Jonathan Jelmini, Allison A. Slijepcevic, Urjeet Patel, Larissa Sweeny, Patrik Pipkorn, Yadro Ducic, Justine Moe, Amy Pittman, Karthik Rajasekaran, Jason Diaz, Carissa Thomas, Patrick Byrne, Jason Rich, Akina Tamaki, Liana Puscas, Daniel Petrisor, Mark K. Wax
Publication date 05-06-2023
Abstract Objectives Iatrogenic injury of the fibula free flap pedicle is rare. Postoperative flap survival and reconstructive outcomes following intraoperative pedicle severance are unknown. This study assesses free flap outcomes following accidental severance of the peroneal vessels.
Methods Multi-institutional retrospective chart review from 2000 to 2020.
Results Of 2975 harvested fibula free flaps, 26 had a history of pedicle severance during surgical reconstruction. Reasons for intraoperative pedicle severance included transection during muscular dissection 10/26 (39%), accidental severance with the bone saw 12/26 (46%), and other 4/26 (15.6%). The surgeon responsible for pedicle severance included residents 5/26 (19%), fellows 10/26 (39%), attendings 10/26 (39%), and unknown 1/26 (3.9%). The pedicle artery and vein were severed 10/26 (39%), artery 8/26 (31%), and vein 8/26 (31%). Truncated pedicle vessels were used 3/26 (11.7%), intraoperative anastomoses were performed 23/26 (89%). Postoperative revision in the OR within 7 days of surgery was required 6/26 (23%); 4 flaps were salvaged and 2 flaps failed, both arterial thrombosis. Flap failure was attributed to vascular thrombosis. Long-term flap survival and successful reconstructions were reported 24/26 (92%).
Conclusion Accidental severance of fibula free flap pedicle vessels can be corrected with intraoperative repair, without affecting long-term flap survival or reconstructive outcomes. Protecting the flap vessels while using the bone saw and during intramuscular dissection prevents accidental severance.
A. K. Yoder, A. S. Farooqi, C. Wernz, A. Subramaniam, V. Ravi, R. Goepfert, E. M. Sturgis, D. Mitra, A. J. Bishop, B. A. Guadagnolo
Publication date 05-06-2023
Abstract Introduction We investigated outcomes and prognostic factors for patients treated for cutaneous angiosarcoma (CA).
Methods We conducted a retrospective review of patients treated for CA of the face and scalp from 1962 to 2019. All received definitive treatment with surgery, radiation (RT), or a combination (S-XRT). The Kaplan–Meier method was used to estimate outcomes. Multivariable analyses were conducted using the Cox proportional hazards model.
Results For the 143 patients evaluated median follow-up was 33 months. Five-year LC was 51% and worse in patients with tumors >5 cm, multifocal tumors, those treated pre-2000, and with single modality therapy (SMT). These remained associated with worse LC on multivariable analysis. The 5-year disease-specific survival (DSS) for the cohort was 56%. Tumor size >5 cm, non-scalp primary site, treatment pre-2000, and SMT were associated with worse DSS.
Conclusion Large or multifocal tumors are negative prognostic factors in patients with head and neck CA. S-XRT improved outcomes.
Nerea Lopetegui‐Lia, Danai Dima, David Scott Buchberger, Anirudh Yalamanchali, Bennett Osantowski, Mariah Ondeck, Robert Roman Lorenz, Brandon Prendes, Jamie Ku, Eric Lamarre, Joseph Scharpf, Natalie Lea Silver, Larisa Schwartzman, Jessica Lyn Geiger, Neil McIver Woody, Shauna Rosalie Campbell, Shlomo A. Koyfman, Emrullah Yilmaz
Publication date 05-06-2023
Abstract Background Metastatic or locally advanced cutaneous squamous cell carcinoma (cSCC) can be treated with immunotherapy (IO). Cranial nerve involvement (CNI) is uncommon in cSCC and is a poor prognostic factor. Our aim is to describe how patients with CNI respond to IO monotherapy and/or as an adjunct to RT.
Methods Under an IRB approved protocol, patients with histologically proven cSCC of the head and neck with CNI treated with IO were retrospectively reviewed.
Results Twelve patients were included and received cemiplimab or pembrolizumab. Eight patients had CNI at diagnosis, and 4 at time of recurrence after non-IO therapy. Best responses were complete response (1), partial response (7), stable disease (1), progressive disease (2), and pending response (1). Nine patients are alive, 6 of which remain on IO.
Conclusions In this cohort, IO showed clinical response in 83% of patients, indicating IO can be an effective monotherapy, reserving RT for instances of local failure after IO.
Caineng Cao, Yuanfan Xu, Mengyun Qiang, Changjuan Tao, Shuang Huang, Lei Wang, Xiaozhong Chen
Publication date 01-06-2023
Abstract Background To evaluate the impact of coronavirus disease 2019 (COVID-19) pandemic on disease extent in patients with nasopharyngeal carcinoma (NPC) using 18 fuorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI).
Methods This retrospective cohort study included biopsy-proven, newly diagnosed NPC patients using whole-body FDG PET/MR staging in two selected intervals: 1 May 2017 to 31 January 2020 (Group A, the pre-COVID-19 period), and 1 February 2020 to 30 June 2021 (Group B, the COVID-19 period).
Results Three-hundred and ninety patients were included. No significant difference was observed in terms of T classification, N classification, overall stage, N stations, and M stations between the two groups (p > 0.05). For the involved neck node levels, more patients had developed level Vc metastasis in the group B (p = 0.044).
Conclusion Although the overall stage was not affected, more patients with NPC had developed level Vc metastasis in the era of COVID-19.
Eric Dowling, Devin J. Okay, Michael P. Saturno, Lily A. Greenberg, Daniel Buchbinder, Mark L. Urken
Publication date 31-05-2023
Abstract Background While a single-stage free-flap reconstruction is the preferred approach for oromandibular defects, a multistaged approach may be necessary in rare cases. These patients can still be effectively restored with functional and aesthetic improvements.
Methods We report two cases with a history of bilateral failed fibula free flaps. We detail the multistaged reconstruction to repair these complex defects and discuss the considerations when planning such procedures.
Results Both patients successfully underwent a staged reconstruction with an iliac crest osteocutaneous flap following either a rectus abdominis or pectoralis major myocutaneous flap.
Conclusion Oromandibular reconstruction is an expected outcome in the contemporary management of oral cavity cancer and osteoradionecrosis. However, complications do occur and can be devastating. In cases of bilateral failed fibula free flaps, a staged approach is a favorable option. Moreover, the iliac crest provides an important reconstructive option with the documented potential for implant born dental rehabilitation.
Haaron S. L. Ting, Zigui Chen, Jason Y. K. Chan
Publication date 30-05-2023
Abstract Objectives The relationship between head and neck squamous cell carcinoma (HNSCC) and the oral microbiome has been drawn in various studies. Microbial diversities, microbiome profiles, metagenomic analysis, and host–pathogen interactions were collected from these studies to highlight similarities and account for inconsistencies. We also evaluate the possible clinical applications of the microbiome regarding screening and diagnosis of HNSCC.
Methods Systematic analysis of studies regarding HNSCC and the microbiome was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Articles were retrieved from four databases (Pub Med, Science Direct, CUHK Full-Text Journals, and Cochrane database) and were screened using predefined criteria.
Results Twenty studies were chosen after screening for full-text review. α-diversity comparison was inconsistent whereas β-diversity between HNSCC and normal samples showed distinct clustering. Microbial dysbiosis characterized by change in the relative abundances of several bacterial species were also seen in HNSCC patients. At a phylum level, inconsistencies were seen between studies using HNSCC tumor tissue samples and saliva samples. At a genus level, Fusobacterium, Peptostreptococcus, Alloprevotella, Capnocytophaga, Catonella, and Prevotella were differentially enriched in HNSCC while Streptococcus, Actinomyces Veillonella, and Rothia were differentially depleted. Co-occurrence network analysis revealed a positive correlation of HNSCC with periodontal pathogens and a negative correlation with commensal bacteria. Metagenomic analysis of microbiota revealed a differential enrichment of pro-inflammatory genomic pathways which was consistent across various studies. Microbial dysbiosis was applied in clinical use as a tool for HNSCC screening. Random-forest analysis was adopted to differentiate between tumor and normal tissue, at 95.7% and 70.0% accuracies respectively in two studies. Microbial dysbiosis index was also used to predict prognosis.
Conclusions Oral microbial dysbiosis could be a promising tool for HNSCC screening and diagnosis. However, more research should be conducted pertaining to clinical applications to improve diagnostic accuracy and explore other clinical uses.
Tiffany Chen, Marvin L. Meng, Ellen M. Hong, Frederick Durrant, Guy Talmor, Richard Chan Woo Park, Brian Benson
Publication date 29-05-2023
Abstract Background The impact of obesity on outcomes after open laryngeal surgery has not been well-described.
Methods The NSQIP database was queried for all open laryngeal surgeries including total laryngectomies between 2005 and 2018. Outcomes of patients identified as obese or nonobese by BMI were compared.
Results Of 1865 patients, 20.1% classified as obese. The most common operation performed was total laryngectomy with or without radical neck dissection (73.2%). Operation time and length of hospital stay were significantly less for obese patients. On multivariate analysis, obesity was associated with less bleeding transfusions occurrences (aOR, 0.395, p = 0.0052), surgical complications (aOR, 0.604, p < 0.001), and any complication (aOR, 0.730, p = 0.0019).
Conclusion Though there may be an inverse association of obesity with complications and bleeding transfusion occurrences, as well as decreased operation time and length of hospital stay, several confounders and bias may exist; therefore, it is difficult to conclude that the obesity paradox is present.
"Niema B. Razavian, Rachel F. Shenker, Ralph B. DAgostino, Ryan T. Hughes"
Publication date 29-05-2023
Abstract Background Ipsilateral neck radiotherapy (INRT) is controversial in some patients with oral cavity cancer due to concern for contralateral neck failure (CNF).
MethodsA systematic review was performed and data were extracted following PRISMA guidelines. Outcomes were the rate of CNF following INRT and the rates of CNF by AJCC 7th ed. tumor and nodal staging.
Results Fifteen studies consisting of 1825 patients were identified. Among the 805 patients treated with INRT, the rate of CNF was 5.7%. Patients with T4 tumors constituted 56% of all CNF cases. The rate of CNF increased by N stage (N0: 1.2%; N1: 3.8%; N2-N3: 17.4%) and was significantly higher for patients with N2-N3 than N0-N1 disease (p < 0.001).
DiscussionINRT is associated with an overall low risk of CNF in well-selected patients with N0-N1 disease. Patients with N2-3 and/or T4 disease should receive bilateral RT due to increased risk of CNF following INRT.
Cheng‐Hung Tu, Rui‐Teng Wang, Bo‐Sen Wang, Chih‐En Kuo, En‐Ying Wang, Ching‐Ting Tu, Wan‐Nien Yu
Publication date 24-05-2023
Abstract Objective Little information is available about deep learning methods used in ultrasound images of salivary gland tumors. We aimed to compare the accuracy of the ultrasound-trained model to computed tomography or magnetic resonance imaging trained model.
Materials and methods Six hundred and thirty-eight patients were included in this retrospective study. There were 558 benign and 80 malignant salivary gland tumors. A total of 500 images (250 benign and 250 malignant) were acquired in the training and validation set, then 62 images (31 benign and 31 malignant) in the test set. Both machine learning and deep learning were used in our model.
Results The test accuracy, sensitivity, and specificity of our final model were 93.5%, 100%, and 87%, respectively. There were no over fitting in our model as the validation accuracy was similar with the test accuracy.
Conclusions The sensitivity and specificity were comparable with current MRI and CT images using artificial intelligence.
Arash Abiri, Cecilia Nguyen, Kareem Latif, Khodayar Goshtasbi, Sina J. Torabi, Jack L. Birkenbeuel, Edward C. Kuan
Publication date 23-05-2023
Abstract Background Head and neck solitary fibrous tumors (SFTs) are rare neoplasms, with few large-scale studies describing this entity. We evaluated the demographics and correlates of survival in a large series of SFT patients.
Methods The 2004–2017 National Cancer Database was queried for head and neck SFT patients receiving definitive surgery. Cox proportional-hazards and Kaplan–Meier analyses assessed overall survival (OS).
Results Of 135 patients, sinonasal (33.1%) and orbital (25.9%) SFTs were most common. Approximately 93% of SFTs were invasive and 64% were classified as hemangiopericytomas. The 5-year OS of skull base SFTs (84.5%) was lower than sinonasal (98.7%) and orbital (90.7%) SFTs (all p < 0.05). Government insurance exhibited higher mortality (HR 5.116; p < 0.001) and lower OS (p = 0.001).
Conclusion Head and neck SFTs presented with distinct prognoses based on anatomical origin. Overall survival was particularly worse in patients with skull base SFTs or government insurance. Prognostically, hemangiopericytomas were indistinct from other SFTs.
Xixi Liu, Jing Huang, You Qin, Zhanjie Zhang, Bian Wu, Kunyu Yang
Publication date 19-05-2023
Abstract BackgroundA nomogram that incorporates tumor response at mid-radiotherapy (mid-RT) to predict the prognosis of locoregionally advanced nasopharyngeal carcinoma (LA-NPC) has not been established.
Methods This study retrospectively reviewed 583 patients with LA-NPC who underwent magnetic resonance imaging scans at mid-RT (the fourth week of RT) between 2015 and 2019.
Results Primary tumor (PT) response at mid-RT was found to predict disease-free survival (DFS) and overall survival (OS). Independent factors from multivariable analysis to predict DFS and OS were assembled into nomograms with (nomograms Amid-RT and Bmid-RT) or without (nomograms Abaseline and Bbaseline) PT response.
Internal validation revealed good performance of these nomograms in discrimination: C-statistics = 0.761 for nomogram Amid-RT and 0.809 for nomogram Bmid-RT, which showed better discrimination performance than (C-statistics: 0.755) nomogram Abaseline and (C-statistics: 0.798) nomogram Bbaseline (Z-statistic = 2.476, p < 0.05; Z-statistic = 1.971, p < 0.05).
Conclusion The nomograms based on PT response at mid-RT showed favorable predictive accuracy for DFS and OS in patients with LA-NPC.
Derek D. Kao, Rocco M. Ferrandino, Scott A. Roof, Deborah C. Marshall, Mohemmed Nazir Khan, Raymond L. Chai, Yeun‐Hee A. Park, Keith M. Sigel
Publication date 19-05-2023
Abstract Background Neutrophil-to-lymphocyte ratio (NLR) is a biomarker of systemic inflammation that is associated with adverse oncologic and surgical outcomes. We investigated the use of NLR as a prognostic indicator of complications of head and neck cancer (HNC) surgeries.
Methods We conducted a retrospective study of 11 187 Veterans who underwent HNC surgery between 2000 and 2020. We calculated preoperative NLR values and fit logistic regression models adjusting for potential confounding factors, comparing high-NLR patients to low-NLR patients.
Results The cohort had a median age of 63 and was 98% men. High-NLR patients had increased odds of 30-day mortality (p < 0.001), having 1+ perioperative complications (p < 0.001), sepsis (p = 0.03), failure to wean from mechanical ventilation (p = 0.04), pneumonia (p < 0.001), and pulmonary embolism (p = 0.02) compared with low-NLR patients.
ConclusionNLR was a robust, independent predictor of 30-day mortality, having 1+ surgical complications, sepsis, failure to wean from mechanical ventilation, pneumonia, and pulmonary embolism.
Kaiyuan Sun, Jia Yan Tan, Peter James Thomson, Siu‐Wai Choi
Publication date 16-05-2023
Abstract The timing of postoperative radiotherapy following surgical intervention in patients with head and neck cancer remains a controversial issue. This review aims to summarize findings from available studies to investigate the influence of time delays between surgery and postoperative radiotherapy on clinical outcomes. Articles between 1 January 1995 and 1 February 2022 were sourced from Pub Med, Web of Science, and Science Direct. Twenty-three articles met the study criteria and were included; ten studies showed that delaying postoperative radiotherapy might negatively impact patients and lead to a poorer prognosis. Delaying the start time of radiotherapy, 4 weeks after surgery did not result in poorer prognoses for patients with head and neck cancer, although delays beyond 6 weeks might worsen patients overall survival, recurrence-free survival, and locoregional control. Prioritization of treatment plans to optimize the timing of postoperative radiotherapy regimes is recommended.
Pubmed PDF WebJun Aoyama, Yusuke Nojima, Daisuke Sano, Yuri Hirai, Natsumi Kijima, Yoshihiro Aizawa, Kentaro Takada, Takashi Hatano, Hideaki Takahashi, Goshi Nishimura, Nobuhiko Oridate
Publication date 15-05-2023
Abstract Background We previously established a patient-derived xenograft (PDX) model, patient-derived organoids (PDOs), and PDX-derived organoids (PDXOs) for salivary duct carcinoma (SDC). Using these models, this study examined the therapeutic effect of human epidermal growth factor receptor 2 (HER2) blockade on HER2-positive SDC.
Methods The therapeutic effect of lapatinib was assessed in SDC PDXOs with regards to cell growth, receptor/downstream signaling molecule expression, phosphorylation levels, and apoptosis. Effect of lapatinib treatment was evaluated in vivo in SDC PDX mice.
Results The siRNA knockdown of HER2 and lapatinib suppressed cell proliferation in SDC PDXOs. Lapatinib inhibited the phosphorylation of HER2 and its downstream targets, and induced apoptosis in SDC PDXOs. Lapatinib also significantly reduced tumor volumes compared with that of the control in SDC PDX mice.
Conclusion For the first time, we demonstrated the efficacy of anti-HER2 therapy in HER2-positive SDC using preclinical models of SDC PDX and PDXO.
Efsun Somay, Busra Yilmaz, Erkan Topkan, Ahmet Kucuk, Berrin Pehlivan, Ugur Selek
Publication date 12-05-2023
Abstract Objectives To explore how well a unique combination of hemoglobin-to-platelet ratio (HPR) and pretreatment maximum mouth opening (MMO) predicts the prevalence of radiation-induced trismus (RIT).
Patients and methodsHPR and MMO cutoff values (0.54 and 40.7 mm) divided patients into two groups. To develop the novel HPR-MMO index, four combinations of these factors were tested for predictive power: Group 1: HPR > 0.54 and MMO > 40.7 mm; Group 2: HPR ≤ 0.54 but MMO > 40.7 mm; Group 3: HPR > 0.54 but MMO ≤ 40.7 mm; Group 4: HPR ≤ 0.54 and MMO ≤ 40.7 mm.
Results Data of 198 patients with LA-NPC was analyzed retrospectively. RIT rates for Groups 1 to 4 were 10.2%, 15.2%, 25%, and 59.4%. Groups 2 and 3 were merged to generate HPR-MMO index because of statistically equivalent RIT rates: Low-risk: HPR > 0.54 and MMO > 40.7 mm; Intermediate-risk: HPR ≤ 0.54 but MMO > 40.7 mm or; HPR > 0.54 but MMO ≤ 40.7 mm; High-risk: HPR ≤ 0.54 and MMO ≤ 40.7 mm. It was revealed that the low-, high-, and intermediate-risk groups RIT rates; 10.2%, 59.4%, and 19.2%, respectively.
Conclusion The novel HPR-MMO index may to classify LA-NPC patients into low, intermediate, and high-risk RIT groups.
Houda Bahig, Hanna Y. Ehab, Adam S. Garden, Sweet Ping Ng, Steven J. Frank, Theresa Nguyen, Gary B. Gunn, David I. Rosenthal, Clifton D. Fuller, Renata Ferrarotto, Diana Bell, Shirley Su, Jack Phan
Publication date 10-05-2023
Abstract Purpose To report long-term outcomes of modern radiotherapy for sinonasal cancers.
Methods and materialsA retrospective analysis of patients with sinonasal tumors treated with intensity-modulated radiotherapy or proton therapy. Multivariate analysis was used to determine predictive variables of progression free survival (PFS) and overall survival (OS).
Results Three hundred and eleven patients were included, with median follow-up of 75 months. The most common histologies were squamous cell (42%), adenoid cystic (15%), and sinonasal undifferentiated carcinoma (15%). Induction chemotherapy was administered to 47% of patients; 68% had adjuvant radiotherapy. Ten-year local control, regional control, distant metastasis free survival, PFS, and overall survival rates were 73%, 88%, 47%, 32%, and 51%, respectively. Age, non-nasal cavity tumor site, T3-4 stage, neck dissection, and radiation dose were predictive of PFS, while age, non-nasal cavity tumor site, T3-4 stage, positive margins, neck dissection, and use of neoadjuvant chemotherapy were predictive of OS. There was a 13% rate of late grade ≥3 toxicities.
Conclusion This cohort of patients with sinonasal cancer treated with modern radiotherapy demonstrates favorable disease control rate and acceptable toxicity profile.
Alvaro Sanabria, Carlos Betancourt, Carlos Chiesa‐Estomba, Andrés Coca‐Pelaz, Ewa Florek, Orlando Guntinas‐Lichius, Fernando Lopez, Antti A. Mäkitie, Iain J. Nixon, Gregory Randolph, Alessandra Rinaldo, Juan Pablo Rodrigo, Ashok R. Shaha, Ralph P. Tufano, Mark Zafereo, Alfio Ferlito
Publication date 10-05-2023
Abstract Adequate pain control enhances patients quality of life and allows a quick return to normal activities. Current pain management practices may contribute to the crisis of opioid addiction. We summarize the evidence that evaluates locoregional interventions to decrease pain and neck discomfort after thyroidectomy. We designed a scoping review. The search strategy was made in the Pubmed/MEDLINE and EMBASE database. We included only systematic reviews and RCTs that compared two or more strategies. Forty-nine publications including 5045 patients fulfilled criteria. Sore throat frequency is higher for endotracheal intubation and topical administration of anesthetic before intubation decreases this. Pre-incisional infiltration of the surgical wound decreases postoperative pain. Bilateral superficial plexus nerve block decreases analgesic requirements during and after thyroidectomy. Wound massage and neck exercises decrease postoperative discomfort. Locoregional interventions significantly impact postoperative pain and may reduce opioid use and improve patient outcomes.
Pubmed PDF WebDaphne A. J. J. Driessen, Anne I. J. Arens, Tim Dijkema, Willem L. J. Weijs, Lisette C. Draaijer, Guido B. Broek, Robert P. Takes, Jimmie Honings, Johannes H. A. M. Kaanders
Publication date 10-05-2023
Abstract Background The aim of this study was to investigate the feasibility of flexible endoscopy-guided tracer injection for sentinel lymph node (SLN) identification in patients with laryngeal and pharyngeal carcinoma.
Methods Sixteen cT1-4N0-2M0 patients with laryngeal or pharyngeal carcinoma underwent intra- and peritumoral 99m Tc Tc-nanocolloid injections after topical anesthesia under endoscopic guidance. SPECT–CT scans were performed at two time points.
Results Tracer injection and visualization of SLNs was successful in 15/16 (94%) patients. Median number of tracer injections was 1 intratumoral and 3 peritumoral. The median duration of the endoscopic procedure including tracer injection after biopsy taking was 7 min (range 4–16 min). A total of 28 SLNs were identified which were all visualized on the early and late SPECT–CT. Most SLNs were visualized in neck levels II and III.
Conclusions Flexible endoscopy-guided tracer injection for SLN identification is a feasible and fast procedure in laryngeal and pharyngeal carcinoma patients.
Krishna S. Hanubal, Zhanna Galochkina, Ji‐Hyun Lee, Marna A. List, Tara C. Massini, Dustin Conrad, Brian Hughley, Deepa Danan, Reordan DeJesus, Kathryn Hitchcock, Spencer Nichols, William Mendenhall, Peter T. Dziegielewski
Publication date 10-05-2023
Abstract Background Recent literature shows that tumor volume (TV) in T3 laryngeal squamous cell carcinoma (LSCC) is associated with response to radiation therapy. The aim of this study was to evaluate the effect of TV on survival outcomes in patients undergoing total laryngectomy (TL).
Methods One hundred and seventeen patients with LSCC undergoing TL between 2013 and 2020 at the University of Florida were included. TV was measured using a previously validated method on preoperative-CT scans. Multivariable CoxPH models for overall survival (OS) and disease-specific survival (DSS), metastasis-free survival (MFS), and recurrence-free survival (RFS) were developed with TV.
Results Mean age was 61.5 years and 81.2% were male. Higher TV was associated with decreased OS, MFS, DSS, and RFS with adjusted hazard ratios 1.02 (95%CI: 1.01, 1.03), 1.01, (95%CI: 1.00, 1.03), 1.03 (95%CI: 1.01, 1.06), and 1.02 (95%CI: 1.00, 1.03) respectively. TV >7.1 cc had worse prognoses.
ConclusionsTV appears associated with decreased survival in LSCC treated with TL.
Behrus Puladi, Mark Ooms, Annette Rieg, Max Taubert, Ashkan Rashad, Frank Hölzle, Rainer Röhrig, Ali Modabber
Publication date 10-05-2023
Abstract Background Although blood transfusions have adverse consequences for microvascular head and neck reconstruction, they are frequently administered. Pre-identifying patients would allow risk-stratified patient blood management.
Methods Development of machine learning (ML) and logistic regression (LR) models based on retrospective inclusion of 657 patients from 2011 to 2021. Internal validation and comparison with models from the literature by external validation. Development of a web application and a score chart.
Results Our models achieved an area under the receiver operating characteristic curve (ROC-AUC) of up to 0.825, significantly outperforming LR models from the literature. Preoperative hemoglobin, blood volume, duration of surgery and flap type/size were strong predictors.
Conclusions The use of additional variables improves the prediction for blood transfusion, while models seems to have good generalizability due to surgical standardization and underlying physiological mechanism. The ML models developed showed comparable predictive performance to an LR model. However, ML models face legal hurdles, whereas score charts based on LR could be used after further validation.
Takumi Hasegawa, Yasumasa Kakei, Nobuhiro Yamakawa, Tadaaki Kirita, Masaya Okura, Tomofumi Naruse, Mitsunobu Otsuru, Shin‐ichi Yamada, Hiroshi Kurita, Eiji Hirai, Shin Rin, Michihiro Ueda, Masahiro Umeda, Masaya Akashi, Japan Oral Oncology Group (JOOG)
Publication date 10-05-2023
Abstract Background The purpose of this retrospective study was to investigate the prognosis of patients with oral cavity cancer with positive margin (PM) or close margin (CM) divided into pN− and pN+ groups.
Methods The evaluated endpoints were local control and disease-specific survival (DSS) rates.
Results Higher T classification, lymphovascular space invasion (LVSI), and older age were significant risk factors for DSS in the pN− groups. On the other hand, extranodal extension, multiple lymph node metastases, and LVSI were significant risk factors for DSS in the pN+ groups. Among the CM pN+ patients, no significant differences in the 3-year DSS were observed between the only surgery (51.9%) and adjuvant groups (53.2%).
Conclusions Higher T classification and LVSI are high-risk features more than PM or CM in the pN− groups for DSS. However, further prospective studies are needed to demonstrate the usefulness of adjuvant treatment in patients with PM or CM.
Ye Feng, Ting Xu, Yiying Xu, Ziyi Wu, Huiling Hong, Yingying Huang, Xiyi Liao, Xiaobin Fu, Jiawei Chen, Xiufang Qiu, Jianming Ding, Chaoxiong Huang, Li Li, Chuanben Chen, Zhaodong Fei
Publication date 10-05-2023
Abstract Background To identify patients at low risk of synchronous bone metastasis who should not receive bone scans when initially diagnosed with nasopharyngeal carcinoma (NPC).
Methods In total, 6652 patients were enrolled in the training cohort and 1919 patients in the multicenter external validation cohort. Logistic regression analyses were performed to assess independent predictors of synchronous bone metastasis for the nomogram model.
Results After risk stratification, 46.3% (3081/6652) patients were separated into the low-risk group with an incidence of 0.71% for synchronous bone metastasis. The odds ratio of the intermediate and high-risk groups was 5.61 and 23.82 times that of the low-risk group, respectively. For patients with high EBV DNA, we recommend routine screening for N2-3 female patients, but that all male subgroups are screened.
Conclusions Bone scans should not be routine. Patients in the low-risk group should not be screened, which would avoid excessive radiation and economize iatrical resource.
Michele Tomasoni, Elisa Marazzi, Vittorio Rampinelli, Davide Mattavelli, Alberto Schreiber, Alberto Deganello, Cesare Piazza
Publication date 10-05-2023
Abstract Background Aim of this study is to investigate the prevalence of cervical nodal metastasis at presentation and as disease relapse in primary, treatment-naive olfactory neuroblastoma (ONB), and to review treatment modalities, risk factors for regional failure and survival outcomes according to nodal status.
MethodsA systematic review and proportion meta-analysis were conducted following PRISMA guidelines based on Pub Med, Web of Science, and Scopus.
Results Eighteen articles were examined. The pooled proportion of patients with nodal metastasis at presentation (11.5%) was comparable to that of cN0 patients not receiving elective neck treatment developing nodal metastasis during follow-up (12.3%). Of the latter, most were Kadish stage C tumors (85.5%).
Conclusions Cervical involvement is common both at presentation and during follow-up of cN0 ONB. The highest risk of developing late nodal metastasis is seen in cN0 patients with Kadish stage C tumors not receiving elective neck treatment. Elective cN0 neck treatment should be encouraged in selected patients to increase regional control.
Timothy P. J. Liu, Michael David, Jonathan R. Clark, Tsu‐Hui (Hubert) Low, Martin D. Batstone
Publication date 10-05-2023
Abstract Background Predictive nomograms are useful tools to guide clinicians in estimating disease course. Oral squamous cell carcinoma (OSCC) patients would benefit from an interactive prediction calculator that defines their levels of survival-risk specific to their tumors to guide the use of postoperative radiotherapy (PORT).
Methods Patients with OSCC surgically treated with curative intent at four Head and Neck Cancer Centres were recruited retrospectively for development and validation of nomograms. Predictor variables include PORT, age, T and N classification, surgical margins, perineural invasion, and lymphovascular invasion. Outcomes were disease-free, disease-specific, and overall survivals over 5 years.
Results1296 patients with OSCC were in training cohort for nomogram analysis. Algorithms were developed to show relative benefit of PORT in survivals for higher-risk patients. External validation on 1212 patients found the nomogram to be robust with favorable discrimination and calibration.
Conclusion The proposed calculator can assist clinicians and patients in the decision-making process for PORT.
Rebecca L. Venchiarutti, Emma K. Charters, Masako Dunn, Jonathan R. Clark
Publication date 10-05-2023
Abstract Background The FACE-Q H&N is a patient reported outcome measure covering multiple constructs for patients with head and neck tumors. Additional testing is needed to determine suitability in assessing speech- and swallowing-related quality of life and function.
MethodsFACE-Q H&N, The M. D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) scores were collected from two patient cohorts who had undergone jaw reconstruction. Construct validity was assessed using convergent validity testing and known groups testing to assess discriminant validity.
ResultsA priori hypotheses testing demonstrated strong correlations (ρ > 0.6, p < 0.05) between FACE-Q H&N eating and drinking, swallowing and eating distress scales with MDADI subscales, and between FACE-Q H&N speech function and distress scales and the SHI. Known groups testing demonstrated all instruments could delineate outcomes among patients who had radiation, advanced tumors, and tracheostomy.
Conclusion The FACE-Q H&N may be an alternative for the SHI and MDADI in this patient cohort.
"Danny Lavigne, Mailys De‐Meric‐de‐Bellefon, Felix‐Phuc Nguyen‐Tan, David Landry, Laurent Létourneau‐Guillon, Manon Bélair, Brian OSullivan, Edith Filion, Houda Bahig"
Publication date 10-05-2023
Abstract Background We investigated the incidence and predictive factors of retropharyngeal lymph node (RPLN) metastases in patients with oropharyngeal cancer (OPC) undergoing multimodality treatment planning imaging before radiotherapy.
Methods Consecutive patients with OPC treated with curative-intent radiotherapy from 2017 to 2019 were retrospectively analyzed. Treatment planning comprised contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) unless contraindicated.
Results Of 300 patients, 66 (22%) had radiological evidence of RPLN involvement on planning images, compared to 17 (6%) on diagnostic CT alone. On multivariate analysis, RPLN involvement was statistically (p < 0.05) associated with tonsil, soft palate, and posterior pharyngeal wall primaries, and with disease extension to the soft palate or vallecula.
Conclusions Multimodality treatment planning imaging reveals a high rate of RPLN metastases from OPC compared to diagnostic CT alone. Patients with tonsil, soft palate, or posterior pharyngeal wall primaries or disease extending to the soft palate or vallecula appear at higher risk.
Rebecca Louise Venchiarutti, Sandra Templeton, Lara Mathers, Emma Charters, Jonathan Robert Clark
Publication date 10-05-2023
Abstract Background Patients treated for head and neck cancer are at high risk of developing head and neck lymphedema (HNL). We describe outcomes of HNL management at an Australian institution from 2018 to 2020.
Methods Electronic records from Chris OBrien Lifehouse were retrospectively reviewed from January 1, 2018 to December 31, 2020. Objective changes in HNL were assessed using The M. D. Anderson Cancer Center (MDACC) HNL rating scale and Assessment of Lymphedema of the Head and Neck (ALOHA).
Results Among the 100 patients referred for management of HNL, surgery was the most frequent treatment modality (80%; 70% with neck dissection) and 69% underwent radiotherapy. Manual lymphatic drainage (MLD) was most often prescribed (96%), followed by self-MLD (93%). Small but significant improvements in ALOHA measurements were observed for 50 patients (50%). Only 5/29 (17%) patients had post-treatment improvements on the MDACC scale.
Conclusions Standardized, prospective measurement of treatment approaches and outcomes is needed to further evaluate the service.
Keiichiro Nakajo, Youichi Ninomiya, Hibiki Kondo, Nobuyoshi Takeshita, Erika Uchida, Naoki Aoyama, Atsushi Inaba, Hiroaki Ikematsu, Takeshi Shinozaki, Kazuto Matsuura, Ryuichi Hayashi, Tetsuo Akimoto, Tomonori Yano
Publication date 10-05-2023
Abstract Background The entire pharynx should be observed endoscopically to avoid missing pharyngeal lesions. An artificial intelligence (AI) model recognizing anatomical locations can help identify blind spots. We developed and evaluated an AI model classifying pharyngeal and laryngeal endoscopic locations.
Methods The AI model was trained using 5382 endoscopic images, categorized into 15 anatomical locations, and evaluated using an independent dataset of 1110 images. The main outcomes were model accuracy, precision, recall, and F1-score. Moreover, we investigated focused regions in the input images contributing to the model predictions using gradient-weighted class activation mapping (Grad-CAM) and Guided Grad-CAM.
Results Our AI model correctly classified pharyngeal and laryngeal images into 15 anatomical locations, with an accuracy of 93.3%. The weighted averages of precision, recall, and F1-score were 0.934, 0.933, and 0.933, respectively.
Conclusion Our AI model has an excellent performance determining pharyngeal and laryngeal anatomical locations, helping endoscopists notify of blind spots.
Ku‐Hao Fang, Chia‐Hsuan Lai, Cheng‐Ming Hsu, Chun‐Ta Liao, Chung‐Jan Kang, Yi‐Chan Lee, Ethan I. Huang, Geng‐He Chang, Ming‐Shao Tsai, Yao‐Te Tsai
Publication date 10-05-2023
Abstract Background We aimed to probe the hemoglobin–albumin–lymphocyte–platelet (HALP) scores prognostic value in oral cavity squamous cell carcinoma (OSCC).
Methods Medical data of 350 patients with primary operated OSCC were retrospectively reviewed. We derived the optimal HALP cutoff by executing receiver operating characteristic curve analysis, and patients were then grouped based on this cutoff value. Cox proportional hazards model were used to discover survival outcome-associated factors.
Results We derived the optimal HALP cutoff as 35.4. A low HALP score (<35.4) predicted poorer overall and disease-free survival (hazard ratio: 2.29 and 1.92, respectively; both p < 0.001) and was significantly associated with OSCC aggressiveness. We established a HALP-based nomogram that accurately predicted overall survival (concordance index: 0.784).
Conclusion The HALP score may be a useful prognostic biomarker in patients with OSCC undergoing surgery, and the HALP-based nomogram can be a promising prognostic tool in clinical setting.
Takeaki Hidaka, Kentaro Tanaka, Hiroki Mori
Publication date 10-05-2023
Abstract Background Interposition nerve grafting is an indispensable technique for facial nerve reconstruction in head and neck, and skull base surgery. The prognostic factors are inconclusive, partly due to limited objective assessment systems for facial nerve function. This study aimed to apply an artificial intelligence (AI)-based facial asymmetry measurement system to assess facial nerve grafting outcomes.
Methods We retrospectively reviewed data of 23 patients who underwent facial nerve grafting between 2011 and 2020. Oral asymmetry and synkinesis severity were measured using AI.
Results Oral movement recovered at 12–18 months postoperatively. Postoperative radiotherapy and a larger number of anastomosed distal stumps were significantly associated with poor and good final oral symmetry, respectively. Synkinesis severity was weakly correlated with the degree of oral movement recovery.
Conclusions Oral function recovered without a strong correlation with synkinesis. Caution should be exercised in facial nerve grafting for cases with postoperative radiotherapy.
Rebecca L. Venchiarutti, Raveena Kapoor, Jonathan R. Clark, Carsten E. Palme, Jane M. Young
Publication date 10-05-2023
Abstract Background We systematically reviewed evidence of health system interventions to reduce diagnostic and treatment intervals for people with head and neck cancer (HNC).
Methods Electronic databases were searched from inception to 30 April 2020 for controlled or uncontrolled comparative studies. Primary outcome was any time interval between first clinical presentation and treatment onset.
Results Thirty-seven studies were included.
Four types of interventions were identified: single clinic-based (N = 4), multidisciplinary clinic-based (N = 15), hospital or service re-design (N = 12), and health system re-design (N = 6). There was some evidence that multidisciplinary interventions improve timeliness of diagnosis and treatment; however, evidence of long-term effectiveness was lacking. Study quality was assessed as either low or moderate.
Conclusions Interventions to reduce times to diagnosis and treatment of HNC are heterogeneous, with limited evidence of effectiveness. Future interventions should account for the complex and dynamic nature of health systems and adhere to best-practice principles for early-diagnosis research.
"Francesco Mattioli, Alfredo Lo Manto, Matteo Miglio, Edoardo Serafini, Davide Rossi, Sara Valerini, Roberto Tonelli, Matteo Fermi, Giuseppe Pugliese, Federica Bertolini, Elisa DAngelo, Roberta Depenni, Massimo Dominici, Frank R. H. Lohr, Daniele Marchioni"
Publication date 10-05-2023
Abstract Background Distant metastasis (DM) development in Oropharyngeal Squamous Cell Carcinoma (OPSCC) represents an important prognostic factor. The identification of a phenotype of metastatic patients may better define therapeutic and follow-up programs.
Methods We included 408 patients with OPSCC, non-metastatic at the time of diagnosis, and treated with curative intent. The Overall Survival (OS) analyses were performed and the impact of developing DM on survival was analyzed through Cox proportional-hazard regression model.
Results57 (14%) patients develop DM. 302 (74%) were p16+ OPSCC and 35 of them experienced DM. Advanced clinical stage, smoking, p16-status, response to primary treatment, and loco-regional relapse influence the DM rate. Only in the p16+ group, DM onset results in a greater impact on OS (p < 0.0001). Lung metastases have a better OS compared to non-pulmonary ones (p = 0.049).
Conclusion This retrospective study shows a possible stratification of OPSCC patients based on the risk of the development of DMs.
Sarah C. Nyirjesy, Rachel Fenberg, Margaret A. Heller, Ryan T. Judd, Michael M. Li, Brandon Koch, Marcelo Bonomi, Ricardo L. Carrau, Kyle K. VanKoevering
Publication date 10-05-2023
Abstract Background Sinonasal malignancy (SNM) is a heterogeneous group of diseases for which induction chemotherapy (IC) may reduce tumor burden. The purpose of this study was to characterize the response to IC in SNM as a prognostic factor through its effect on survival.
Methods Retrospective cohort of patients undergoing IC for SNM between 2010 and 2019 at our quaternary referral center.
Results Forty-two patients with advanced SNM were included in the analysis. Patients with a favorable response to IC had higher survival rates than those who had an unfavorable response (5-year OS: 66.8% vs. 9.7%; p < 0.001; PFS: 56.8% vs. 0%; p < 0.001).
Conclusions Response to IC in our patient cohort was a prognostic indicator of overall response to treatment. Further elucidation of predictors of response is needed for appropriate patient selection.
Chun‐Chi Huang, Wan‐Ming Chen, Ben‐Chang Shia, Mingchih Chen, Szu‐Yuan Wu
Publication date 10-05-2023
Abstract Background This study examines the relationship between statin use and oral cancer squamous cell carcinoma (OCSCC) risk in a cohort of 47 942 betel nut chewers.
Methods The study used individual 1:1 matching and propensity score matching to compare statin users and nonusers.
Results The incidence rate of OCSCC was significantly lower in statin users compared to nonusers (17.12 vs. 26.75 per 10 000 person-years), yielding an incidence rate ratio of 0.64. After adjusting for confounders, statin use was associated with a reduced risk of OCSCC (adjusted hazard ratio: 0.61; 95% confidence interval: 0.52–0.71). A dose–response relationship was observed, with a significant reduction in OCSCC incidence when the cumulative defined daily dose of statin use was equal to or greater than Q3. The risk of OCSCC was lower among users of both hydrophilic and lipophilic statins.
Conclusion This study provides evidence that statin use is associated with a reduced risk of OCSCC in betel nut chewers.
William J. Benjamin, Pratyusha Yalamanchi, Jeremy M. G. Taylor, Nicholas Lenze, Francis P. Worden, Steven B. Chinn, Michelle M. Chen
Publication date 10-05-2023
Abstract Background The impact of monoclonal antibody therapy (mAB) for advanced head and neck cancer on end-of-life health care utilization and costs has yet to be adequately studied.
Methods Retrospective cohort study of patients aged 65 and over with a diagnosis of head and neck cancer between 2007 and 2017 within the SEER-Medicare registry assessing the impact of mAB therapy (i.e., cetuximab, nivolumab, or pembrolizumab) on end-of-life health care utilization (ED visits, inpatient admissions, ICU admissions, and hospice claims) and costs.
Results Of 12 544 patients with HNC, 270 (2.2%) utilized mAB therapy at the end-of-life period. On multivariable analyses adjusting for demographic and clinicopathologic characteristics, there was a significant association between mAB therapy and emergency department visits (OR: 1.38, 95% CI: 1.1–1.8, p = 0.01) and healthcare costs (β: $9760, 95% CI: 5062–14 458, p < 0.01).
ConclusionsmAB use is associated with higher emergency department utilization and health care costs potentially due to infusion-related and drug toxicity expenses.
Leba Michael Sarkis, Rory Clifton‐Bligh, David Veivers, Anthony James Gill
Publication date 10-05-2023
Abstract Background Collectively, germline pathogenic variants in succinate dehydrogenase (SDH) genes are the most common cause of hereditary paragangliomas. Loss of immunohistochemical expression of SDHB protein (termed SDH deficiency) occurs whenever there is biallelic inactivation of any SDH gene. We sought to estimate the prevalence of SDH deficiency in patients with carotid body paragangliomas.
Methods We identified all carotid body paragangliomas that had undergone surgical excision at our institution over the last 30 years. If SDHB immunohistochemistry was not performed at the time of excision, it was performed on archived material.
Results There were 64 carotid body paragangliomas identified in the 62 patients. Two-thirds of the patients were female, and 43 (67%) were SDH-deficient.
Conclusion Up to two-thirds of all carotid body paragangliomas are associated with SDH deficiency. Therefore, genetic testing and counseling should be offered to all patients with carotid body paragangliomas, regardless of age or family history.
Saskia Naegele, Vasileios Efthymiou, Shun Hirayama, Brian Y. Zhao, Dipon Das, Annie W. Chan, Jeremy D. Richmon, A. John Iafrate, Daniel L. Faden
Publication date 10-05-2023
Abstract Background Human papillomavirus-associated head and neck squamous cell carcinoma (HPV + HNSCC) occurs in the oropharynx (HPV + OPSCC), sinonasal cavity (HPV + SNSCC), and nasopharynx (HPV + NPC). Circulating tumor HPV DNA (ctHPVDNA) is an accurate tool for diagnosis, treatment monitoring, and recurrence detection. An emerging challenge with ctHPVDNA is that ~7.4% of HPV + HNSCC patients develop synchronous or metachronous HPV+ primaries, which could confound ctHPVDNA monitoring.
Methods We describe a 65-year-old patient with T2N1M0 HPV16 + OPSCC and a 55-year-old patient with T2N2M0 HPV16 + OPSCC. Both patients were enrolled in our prospective observational ctHPVDNA study with longitudinal blood collections throughout treatment. Both patients developed multiple HPV+ primaries.
Results Detailed discussion of the patients treatment courses, the subsequent diagnoses of their second HPV+ primaries, and their ctHPVDNA monitoring is presented.
Conclusions As ctHPVDNA use becomes more prevalent, it is important to recognize that an increase in ctHPVDNA can come not only from the primary tumor or metastatic clones, but also from synchronous or metachronous second primaries.
Publication date 10-05-2023
Sophie Dugast, Julie Longis, Marine Anquetil, Benoit Piot, Pierre Corre, Jean‐François Huon, Hélios Bertin
Publication date 10-05-2023
Abstract This systematic review aimed to evaluate the surgical techniques used for orbital floor reconstruction after Brown class III maxillectomy for cancer. Three databases were searched from January 1990 to January 2022. Of the 614 studies identified, 20 were retained after eligibility assessment.
The surgical techniques were classified into four groups: free bone flaps (A), alloplastic implants (B), bone grafts (C), and soft-tissue reconstructions (D). Ectropion and diplopia concerned 42.6% and 6.6% of the patients, respectively. Soft tissue reconstruction was more likely to cause ectropion (17/27), followed by the reconstruction techniques of group B (34/79), group C (26/70), and group A (1/7). Postoperative enophthalmos was identified in 18 patients (9.6%), mostly in group D (5/35), followed by groups B (8/68), A (3/33), and C (2/52). Free bone flaps and alloplastic implants represent good reconstructive options in terms of postoperative ocular parameters.
"Sataksi Chatterjee, Naomi Kiyota, Richa Vaish, Atul Sharma, Makoto Tahara, Vanita Noronha, Kumar Prabhash, Anil DCruz"
Publication date 10-05-2023
Abstract Concurrent chemoradiotherapy with 3-weekly cisplatin 100 mg/m2 has been the standard of care for locoregionally advanced head and neck cancer (LA-HNC) with level I evidence. While the outcomes in terms of efficacy have been well established, the toxicity profile, compliance, and real-world applicability has been an area of ongoing concern for this regimen, leading the oncologists to explore weekly cisplatin chemoradiotherapy regimen to potentially address the issue. A review of literature was conducted in Pubmed, Scopus, and Medline to compare and evaluate the present role of weekly cisplatin chemotherapy along with radiotherapy versus 3-weekly cisplatin chemotherapy along with radiotherapy in both adjuvant and definitive settings for locoregionally advanced head and neck cancers. Nasopharyngeal subsites were excluded from the literature review and 50 relevant articles were included in the analysis. Recently published evidences of noninferiority of weekly over 3-weekly cisplatin chemoradiotherapy regimen in definitive as well as adjuvant settings in locoregionally advanced head and neck cancers is highlighted and interpreted. Results supporting and against the above in different publications is elaborated in this article. Trials designed to demonstrate noninferiority of the weekly cisplatin chemoradiotherapy regimen over 3-weekly regimen, especially in definitive setting may conclude the debate in future. A lacunae in the existing literature is noted in the form of lack of superiority trials on the above topic, which may impact future conclusions.
Pubmed PDF WebXinni Xu, Anil Gopinathan, Yew Kwang Ong, Mark Kim Thye Thong, Woei Shyang Loh, Kwok Seng Loh
Publication date 10-05-2023
Abstract The objective of this study was to compare the outcomes of parent artery occlusion (PAO) versus stent-assisted reconstruction in radiated nasopharyngeal carcinoma (NPC) patients with internal carotid artery (ICA) blowouts. A retrospective review from our institution (2011–2021) and systematic review of Pubmed and Embase (1995–2022) was performed. Twenty-eight eligible studies were identified. Eighty-six PAOs and 37 stent-assisted reconstructions were analyzed, including 11 PAOs and 5 stents from our institution. Stents were associated with significantly higher incidence of overall re-bleeding (16.2% 95% CI 7.4–31.9 vs. 4.6% 95% CI 1.3–13.5, p = 0.047), delayed stroke (5.4% 95% CI 1.3–19.4 vs. 0%, p = 0.034) and reduced median survival (7.1 95% CI 3.8–14.0 months vs. 29.0 95% CI 9.4–63.4 months, p = 0.017) compared to PAO. There were no significant differences in terms of overall stroke, infection, extruded/migrated foreign body, and peri-procedure death. PAO is preferred over reconstructive treatment in patients with adequate collateral circulation.
Pubmed PDF WebChih‐Wei Luan, Liang‐Tseng Kuo, Yun‐Ting Wang, Chun‐Ta Liao, Chung‐Jan Kang, Yi‐Chan Lee, Kuan‐Yin Chen, Chia‐Hsuan Lai, Yuan‐Hsiung Tsai, Ethan I. Huang, Ming‐Shao Tsai, Cheng‐Ming Hsu, Geng‐He Chang, Yao‐Te Tsai
Publication date 10-05-2023
Abstract Whether the modified Glasgow prognostic score (mGPS) is useful for patients with head and neck squamous cell carcinoma (HNSCC) remains controversial. An electronic database search on EMBASE, Pub Med, and the Cochrane Library from inception to 30 June 2022 was performed for study selection and data extraction. The associations between the mGPS and survival outcomes were evaluated using a random-effects meta-analysis and expressed as pooled hazard ratios (HRs) and 95% CIs. We included 11 studies involving a total of 2017 patients with HNSCC. A higher mGPS was associated with poorer progression-free survival (HR = 2.39, 95% CI 1.69–3.38), overall survival (HR = 2.40, 95% CI 1.94–2.98), disease-specific survival (HR = 2.57, 95% CI 1.71–3.88), and disease-free survival (HR = 2.67, 95% CI 1.51–4.73, all p ≤ 0.001) in HNSCC. The mGPS can function as a valid prognostic biomarker for patients diagnosed as having HNSCC.
Pubmed PDF WebHiroyuki Harada, Masahiro Kikuchi, Ryo Asato, Kiyomi Hamaguchi, Hisanobu Tamaki, Masanobu Mizuta, Ryusuke Hori, Tsuyoshi Kojima, Keigo Honda, Takashi Tsujimura, Yohei Kumabe, Kazuyuki Ichimaru, Yoshiharu Kitani, Koji Ushiro, Morimasa Kitamura, Shogo Shinohara, Koichi Omori
Publication date 10-05-2023
Abstract Background Some oral squamous cell carcinoma (OSCC) cases are unaffected by smoking or drinking. This study aimed to clarify distinctive groups among OSCC patients and examine the characteristics of multiple primary carcinomas (MPCs).
Methods We analyzed data from 970 patients.
The patients were divided into three groups: all individuals <45 years (<45 y), smokers/drinkers ≥45 years (SD ≥45 y), and non-smokers/non-drinkers ≥45 years (NSND ≥45 y).
Results Tongue cancers were more common in the <45 y group than in the other groups (p < 0.001). The NSND ≥45 y group was significantly older and more likely to be female than the SD ≥45 y group (p < 0.001). MPCs in the upper aerodigestive tract were more common in men and smokers/drinkers, whereas women were at risk for multiple primary OSCCs (p = 0.022).
Conclusions The “young tongue” and “elderly female” subgroups and characteristics of MPCs suggest carcinogenic factors of OSCC other than smoking and drinking.
Caroline M. J. Kinschot, Vikas R. Soekhai, Esther W. Bekker‐Grob, W. Edward Visser, Robin P. Peeters, Charlotte Noord, Tessa M. Ginhoven
Publication date 09-05-2023
Abstract Background Active surveillance is propagated as an alternative for hemithyroidectomy in the management of Bethesda III thyroid nodules.
MethodsA cross-sectional survey questioned respondents on their willingness to accept risks related to active surveillance and hemithyroidectomy.
Results In case of active surveillance, respondents (129 patients, 46 clinicians, and 66 healthy controls) were willing to accept a risk of 10%–15% for thyroid cancer and 15% for needing more extensive surgery in the future. Respondents were willing to accept a risk of 22.5%–30% for hypothyroidism after hemithyroidectomy. Patients and controls were willing to accept a higher risk on permanent voice changes compared with clinicians (10% vs. 3%, p < 0.001).
Conclusion Real-life risks associated which active surveillance and hemithyroidectomy for Bethesda III nodules are equivalent or less than the risks people are willing to accept. Clinicians accepted less risk for permanent voice changes.
Gabriela Souza Rodrigues Queiroz, Juliana Carron, Ligia Traldi Macedo, Carmen Silvia Passos Lima, Gustavo Jacob Lourenço
Publication date 09-05-2023
Abstract Background Serotonin (5-HT) is involved in regulating tumor growth, as well as psychiatric disorders. It is synthesized by tryptophan hydroxylase (TPH) and acts through 5-HT receptors (HTRs). Single-nucleotide variations (SNVs) in TPH1 rs623580 (T>A), TPH2 rs4570625 (G>T), and HTR1D rs674386 (G>A) may affect 5-HT levels. However, the effect of these SNVs on oropharynx carcinoma (OPC) is unknown.
MethodsDNA from 251 patients with OPC and 254 controls was analyzed by RT-PCR. Transcriptional activity of TPH1 rs623580 and HTR1D rs674386 was studied by luciferase assays. Multivariate statistical tests were utilized to evaluate group differences and survival outcomes.
ResultsTPH1 TT was more frequent in patients than in controls (OR: 1.56, p = 0.03). Patients with HTR1D GG/GA showed invasive tumors (p = 0.01) and shorter survival (HR: 1.66, p = 0.04). TPH1 TT (0.79-fold, p = 0.03) and HTR1D GG (0.64-fold, p = 0.008) presented lower transcriptional activity.
Conclusion Our data suggest that SNVs in 5-HT modulating genes can influence OPC.
Nitish Khurana, Eric Babajanian, Hilary McCrary, Abigail Pulsipher, Hamidreza Ghandehari, Jeremiah A. Alt, Richard B. Cannon
Publication date 09-05-2023
Abstract Background Indocyanine green (ICG) fluorescent image (FI)-guided surgery has demonstrated success in improving intraoperative visualization and tumor resections. The objectives were to evaluate the use of IGC in FI-guided transoral robotic surgery (TORS) and the underlying molecular mechanism.
MethodsHPV+ oropharyngeal squamous cell carcinoma (OPSCCa) patient (n = 10) undergoing TORS were enrolled in this prospective study. Participants received intravenous ICG. Excised tissues were evaluated for ICG accumulation, tumor demarcation, and pathological characteristics using In-vivo imaging system (IVIS), histology, and RNA sequencing.
ResultsICG accumulation was significantly increased in primary tumor and pathological lymph nodes compared with normal tissues (p < 0.001). IVIS was 91.3% accurate in identifying OPSCCa in excised tissues; the correlation between IVIS- and histologically determined tumor tissues was significant (R2 = 0.8301; p = 0.001). Genes associated with vascular and angiogenic signaling pathways were significantly upregulated in OPSCCa tissues.
ConclusionICG effectively demarcates tumor margins in OPSCCa, due to the increased upregulation of genes associated with vascular permeability.
Nai‐Hsin Meng, Chia‐Ing Li, Chun‐Hung Hua, Tzu‐Chieh Lin, Chien‐Jen Chiu, Chien‐Lin Lin, Ming‐Hsui Tsai, Pei‐Ju Chiu, Wen‐Dien Chang, Yung‐An Tsou
Publication date 08-05-2023
Abstract Background This study aimed to describe and explore the longitudinal changes in swallowing function among patients with oral cancer who underwent surgery and proactive swallowing therapy from baseline to 1-year postoperation.
Methods We retrospectively studied 118 patients over a 4.5-year duration. Swallowing functional assessment including 10-item Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), M. D. Anderson Dysphagia Inventory, and Modified Barium Swallow Impairment Profile (MBSImP™) was performed at baseline, 1-month, 6-month, and 1-year postoperatively.
Results All swallowing parameters worsened 1-month postoperation. EAT-10, FOIS, and MBSImP™ oral and pharyngeal impairment scores improved significantly compared with 1-month postoperation at 6 months. Other swallowing parameters, except for weight, did not differ significantly from baseline at 6 months. The rate of tube-feeding dependency was 11.5% and 5.6% at 1 and 6 months postoperation, respectively.
Conclusions Periodic swallowing functional assessments help delineate the longitudinal changes in swallowing functional outcomes.
Katherine Tashman, Elizabeth A. Noyes, Chloe B. Warinner, Joseph Ogbonna, Ernest Gomez, Scharukh M. Jalisi
Publication date 08-05-2023
Abstract Background The impact of safety-net status, case volume, and outcomes among geriatric head and neck cancer patients is unknown.
Methods Chi-square tests and Students t tests to compare head and neck surgery outcomes of elderly patients between safety-net and non-safety-net hospitals. Multivariable linear regressions to determine predictors of outcome variables including mortality index, ICU stays, 30-day readmission, total direct cost, and direct cost index.
Results Compared with non-safety-net hospitals, safety-net hospitals had a higher average mortality index (1.04 vs. 0.32, p = 0.001), higher mortality rate (1% vs. 0.5%, p = 0.002), and higher direct cost index (p = 0.001). A multivariable model of mortality index found the interaction between safety-net status and medium case volume was predictive of higher mortality index (p = 0.006).
Conclusion Safety-net status is correlated with higher mortality index and cost in geriatric head and neck cancer patients. The interaction between medium volume and safety-net status is independently predictive of higher mortality index.
Konthoujam Shaphaba, Alok Thakar, Pirabu Sakthivel, Kapil Sikka, Chirom Amit Singh, Rajeev Kumar, Ashwin Chandran, Ravinder Goswami
Publication date 05-05-2023
Abstract Background To assess the promise of surgical magnification and of intraoperative indocyanine green (ICG) assisted near-infrared fluorescence (NIRF) in improving parathyroid identification and viability assessment during thyroidectomy.
Methods Prospective comparative study. Parathyroid gland identification sequentially assessed by naked eye, surgical microscopy, and by NIRF imaging following ICG administration (5 mgIV). Parathyroid perfusion/vitality reassessed end-surgery by ICG-NIRF.
Results An expected total of 104 parathyroid glands were assessed in 35 patients (17 total-thyroidectomy, 18 hemi-thyroidectomy). 54/104 (51.9%) were identified by naked eye, and sequentially greater numbers identified by microscope magnification (n = 61; 58.7%; p = 0.33), and by ICG-NIRF (n = 72; 69.2%; p = 0.01). ICG-NIRF detected additional parathyroid glands in 16/35 patients (45.7%). Confident identification of at least one parathyroid remained unachieved in 5/35 by naked eye, in 4/35 by microscopic magnification, and in no patient by ICG-NIRF. ICG-NIRF indicated end-of-surgery devascularization in 12/72 glands and informed decisions regarding gland implantation.
Conclusion Significantly greater parathyroid glands are identified and preserved with surgical magnification and with ICG-NIRF. Both techniques merit routine adoption for thyroidectomy.
Christian Fritz, Karthik Rajasekaran
Publication date 05-05-2023
Abstract Background Factors that prompt litigation and influence outcomes for malpractice cases involving cancers of the upper aerodigestive tract are incompletely described.
Methods Westlaw, a national legal database, was searched for medical malpractice claims related to upper aerodigestive tract cancer for all years available.
Results Of the 122 cases meeting inclusion criteria, 106 (86.9%) involved allegations of failure to diagnose or delay in diagnosis. Tongue, larynx, and nasopharynx cancers were more frequently litigated than would be expected based on their incidence (tongue, 38.7% of aerodigestive tract litigation vs. 26.9% of aerodigestive tract cancers; larynx, 33.0% vs. 22.3%; nasopharynx, 10.4% vs. 4.6%). Payouts were made in over half of diagnosis failure lawsuits (56.6%), which carried an average award of $2840690 IQR 850219–2537509.
Conclusions An awareness of litigation on cancers of the upper aerodigestive tract holds the potential to improve patient care and help otolaryngologists avoid potential risks for litigation.
Kedar Kirtane, Aasha I. Hoogland, Xiaoyin Li, Yvelise Rodriguez, Kelsey Scheel, Brent J. Small, Laura B. Oswald, Jameel Muzaffar, Julie A. Kish, Marcelo Bonomi, Priyanka Bhateja, Nabil F. Saba, Conor E. Steuer, Christine H. Chung, Heather S. L. Jim
Publication date 04-05-2023
Abstract Background Data about patient-reported outcomes (PROs) among patients with head and neck squamous cell carcinoma (HNSCC) treated with immune checkpoint inhibitors are sparse. Our exploratory study evaluated PROs in patients with HNSCC starting treatment with immune checkpoint inhibitor monotherapy or combination therapy with cetuximab.
Methods Patients were recruited prior to receipt of their first checkpoint inhibitor therapy infusion. Participants completed measures of checkpoint inhibitor toxicities and quality of life (QOL) at on-treatment clinic visits.
Results Among patients treated with checkpoint inhibitor monotherapy (n = 48) or combination therapy (n = 38) toxicity increased over time (p < 0.05), while overall QOL improved from baseline to 12 weeks, with stable or declining QOL thereafter (p < 0.05). There were no group differences in change in toxicity index or QOL. Toxicity index scores were significantly higher in the combination group at 18–20 weeks and 6 months post-initiation of immune checkpoint inhibitor (p < 0.05). There were no significant group differences at baseline, the 6–8 week (p = 0.13) or 3-month (p = 0.09) evaluations. The combination group reported better emotional well-being at baseline than the monotherapy group (p = 0.04), There were no other group differences QOL at baseline or later timepoints.
Conclusions Despite increasing patient-reported toxicity, checkpoint inhibitor monotherapy and combination therapy were associated with similar transient improvements, then worsening, of QOL in patients with HNSCC.
Wan‐Ming Chen, Chia‐Hao Chang, Jenq‐Yuh Ko, Ming‐Chih Chen, Ben‐Chang Shia, Szu‐Yuan Wu
Publication date 04-05-2023
Abstract Purpose No study has compared long-term medical resource consumption between patients with oral cavity squamous cell carcinoma (OCSCC) with and without sarcopenia receiving curative surgery.
Patients and Methods Generalized linear mixed and logistic regression models were employed to evaluate the number of postoperative visits and medical reimbursement for head and neck cancer or complications and the number of hospitalizations for treatment-related complications over 5 years after curative surgery, respectively.
Results The mean difference (95% CI) in total medical claims amounts between the nonsarcopenia and sarcopenia groups were new Taiwan dollars (NTD) 47 820 (35 864–59 776, p < 0.0001), 11 902 (4897–18 908, p = 0.0009), 17 282 (10 666–23 898, p < 0.0001), 17 364 (9644–25 084, p < 0.0001), and 8236 (111–16 362, p = 0.0470) for the first, second, third, fourth, and fifth years, respectively.
Conclusion The long-term medical resource consumption was higher in the sarcopenia group than in the nonsarcopenia group.
Ryan N. Hellums, Kevin J. Kovatch, Michael E. Friscia, Tyler R. Schwartz, Phillip K. Pellitteri
Publication date 04-05-2023
Abstract Introduction Metastatic renal cell carcinoma (RCC) represents 25%–42% of metastatic thyroid malignancies. Propensity for RCC to demonstrate intravascular extension to the inferior vena cava is well documented. We present an analogous phenomenon of intravascular extension to the internal jugular vein (IJV) from thyroid gland metastasis.
MethodsA 69-year-old male presented with metastatic RCC of the right thyroid lobe. Imaging demonstrated tumor thrombosis of the ipsilateral IJV, extending inferiorly to the junction of the brachiocephalic, subclavian, and internal jugular veins within the mediastinum.
Results Surgical excision required control of both the IJV in the neck and mediastinal venous great vessels via sternotomy, prior to subtotal thyroidectomy and venotomy for en bloc resection.
Conclusion This case report describes metastatic RCC to the thyroid gland with cervicothoracic venous tumor thrombosis successfully treated with subtotal thyroidectomy, sternotomy for venotomy and tumor thrombectomy, and preservation of IJV conduit.
Rushil R. Dang, Sam El Abbadi, Chung‐Kan Tsao
Publication date 02-05-2023
Abstract Extensive resections of advanced stage oral cavity cancers can sometimes lead to significant through and through buccal defects with compromise of the oral commissure/lips. Post free flap reconstruction, such patients often require a secondary delayed commissuroplasty to assist with improved oral function and quality of life. In current literature, limited methods exist for free flap commissuroplasty with some key limitations, particularly their negative impact on buccal sulcus or oral vestibule. Our technique of the triangular cheek flap commissuroplasty allows the surgeon to reconstruct a neo-commissure without compromising the oral vestibular depth or decreasing mouth opening. Through this pictorial essay we describe a detailed surgical technique for secondary reconstruction of the oral commissure.
Pubmed PDF WebKushi Ranganath, Lauren E. Miller, Deborah Goss, Derrick T. Lin, Daniel L. Faden, Daniel G. Deschler, Kevin S. Emerick, Jeremy D. Richmon, Mark A. Varvares, Allen L. Feng
Publication date 02-05-2023
Abstract Background Comparisons of patient-reported donor site morbidity based on the Disabilities in Arm, Shoulder, and Hand (DASH) instrument across upper trunk free flaps in head and neck surgery, including radial forearm (RFFF), osteocutaneous radial forearm (OCRFF), scapular tip (STFF), and serratus anterior (SAFF) free flaps, may help inform donor tissue selection.
Methods In this meta-analysis, 12 studies were included and the primary outcome was average DASH score.
Results The pooled DASH scores were 12.14 (95% CI: 7.40–16.88) for RFFF (5 studies), 17.99 (11.87–24.12) for OCRFF (2 studies), 12.19 (8.74–15.64) for STFF (3 studies), and 16.49 (5.92–27.05) for SAFF (2 studies) and were not significantly different.
Conclusions Results suggest that patients generally function well, with minimal to mild donor site morbidity, when assessed at an average of 20 months after flap harvest. These results are based on few effects from primarily retrospective studies of fair quality, and further research is needed.
Di Zhang, Lixi Li
Publication date 28-04-2023
Abstract Background To investigate the value of lymph node ratio (LNR) for postoperative major salivary duct carcinoma (MSDC) and to establish a model for prognosis assessment and treatment optimization.
Methods Data of MSDC were retrieved in public database, and prognostic factors were identified by univariate and multivariate analyses. A nomogram and risk stratification system were constructed.
Results Four hundred and eleven eligible patients were included (training cohort vs.
validation cohort: 287: 124). LNR ≥0.09 was associated with worse overall survival (OS). Age at diagnosis, sex, T stage, and LNR were identified as prognostic factors and integrated into nomogram. Low-risk patients were found to have better OS than high-risk patients. Furthermore, postoperative radiotherapy (PORT) significantly improved OS in the high-risk subgroup, but chemotherapy did not confer a long-term survival benefit.
ConclusionsA nomogram model integrating LNR could better assess postoperative prognosis and risk stratification in MSDC, and identify patients who might benefit from PORT to avoid overtreatment.
F. Jeffrey Lorenz, Sean S. Mahase, Joseph Miccio, Tonya S. King, Sandeep Pradhan, Neerav Goyal
Publication date 27-04-2023
Abstract BackgroundA prior study reported that over half of patients with HNSCC initiated PORT after 6 weeks from surgery during 2006–2014. In 2022, the CoC released a quality metric for patients to initiate PORT within 6 weeks. This study provides an update on time to PORT in recent years.
Methods The NCDB and Tri NetX Research Network were queried to identify patients with HNSCC who received PORT during 2015–2019 and 2015–2021, respectively. Treatment delay was defined as initiating PORT beyond 6 weeks after surgery.
Results In NCDB, PORT was delayed for 62% of patients. Predictors of delay included age >50, female sex, black race, nonprivate insurance/uninsured status, lower education, oral cavity site, negative surgical margins, increased postoperative length of stay, unplanned hospital readmissions, IMRT radiation modality, treatment at an academic hospital or in the Northeast, and surgery and radiation at different facilities. In Tri NetX, 64% experienced treatment delay. Additional associations with prolonged time to treatment included never married/divorced/widowed marital status, major surgery (neck dissection/free flaps/laryngectomy), and gastrostomy/tracheostomy dependence.
Conclusions There continue to be challenges to timely initiation of PORT.
Feng Zhao, Siyi Zhu, Jun Fang, Huilei Dong, Chenfang Zhu
Publication date 25-04-2023
Abstract Background Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer with a primarily good prognosis, and its 10-year survival rate is over 90%. However, PTC is prone to early lymph node metastasis.
Methods Thyroid cancer tissues from PTC patients with lymphatic metastasis and normal tissues were collected for DNA methylation analysis. Different methylation sites, different methylation regions, gene-enriched pathways, and protein–protein interactions (PPIs) were analyzed.
Results There were 1004 differentially methylated sites in the PTC group versus the control group; these involved 479 hypermethylated sites in 415 related genes, 525 hypomethylated sites in 482 related genes, 64 differentially methylated regions located in the CpG island region, 34 differentially methylated genes closely related to thyroid cancer, and 17 genes with differentially methylated genes in the DNA promoter region.
ConclusionNDRG4 hypermethylation and FOXO3, ZEB2, and CDK6 hypomethylation were associated with PTC lymph node metastasis.
Antoine Mavrikios, Farid Goudjil, Arnaud Beddok, Sofia Zefkili, Stéphanie Bolle, Loic Feuvret, Christophe Le Tourneau, Olivier Choussy, Elisabeth Sauvaget, Philippe Herman, Rémi Dendale, Valentin Calugaru
Publication date 25-04-2023
Abstract Background Sinonasal adenoid cystic carcinomas (SNACC) have high propensity for skull base (SB) infiltration. Unresectability or incomplete surgical resection in such cases make radiotherapy treatment paramount. Curative dose escalation is challenging because of adjacent organs at risk, especially in locally advanced cases.
Methods Eighteen patients that had locally advanced SB SNACC with unresectable or incomplete surgical resection treated by proton therapy and/or helical tomotherapy at Institut Curie between 3/2010 and 8/2020 were retrospectively included.
Results After median follow-up of 52 months, 5-year OS, LRRFS, DMFS, DFS rates were, respectively, 47% (95%CI: 26–83), 50% (95%CI: 36–88), 39% (95%CI: 26–81), 33% (95%CI: 22–73). One patient had grade 4 late optic nerve disorder. Eight patients had grade 3 late toxicity including mainly hearing impairments.
Conclusion Proton therapy and helical tomotherapy are effective and safe methods for curative dose escalation of locally advanced SB SNACC, which are a poor prognosis subgroup. Available literature suggests carbon-ion therapy could be an efficient alternative.
Joshua B. Smith, Prerana Jayanth, Scott A. Hong, Matthew C. Simpson, Sean T. Massa
Publication date 25-04-2023
Abstract Background Uninsured individuals age 55–64 experience disproportionately poor outcomes compared to their insured counterparts. Adequate coverage may prevent these delays. This study investigates a “Medicare-effect” on head and neck squamous cell carcinoma (HNSCC) diagnosis and treatment.
Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for persons ages 60–70 years in the United States from 2000 to 2016 with HNSCC. A “Medicare effect” was defined as an increase in incidence, reduction in advanced stage presentation, and/or decrease in cancer-specific mortality (CSM).
Results Compared to their Medicaid or uninsured counterparts, patients age 65 have an increased incidence of HNSCC diagnosis, reduction in advanced stage presentation, decrease in cancer-specific mortality, and higher likelihood of receiving cancer-specific surgery.
Conclusions Patients age 65 with Medicare have decreased incidence of HNSCC, less hazard of late-stage diagnosis, and lower cancer-specific mortality than their Medicaid or uninsured counterparts, supporting the idea of a “Medicare effect” in HNSCC.
Muhammet Bekir Hacioglu, Bulent Erdogan, Murat Bardakcı, Efnan Algın, Burcu Gulbagcı, Ilhan Hacibekiroglu, Jamshid Hamdard, Omer Fatih Olmez, Hadi Akkus, Berna Oksuzoglu, Sema Sezgin Goksu, Shute Ailia Dae, Ahmet Taner Sumbul, Muzaffer Ugraklı, Mustafa Karaagac, Elif Sahin, Devrim Cabuk, Ozden Ozer, Tugba Yavuzsen, Rukiye Arıkan, Osman Köstek, Muhammed Mustafa Atcı, Abdullah Sakin, Adem Deligonul, Duygu Bayır, Murat Dincer, Oktay Unsal, Ozan Yazıcı, Esra Zeynelgil, Ahmet Gulmez, Hakan Harputluoglu, Cihan Erol, Mehmet Ali Nahit Sendur, Aydin Aytekin, Baran Akagunduz, Irem Oner, Ozlem Er, Bugra Oztosun, Mahmut Gumus, Fatih Selcuk Biricik, Musa Baris Aykan, Nuri Karadurmus, Ezgi Degerli, Nebi Serkan Demirci, Esma Turkmen, Teoman Şakalar, Saban Secmeler, Ozgur Tanrıverdi, Ali Alkan, Yasemin Kemal, Ibrahim Cil, Caglar Unal, Yakup Iriagaç, Ozkan Alan, Sevinc Balli, Yuksel Urun, Erkan Ozcan, Nazım Serdar Turhal, Irfan Cicin
Publication date 21-04-2023
Abstract Background Most of the studies on salivary gland cancers are limited for various reasons such as being single-center, small number of patients, including only major or minor SGCs, or only including epidemiological data.
MethodsA total of 37 medical oncology clinics from different regions of Turkey participated in this retrospective-multicenter study. The analyzed data included clinical and demographical features, primary treatment, metastasis localizations, and treatments and includes certain pathologic features.
Results The study included data from a total of 443 SGCs. 56.7% was in major salivary glands and 43.3% was in minor salivary glands. Distant metastasis in the major SGCs was statistically significantly more common than in the minor SGCs, locoregional recurrence was statistically significantly more common in the minor SGCs than in the major SGCs (p = 0.003).
Conclusions Epidemiological information, metastasis and recurrence patterns, treatment modalities, and survival analysis of the patients over 20 years of follow-up are presented.
Publication date 15-11-2020
Patrick Dubach, Thiago Oliveira–Santos, Stefan Weber, Nicolas Gerber, Andreas Dietz, Marco Caversaccio
Publication date 03-09-2018
ABSTRACTBackground Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT is increasingly used for the evaluation of regional or distant metastasis in head and neck oncology. However, positive PET findings lack specificity, which is especially challenging for localized disease at the skull base.
Methods An optically tracked navigation system for multimodal image-guided biopsies was tested to evaluate PET-positive skull base lesions between 2009 and 2013.
ResultsFDG-PET/CT navigated biopsies of patients with suspected persistence or recurrence of carcinoma (sinonasal, n = 3; nasopharyngeal, n = 1; adenocarcinoma, n = 2; and carcinoma of unknown primary origin, n = 1) have been safely performed. Histology confirmed local persistent or recurrent malignant disease (n = 5), radio-osteonecrosis (n = 1), and super-infection (n = 1).
Conclusion In the follow-up of patients with tumors, FDG-PET/CT-navigated biopsies are a valid tool to evaluate PET-positive skull base lesions. This is an especially useful technique if functional anomalous areas in FDG-PET/CT do not cause structural alterations in MRI/CT, and if endoscopic visualization is impossible because of posttreatment alterations. © 2014 Wiley Periodicals, Inc. Head Neck, 2014