Endoscopic screening of the upper gastrointestinal tract for second primary tumors in patients with head and neck cancer in a Western country

Chemotherapy May Influence Esophageal Lugol Chromoendoscopy Severity: A Retrospective Cohort Study and Literature Review

Lugol chromoendoscopy is widely used for screening esophageal squamous cell neoplasms (ESCNs) and evaluating dissection margins during endoscopic submucosal dissection (ESD). However, morphological variations may arise following treatment for synchronous cancers. This study aimed to assess the impact of chemotherapy on Lugol chromoendoscopy findings during both screening and ESD. From August 2009 to March 2024, ESCN patients undergoing esophageal ESD were enrolled. Lugol chromoendoscopy findings were analyzed based on four criteria: iodine staining, lesion size, margin assessment, and the pink-color sign. Findings from screening endoscopy and ESD were compared, and medical records were reviewed for chemotherapy and radiation data. A literature review was also conducted to explore the potential effects of chemotherapy on Lugol chromoendoscopy findings. Among the 162 patients in this ESD cohort, 32 (19.8%) demonstrated notable differences between initial and follow-up Lugol chromoendoscopy. Among them, 14 (43.8%) had undergone chemotherapy prior to ESD, while 26 received chemotherapy within 2 months before ESD. A significant proportion (53.8%) of chemotherapy-treated patients exhibited faded chromoendoscopy findings (p < 0.01), despite no esophageal radiation exposure. Literature review findings supported our observation that chemotherapy may reduce Lugol voiding lesions. These findings suggest that chemotherapy influences lesion size and morphology during Lugol chromoendoscopy, underscoring the importance of careful timing and interpretation in these patients.

Impact of preceding treatment for head and neck squamous cell carcinoma on synchronous superficial esophageal squamous cell carcinoma

BACKGROUND

Patients with esophageal squamous cell carcinoma (ESCC) frequently develop synchronous head and neck squamous cell carcinoma (HNSCC). With advances in endoscopic technology and widespread screening of synchronous cancers, the detection of synchronous HNSCC and superficial ESCC (SESCC) is increasing. We aimed to evaluate the impact of preceding HNSCC treatment on synchronous SESCC.

METHODS

This single-center retrospective study enrolled patients with synchronous HNSCC and SESCC who were treated between January 2010 and December 2023. Tumor size and depth of SESCC before and after HNSCC treatment were evaluated. The factors associated with SESCC progression were investigated.

RESULTS

Of the 299 patients with synchronous HNSCC and SESCC, 134 who underwent preceding HNSCC treatment with follow-up esophagogastroduodenoscopy (EGD) for SESCC were evaluated. Chemoradiotherapy was the most common treatment for HNSCC (56.0%), followed by surgery (17.2%), radiotherapy (14.9%), local resection (7.5%), and chemotherapy (4.5%). The tumor size of SESCC increased after HNSCC treatment in 18 patients (13.4%). Multivariate analysis revealed that an EGD interval of ≥ 120 days was significantly associated with increased tumor size in SESCC (odds ratio, 6.64; 95% confidence interval, 1.91-23.1). Tumor regrowth was observed in 70.6% of SESCCs that shrank with HNSCC treatment, mostly within six months. Tumor depth aggravation was rare (2.2%), but progression to advanced ESCC was observed in two patients.

CONCLUSIONS

Timely endoscopic follow-up, preferably within 120 days, is crucial for managing synchronous SESCC after HNSCC treatment to prevent tumor progression. Tumor regrowth should be monitored when SESCC shrinks with HNSCC treatment.

Global, regional and national burden and trends of larynx cancer among adults aged 55 and older from 1990 to 2021: results from the global burden of disease study 2021

BACKGROUND

Laryngeal cancer (LC), as a common head and neck tumor, significantly impacts the quality of life. Utilizing data from the 2021 Global Burden of Disease (GBD) study, we sought to delve deeply into the global LC burden experienced by individuals aged 55 and older from 1990 to 2021 at the global, regional, and national levels. This research encompassed three key indicators: incidence rate, mortality, and disability-adjusted life years (DALYs).

METHODS

Based on the GBD 2021 database, we selected data from 204 countries and regions covering the period from 1990 to 2021 for individuals aged 55 and above. We analyzed LC's performance in terms of incidence, mortality, and DALYs, calculating the age-standardized rates and the mean average annual percent change (AAPC) at global, regional, and national levels. In our analysis of global trends, we carefully considered multiple variables including age, sex, and the socio-demographic index (SDI). Furthermore, we assessed potential risk factors for LC-associated DALYs and made prospective predictions for the possible scenario by 2035.

RESULTS

Globally, the age-standardized DALY rate of LC among adults aged 55 years and older has undergone significant changes. Specifically, this rate dropped sharply from 245.89 cases per 100,000 people in 1990 to 153.76 cases per 100,000 people in 2021, with an AAPC showing a decreasing trend of -2.916. Simultaneously, the age-standardized incidence rate and mortality rate also exhibited a similar downward trend. From a regional perspective, South Asia ranked highest in relevant indicators in 2021, reporting a death toll of 29,258.96, confirmed cases of 34,234.23, and DALYs related to LC reaching 709,622.00. In contrast, the figures in Oceania were the lowest, with only 26.23 deaths, 29.53 incident cases, and 609.09 DALYs. When divided according to the quintiles of the SDI, in 2021, the medium-high SDI led in incidence rates, while the low SDI ranked last. However, in terms of mortality and DALY rates, medium-low SDI topped the list, with high SDI being the lowest. In terms of gender differences, in 2021, the age-standardized DALY rate of LC in males was approximately 7.13 times that of females, with the former reaching 282.12 cases per 100,000 people and the latter only 39.59 cases per 100,000 people. Among all age groups, a notable decrease was observed in the age-specific incidence rate and DALY for adults aged 60-64 years, with AAPC values of -0.123 (95% CI: -0.130 to -0.116) and - 3.553 (95% CI: -3.620 to -3.486), respectively. Similarly, the mortality rate for adults aged 65-69 years also showed a significant decline, with an AAPC of -0.123 (95% CI: -0.127 to -0.118). Additionally, tobacco has been revealed as the most important risk factor affecting the mortality and DALY of LC in adults aged 55 years and older. Looking ahead, it is predicted that by 2035, the incidence rate, mortality rate, and DALY rate of LC among people over 55 years old will continue to decline.

CONCLUSIONS

Despite the current data and future predictions indicating a decline in the global age-standardized incidence rate, the absolute number of estimates continues to increase. Therefore, we advocate that cancer prevention strategies should place greater emphasis on vigorously addressing modifiable risk factors, particularly for the male population, which requires special attention and scientific intervention.

Association of esophageal squamous cell carcinoma with head and neck cancer

BACKGROUND AND OBJECTIVES

Esophageal squamous cell carcinomas (ESCC) are often accompanied by head and neck squamous cell carcinoma (HNSCC) and vice versa. Our study aimed to describe the prevalence of HNSCC in patients with ESCC, the chronology of appearance and the impact on survival.

METHODS

A retrospective review was carried out through a computerized database of patients diagnosed with ESCC at Hospital Clinic of Barcelona between January 1999 and June 2019. Demographic data, date of ESCC diagnosis, survival time, primary tumor location, diagnosis of HNSCC and chronological relationship were recorded.

RESULTS

A total of 231 patients with ESCC confirmed histologically were included in the study with a median age of 64 years (IQR, 56.0-72.0), and 178 (77%) were male. The majority of the patients had a history of smoking and alcohol consumption (69.7% and 60.6%, respectively). The predominant location of ESCC was the middle esophagus (n=124, 53.7%). Forty-one patients (17.7%) had HNSCC: 21 (51.2%) were previous, 14 (34.1%) synchronous and 6 (14.6%) metachronous. All the patients were followed and 196 (84.8%) died with a median survival time of 19 months (IQR, 7-66). There were not statistically significant differences among the living patients and the deceased.

CONCLUSIONS

In our setting, a 17.7% of patients with ESCC have an associated HNSCC with no significant differences in survival between patients with both ESCC and HNSCC compared to those with only ESCC. However, the implementation of a screening program could allow the detection of a second primary tumor at early stages.

Efficacy of 18FDG-PET/CT in Detecting Synchronous Malignancies in Patients With Head and Neck Cancer: A Systematic Review and Meta-analysis

OBJECTIVE

To assess the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (18FDG-PET/CT) in detecting second primary malignancies (SPMs) in patients with treatment naïve head and neck squamous cell carcinoma (HNSCC).

DATA SOURCES

Medline, Embase, Cochrane Library, and Scopus searched from 1946 to December 2022.

REVIEW METHODS

Studies reporting the performance of 18FDG-PET/CT in patients with treatment-naïve, index HNSCC for detection of SPMs were included. The reference standard was histopathology, clinical follow-up over the duration of study, and other imaging modalities. Multiple investigators completed depth full-text analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. Methodologic and diagnostic accuracy data were abstracted independently by multiple investigators. Risk of bias assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies tool independently. Bivariate random-effects model meta-analysis and multivariable meta-regression modeling were used.

RESULTS

Seventeen studies examining 4624 patients with a total of 475 SPMs were included in the final analysis. Eleven studies were found to be at low risk for bias, while the rest were in the high-risk category. 18FDG-PET/CT demonstrated pooled sensitivity and specificity of 0.73 (95% confidence interval [CI]: 0.49-0.88) and 0.99 (95% CI: 0.98-1.00) in detecting SPMs. Further subsite analysis revealed varied diagnostic performance across different anatomical regions, with sensitivity and specificity of esophageal SPMs being 0.47 (0.30-0.64) and 0.99 (0.98-1.00), and sensitivity and specificity of 0.86 (0.73-0.94) and 0.99 (0.98-1.00) for head and neck SPMs. Finally, this imaging modality showed sensitivity and specificity of 0.92 (0.84-0.96) and 0.99 (0.98-1.00) for lung SPMs.

CONCLUSION

The findings of this study suggest varied accuracy of 18FDG-PET/CT in detecting SPMs during initial workup for HNSCC, highlighting the importance of screening modalities such as esophagoscopy in high-risk patients.

SCC-NET: segmentation of clinical cancer image for head and neck squamous cell carcinoma

Purpose

Squamous cell carcinoma (SCC) accounts for 90% of head and neck cancer. The majority of cases can be diagnosed and even treated with endoscopic examination and surgery. Deep learning models have been adopted for various medical endoscopy exams. However, few reports have been on deep learning algorithms for segmenting head and neck SCC.

Approach

Head and neck SCC pre-treatment endoscopic images during 2016-2020 were collected from the Kaohsiung Veterans General Hospital Department of Otolaryngology-Head and Neck Surgery. We present a new modification of the neural architecture search-U-Net-based model called SCC-Net for segmenting our enrolled endoscopic photos. The modification included a new technique called "Learnable Discrete Wavelet Pooling" to design a new formulation that combines the outputs of different layers using a channel attention module and assigns weights based on their importance in the information flow. We also incorporated the cross-stage-partial design from CSPnet. The performance was compared with other eight state-of-the-art image segmentation models.

Results

We collected a total of 556 pathologically confirmed SCC photos. The new SCC-Net algorithm achieves a high mean intersection over union (mIOU) of 87.2%, accuracy of 97.17%, and recall of 97.15%. When comparing the performance of our proposed model with eight different state-of-the-art image segmentation artificial neural network models, our model performed best in mIOU, Dice similarity coefficient, accuracy, and recall.

Conclusions

Our proposed SCC-Net architecture was able to successfully segment lesions from white light endoscopic images with promising accuracy, with a single model performing well in all upper aerodigestive tracts.

Diagnosis of laryngopharyngeal carcinoma through office-based flexible laryngoscopy as a reliable alternative for biopsies under general anesthesia: Faster diagnostics with equal oncological outcome

PURPOSE

Diagnostic endoscopy with biopsy under general anesthesia (DE-GA) is still considered as the established standard to assess laryngopharyngeal cancer patients. Office-based flexible laryngoscopic biopsy (FLB) offers an alternative, but the effect on oncological outcome remains uncertain. Therefore, the diagnostic process and survival of patients undergoing FLB, compared to those undergoing DE-GA were evaluated.

METHODS

Patients suspected of laryngopharyngeal cancer who underwent FLB were evaluated. Patients with FLB-confirmed squamous cell carcinoma (SCC) were matched with DE-GA patients based on tumor site, T-classification, N-classification, age, and p16 overexpression. Time from first visit to diagnosis (FVD), time to treatment interval (TTI), disease-specific survival (DSS) and overall survival (OS) were analyzed.

RESULTS

FLB yielded a definitive diagnosis in 155/164 (95 %) patients. No complications were observed. Ninety-eight of the 124 patients in which FLB revealed a SCC received curative treatment and were compared with 98 matched patients who underwent DE-GA. Median FVD interval was 6 days after FLB and 15 days after DE-GA (p < 0.001). Median TTI interval (FLB: 28 days, DE-GA: 28 days) was equal (p = 0.91). Oncological outcomes were comparable (p > 0.05) between FLB (OS: 2-yr: 76 %, 5-yr: 42 %; DSS: 2-yr: 86 %, 5-yr: 85 %) and DE-GA groups (OS: 2-yr: 76 %, 5-yr: 50 %; DSS: 2-yr: 81 %, 5-yr: 79 %).

CONCLUSION

FLB in the outpatient setting demonstrates a high diagnostic accuracy, is safe, accelerates the diagnostic process and has no negative effects on clinical outcome compared to DE-GA. Therefore, FLB should be considered as the standard diagnostic procedure in patients suspected of laryngopharyngeal cancer.

Global burden of head and neck cancers from 1990 to 2019

Head and neck cancer (HNC) exerts a significant healthcare burden worldwide. Insufficient data impedes a comprehensive understanding of its global impact. Through analysis of the 2019 Global Burden of Disease (GBD) database, our secondary investigation unveiled a surging global incidence of HNC, yet a decline in associated mortality and disability-adjusted life years (DALYs) owing to enhanced prognosis. Particularly noteworthy is the higher incidence of escalation among females compared to males. Effective resource allocation, meticulous control of risk factors, and tailored interventions are imperative to curtail mortality rates among young individuals afflicted with HNC in underprivileged regions, as well as in elderly individuals grappling with thyroid cancer.