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Tagliaferri L, Sciurti E, Fionda B, Loperfido A, Lancellotta V, Placidi E, Parrilla C, La Milia MC, Rosa E, Rigante M, De Angeli M, Cornacchione P, Galli J, Bussu F, Gambacorta MA. PRO-NOVELTY: Patient-Reported Outcomes in NOse VEstibule interventionaL radioTherapY (brachytherapy). J Clin Med 2024; 13:4683. [PMID: 39200822 PMCID: PMC11355133 DOI: 10.3390/jcm13164683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/26/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Background: The aim of this paper is to evaluate the impact on the quality of life of the treatment of nasal vestibule tumors by interventional radiotherapy (IRT-brachytherapy) through a patient reported outcome questionnaire. Methods: We prospectively collected data about patients undergoing IRT according to our institutional schedule of 44 Gy delivered in 14 fractions twice a day. We recorded both acute toxicity data, using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, and quality of life data, using the 22-item Sino-Nasal Outcome Test (SNOT-22) at baseline (T0), at 1 month (T1), at 3 months (T3), and at 6 months (T6). Results: We enrolled 10 consecutive patients treated between February 2023 and October 2023. The decrease in terms of SNOT-22 mean value was statistically significant from T0 and T6 with a p-value < 0.001. A noteworthy clinical finding is that quality of life improved regardless of the occurrence of G1-G2 side effects. Conclusions: Using SNOT-22 on patients with nasal vestibule carcinoma treated with IRT has shown an improvement in quality of life that is not strictly dependent on the occurrence of expected G1-G2 side effects.
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Affiliation(s)
- Luca Tagliaferri
- UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Elisabetta Sciurti
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Bruno Fionda
- UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Valentina Lancellotta
- UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Elisa Placidi
- UOC Fisica per le Scienze della Vita, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Claudio Parrilla
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento Neurologiche Ortopediche e del Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Enrico Rosa
- UOC Fisica per le Scienze della Vita, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- eCampus University, 22060 Novedrate, Italy
| | - Mario Rigante
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento Neurologiche Ortopediche e del Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Martina De Angeli
- UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Patrizia Cornacchione
- UOC Fisica per le Scienze della Vita, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Jacopo Galli
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento Neurologiche Ortopediche e del Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Bussu
- Otorhinolaryngology Division, Azienda Ospedaliero Universitaria Sassari, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maria Antonietta Gambacorta
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Servizi di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Testa G, Mattavelli D, Rampinelli V, Conti C, Piazza C. Squamous cell carcinoma of the nasal vestibule: a diagnostic and therapeutic challenge. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08813-8. [PMID: 39042173 DOI: 10.1007/s00405-024-08813-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024]
Abstract
Nasal vestibule squamous cell carcinoma (NVSCC) is an exceedingly rare malignancy, often misclassified due to its anatomical location and lack of a standardized definition. This review aims to consolidate current evidence on NVSCC, focusing on epidemiology, risk factors, classification, clinical presentation, treatment modalities, and prognostic factors. The NV anatomy is delineated, emphasizing the need for a clear definition to avoid misclassification. Risk factors include smoking, sunlight exposure, and debated associations with chalk exposure or viral factors. Clinical presentation includes symptoms like nasal obstruction, pain, burning, and bleeding, often misdiagnosed as inflammatory conditions. NVSCC exhibits distinct local spread patterns along cartilaginous surfaces, with the facial and submandibular lymph nodes at higher metastatic risk. Current classifications lack consensus, hindering comparison of outcomes. Treatment varies, with surgery or radiotherapy for early-stage tumors and multimodality approaches for advanced cases. The choice between surgery and radiotherapy is debated, with potential advantages and drawbacks for each. Radiotherapy, especially with Interventional RadioTherapy (IRT, previously known as brachytherapy), is gaining prominence, showing promising outcomes in terms of local control and cosmetic results. Prophylactic neck treatment remains controversial, with indications based on tumor characteristics. Prognostic factors include T classification, tumor size, surgical margins, nodal involvement, and histological features. Long-term survival rates range widely, emphasizing the need for further studies to refine management strategies for this rare malignancy. In conclusion, NVSCC poses diagnostic and therapeutic challenges, warranting multidisciplinary approaches and continued research efforts to optimize patient outcomes.
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Affiliation(s)
- Gabriele Testa
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili di Hospital, University of Brescia, Piazza Spedali Civili 1, Brescia, 25123, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - D Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili di Hospital, University of Brescia, Piazza Spedali Civili 1, Brescia, 25123, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - V Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili di Hospital, University of Brescia, Piazza Spedali Civili 1, Brescia, 25123, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - C Conti
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili di Hospital, University of Brescia, Piazza Spedali Civili 1, Brescia, 25123, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - C Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili di Hospital, University of Brescia, Piazza Spedali Civili 1, Brescia, 25123, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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van de Velde LJ, Scheurleer WFJ, Braunius WW, Devriese LA, de Ridder M, de Bree R, Breimer GE, van Dijk BA, Rijken JA. Squamous cell carcinoma of the nasal vestibule in the Netherlands: A clinical and epidemiological review of 763 cases (2008-2021). Head Neck 2024; 46:1809-1821. [PMID: 38511478 DOI: 10.1002/hed.27749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
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. RESULTS A 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. CONCLUSION SCC 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.
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Affiliation(s)
- Lise J van de Velde
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W F Julius Scheurleer
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Weibel Braunius
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mischa de Ridder
- Department of Radiation oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerben E Breimer
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Boukje A van Dijk
- Department of Research, Comprehensive Cancer Center The Netherlands (IKNL), Utrecht, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes A Rijken
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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Pirola F, Di Santo D, Turri-Zanoni M, Chabrillac E, Fradeani D, Sionis S, Carta F, Lambertoni A, Malvezzi L, Galli A, Giordano L, Puxeddu R, Castelnuovo P, Mercante G, Spriano G, Ferreli F. Squamous Cell Carcinoma of the Nasal Vestibule: A Multi-Centric Observational Cohort Study. Laryngoscope 2024; 134:2634-2645. [PMID: 38158584 DOI: 10.1002/lary.31251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Squamous cell carcinoma of the nasal vestibule (NV-SCC) is a rare but challenging entity, due to the complex anatomy of the region. Consensus on the best treatment strategy is still lacking, as well as a dedicated staging system. Our aim was to analyze oncological outcomes of surgically treated patients and to investigate possible prognostic factors. METHODS We performed a retrospective multi-centric observational study including six Academic Hospitals over a 10-year period, including only patients who underwent upfront surgery for primary NV-SCC. Patients were staged according to all currently available staging systems. The Kaplan-Meier method was used to compute overall, disease-free, and disease-specific survival. Logistic regression models were used to correlate between survival outcomes and clinical and pathological variables. RESULTS Seventy-one patients with a median follow-up of 38 months were included in the study. Partial and total rhinectomy were the most commonly performed procedures, respectively, in 49.3% and 25.4% of cases. Neck dissection was performed on 31% of patients, and 45.1% of them underwent adjuvant radiotherapy. Three years overall, disease-specific and disease-free survival were, respectively, 86.5%, 90.3%, and 74.2%. None of the currently available staging systems were able to effectively stratify survival outcomes. Factors predicting lower overall survival on multivariate analysis were age (p = 0.021) and perineural invasion (p = 0.059), whereas disease-free survival was negatively affected by age (p = 0.033) and lymphovascular invasion (p = 0.019). CONCLUSION Currently available staging systems cannot stratify prognosis for patients who underwent surgery for NV-SCC. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2634-2645, 2024.
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Affiliation(s)
- Francesca Pirola
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Davide Di Santo
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute Toulouse-Oncopole, Toulouse, France
| | - Dario Fradeani
- Department of Ear, Nose and Throat Surgery, Sheffield Teaching Hospitals Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Sara Sionis
- Department of Ear, Nose and Throat Surgery, Sheffield Teaching Hospitals Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Alessia Lambertoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Galli
- IRCCS Ospedale San Raffaele; Department of Otolaryngology-Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Leone Giordano
- IRCCS Ospedale San Raffaele; Department of Otolaryngology-Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
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5
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Scheurleer WFJ, de Ridder M, Tagliaferri L, Crescio C, Parrilla C, Mattiucci GC, Fionda B, Deganello A, Galli J, de Bree R, Rijken JA, Bussu F. Validation of the "Rome" Classification for Squamous Cell Carcinoma of the Nasal Vestibule. Cancers (Basel) 2023; 16:37. [PMID: 38201465 PMCID: PMC10778048 DOI: 10.3390/cancers16010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Squamous cell carcinoma of the nasal vestibule is considered a rare malignancy that differs from other sinonasal malignancies in many respects. Four staging systems currently exist for this disease, the most recent addition being the "Rome" classification. This study assesses the use of this new classification and its prognostic value regarding various outcome measures. A retrospective multicenter cohort study of patients with a primary squamous cell carcinoma of the nasal vestibule who were treated in three tertiary head and neck oncology referral centers was conducted. A total of 149 patients were included. The median follow-up duration was 27 months. Five-year locoregional control (LRC), disease-specific survival (DSS), and overall survival (OS) were 81.6%, 90.1, and 62.5% respectively. A statistically significant association was observed between the Rome classification and all survival outcomes in both univariable and multivariable analyses. Moreover, it appeared to perform better than the Union for International Cancer Control TNM classification for tumors of the nasal cavity and paranasal sinuses. The new Rome classification can be used effectively and is associated with LRC, DSS, and OS. However, it requires further validation in a larger (prospective) study population.
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Affiliation(s)
- Willem Frederik Julius Scheurleer
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Mischa de Ridder
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Luca Tagliaferri
- Radiation Oncology Division, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Claudia Crescio
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
| | - Claudio Parrilla
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gian Carlo Mattiucci
- Department of Radiation Oncology, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026 Olbia, Italy
| | - Bruno Fionda
- Radiation Oncology Division, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Alberto Deganello
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Istituto Nazionale dei Tumori (INT), 20133 Milan, Italy
| | - Jacopo Galli
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Johannes A Rijken
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
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6
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Fionda B, Bussu F, Placidi E, Rosa E, Lancellotta V, Parrilla C, Zinicola T, De Angeli M, Greco F, Rigante M, Massaccesi M, Gambacorta MA, Indovina L, De Spirito M, Tagliaferri L. Interventional Radiotherapy (Brachytherapy) for Nasal Vestibule: Novel Strategies to Prevent Side Effects. J Clin Med 2023; 12:6154. [PMID: 37834798 PMCID: PMC10573955 DOI: 10.3390/jcm12196154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Interventional radiotherapy (brachytherapy) has become the new therapeutic standard in the management of early stages nasal vestibule tumors; in fact it allows for high local control rates and low toxicity profiles. However, since more and more patients will receive interventional radiotherapy (brachytherapy) as primary treatment, it is desirable to implement novel strategies to reduce the dose to organs at risk with the future aim to result in further lowering long-term side effects. MATERIALS AND METHODS We were able to identify two different strategies to reduce dose to the treatment volume, including the implantation technique (the implant can be interstitial, endocavitary or mixed and the catheters may be placed either using the Paris system rules or the anatomical approach) and the dose distribution within the implant (the most commonly used parameter to consider is the dose non-uniformity ratio). We subsequently propose two novel strategies to reduce dose to organs at risk, including the use of metal shields for fixed organs as in the case of the eyes and the use of a mouth swab to push away mobile organs, such in the case of the mandible. We used two different algorithms to verify the values namely the TG-43 and the TG-186. RESULTS We provided an accurate literature review regarding strategies to reduce toxicity to the treatment volume, underlining the pros and cons of all implantation techniques and about the use dose non-uniformity ratio. Regarding the innovative strategies to reduce the dose to organs at risk, we investigated the use of eye shielding and the use of swabs to push away the mandible by performing an innovative calculation using two different algorithms in a series of three consecutive patients. Our results show that the dose reduction, both in the case of the mandible and in the case of eye shielding, was statistically significant. CONCLUSION Proper knowledge of the best implantation technique and dose non-uniformity ratio as highlighted by existing literature is mandatory in order to reduce toxicity within the treatment volume. With regard to the dose reduction to the organs at risk we have demonstrated that the use of eye shielding and mouth swab could play a pivotal role in clinical practice; in fact, they are effective at lowering the doses to the surrounding organs and do not require any change to the current clinical workflow.
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Affiliation(s)
- Bruno Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.F.); (T.Z.); (M.D.A.); (M.M.); (M.A.G.)
| | - Francesco Bussu
- Divisione di Otorinolaringoiatria, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy;
- Dipartimento di Medicina, Chirurgia e Farmacia Università di Sassari, 00168 Sassari, Italy
| | - Elisa Placidi
- U.O.S.D. Fisica Medica e Radioprotezione, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.G.); (L.I.)
| | - Enrico Rosa
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Valentina Lancellotta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.F.); (T.Z.); (M.D.A.); (M.M.); (M.A.G.)
| | - Claudio Parrilla
- U.O.C. Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Tiziano Zinicola
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.F.); (T.Z.); (M.D.A.); (M.M.); (M.A.G.)
| | - Martina De Angeli
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.F.); (T.Z.); (M.D.A.); (M.M.); (M.A.G.)
| | - Francesca Greco
- U.O.S.D. Fisica Medica e Radioprotezione, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.G.); (L.I.)
| | - Mario Rigante
- U.O.C. Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Mariangela Massaccesi
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.F.); (T.Z.); (M.D.A.); (M.M.); (M.A.G.)
| | - Maria Antonietta Gambacorta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.F.); (T.Z.); (M.D.A.); (M.M.); (M.A.G.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Indovina
- U.O.S.D. Fisica Medica e Radioprotezione, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.G.); (L.I.)
| | - Marco De Spirito
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy
| | - Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.F.); (T.Z.); (M.D.A.); (M.M.); (M.A.G.)
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7
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Scheurleer WFJ, Tagliaferri L, Rijken JA, Crescio C, Rizzo D, Mattiucci GC, Pameijer FA, de Bree R, Fionda B, de Ridder M, Bussu F. Evaluation of Staging Systems for Cancer of the Nasal Vestibule. Cancers (Basel) 2023; 15:cancers15113028. [PMID: 37296990 DOI: 10.3390/cancers15113028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Squamous cell carcinoma of the nasal vestibule is reported to account for less than one percent of all head and neck malignancies. It lacks a designated WHO ICD-O topography code, and multiple systems are available for the staging of this disease, which results in unwanted variability and the subsequent poor reliability of data. The aim of this study was to evaluate the currently available staging systems for cancer of the nasal vestibule, including the recently introduced classification by Bussu et al., which built on Wang's original concept but with clearer anatomical cutoffs. Different staging systems for cancer of the nasal vestibule (UICC nasal cavity, UICC skin cancer of the head and neck, Wang and Bussu et al.) were evaluated via a retrospective analysis of 148 patients. The staging system, per Bussu et al., had the most balanced allocation of patients among the stages. When using the Wang classification as a reference, stage migration occurred less frequently with the Bussu classification. The widespread adoption of a single staging system, as well as the introduction of a designated topography code for cancer of the nasal vestibule, could lead to more uniformity in data reporting and improve an understanding of the incidence and disease outcome. The newly proposed carcinoma of the nasal vestibule classification by Bussu et al. has the potential to improve the staging and allocation among stages. Further analysis of survival data is needed to assess which classification system is best suited for nasal vestibule carcinoma.
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Affiliation(s)
- Willem Frederik Julius Scheurleer
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Johannes A Rijken
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Claudia Crescio
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
| | - Davide Rizzo
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
| | - Gian Carlo Mattiucci
- Department of Radiation Oncology, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026 Olbia, Italy
| | - Frank A Pameijer
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Mischa de Ridder
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
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8
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Scheurleer WFJ, Dehnad H, Braunius WW, Janssen LM, Tijink BM, Breimer GE, Smid EJ, Devriese LA, Bree RD, Ridder MD, Rijken JA. Long-term oncological follow-up after mold-based pulsed dose rate brachytherapy for early stage squamous cell carcinoma of the nasal vestibule: A single center experience of 68 patients over a 17-year period. Brachytherapy 2023; 22:221-230. [PMID: 36539317 DOI: 10.1016/j.brachy.2022.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Cancer of the nasal vestibule is a rare type of malignancy constituting less than one percent of all head and neck cancers. These tumors are typically diagnosed at an early stage. Both surgery and radiotherapy provide excellent oncological results, but esthetic results are better after radiotherapy. The aim of this study was to evaluate the long-term oncological follow-up after brachytherapy for early stage squamous cell carcinoma of the nasal vestibule. METHODS AND MATERIALS Retrospective analysis of patients with carcinoma of the nasal vestibule who were treated with primary brachytherapy in the Utrecht University Medical Center. RESULTS In this single center experience over a 17-year period 68 patients with early stage squamous cell carcinoma of the nasal vestibule were treated with brachytherapy. Two patients had lymph node metastases at first clinical presentation. Median follow-up duration was 46.5 months. Five-year locoregional recurrence-free survival, disease-specific survival, and overall survival were 91.1%, 96.1%, and 66.2%, respectively. All recurrences occurred within the first 3 years of follow-up. CONCLUSIONS Brachytherapy offers excellent oncological outcomes and is a safe and effective treatment for early stage carcinoma of the nasal vestibule. Recurrences typically occur within 3 years after treatment.
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Affiliation(s)
- W F Julius Scheurleer
- Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Homan Dehnad
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Weibel Braunius
- Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luuk M Janssen
- Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bernard M Tijink
- Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerben E Breimer
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ernst J Smid
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mischa de Ridder
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes A Rijken
- Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Bussu F, Tagliaferri L, Crescio C, Rizzo D, Gallus R, Parrilla C, Fionda B, Lancellotta V, Mattiucci GC, Galli J. New standards for the management of nose vestibule malignancies. Acta Otolaryngol 2023; 143:215-222. [PMID: 36855802 DOI: 10.1080/00016489.2023.2179662] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Nasal vestibule squamous cell carcinoma (NVSCC) is an ill-defined underestimated condition. Aim/objective: To define the current standard of care. MATERIAL AND METHODS We review recent acquisitions concerning clinical features and therapeutic approaches. RESULTS The current AJCC staging system, which attributes to nasal vestibule the same topographic code as nasal cavity proper and the same T-classification criteria as ethmoid, appears inadequate. As for treatment of primary lesions without bone invasion, current evidence suggests that brachytherapy is at least equivalent to surgery and superior to external beams in terms of oncological outcomes, and superior to both modalities in terms of cosmesis and function. CONCLUSIONS As for classification and staging, the nasal vestibule should be defined as a subsite of the nose and paranasal sinuses, distinct from the 'nasal cavity proper and ethmoid', with specific topographic code and T-classification criteria. This will improve the assessment of prognosis and prevalence, underestimated also because of misdiagnosis with skin cancers. Secondly, brachytherapy should become the new standard for the treatment of primary lesions without bone invasion. To optimize the advantages of brachytherapy, we propose novel anatomic criteria for the implantation. Significance: Increasing evidence supports a paradigm shift in staging and treatment of NVSCC.
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Affiliation(s)
- Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Sassari, Italy.,Otolaryngology, Department of Medicine, Surgery and Pharmacy, Università di Sassari, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Claudia Crescio
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Sassari, Italy
| | - Davide Rizzo
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Sassari, Italy.,Otolaryngology, Department of Medicine, Surgery and Pharmacy, Università di Sassari, Italy
| | | | - Claudio Parrilla
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Otorinolaringoiatria, Roma, Italia
| | - Bruno Fionda
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Valentina Lancellotta
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | | | - Jacopo Galli
- Dipartimento Testa-collo e organi di senso, Università Cattolica del Sacro Cuore, Roma, Italia
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10
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Hohenberger R, Beckmann S, Kaecker C, Elicin O, Giger R, Caversaccio M, Anschuetz L. Morbidity and Oncological Outcome After Curative Treatment in Sinonasal Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2022:1455613221117787. [PMID: 35938196 DOI: 10.1177/01455613221117787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES Sinonasal squamous cell carcinomas are rare and aggressive tumors. Curative therapy includes surgery and radiotherapy, with high risk for local morbidity and impaired quality of life. The objective of this study was to analyze a large cohort of patients with sinonasal squamous cell carcinoma on treatment morbidity and oncological outcome. METHODS Patients with sinonasal squamous cell carcinoma (n = 75) treated at a tertiary referral center between 2008 and 2019 were identified. In patients with curative treatment intent (n = 70), a chart review and analysis on patient and tumor characteristics, morbidity, and oncological outcome was performed. RESULTS Mean follow-up was 59 months. Primary curative therapy was surgery alone (n = 18), surgery with radiation (n = 25), and primary (chemo)radiation (n = 27). Forty-two (60%) patients suffered from treatment-related morbidity; most frequent symptoms were dry nasal mucosa (20%), nasal obstruction (14.3%), and vision impairment or loss (11.5%). Patients with early disease had less morbidity (51.4 vs 71.1%; P = 0.09), a lower recurrence rate (27% vs. 48.5%; P = 0.08), and better overall survival (92.5% vs. 71.1%; P = 0.01). CONCLUSION Treatment-related morbidity is common after curative treatment of sinonasal squamous cell carcinomas. Early disease is beneficial in terms of occurrence and severity as multimodal treatment and recurrence can more likely be avoided.
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Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sven Beckmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Kaecker
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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11
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Eberle F, Engenhart-Cabillic R, Schymalla MM, Dumke C, Schötz U, Subtil FSB, Baumann KS, Stuck BA, Langer C, Jensen AD, Hauswald H, Lautenschläger S. Carbon Ion Beam Boost Irradiation in Malignant Tumors of the Nasal Vestibule and the Anterior Nasal Cavity as an Organ-Preserving Therapy. Front Oncol 2022; 12:814082. [PMID: 35242709 PMCID: PMC8886023 DOI: 10.3389/fonc.2022.814082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background Surgery and radiotherapy are current therapeutic options for malignant tumors involving the nasal vestibule. Depending on the location, organ-preserving resection is not always possible, even for small tumors. Definitive radiotherapy is an alternative as an organ-preserving procedure. Carbon ion beam radiotherapy offers highly conformal dose distributions and more complex biological radiation effects eventually resulting in optimized normal tissue sparing and improved outcome. The aim of the current study was to analyze toxicity, local control (LC), and organ preserving survival (OPS) after irradiation of carcinoma of the nasal vestibule with raster-scanned carbon ion radiotherapy boost (CIRT-B) combined with volumetric intensity modulated arc therapy (VMAT) with photons. Methods Between 12/2015 and 05/2021, 21 patients with malignant tumors involving the nasal vestibule were irradiated with CIRT-B combined with VMAT and retrospectively analyzed. Diagnosis was based on histologic findings. A total of 17 patients had squamous cell carcinoma (SCC) and 4 had other histologies. In this series, 10%, 67%, and 24% of patients had Wang stages 1, 2, and 3 tumors, respectively. Three patients had pathologic cervical nodes on MRI. The median CIRT-B dose was 24 Gy(RBE), while the median VMAT dose was 50 Gy. All patients with pathologic cervical nodes received simultaneously integrated boost with photons (SIB) up to a median dose of 62.5 Gy to the pathological lymph nodes. Eight patients received cisplatin chemotherapy. All patients received regular follow-up imaging after irradiation. Kaplan–Meier estimation was used for statistical assessment. Results The median follow-up after irradiation was 18.9 months. There were no common toxicity criteria grade 5 or 4 adverse events. A total of 20 patients showed grade 3 adverse events mainly on skin and mucosa. All patients were alive at the end of follow-up. The median OPS after treatment was 56.5 months. The 6- and 24-month OPS were 100% and 83.3%, respectively. All local recurrences occurred within 12 months after radiotherapy. The median progression free survival (PFS) after treatment was 52.4 months. The 6-, 12-, and 24-month PFS rates were 95%, 83.6%, and 74.3%, respectively. Conclusion CIRT-B combined with VMAT in malignant tumors of the nasal vestibule is safe and feasible, results in high local control rates, and thus is a good option as organ-preserving therapy. No radiation-associated grade 4 or 5 acute or late AE was documented.
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Affiliation(s)
- Fabian Eberle
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Rita Engenhart-Cabillic
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Markus M Schymalla
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Christoph Dumke
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Ulrike Schötz
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Florentine S B Subtil
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Kilian-Simon Baumann
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Boris A Stuck
- Department of Otolaryngology/Head & Neck Surgery, Marburg University Hospital, Marburg, Germany
| | - Christine Langer
- Department of Otolaryngology/Head & Neck Surgery, Gießen University Hospital, Gießen, Germany
| | - Alexandra D Jensen
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Department of Radiation Oncology, Gießen University Hospital, Gießen, Germany
| | - Henrik Hauswald
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Lautenschläger
- Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
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12
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Filtenborg MV, Lilja-Fischer JK, Sharma MB, Primdahl H, Kjems J, Plaschke CC, Charabi BW, Kristensen CA, Andersen M, Andersen E, Godballe C, Johansen J, Overgaard J, Petersen KB. Nasal vestibule squamous cell carcinoma: a population-based cohort study from DAHANCA. Acta Oncol 2022; 61:127-133. [PMID: 34709956 DOI: 10.1080/0284186x.2021.1994646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cancer of the nasal vestibule is a rare type of malignancy dominated by squamous cell carcinoma (SCC), and with poor survival. The treatment is either radiotherapy, surgery or a combination of both. Previous studies have shown a 5-year disease-specific survival of 74% and overall survival (OS) of 50%.Our objective was to describe the consecutive cohort of patients diagnosed with SCC of the nasal vestibule in Denmark from 2008 until 2018 and evaluate prognostic factors and treatment outcome using locoregional failure (LRF), disease-specific mortality (DSM), and OS as endpoints. METHODS All patients diagnosed with SCC of the nasal vestibule from 2008 until 2018 were identified in the nationwide clinical database, DAHANCA and were followed for LRF and death (DSM and OS) until March 2021. OS was analysed using Kaplan-Meier estimator, and cumulative incidence of LRF and DSM were analysed using the Aalen-Johansen estimator. Analysis of prognostic factors was performed using Cox proportional hazard models. RESULTS A total of 162 patients were identified. The median age was 71 years and 54% were male. Disease stage at the time of diagnosis were stage I (70%), II (17%), III (2%) and IV (11%). Curatively intended treatment was performed in 146 patients (90%), of which treatment failure occurred in 42 patients (29%). Most failures occurred at the primary tumour site (64%). Cancer Patient Pathways recommended time to treatment was fulfilled in 71% of patients. The 5-year OS and DSM in patients treated with curative intent were 65% and 11%, respectively. Stage was a significant independent prognostic factor. No difference in LRF, DSM or OS were shown between the applied treatments. CONCLUSIONS Stage is the main independent prognostic factor, and failure most commonly appear at the primary tumour site.
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Affiliation(s)
- Mads V. Filtenborg
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob K. Lilja-Fischer
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maja B. Sharma
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Julie Kjems
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina C. Plaschke
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte W. Charabi
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claus A. Kristensen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Elo Andersen
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Christian Godballe
- Department of Otorhinolaryngology, Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kristian B. Petersen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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13
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Czerwinski MD, Jansen PP, Zwijnenburg EM, Al-Mamgani A, Vergeer MR, Langendijk JA, Wesseling FWR, Kaanders JHAM, Verhoef CG. Radiotherapy as nose preservation treatment strategy for cancer of the nasal vestibule: The Dutch experience. Radiother Oncol 2021; 164:20-26. [PMID: 34487765 DOI: 10.1016/j.radonc.2021.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/19/2021] [Accepted: 08/25/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Primary radiotherapy is often preferred for early-stage cancer of the nasal vestibule (CNV), combining high disease control with preservation of nasal anatomy. However, due to practice variation and an absence of comparative trials, no consensus exists on preference for brachytherapy (BT) or external beam radiotherapy (EBRT). We compared these modalities in terms of disease control, nose preservation rates and toxicity. MATERIALS AND METHODS Medical records of 225 patients with T1-T2 squamous cell carcinoma of the nasal vestibule treated with 3D image-guided primary radiotherapy between Jan 2010 and Dec 2016 in 6 Dutch institutions were reviewed retrospectively. RESULTS 153 of 225 patients were treated with BT, 65 with EBRT and 7 with other modalities. Median follow-up was 46 months. Overall 3-year local control (LC) and regional control (RC) were 87% and 89%. Five-year disease-specific survival (DSS) and overall survival (OS) were 94% and 82%. Three-year survival with preserved nose (SPN) was 76%. BT provided higher 3-year LC (95% vs 71%, p < 0.01) and SPN compared with EBRT (82% vs 61%, p < 0.01). Multivariable and propensity-score-matched cohort analyses confirmed better outcomes after BT. No difference was seen in DSS or OS. Five-year incidence of CTCAE 5.0 grade ≥2 toxicity was higher after BT (20% vs 3%, p = 0.03) and consisted mostly of radiation ulcers. 50% of all late toxicity recovered. CONCLUSION In this largest-to-date multicenter analysis of T1-T2 CNV, BT achieved superior LC and SPN compared with EBRT. Grade 1-2 radiation ulcers occurred more frequently after brachytherapy, but were transient in half the cases. Considering these results, BT can be recommended as first-line treatment for T1-T2 CNV.
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Affiliation(s)
- Michal D Czerwinski
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Peter P Jansen
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ellen M Zwijnenburg
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marije R Vergeer
- Department of Radiation Oncology, Amsterdam University Medical Center, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen,, The Netherlands
| | - Frederik W R Wesseling
- Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO), The Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelia G Verhoef
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Bussu F, Tagliaferri L, Piras A, Rizzo D, Tsatsaris N, De Corso E, Parrilla C, Paludetti G. Multidisciplinary approach to nose vestibule malignancies: setting new standards. ACTA ACUST UNITED AC 2021; 41:S158-S165. [PMID: 34060531 PMCID: PMC8172111 DOI: 10.14639/0392-100x-suppl.1-41-2021-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
Nose vestibule malignancies, mainly SCCs, are considered rare neoplasms. In the present paper, we review the current state of the art concerning classification and treatment, and describe current evidence supporting a paradigm shift. In the current AJCC classification nose vestibule is considered part of nasal cavity/ethmoid. In daily clinical practice, nose vestibule lesions are often misclassified as skin primaries. This leads to an underestimation of the real incidence and to a mis-management. When nose vestibule primaries are correctly classified as nose primaries, the current AJCC TNM appears inadequate for prognostic stratification and an old staging system described 4 decades ago by Wang has been demonstrated to be more reliable in the literature and is preferred in centers with the largest volume of cases treated. The principles of Wang classification should be applied and nose vestibule acknowledged as a new distinct subsite of nose and paranasal sinuses by the AJCC/UICC. Surgery, External Beam RadioTherapy (EBRT) and Interventional RadioTherapy (IRT, BrachyTherapy BT) are the current therapeutic options for nose vestibule (NV) SCC. Increasing evidence demonstrates that IRT, with a proper multidisciplinary approach, is at least equivalent to surgery and EBRT for treatment of the primary lesions in terms of oncological outcomes, but markedly superior in terms of cosmetic and functional results, supporting HDR (high dose rate) IRT as the new standard for the treatment of the primary lesion in these malignancies. To optimize the advantages of IRT as primary therapeutic modality we set up a new approach to the implantation phase of IRT exploiting the anatomic planes of esthetic and functional nose surgery and the potential of intensity modulated and image guided brachytherapy to avoid septal and alar perforation (anatomic implantation).
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Affiliation(s)
- Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Sassari, Italy.,UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Antonio Piras
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Sassari, Italy
| | - Davide Rizzo
- Otolaryngology, Dipartimento delle Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, Italy
| | - Nicola Tsatsaris
- Otolaryngology Division, Azienda Ospedaliero Universitaria, Sassari, Italy
| | - Eugenio De Corso
- UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Claudio Parrilla
- UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gaetano Paludetti
- UOC di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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15
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Functional results of exclusive interventional radiotherapy (brachytherapy) in the treatment of nasal vestibule carcinomas. Brachytherapy 2020; 20:178-184. [PMID: 33041229 DOI: 10.1016/j.brachy.2020.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/22/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Surgery, external beam radiotherapy (EBRT), and interventional radiotherapy (IRT, BrachyTherapy BT) are the current therapeutic options for nose vestibule (NV) squamous cell carcinoma (SCC). In this article, we evaluate the nose functional parameters of patients affected by SCCs of the NV, primarily treated by interstitial IRT comparing them with healthy controls and with patients treated with intensity-modulated EBRT. METHODS Ten patients treated by using IRT (group 1), 10 healthy controls and eight patients treated by EBRT (group 2) on the region of the nose were submitted to clinical evaluation (with the NOSE scale score), rhinomanometry, olfactory testing, nasal citology, and evaluation of mucociliary clearance through saccharine test. RESULTS No long-term skin or cartilaginous toxicity are recorded. The olfactometry threshold discrimination identification TDI is lower in EB group. The mean NOSE scale score was significantly higher in group 2 than in group 1 and healthy controls (p < 0.05). The distribution of cytologic patterns resulted significantly different as well. Patients treated by EB have a significantly impaired mucociliary clearance, with a mean time for the transport of the stained marker, which is more than double in the patients treated by EB than in those treated with IRT (p < 0.001). CONCLUSIONS Nasal function and cytological findings are significantly better, substantially preserved, in patients treated by IRT than in those treated by EBRT, bringing new relevant evidence for the establishment of interstitial IRT as the new standard for the treatment of the primary lesion in cT1 and cT2 -Wang staging NV SCCs.
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16
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Lambertoni A, Cherubino M, Battaglia P, De Col A, Giovannardi M, Antognoni P, Valdatta L, Karligkiotis A, Bignami M, Castelnuovo P, Turri-Zanoni M. Squamous Cell Carcinoma of Nasal Vestibule and Pyramid: Outcomes and Reconstructive Strategies. Laryngoscope 2020; 131:E1198-E1208. [PMID: 33006408 DOI: 10.1002/lary.29107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Squamous cell carcinoma of nasal vestibule and pyramid is rare, thus classification, treatment protocol, and indications for elective neck treatment are still controversial. Nasal reconstruction is challenging, as well, and prosthesis is still used. STUDY DESIGN Retrospective cohort study. METHODS Retrospective review of patients surgically treated from 2010 to 2018 in a single Institution. Advanced tumors were further treated with adjuvant irradiation. Reconstruction strategy included grafts, locoregional and free flaps, and was customized on layers removed. RESULTS Forty-five patients were enrolled. The 5-year overall survival and disease-free survival were 81.9% ± 7.45% and 61.9% ± 9.09%, respectively. Wang's classification, site of origin, extent of surgery and margins status significantly correlated with prognosis and recurrence rate. Regional recurrences occurred in patients affected by advanced tumors who did not receive any form of elective neck treatment. CONCLUSION Multidisciplinary management and a proper reconstructive algorithm are recommended. Adjuvant irradiation and elective neck treatment should be advocated for advanced stage high-risk patients. LEVEL OF EVIDENCE 4. Laryngoscope, 131:E1198-E1208, 2021.
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Affiliation(s)
- Alessia Lambertoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Cherubino
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alessia De Col
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marta Giovannardi
- Unit of Biostatistics, Department of Statistics, University of Milan, Italy
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, Varese, Italy
| | - Luigi Valdatta
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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17
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Tagliaferri L, Carra N, Lancellotta V, Rizzo D, Casà C, Mattiucci G, Parrilla C, Fionda B, Deodato F, Cornacchione P, Gambacorta MA, Paludetti G, Valentini V, Bussu F. Interventional radiotherapy as exclusive treatment for primary nasal vestibule cancer: single-institution experience. J Contemp Brachytherapy 2020; 12:413-419. [PMID: 33299429 PMCID: PMC7701927 DOI: 10.5114/jcb.2020.100373] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/12/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of this paper was to evaluate treatment outcomes following interventional radiotherapy (brachytherapy - BT) for nasal vestibule cancer. MATERIAL AND METHODS Considering histological diagnosis and staging, a multidisciplinary tumor board indicated an exclusive interventional radiotherapy for all patients. Plastic tubes were placed mainly with interstitial approach. The total dose was 44 Gy in 14 fractions, 3 Gy/fraction (except for the first and last fractions, 4 Gy), 2 fractions per day (b.i.d.), 5 days a week. Inclusion criteria for this analysis were: patients affected by squamous cell carcinoma with follow-up more than 6 months. RESULTS 20 patients with primary nasal vestibule cancer were treated with IRT from May 2012 to June 2019. We excluded 4 patients due to follow-up less than 6 months and 2 patients affected by basal cell carcinoma. In total, 14 consecutive previously untreated patients were considered for definitive analysis, median age was 67.5 (range, 51-83) years, median follow-up was 53 (range, 6-84) months. All patients followed the protocol except one, who received a total dose of 42 Gy in 12 fractions, 3 Gy per 6 fractions, and 4 Gy per 6 fractions. Local control at 12, 24, and 36 months was 85.7%. Overall survival at 12 months was 92.3%, at 24 months was 76.9%, and at 36 months was 69.2%. Staging system proposed by Wang was statistically significant on local control (LC), disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). Excellent cosmetic results were observed. CONCLUSIONS This study confirms that interventional radiotherapy could be considered as a definitive treatment in nasal vestibule cancer with excellent oncological and cosmetic outcomes.
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Affiliation(s)
- Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Nadia Carra
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
- Address for correspondence: Nadia Carra, MD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS – Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Agostino Gemelli 8, Roma, Italy, phone: +39-34-76974405, ) e-mail:
| | - Valentina Lancellotta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Davide Rizzo
- Divisione di Otorinolaringoiatria, Azienda Ospedaliero Universitaria, Sassari, Italy,
| | - Calogero Casà
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Giancarlo Mattiucci
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Claudio Parrilla
- U.O.C. Otorinolaringoiatria, Dipartimento Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della testa collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Francesco Deodato
- Dipartimento di Radioterapia, Fondazione Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy,
| | - Patrizia Cornacchione
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
| | - Maria Antonietta Gambacorta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Gaetano Paludetti
- U.O.C. Otorinolaringoiatria, Dipartimento Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della testa collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
- Istituto di Otorinolaringoiatria, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Vincenzo Valentini
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy,
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,
| | - Francesco Bussu
- Divisione di Otorinolaringoiatria, Azienda Ospedaliero Universitaria, Sassari, Italy,
- Otorinolaringoiatria, Università degli studi di Sassari, Sassari, Italy
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18
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Bussu F, Tagliaferri L, Mattiucci G, Parrilla C, Rizzo D, Gambacorta MA, Lancellotta V, Autorino R, Fonnesu C, Kihlgren C, Galli J, Paludetti G, Kovács G, Valentini V. HDR interventional radiotherapy (brachytherapy) in the treatment of primary and recurrent head and neck malignancies. Head Neck 2019; 41:1667-1675. [DOI: 10.1002/hed.25646] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/14/2018] [Accepted: 12/10/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Francesco Bussu
- Universitá Cattolica del Sacro CuoreIstituto di Otorinolaringoiatria Roma Italia
- ENT DivisionAzienda Ospedaliero Universitaria Sassari Italia
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
| | - Giancarlo Mattiucci
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
| | - Claudio Parrilla
- Universitá Cattolica del Sacro CuoreIstituto di Otorinolaringoiatria Roma Italia
| | - Davide Rizzo
- ENT DivisionAzienda Ospedaliero Universitaria Sassari Italia
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
- Università Cattolica del Sacro CuoreIstituto di Radiologia Roma Italia
| | - Valentina Lancellotta
- Radiation OncologyUniversitá di Perugia, Azienda Ospedaliera di Perugia Perugia Italy
| | - Rosa Autorino
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
| | - Carla Fonnesu
- ENT DivisionAzienda Ospedaliero Universitaria Sassari Italia
| | | | - Jacopo Galli
- Universitá Cattolica del Sacro CuoreIstituto di Otorinolaringoiatria Roma Italia
| | - Gaetano Paludetti
- Universitá Cattolica del Sacro CuoreIstituto di Otorinolaringoiatria Roma Italia
| | - György Kovács
- Interdisciplinary Brachytherapy UnitUniversity of Lübeck and University Hospital S‐H Campus Lübeck Germany
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche Roma Italia
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19
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Vital D, Huber GF, Holzmann D, Moch H, Ikenberg K. The presence of aberrant p53 pattern is a negative prognostic predictor in squamous cell carcinoma of the nasal vestibule. Eur Arch Otorhinolaryngol 2017; 274:3503-3512. [PMID: 28669050 DOI: 10.1007/s00405-017-4659-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
Abstract
The aim of this study was to analyze the role of Ki-67, p53, and the "aberrant p53 pattern" in squamous cell carcinomas of the nasal vestibule. Patients between 1995 and 2014 were included. Baseline characteristics and outcome were analyzed with respect to immunohistochemical staining of Ki-67 and p53. "Aberrant p53 pattern" was represented by a moderate or strong staining of at least 60% of the tumor cells or a complete absence of immunoreactivity. Forty-six patients were included of whom 31 (67.4%) were available for Ki-67 and 32 (69.9%) for p53 immunohistochemistry. The "aberrant pattern" of p53 was present in 50% of the patients. While immunoreactivity for both Ki-67 and p53 was not related to each other or outcome, the "aberrant p53 pattern" was associated with a worse disease-free survival (p = 0.014). The "aberrant p53 pattern" is a negative prognostic factor in squamous cell carcinoma of the nasal vestibule and might enable a patient-tailored treatment.
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Affiliation(s)
- Domenic Vital
- Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
| | - Gerhard F Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, Zurich University Hospital and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Kristian Ikenberg
- Department of Pathology and Molecular Pathology, Zurich University Hospital and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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20
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Vital D, Holzmann D, Huber GF, Soyka MB, Moch H, Zimmermann DR, Ikenberg K. p16 INK4a : A surrogate marker of high-risk human papillomavirus infection in squamous cell carcinoma of the nasal vestibule. Head Neck 2017; 39:1392-1398. [PMID: 28371015 DOI: 10.1002/hed.24767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/15/2017] [Accepted: 02/08/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The purpose of this study was to analyze the role of p16INK4a and the prevalence of human papillomavirus (HPV) in squamous cell carcinoma (SCC) of the nasal vestibule. METHODS Patients diagnosed from 1995 to 2014 were included in this study. Assessment of p16INK4a and HPV-DNA polymerase chain reaction (PCR) was performed and analyzed with respect to baseline, clinicopathological, and outcome parameters. The p16INK4a positivity was defined as unequivocal nuclear and cytoplasmic staining of ≥70% of the cells, whereas 50%-69% was considered to be a "borderline" result. RESULTS There were 46 patients with SCCs of the nasal vestibule, of whom 31 (67.4%) were available for p16INK4a and 30 (65.2%) for analysis of HPV. Expression of p16INK4a was present in 19.4% and showed coincidence with high-risk HPV (P < .001). Neither p16INK4a nor HPV-DNA had significant impact on outcome. CONCLUSION Significant immunoreactivity for p16INK4a was present in about one-fifth of the samples and figured as a surrogate marker of high-risk HPV infection. There was no influence on outcome.
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Affiliation(s)
- Domenic Vital
- Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Frauenklinikstrasse 24, CH-8091, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Frauenklinikstrasse 24, CH-8091, Zurich, Switzerland
| | - Gerhard F Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Frauenklinikstrasse 24, CH-8091, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Frauenklinikstrasse 24, CH-8091, Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, Zurich University Hospital and University of Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland
| | - Dieter R Zimmermann
- Department of Pathology and Molecular Pathology, Zurich University Hospital and University of Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland
| | - Kristian Ikenberg
- Department of Pathology and Molecular Pathology, Zurich University Hospital and University of Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland
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21
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Mukai Y, Janssen S, Glanzmann C, Holzmann D, Studer G. Local control and intermediate-term cosmetic outcome following IMRT for nasal tumors : An update. Strahlenther Onkol 2016; 193:295-304. [PMID: 27921123 DOI: 10.1007/s00066-016-1083-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to evaluate local control and intermediate-term cosmetic outcome in patients with cancer of the nose treated with intensity-modulated radiotherapy (IMRT). METHODS From June 2008 to September 2015, 36 consecutive patients presenting with nasal cavity, ala of the nose, or nasal vestibule tumors were treated at the Department of Radiation Oncology, University Hospital Zurich either postoperatively (n = 14; 3/14 with nasal ablation) or with definitive IMRT (n = 22). Of these 36 patients, 8 presented with recurrent disease after surgery only and 1/36 with N1 disease. Concurrent systemic therapy was administered in 18/36 patients (50%). Nasal follow-up (FU) imaging documentation of 13 patients with preserved organ and >6 months FU offers a pre/post IMRT FU comparison. In addition, these patients' subjective evaluation of cosmesis was assessed. RESULTS Mean/median FU was 41/33 months (range 5-92 months). Salvage ablation with curative intent was undergone by 3 patients with local relapse after definitive (n = 2) and postoperative (n = 1) IMRT. The 3‑year local control, ultimate local control, and overall survival rates were 90, 97, and 90 %, respectively. Subjective and objective cosmetic outcome after IMRT is very satisfying so far. CONCLUSION IMRT for nasal tumors was found to be effective and well tolerated. Intermediate-term cosmetic results are good. Radical surgical procedures may be saved for curative salvage treatment.
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Affiliation(s)
- Yuki Mukai
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.,Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Stefan Janssen
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland
| | - Christoph Glanzmann
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.,Institute for Radiation Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Head Neck Cancer Center, University Hospital Zurich, Zurich, Switzerland
| | - Gabriela Studer
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland. .,Institute for Radiation Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland.
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22
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Ji HJ, Zang QI, Wang W, Sun NB, Cao M, Zhu Q, Jiang ZM. Synchronous double primary cancer of the lung and nasal vestibule: A case report and literature review. Mol Clin Oncol 2016; 4:807-810. [PMID: 27123284 DOI: 10.3892/mco.2016.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 02/22/2016] [Indexed: 11/06/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the nasal vestibule is a rare tumor entity, and its occurrence combined with lung cancer is even rarer. Thus, several patients are often initially misdiagnosed or remain undiagnosed. This is the case report of a 55-year-old male patient who presented to our hospital with a neoplasm in the left lung. The patient was treated with left upper pulmonary lobectomy and the subsequent histopathological examination of the surgical specimen revealed a poorly differentiated SCC. On postoperative week 4, the patient presented with purulent and bloody discharge from the left nostril and was misdiagnosed with an upper jaw cyst. After another 3 weeks, the patient was re-admitted to the hospital with a mass of left nostril and nasal congestion. Tru-Cut biopsies from the nasal area and histopathological examination revealed a moderately differentiated SCC. According to the clinical presentation and the histopathological findings, the patient was diagnosed with double primary cancer of the lung and the nasal vestibule. The mass of the left nostril was significantly reduced in size with radiotherapy. To the best of our knowledge, there is no similar case previously reported in the literature. Due to the rarity of scc of the nasal vestibule concomittant with lung cancer, we herein present this case report with a review of the relevant literature and investigation of the clinical characteristics.
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Affiliation(s)
- Huai Jun Ji
- Division of Surgery, Graduate Department, Weifang Medical College, Weifang, Shandong 261031, P.R. China
| | - Q I Zang
- Department of Thoracic Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
| | - Wei Wang
- Department of Thoracic Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
| | - Ning Bo Sun
- Division of Surgery, Graduate Department, Weifang Medical College, Weifang, Shandong 261031, P.R. China
| | - Ming Cao
- Department of Thoracic Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
| | - Qiang Zhu
- Department of Thoracic Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
| | - Zhong Min Jiang
- Department of Thoracic Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
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23
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Bussu F, Tagliaferri L, Mattiucci G, Parrilla C, Dinapoli N, Miccichè F, Artuso A, Galli J, Almadori G, Valentini V, Paludetti G. Comparison of interstitial brachytherapy and surgery as primary treatments for nasal vestibule carcinomas. Laryngoscope 2015; 126:367-71. [PMID: 26372494 DOI: 10.1002/lary.25498] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma arising from the nasal vestibule is a rare condition accounting for about 1% of head and neck malignancies with several peculiarities concerning both staging and treatment. The aim of this study was to compare the oncological and functional results of two different treatment modalities for the primary site: surgery and brachytherapy. STUDY DESIGN A case series with the comparison of two different treatment modalities. METHODS We evaluate clinical and survival data of 12 untreated patients, enrolled by a multidisciplinary tumor board, comparing oncological, functional, and esthetic results after surgery or after interstitial brachytherapy as exclusive treatments for the primary site. The functional and esthetic outcome was subjectively rated by the patients using a five-point scale. RESULTS Locoregional control and survival are not significantly different between patients primarily treated by surgery and by brachytherapy. The functional and esthetic outcome, as assessed by the degree of satisfaction of the patients, is significantly better after primary brachytherapy than after primary surgery (P = .014). CONCLUSIONS In our experience brachytherapy, accomplished in close cooperation between surgeons and radiation oncologists, achieves oncological results that are not different from surgery, but with a higher degree of patient satisfaction, mainly due to the esthetic outcome. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Francesco Bussu
- Institute of Otolaryngology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Luca Tagliaferri
- Institute of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Giancarlo Mattiucci
- Institute of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Claudio Parrilla
- Institute of Otolaryngology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Nicola Dinapoli
- Institute of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Francesco Miccichè
- Institute of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Alberto Artuso
- Institute of Otolaryngology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Jacopo Galli
- Institute of Otolaryngology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Giovanni Almadori
- Institute of Otolaryngology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Vincenzo Valentini
- Institute of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
| | - Gaetano Paludetti
- Institute of Otolaryngology, Catholic University of the Sacred Heart, Agostino Gemelli Polyclinic, Rome, Italy
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