publication date 12-03-2024
Abstract Background Extrathyroid implantation or dissemination of thyroid tissue secondary to a thyroid procedure is rare. Most of these belonged to thyroid carcinoma with metastatic potential and uncommon for benign pathologies.
Methods We report the case of a 31-year-old female who was identified to have multiple subcutaneous implantation of thyroid tissue 5 years after transoral endoscopic thyroidectomy vestibular approach. A comprehensive literature search on implantation of thyroid tissue secondary to thyroid procedures was performed.
Results Accidental tearing of the capsule during previous surgery may lead to the subcutaneous implantation. Through literature review, a total 29 articles with 47 patients were identified. 33.3% were benign lesions, and implantation was mostly secondary to fine needle aspiration biopsy (46.5%).
Conclusions Subcutaneous or port site implantation after endoscopic thyroid surgery may occur in benign thyroid pathologies and therefore, oncologic principles must be strictly followed during surgery regardless of its histopathological nature.
Hao Wu, Yuehao Hu, Zilin Wang, Yige Liu, Jing Han, Chenping Zhang, Zanjing Zhai, Jiannan Liu
Publication date 11-03-2024
Abstract Background This study aimed to investigate the incidence of toe flexion deformity after fibular free flap transplantation and to analyze the etiology of the deformity.
Methods Fifty patients underwent vascularized fibular free flap transplantation were retrospectively included. Statistical analysis examined correlations between deformity occurrence and resected fibula length and residual distal fibula length using the χ2 test. Doppler ultrasound and anatomical evaluations were conducted.
Results Flexion deformity of the first toe was observed in all patients (100%), exacerbated by ankle dorsiflexion. χ2 test revealed no significant correlation between fibula length, distal residual fibula length, and flexion deformity. Doppler ultrasound revealed elevated echoes and blurred textures in the flexor hallucis longus post-fibular transplantation, while anatomical evaluation confirmed the peroneal artery as its primary nutrient supplier.
Conclusion This study reports a 100% incidence of toe flexion deformity post-transplantation. The deformity correlated strongly with ischemic contracture of the flexor hallucis longus.
Marian Mikhael, Bhargav Kansara, Ameer Basta, Emma Hume, Oliver T. Nguyen, Maija Reblin, Young‐Rock Hong, Amir Alishahi Tabriz, Krupal Patel, Jeffery Scott Magnuson, Kea Turner
Publication date 09-03-2024
Abstract Background There has been limited study of oncology professionals perspectives on optimizing delivery of presurgical education for individuals with head and neck cancer (HNC). Therefore, we assessed oncology professionals perspectives about presurgical education for laryngectomy and free flap surgeries, which have a significant impact on patients quality of life.
Methods Interviews were conducted with 27 oncology professionals from an NCI-designated Comprehensive Cancer Center and a community oncology setting.
Results Participants identified six recommendations to improve presurgical education: (1) establishing preoperative consultations with allied health professionals; (2) educating patients and providers on the concept of team-based care; (3) optimizing education through multimodal strategies; (4) connecting patients with other HNC surgical patients; (5) preparing caregivers for their role; and (6) educating patients on insurance navigation.
Conclusions Study findings demonstrate gaps in the timing, content, and mode of delivery for presurgical education and suggest strategies for further evaluation in future studies.
Behrus Puladi, Beatrice Coldewey, Julia S. Volmerg, Kim Grunert, Jeff Berens, Ashkan Rashad, Frank Hölzle, Rainer Röhrig, Myriam Lipprandt
Publication date 07-03-2024
Abstract Background Early detection of oral cancer (OC) or its precursors is the most effective measure to improve outcome. The reasons for missing them on conventional oral examination (COE) or possible countermeasures are still unclear.
Methods In this randomized controlled trial, we investigated the effects of standardized oral examination (SOE) compared to COE. 49 dentists, specialists, and dental students wearing an eye tracker had to detect 10 simulated oral lesions drawn into a volunteers oral cavity.
ResultsSOE had a higher detection rate at 85.4% sensitivity compared to 78.8% in the control (p = 0.017) due to higher completeness (p < 0.001). Detection rate correlated with examination duration (p = 0.002).
ConclusionsA standardized approach can improve systematics and thereby detection rates in oral examinations. It should take at least 5 min. Perceptual and cognitive errors and improper technique cause oral lesions to be missed. Its wide implementation could be an additional strategy to enhance early detection of OC.
Katherine C. Wai, Trine Line H. Okholm, Patrick K. Ha, Diana M. Marquez, Iliana Tenvooren, Kyle B. Jones, Matthew H. Spitzer
Publication date 07-03-2024
Abstract Background Treatment of salivary gland tumors (SGTs) remains challenging. Little is known about the immune landscape of SGTs. We aimed to characterize the tumor microenvironment in benign and malignant SGTs.
Methods Eleven benign and nine malignant tumors were collected from patients undergoing curative intent surgery. Specimens were analyzed using mass cytometry by time-of-flight. Immune cell populations were manually gated, and T cells were clustered using the FlowSOM algorithm. Population frequencies were compared between high-grade and low-grade malignancies, corrected for multiple hypothesis testing.
Results There were trends towards increased CD4+ and CD8+ T cells among malignant tumors. High-grade malignancies exhibited trends towards higher frequencies of CD8+ PD-1+ CD39+ CD103+ exhausted T cells, CD4+ FoxP3+ TCF-1+ CD127− Tregs, and CD69+ CD25− CD4+ T cells compared to low-grade malignancies.
ConclusionSGTs exhibit significant immunologic diversity. High-grade malignancies tended to have greater infiltration of exhausted CD8+ T cells and Tregs, which may guide future studies for immunotherapy strategies.
Hasan Abdulbaki, Patrick K. Ha, Philip D. Knott, Andrea M. Park, Rahul Seth, Chase M. Heaton, Katherine C. Wai
Publication date 06-03-2024
Abstract Background Complications following head and neck microvascular free tissue transfer (MFTT) are common. Less is known about when they occur.
Method Retrospective study of patients with primary or recurrent head and neck cancer undergoing MFTT reconstruction at a tertiary care institution. MFTT reconstructions with inpatient postoperative complications were included. The Kruskal–Wallis test was used to compare median postoperative day (POD) onset of complication by flap type.
Results Of 1090 patients undergoing MFTT reconstruction, 126 (11.6%) patients experienced inpatient complications including fibula (n = 35), anterolateral thigh (n = 60), or radial forearm (n = 31) MFTTs. POD onset was shortest for surgical site hematoma (median = 1 IQR 1–5), and longest for donor site infection (median = 11.5 IQR 8–15). There was no significant difference between flap types and POD onset of complications (p > 0.05).
Conclusion Hematoma formation and flap failure occur earliest during hospitalization, while dehiscence, infection, and fistula occur later. There is no difference in complication timing between flap types.
Lara Bessa Campelo Pinheiro Cavalcante, Natalia Treistman, Fabiola Maria Teresa Torres Gonzalez, Pollyanna Iemini Weyll Fernandes, Paulo Alonso Garcia Alves Junior, Fernanda Accioly Andrade, Elisa Napolitano Ferreira, Tarcisio Fontenele De Brito, Attilio Pane, Rossana Corbo, Felipe Erlich, Daniel Alves Bulzico, Fernanda Vaisman
Publication date 06-03-2024
Abstract Introduction Cervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are controversial.
Purpose To identify clinical and molecular factors associated with control of cervical disease with EBRT.
Methods Retrospective evaluation and molecular analysis of the primary tumor DTC patients who underwent cervical EBRT between 1995 and 2022 was performed.
Results Eighty adults, median age of 61 years, were included. T4 disease was present in 43.7%, lymph node involvement in 42.5%, and distant metastasis in 47.5%. Those with cervical progression were older (62.5 vs. 57.3, p = 0.04) with more nodes affected (12.1 vs. 2.8, p = 0.04) and had EBRT performed later following surgery (76.6 vs. 64 months, p = 0.05). EBRT associated with multikinase inhibitors showed longer overall survival than EBRT alone (64.3 vs. 37.9, p = 0.018) and better local disease control. Performing EBRT before radioiodine (RAI) was associated with longer cervical progression-free survival (CPFS) than was RAI before (67.5 vs. 34.5, p < 0.01). EBRT ≥2 years after surgery was associated with worse CPFS (4.9 vs. 34, p = 0.04). The most common molecular alterations were ERBB2, BRAF, FAT1, RET and ROS1 and TERT mutation was predictive of worse disease control after EBRT (p = 0.04).
Conclusion Younger patients, with fewer affected nodes and treated earlier after surgery had better cervical disease control. Combination of EBRT with MKI improved OS. TERT mutation might indicate worse responders to EBRT; however, further studies are necessary to clarify the role of molecular testing in selecting candidates for cervical EBRT.
Constantina Nadia Christou, Karl Sandström, Naresh Regula, Ylva Tiblom Ehrsson, Hemming Johansson, Jens Sörensen, Göran Laurell
Publication date 05-03-2024
Abstract Aims To examine the prognostic value of F-18 fluorodeoxyglucose (FDG) uptake in the bone marrow (BM) for disease recurrence and survival in patients with oropharyngeal squamous cell carcinoma (OP-SCC). The secondary aims were to evaluate the prognostic value of PET/CT parameters for the primary oropharyngeal tumor and total tumor burden, and to assess the correlation between FDG uptake variables and serum inflammatory markers.
Methods This was an observational study of 91 patients with OP-SCC who underwent pretreatment FDG-PET/CT. The patients blood samples were collected before treatment, and treatment was administered with the intention to cure. The median follow-up time was 40 months. The PET parameters measured were SUVmeanBM for the assessment of BM FDG uptake, SUVmean, SUVmax, total lesion glycolysis (TLG), and metabolic tumor volume (MTV) for the evaluation of primary oropharyngeal tumor and total tumor burden.
Blood samples were analyzed to determine each patients white cell, red cell, and platelet cell counts, hemoglobin, and C-reactive protein level. In a subgroup of 33 patients, blood serum was analyzed to evaluate the expression of serum immune proteins using a proximity extension assay (Olink Proteomics).
Results The univariate analysis revealed that SUVmeanBM and tumor-specific parameters (SUVmaxtumor, SUVmeantotal, SUVmaxtotal, MTVtotal, TLGtotal) were significantly associated with recurrence-free survival (RFS). After adjusting for age, sex, and stage only SUVmeanBM remained significantly associated with RFS. Spearmans correlation identified several correlations between PET parameters and inflammatory markers.
Conclusions Our results show that several FDG-PET/CT parameters may have a prognostic value of treatment outcome in patients with OP-SCC. However, SUVmeanBM was the only independent PET parameter that showed a prognostic value for RFS in the study cohort. Moreover, the study findings might suggest an association between systemic inflammation and the metabolic activity in the BM.
Congxian Lu, Yuteng Yang, Mingjun Zhang, Jiaxuan Li, Hao Song, Hongfei Zhao, Yakui Mou, Yumei Li, Xicheng Song
Publication date 04-03-2024
Abstract Objective Establish an in situ model for investigating HNSCC, focusing on tumor growth, metastasis, and the immune microenvironment.
Methods Generated a monoclonal SCCVII-Zs Green cell line through lentiviral transfection. Selected monoclonal lines with growth rates similar to the original SCCVII for in vivo tumorigenesis. Monitored tumor development and metastasis through fluorescence in vivo imaging. Employed immunohistochemistry to assess immune cell distribution in the tumor microenvironment.
ResultsSCCVII-Zs Green exhibited comparable proliferation and in vivo tumorigenicity to SCCVII. In situ tumor formation on day 10, with cervical metastasis in C57BL/6 mice by day 16. No significant fluorescence signals in organs like liver and lungs, while SCCVII-Zs Green presence confirmed in cervical lymph node metastases. Immunohistochemistry revealed CD4+ T, CD8+ T, B, and dendritic cells distribution, with minimal macrophages.
Conclusion Our model is a valuable tool for studying HNSCC occurrence, metastasis, and immune microenvironment. It allows dynamic observation of tumor development, aids preclinical drug experiments, and facilitates exploration of the tumor immune contexture.
Aathira T. Sreejeev, Deepa Joseph, Ajay S. Krishnan, Rajesh Pasricha, Sweety Gupta, Rachit Ahuja, Nidhi Sharma, Debanjan Sikdar, Sagar Raut, Abhijith Sasi, Manoj Gupta
Publication date 04-03-2024
Abstract Background Chemoradiation in head and neck carcinoma (HNC) shows significant anatomical resulting in erroneous dose deposition in the target or the organ at risk (OAR). Adaptive radiotherapy (ART) can overcome this. Timing of significant target and OAR changes with dosimetric impact; thus, most suitable time and frequency of ART is unclear.
Methods This dosimetric study used prospective weekly non-contrast CT scans in 12 HNC patients (78 scans). OARs and TVs were manually contoured after registration with simulation scan. Dose overlay done on each scan without reoptimization. Dosimetric and volumetric variations assessed.
Results Commonest site was oropharynx. Gross Tumor Volume (GTV) reduced from 47.5 ± 19.2 to 17.8 ± 10.7 cc. Nodal GTV reduced from 15.7 ± 18.8 to 4.7 ± 7.1 cc. Parotid showed mean volume loss of 35%. T stage moderately correlated with GTV regression.
Conclusion Maximum GTV changes occurred after 3 weeks. Best time to do single fixed interval ART would be by the end of 3 weeks.
James D. Johns, Erica J. Choe, Paul F. Chisolm, Morgan J. Pothast, Jackson R. Randolph, Jiling Chou, Jessica H. Maxwell
Publication date 03-03-2024
Abstract Background The impact of both COVID-19 infection and vaccination status on patients with head and neck squamous cell carcinoma (HNSCC) remains unknown.
Objective To determine the impact of COVID-19 infection and vaccination status on 60-day mortality, cardiovascular, and respiratory complications in patients with a prior diagnosis of HNSCC.
Methods This was a retrospective cohort study through the Veterans Affairs (VA) Corporate Data Warehouse of Veterans with HNSCC who were tested for COVID-19 during any inpatient VA medical center admission. A cohort of patients was created of Veterans with a diagnosis of HNSCC of the oral cavity,oropharynx, hypopharynx, larynx, and nasopharynx based on International Classification of Disease (ICD) codes. Data collected included clinical/demographic data, vaccination status, and incidence of 60-day mortality, 60-day cardiovascular complication (including myocardial infarction, venous thromboembolism, cerebrovascular accident), and 60-day respiratory complication (including acute respiratory failure, acute respiratory distress syndrome, and pneumonia). The interactions between COVID-19 infection, vaccination status, morbidity and mortality were investigated.
Results Of the 14 262 patients with HNSCC who were tested for COVID-19 during inpatient admission, 4754 tested positive (33.3%), and 9508 (67.7%) tested negative. Patients who tested positive demonstrated increased 60-day mortality (4.7% vs. 2.0%, respectively; p < 0.001), acute respiratory failure (ARF; 15.4% vs. 7.1%, p < 0.001), acute respiratory distress syndrome (ARDS; 0.9% vs. 0.2%, p < 0.001), and pneumonia (PNA; 20.0% vs. 6.4%, p < 0.001) compared to those who never tested positive, respectively. Patients who received COVID-19 vaccination between 2 weeks and 6 months prior to a positive test demonstrated decreased rates of ARF (13.2% vs. 16.0%, p = 0.034) and PNA (16.7% vs. 20.9%, p = 0.003) compared to the unvaccinated group. A logistic regression of patients with COVID-19 infections who died within 60 days was performed, with no significant survival advantage among patients vaccinated between 2 weeks and 6 months prior to the positive test.
ConclusionCOVID-19 infection may significantly increase rates of 60-day mortality and respiratory complications in patients with HNSCC. COVID-19 vaccination between 2 weeks and 6 months prior to infection may decrease severity of respiratory complications but did not show significant mortality benefits in this study. These data highlight the need for surveillance of respiratory infection and vaccination in this vulnerable population.
Bochun Wang, Yiyuan Zhu, Shiguo Zhou, Cheng Lu, Aobo Zhang, Jun Tian, Wanxin Li, Shuling Ren, Yanbo Dong, Liangfa Liu
Publication date 01-03-2024
Abstract Background The long-term effect of intraoperative usage of carbon nanoparticles (CN) and parathyroid hormone (PTH) test strip using immune colloidal gold technique (ICGT) is unclear. This study aims to compare the effect of intraoperative usage of CN and ICGT test strips on PG function.
Methods This randomized clinical study involved adult patients who underwent total thyroidectomy. They were randomly allocated into three groups (control, CN, and ICGT group). Clinical data were analyzed.
Results Each group involved 98 patients. Serum calcium and PTH concentrations at 24 h postoperatively (PTH24h) were higher in CN group. The parathyroid function recovered quicker in CN group. Use of CN increased in situ PG preservation and PTH24h. Mediation analysis indicated that 23.05% of the total effect of CN on PTH24h was attributed to PGRIS.
ConclusionCN holds promise to improve in situ PG preservation and protect PG vasculature, thereby reducing the incidence of early hypoparathyroidism. The value of ICGT test strips for PG protection is dubious.
Hiroshi Matsumoto, Tomoyuki Ota, Motoi Kato, Takuma Makino, Seiichiro Makihara, Mizuo Ando, Yoshihiro Kimata
Publication date 01-03-2024
Abstract Background The pharyngeal flap (PF) is useful for reconstruction of soft palate defects, but effective arrangements of PF for various types of soft palate defects are controversial. Here, we classify three types of soft palate defects and discuss the arrangements of PF and their functional prognosis.
Methods Reconstruction was performed based on the classification of the defects. Clinical details were collected, and postoperative function was analyzed.
Results Eight patients were included in the study. The defect sizes ranged from 25 (width) × 40 (depth) to 40 × 60 mm. Six patients underwent pharyngeal flap reconstruction with free-flap reconstruction, and two underwent pharyngeal flap reconstruction. The pharyngeal flap was harvested at the maximum width of the posterior pharyngeal wall, ranging from 25 to 40 mm in length. Eating and speaking functions were maintained in all patients.
Conclusions Good postoperative function can be maintained by narrowing the velopharyngeal space with a pharyngeal flap.
Maryline Hoste, Sébastien Van der Vorst, Georges Lawson, Marie‐Cécile Nollevaux, Anne‐Sophie Pirson, Vincent Bachy, Olivier Desgain, Samantha Hassid, Gilles Delahaut
Publication date 29-02-2024
Abstract Background In oral and oropharyngeal squamous cell carcinoma (SCC), sentinel node biopsy (SNB) was described as a reliable and reproductive alternative to elective neck dissection for the staging of clinical N0 T1–T2 patients. The SNB technique in supraglottic laryngeal SCC was successfully described in small series. The aim of this study is to analyze retrospectively the results of SNB technique in supraglottic SCC in CHU Godinne, to determine if the technique is reliable and may be proposed in a future multicentral prospective trial.
Methods The study involved a retrospective analysis of 39 patients who underwent surgery between 2003 and 2019 at CHU Godinne. All patients presented with clinical N0 neck status. The SNB procedure included general anesthesia, 99-technetium colloid peritumoral injection, and lymphoscintigraphy. The hand-held gamma probe was utilized for SNB after tumoral resection during the same operating session. Out of 39 patients, 36 underwent SNB as the sole staging tool, while 3 patients received SNB in combination with elective neck dissection.
Primary outcome was the 2-years neck recurrence-free survival (RFS). Secondary outcomes were the 2- and 5-years disease-specific survival (DSS). Additionally, sensitivity and negative predictive value (NPV) of the SNB technique were analyzed.
Results Sentinel nodes were successfully identified in all 39 patients. An average of 4 nodes excised per patient. Positives SN were detected in 23% (9 in 39) cases, leading to subsequent selective neck dissection. Two cases of neck recurrence were observed, both considered as false negatives, occurring after an average of 3.5 months. Th median follow-up period was 48 months with a 2-year RFS of 95%. Sensitivity and NPV of the SNB technique were found to be 82% and 94%, respectively. Two and five years DSS were 84% and 71.7%, respectively.
Conclusions The results suggest that SNB in T1–T2 supraglottic SCC is a feasible and reliable technique for managing the neck in N0 early-stage patients. However, to establish its oncological equivalence with selective node dissection, further prospective and comparative studies are warranted. The findings of this study underscore the importance of ongoing research in refining and validating the role of SNB in the management of supraglottic SCC, potentially paving the way for more widespread adoption in clinical practice.
Benjamin T. Ostrander, Leo Meller, Matthew Harmon, Katya Archambault, Thanos Kristallis, Daniel Hammer, Ryan K. Orosco
Publication date 29-02-2024
Abstract Background We sought to review our institutions experience with dental implant placement in free flap jaw reconstruction to determine factors impacting restoration of dental occlusion.
Methods Exactly 48 patients underwent free flap jaw reconstruction with or without dental restoration from 2017 to 2022. Primary outcome was achievement of restored dental occlusion after jaw free flap reconstruction.
ResultsA total of 48 patients with a mean age of 59.8 ± 16.4 years underwent jaw reconstruction from 2017 to 2022. Ten patients (20.8%) received osteointegrated dental implants. Two patients received a temporary dental prosthesis, 12 ± 4 months after initial reconstruction. Three patients received a final prosthesis, with a mean time to final prosthesis of 17.7 ± 12.4 months. Five patients did not receive any prosthesis despite placement of implants.
ConclusionA minority of patients received dental implant placement with free flap jaw reconstruction and only a small subset of these received a definitive dental prosthesis.
Jane Kwon, Douglas Farquhar, Jason Tasoulas, Trevor G. Hackman
Publication date 28-02-2024
Abstract Background Otolaryngology patients are a high-readmission-risk group due to the complexity of surgeries, significant alterations to speech and swallowing functions, and high postoperative complications risk.
MethodsA retrospective review was performed on patients who underwent otolaryngologic surgery at a single-academic-institution between March 2019 and February 2020.
Results Among 365 discharges, 21 patients had unplanned readmissions within 30 days. On univariable analysis, acute myocardial infarction, number of total comorbidities, prior chemotherapy/radiation, active smoking, airway surgery, and enteral feeding, and on multivariable analysis, prior chemotherapy/radiation and active smoking were identified as significant readmission risk factors. Readmission risk increased from 2.43% to 7.48% and 41.67% with the addition of each risk factor.
Conclusion Nearly 75% of the readmissions were due to potentially preventable reasons. By identifying and proactively intervening on “at risk” patients during the perioperative timeframe, complications and readmission can be reduced, thereby improving the overall quality of care delivered.
Jacquelyn K. Callander, Spenser S. Souza, Yasmin Eltawil, Ivan H. El‐Sayed, Jonathan R. George, Patrick Ha, William R. Ryan, Mary Jue Xu, Chase M. Heaton
Publication date 27-02-2024
Abstract Objectives To describe the clinicopathologic presentation of buccal squamous cell carcinoma and identify risks factors for recurrence and overall survival.
Methods This is a retrospective case–control study of patients with oral cavity squamous cell carcinoma (OCSCC) treated at a single tertiary care center between 2010 and 2022. All patients with buccal subsite OCSCC treated during this time frame were included and paired with a randomly selected age and gender matched patient with non-buccal OCSCC. Relevant data was collected via chart review.
Results Seventy-seven patients with buccal SCC were matched with 77 non-buccal OCSCC controls. The median follow-up time was 27 months (IQR 14–61). Median age was 67 years (IQR 57–75) and 53% of the cohort was female. Twenty (26%) buccal SCC patients experienced a recurrence versus 19 (25%) in the controls. Age ≥65-years-old increased odds of all-cause mortality in the buccal SCC group, but not in the control group. Perineural invasion and positive margins increased odds of recurrence in the buccal group only. Overall survival and progression-free survival did not differ between the groups, despite a greater number of T2 buccal tumors and T1 non-buccal tumors.
Conclusions Buccal SCC presents at a higher T stage than other oral cavity SCC subsite and may exhibit variance in the pathologic risk factors that predict poor outcomes versus non-buccal OCSCC. Despite these relatively minor differences, however, oncologic outcomes between these groups were similar.
Shinichi Okada, Takashi Mukaigawa, Seiya Goto, Yohei Hiiragi, Fuyuki Sato, Shoichi Deguchi, Hirofumi Ogawa, Tsuyoshi Onoe, Shigeyuki Murayama, Yoshichika Yasunaga, Nakamasa Hayashi
Publication date 26-02-2024
Abstract Background This study aimed to examine treatment outcomes and postoperative complications associated with salvage skull base surgery following radical proton beam therapy (PBT).
Methods Nine patients who underwent salvage skull base surgery following curative PBT as the initial treatment at our institution between September 2002 and May 2023 were retrospectively reviewed.
Results The cohort comprised four males and five females with a mean age of 48.1 years. The average proton dose administered during initial therapy was 68.5 Gy (relative biological effectiveness). Among the salvage surgeries, eight were anterior skull base surgeries, and one was an anterior middle skull base surgery. No local recurrences or perioperative deaths were observed. Postoperative complications occurred in three patients (33.3%), all experiencing surgical site infections, with one also having cerebrospinal fluid leakage.
Conclusion The study demonstrates that salvage skull base surgery after PBT effectively achieves local control and safety in patients with recurrent sinonasal malignancies.