Evaluation of sarcopenia as a prognostic biomarker in locally advanced head and neck squamous cell carcinoma

Background: We aimed to evaluate the effect of sarcopenia on survival in head and neck squamous cell carcinoma patients treated with chemoradiotherapy. Materials & methods: Disease-free survival and overall survival were compared according to cervical computed tomography for radiotherapy in 123 sarcopenic and non-sarcopenic patients with locally advanced head and neck squamous cell carcinoma treated with chemoradiotherapy with weekly cisplatin. Results: In multivariate analyses, pretreatment sarcopenia was associated with lower disease-free survival (hazard ratio: 2.60; 95% CI: 1.38-4.87; p = 0.003) and overall survival (hazard ratio: 2.86; 95% CI: 1.40-5.85; p = 0.004). Sarcopenic patients experienced more frequent radiotherapy-related toxicities and platinum-related side effects than non-sarcopenic patients. Conclusion: Sarcopenia could be a potential biomarker to predict prognosis and treatment toxicity in head and neck squamous cell carcinoma.

Development and validation of an improved classification and risk stratification system for carotid body tumors: Multinational collaborative cohort study

BACKGROUND

This study aims to develop and validate a new classification system that better predicts combined risk of neurological and neurovascular complications following CBT surgery, crucial for treatment decision-making.

METHODS

Multinational retrospective cohort study with 199 consecutive cases. A cohort of 132 CBT cases was used to develop the new classification. To undertake external validation, assessment was made between the actual complication rate and predicted risk by the model on an independent cohort (n = 67).

RESULTS

Univariate analyses showed statistically significant associations between developing a complication and the following factors: craniocaudal dimension, volume, Shamblin classification, and Mehanna types. In the multivariate prognostic model, only Mehanna type remained as a significant risk predictor. The risk of developing complications increases with increasing Mehanna type.

CONCLUSIONS

We have developed and then validated a new classification and risk stratification system for CBTs, which demonstrated better prognostic power for the risk of developing neurovascular complications after surgery.

The role of suprahyoid neck dissection in the treatment of squamous cell carcinoma of the lower lip: 20 years' experience at a Tertiary Center

PURPOSE

To evaluate the efficacy of L1-2ND in the management of the lower lip squamous cell carcinoma and to achieve the highest cure rates with adequate neck dissection.

METHODS

A retrospective review was completed on patients treated between 1994 and 2014. The case histories of 184 patients who were treated with surgical excision of the primary tumor along with neck dissection, and 24 patients who were treated only with surgical excision without neck dissection at another center, were studied. All patients were followed up for evidence of recurrent disease.

RESULTS

In 208 patients (193 men, 15 women) with a mean age of 51 years, 12 were N1, 3 were N2, and 169 were N0; 24 patients had undergone operation at another center without neck dissection. Lymph node metastases were present in 34 patients (18.4%) with dissected necks and occult metastases were detected in 19 patients with clinically N0 necks (11.2%). The median follow-up of each patient was 28 months. Only 1 patient developed neck recurrence, and there was no local recurrence. The overall survival rate (OAS) of patients with clinical N0 disease who underwent neck dissection was 94.7%; the OAS of the patients who were not treated with neck dissection was 29.1%.

CONCLUSION

Level 1-2 neck dissection (L1-2ND) is the treatment of choice for controlling neck disease in patients with lower lip carcinoma, and serves as a staging procedure to detect patients who require adjuvant therapy.

Management and Outcome of Airway Infantile Hemangiomas

Objectives:

(1) Analyze the data of our series of cases of infantile hemangiomas (IH). (2) Describe the clinical characteristics and contemporary treatment modalities of the disease to general and pediatric otorhinolaryngologists.

Methods:

The medical records of children diagnosed with airway hemangiomas at Hacettepe University Hospital, Department of Otolaryngology between 2005 and 2013 were reviewed retrospectively. The study included 17 patients with IH of the airway. Four patients (23.5%) were male and 13 (76.5%) were female. All of the patients received medical treatment. Six patients (35%) did not respond to medical treatment and surgical intervention was needed. Five in the surgical group required tracheotomy.

Results:

All patients with tracheotomies were decanulated and stridor in all of them either disappeared or significantly improved. Endoscopic examinations of all of the patients revealed an open and safe lumen. After beginning propranalol as the medical agent, only one patient needed surgical intervention. None of the patients had any major complications.

Conclusions:

Medical treatment with propranalol of subglottic hemangioma is the first line choice. If medical treatment options fail, surgical intervention should be considered. Overall purpose should be the patient’s airway safety.

Endolaryngeal dilatation versus laryngotracheal reconstruction in the primary management of subglottic stenosis

OBJECTIVES

The scope of the study is to compare endolaryngeal dilatations (ED) with laryngotracheal reconstruction with cartilage grafting (LTRCG) in terms of restenosis.

METHODS

Pediatric subglottic stenosis patients treated in Hacettepe University, between 2002 and 2012 were retrospectively evaluated. Patients who had ED or LTRCG as primary management were included in the study. EDs were grouped into bronchoscopic dilatation (BD), laser incision and balloon dilatation (LBD) and cold knife incision and balloon dilatation (CKBD). The groups were evaluated in terms of restenosis and decannulation rates.

RESULTS

There were 35 patients (9 females, 26 males; mean age 4.42). LTRCG was performed in 16 patients (9 anterior and 7 anterior and posterior grafts). EDs were performed in 19 patients with 6 CKBDs, 7 LBDs and 6 BDs. There were 3 grade II, 13 grade III cases in the LTRCG group while 4 grade I, 6 grade II, 8 grade 3 and 1 grade 4 in the ED group. Overall decannulation rate was 97% (34/35) in all patients. Restenosis was higher in the ED group (63.2%) than the LTRCG group (31.3%) with rates of CKBD 16.7% (1/6), LBD 71.4% (5/7) and BD 100% (6/6). Restenosis rates were found to be increasing with higher grades (grade I-25%, grade II-66%, grade III-85%).

CONCLUSION

ED may need more repetitive interventions than LTRCG due to restenosis. Less restenosis might be observed when balloon is used for dilatation and cold knife for mucosal incisions.