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Ferrari M, Mularoni F, Taboni S, Crosetti E, Pessina C, Carobbio ALC, Montalto N, Marchi F, Vural A, Paderno A, Caprioli S, Gaudioso P, Fermi M, Rigoni F, Saccardo T, Contro G, Ruaro A, Lo Manto A, Varago C, Baldovin M, Bandolin L, Filauro M, Sampieri C, Missale F, Ioppi A, Carta F, Ramanzin M, Ravanelli M, Maiolo V, Bertotto I, Del Bon F, Lancini D, Mariani C, Marrosu V, Tatti M, Cağlı S, Yüce I, Gündoğ M, Dogan S, Anile G, Gottardi C, Busato F, Vallin A, Gennarini F, Bossi P, Ghi MG, Lionello M, Zanoletti E, Marioni G, Maroldi R, Mattioli F, Puxeddu R, Bertolin A, Presutti L, Piazza C, Succo G, Peretti G, Nicolai P. How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group. Oral Oncol 2024; 152:106744. [PMID: 38520756 DOI: 10.1016/j.oraloncology.2024.106744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. METHODS In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. RESULTS Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. CONCLUSIONS The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.
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Affiliation(s)
- M Ferrari
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy.
| | - F Mularoni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - S Taboni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - E Crosetti
- Otorhinolaryngology Department - Head Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - C Pessina
- Radiology Unit, Sant'Antonio Hospital, University of Padova, Padova, Italy
| | - A L C Carobbio
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - N Montalto
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - F Marchi
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - A Vural
- Otorhinolaryngology Unit, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - A Paderno
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - S Caprioli
- Radiology Unit, San Martino Hospital, Genoa, Italy
| | - P Gaudioso
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - M Fermi
- Otorhinolaryngology Unit, Azienda Ospedaliera Universitaria di Bologna IRCCS, Bologna, Italy; Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - F Rigoni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - T Saccardo
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - G Contro
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - A Ruaro
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - A Lo Manto
- Otorhinolaryngology Unit, Infermi Hospital, Rimini, Italy
| | - C Varago
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - M Baldovin
- Otorhinolaryngology Unit, San Martino di Belluno Hospital, Belluno, Italy
| | - L Bandolin
- Otorhinolaryngology Unit, Hospital of Santorso, Vicenza, Italy
| | - M Filauro
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - C Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Italy; Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - F Missale
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, the Netherlands
| | - A Ioppi
- Department of Otorhinolaryngology-Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - F Carta
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - M Ramanzin
- Radiology Unit, Hospital of Vicenza, Vicenza, Italy
| | - M Ravanelli
- Radiology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - V Maiolo
- Pediatric and Adult Cardiothoracic and Vascular, Oncohematologic and Emergency Radiology Unit (IRCCS AOUBO), University of Bologna, Italy
| | - I Bertotto
- Radiology Unit, IRCCS Istituto di Candiolo, Turin, Italy
| | - F Del Bon
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - D Lancini
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - C Mariani
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - V Marrosu
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - M Tatti
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - S Cağlı
- Otorhinolaryngology Unit, Erciyes University, Kayseri, Turkey
| | - I Yüce
- Otorhinolaryngology Unit, Erciyes University, Kayseri, Turkey
| | - M Gündoğ
- Department of Radiation Oncology, Erciyes University, Kayseri, Turkey
| | - S Dogan
- Department of Radiology, Erciyes University, Kayseri, Turkey
| | - G Anile
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - C Gottardi
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - F Busato
- Unit of Radiation Oncology, Policlinico Abano, Padova, Italy
| | - A Vallin
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - F Gennarini
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - P Bossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - M G Ghi
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - M Lionello
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - E Zanoletti
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - G Marioni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - R Maroldi
- Radiology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - F Mattioli
- Otorhinolaryngology Unit, University of Modena, Modena, Italy
| | - R Puxeddu
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy; King's College Hospital London, Dubai, United Arab Emirates
| | - A Bertolin
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - L Presutti
- Otorhinolaryngology Unit, Azienda Ospedaliera Universitaria di Bologna IRCCS, Bologna, Italy; Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - C Piazza
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - G Succo
- Otorhinolaryngology Department - Head Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy; Oncology Department, University of Turin, Turin, Italy
| | - G Peretti
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - P Nicolai
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
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Mattavelli D, Verzeletti V, Deganello A, Fiorentino A, Gualtieri T, Ferrari M, Taboni S, Anfuso W, Ravanelli M, Rampinelli V, Grammatica A, Buffoli B, Maroldi R, Elisabetta C, Rezzani R, Nicolai P, Piazza C. Computer-aided designed 3D-printed polymeric scaffolds for personalized reconstruction of maxillary and mandibular defects: a proof-of-concept study. Eur Arch Otorhinolaryngol 2024; 281:1493-1503. [PMID: 38170208 PMCID: PMC10857968 DOI: 10.1007/s00405-023-08392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To investigate the potential reconstruction of complex maxillofacial defects using computer-aided design 3D-printed polymeric scaffolds by defining the production process, simulating the surgical procedure, and explore the feasibility and reproducibility of the whole algorithm. METHODS This a preclinical study to investigate feasibility, reproducibility and efficacy of the reconstruction algorithm proposed. It encompassed 3 phases: (1) scaffold production (CAD and 3D-printing in polylactic acid); (2) surgical simulation on cadaver heads (navigation-guided osteotomies and scaffold fixation); (3) assessment of reconstruction (bone and occlusal morphological conformance, symmetry, and mechanical stress tests). RESULTS Six cadaver heads were dissected. Six types of defects (3 mandibular and 3 maxillary) with different degree of complexity were tested. In all case the reconstruction algorithm could be successfully completed. Bone morphological conformance was optimal while the occlusal one was slightly higher. Mechanical stress tests were good (mean value, 318.6 and 286.4 N for maxillary and mandibular defects, respectively). CONCLUSIONS Our reconstructive algorithm was feasible and reproducible in a preclinical setting. Functional and aesthetic outcomes were satisfactory independently of the complexity of the defect.
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Affiliation(s)
- Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy.
| | - Vincenzo Verzeletti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
| | - Alberto Deganello
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), Milan, Italy
| | - Antonio Fiorentino
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Department of Otorhinolaryngology, Head and Neck Surgery, "Nuovo Santo Stefano" Civil Hospital, Prato, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada
| | - Stefano Taboni
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
- Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - William Anfuso
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), Milan, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Unit of Radiology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, School of Medicine, Brescia, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Unit of Radiology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Ceretti Elisabetta
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, School of Medicine, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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Contro G, Sordi A, Taboni S, Citterio M, Ruaro A, De Lucia G, Pinacoli A, Carobbio ALC, Montalto N, Ramacciotti G, Grammatica A, Marioni G, Zanoletti E, Maroldi R, Piazza C, Mattavelli D, Nicolai P, Ferrari M. Prognostic Value of Anteroposterior Extension in Oral Tongue and Floor Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2024; 150:142-150. [PMID: 38153706 PMCID: PMC10853838 DOI: 10.1001/jamaoto.2023.3809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/29/2023] [Indexed: 12/29/2023]
Abstract
Importance The tongue and oral floor represent the most involved subsite by oral cancer, and there are no reported systems to classify anteroposterior tumor extension with prognostic effect. In other cancers, the anterior vs posterior tumor extension is a relevant prognostic factor. Objective To establish whether anterior vs posterior tumor extension may represent a prognostic factor in oral tongue and floor squamous cell carcinoma (OTFSCC). Design, Setting, and Participants This was a retrospective cohort study of patients who underwent surgery for OTFSCC from January 1, 2010, to December 31, 2021, at 2 tertiary-level academic institutions in Italy (University of Padua and University of Brescia). Patients eligible for the study had histologically proven primary OTFSCC; underwent surgery-based, curative treatment; and had available preoperative contrast-enhanced imaging. Exposures Four anatomical lines were designed to assess tumor extension: (1) chin-palate line (CPL), (2) chin-basion line, (3) Stensen duct line, and (4) lingual septum line. Preoperative imaging was re-evaluated, and tumor extension was classified as either anterior or posterior according to the lines. Main Outcomes and Measures Overall survival and time to recurrence (TTR) were evaluated according to tumor extension. These outcomes were reported as 5-year survival rates with 95% CIs. Results Of the 133 patients included, 79 (59.4%) were male, and the mean (SD) age was 62.7 (15.4) years. The 5-year TTR difference was higher for posterior vs anterior OTFSCC classified according to CPL (21.0%; 95% CI, 8.3%-33.7%), Stensen duct line (15.5%; 95% CI, 1.0%-30.0%), and lingual septum line (17.2%; 95% CI, 2.2%-32.3%). Overall survival analysis showed similar results. At the multivariable analysis on TTR, N status (adjusted hazard ratio [HR], 3.0; 95% CI, 1.2-7.1) and anteroposterior classification according to CPL (adjusted HR, 7.1; 95% CI, 0.9-54.6) were the variables associated with the highest adjusted HRs. Conclusions and Relevance In this cohort study, OTFSCC with a posterior extension to the CPL was associated with a higher risk of recurrence and death. This analysis suggests that the poor prognosis conveyed by the posterior tumor extension is independent of other relevant prognosticators except for the burden of nodal disease. This estimate is not precise and does not allow for definitive clinically important conclusions; therefore, further prospective studies are necessary to confirm these data.
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Affiliation(s)
- Giacomo Contro
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Alessandra Sordi
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, Ontario, Canada
- Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Citterio
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
| | - Alessandra Ruaro
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
| | - Giulia De Lucia
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
| | - Aurora Pinacoli
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Andrea Luigi Camillo Carobbio
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
| | - Nausica Montalto
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
| | - Giulia Ramacciotti
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
| | - Alberto Grammatica
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Gino Marioni
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
- Phoniatrics and Audiology Unit, Department of Neuroscience, University of Padua, Treviso, Italy
| | - Elisabetta Zanoletti
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
| | - Roberto Maroldi
- Division of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology–Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, Padua, Italy
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, Ontario, Canada
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4
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Rampinelli V, Ferrari M, Mattavelli D, Bonomo P, Lambertoni A, Turri-Zanoni M, D’Angelo E, Alterio D, Cianchetti M, Vischioni B, Rosati R, Tomasoni M, Alparone M, Taboni S, Tomasini D, Maddalo M, Bastia MBDM, Iacovelli NA, Dionisi F, Bignami M, Battaglia P, Bossi P, Deganello A, Piazza C, Schreiber A, Nicolai P, Castelnuovo P, Orlandi E. Treatment of loco-regional recurrence of nasopharyngeal carcinoma in a non-endemic area: oncologic outcomes, morbidity, and proposal of a prognostic nomogram. Front Oncol 2023; 13:1157584. [PMID: 37260976 PMCID: PMC10228821 DOI: 10.3389/fonc.2023.1157584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction The study assessed outcomes and toxicities of different treatment modalities for local and/or regional recurrent nasopharyngeal carcinoma (NPC) in a non-endemic area. Methods Patients treated with curative intent for recurrent NPC with salvage surgery, photon-based radiotherapy, proton therapy (PT), with or without chemotherapy, at different Italian referral centers between 1998 and 2020 were included. Adverse events and complications were classified according to the Common Terminology Criteria for Adverse Events. Characteristics of the patients, tumors, treatments, and complications are presented along with uni- and multivariate analysis of prognostic factors. A survival predictive nomogram is also provided. Results A total of 140 patients treated from 1998 to 2020 were retrospectively assessed. Cases with lower age, comorbidity rate, stage, and shorter disease-free interval (DFI) preferentially underwent endoscopic surgery. More advanced cases underwent re-irradiation, fairly distributed between photon-based radiotherapy and PT. Age and DFI were independent factors influencing overall survival. No independent prognostic effect of treatment modality was observed. No significant difference in the morbidity profile of treatments was observed, with 40% of patients experiencing at least one adverse event classified as G3 or higher. Conclusion Recurrent NPC in a non-endemic area has dissimilar aspects compared to its endemic counterpart, suggesting the need for further studies that can guide the choice of the best treatment modality.
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Affiliation(s)
- Vittorio Rampinelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessia Lambertoni
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Elisa D’Angelo
- Radiotherapy Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Daniela Alterio
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Cianchetti
- Proton Therapy Unit, Azienda Provinciale Per i Servizi Sanitari, Trento, Italy
| | - Barbara Vischioni
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Roberta Rosati
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Marco Alparone
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Davide Tomasini
- Department of Radiation Oncology, Brescia University, Brescia, Italy
| | - Marta Maddalo
- Department of Radiation Oncology, Brescia University, Brescia, Italy
| | | | | | - Francesco Dionisi
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maurizio Bignami
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Otolaryngology Head and Neck Surgery, IRCCS National Cancer Institute (INT), Milan, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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5
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Ferrari M, Alessandrini L, Savietto E, Cazzador D, Schiavo G, Taboni S, Carobbio ALC, Calvanese L, Contro G, Gaudioso P, Emanuelli E, Sbaraglia M, Zanoletti E, Marioni G, Dei Tos AP, Nicolai P. The Prognostic Role of the Immune Microenvironment in Sinonasal Intestinal-Type Adenocarcinoma: A Computer-Assisted Image Analysis of CD3 + and CD8 + Tumor-Infiltrating Lymphocytes. J Pers Med 2023; 13:jpm13050726. [PMID: 37240896 DOI: 10.3390/jpm13050726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
The prognostic value of conventional histopathological parameters in the sinonasal intestinal-type adenocarcinoma (ITAC) has been debated and novel variables should be investigated. Increasing evidence demonstrated that the evolution of cancer is strongly dependent upon the complex interactions within tumor microenvironment. The aim of this retrospective study was to assess the features of immune microenvironment in terms of CD3+ and CD8+ cells in a series of ITAC and explore their prognostic role, as well as their relations with clinicopathological variables. A computer-assisted image analysis of CD3+ and CD8+ tumor-infiltrating lymphocytes (TIL) density was conducted on surgical specimens of 51 patients with ITAC that underwent a curative treatment including surgery. ITAC displays variable TIL density, which is associated with OS. In a univariate model, the density of CD3+ TIL was significantly related to OS (p = 0.012), whereas the association with CD8+ TIL density resulted in being non-significant (p = 0.056). Patients with intermediate CD3+ TIL density were associated with the best outcome, whereas 5-year OS was the lowest for intermediate CD8+ TIL density. CD3+ TIL density maintained a significant association with OS in the multivariable analysis. TIL density was not significantly related to demographic and clinicopathological variables. CD3+ TIL density was independently associated with OS in a non-linear fashion and patients with intermediate CD3+ TIL density had the best outcome. Though based on a preliminary analysis on a relatively small series of patients, this finding makes TIL density a potential independent prognostic factor of ITAC.
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Affiliation(s)
- Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON M5G1L7, Canada
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, 25123 Brescia, Italy
| | - Lara Alessandrini
- Section of Pathology, Department of Medicine, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Enrico Savietto
- Unit of Otolaryngology, Hospital of Treviso AULSS 2-Marca Trevigiana, 31100 Treviso, Italy
| | - Diego Cazzador
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Gloria Schiavo
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON M5G1L7, Canada
- Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology, Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy
| | - Andrea L C Carobbio
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Leonardo Calvanese
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Giacomo Contro
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, 25123 Brescia, Italy
| | - Piergiorgio Gaudioso
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Enzo Emanuelli
- Unit of Otolaryngology, Hospital of Treviso AULSS 2-Marca Trevigiana, 31100 Treviso, Italy
| | - Marta Sbaraglia
- Section of Pathology, Department of Medicine, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Elisabetta Zanoletti
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Gino Marioni
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Angelo P Dei Tos
- Section of Pathology, Department of Medicine, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, 35128 Padua, Italy
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6
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Albano D, Bellini P, Dondi F, Calabrò A, Casella C, Taboni S, Lombardi D, Treglia G, Bertagna F. Temporal Evolution and Prognostic Role of Indeterminate Response Sub-Groups in Patients with Differentiated Thyroid Cancer after Initial Therapy with Radioiodine. Cancers (Basel) 2023; 15:cancers15041270. [PMID: 36831612 PMCID: PMC9954717 DOI: 10.3390/cancers15041270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
The clinical outcome of patients affected by Differentiated Thyroid Carcinoma (DTC) and an indeterminate response (IR) after initial therapy is not yet clear. IR includes three different sub-groups of patients: (1) IRTg+ group: Detectable thyroglobulin (Tg), regardless of antithyroglobulin antibodies (TgAb) presence or imaging studies; (2) IRTgAb+ group: Positive TgAb, regardless of Tg levels and nonspecific imaging findings; (3) IRImaging+ group: Nonspecific findings on neck ultrasonography or faint uptake in the thyroid bed on the whole-body scan, negative TgAb, and undetectable Tg. The main aim of this retrospective study was to investigate the dynamic evolution and prognostic role of these patients. From January 2010 to December 2017, 2176 patients who received radioiodine for DTC after total thyroidectomy were included. Two-hundred-eighty-eight patients had IR one year after therapy (187 TgAb+, 76 Tg+, 25 imaging+). After two years, 110 patients (38%) were reclassified as an excellent response and 5 (2%) as an incomplete response; after five years, 221 (77%) achieved an excellent response and 11 (4%) showed an incomplete response. One-year stimulated Tg and nodal disease at diagnosis may predict the final status of the disease. Progression-free survival was significantly shorter in IRTg+ than in IRTgAb+ and IRimaging+ groups. Considering Tg+ patients, a threshold of 3.3 ng/mL is best to predict prognosis.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia, ASST Spedali Civili Brescia, 25123 Brescia, Italy
- Correspondence: or
| | - Pietro Bellini
- Nuclear Medicine, University of Brescia, ASST Spedali Civili Brescia, 25123 Brescia, Italy
| | - Francesco Dondi
- Nuclear Medicine, University of Brescia, ASST Spedali Civili Brescia, 25123 Brescia, Italy
| | - Anna Calabrò
- Nuclear Medicine, University of Brescia, ASST Spedali Civili Brescia, 25123 Brescia, Italy
| | - Claudio Casella
- Department of Molecular and Translation Medicine, Surgical Clinic, University of Brescia, 25121 Brescia, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, Azienda Ospedale-Università di Padova, 35131 Padova, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Giorgio Treglia
- Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia, ASST Spedali Civili Brescia, 25123 Brescia, Italy
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7
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Mattavelli D, Tomasoni M, Ferrari M, Compagnoni A, Schreiber A, Taboni S, Rampinelli V, Marazzi E, Raffetti E, Redaelli de Zinis LO, Deganello A, Maroldi R, Bossi P, Piazza C, Nicolai P. Salvage surgery in recurrent sinonasal cancers: Proposal for a prognostic model based on clinicopathologic and treatment-related parameters. Head Neck 2022; 44:1857-1870. [PMID: 35652409 PMCID: PMC9539884 DOI: 10.1002/hed.27102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/24/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence on survival and major prognosticators after salvage surgery in recurrent sinonasal cancers (SNC) is limited. METHODS A retrospective, single-center study of recurrent SNC treated with salvage surgery between 1997 and 2019 was conducted. Univariate and multivariable analyses were performed to define a prognostic score for overall survival (OS). RESULTS One hundred and eighteen patients were included. Recurrent SNC originated mostly in the naso-ethmoidal box (67.8%) and were mainly epithelial (76.2%), high-grade (49.2%), and locally advanced (rpT4, 60.1%) malignancies. Negative margins were achieved in 56.6% of cases. Two- and 5-year OS were 71.7% and 56%, respectively. The prognostic model included treatment modality for primary tumor, histology, rpT class, margin status, perineural invasion, and adjuvant radiotherapy and stratified patients into three prognostic groups (5-year OS: 84.4%, 44.9%, and 0%, respectively). CONCLUSIONS Treatment of recurrent SNC can result in good long-term survival estimates with limited morbidity. Our score can provide excellent prognostic stratification.
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Affiliation(s)
- Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck SurgeryASST Spedali Civili of BresciaBresciaItaly,Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Michele Tomasoni
- Unit of Otorhinolaryngology – Head and Neck SurgeryASST Spedali Civili of BresciaBresciaItaly,Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Marco Ferrari
- Section of Otorhinolaryngology – Head and Neck Surgery, Department of NeurosciencesUniversity of Padova – Azienda Ospedale‐Università di PadovaPadovaItaly,Technology for Health (PhD Program), Department of Information EngineeringUniversity of BresciaBresciaItaly,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHNTorontoCanada
| | - Alessandra Compagnoni
- Unit of Otorhinolaryngology – Head and Neck SurgeryASST Spedali Civili of BresciaBresciaItaly,Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Alberto Schreiber
- Unit of Otorhinolaryngology – Head and Neck SurgeryASST Spedali Civili of BresciaBresciaItaly
| | - Stefano Taboni
- Section of Otorhinolaryngology – Head and Neck Surgery, Department of NeurosciencesUniversity of Padova – Azienda Ospedale‐Università di PadovaPadovaItaly
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology – Head and Neck SurgeryASST Spedali Civili of BresciaBresciaItaly,Technology for Health (PhD Program), Department of Information EngineeringUniversity of BresciaBresciaItaly
| | - Elisa Marazzi
- Unit of Otorhinolaryngology – Head and Neck SurgeryASST Spedali Civili of BresciaBresciaItaly,Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Elena Raffetti
- Epidemiology and Public Health Intervention Research Group (EPHIR), Department of Global Public HealthKarolinska InstituteStockholmSweden
| | - Luca Oscar Redaelli de Zinis
- Unit of Otorhinolaryngology – Head and Neck SurgeryASST Spedali Civili of BresciaBresciaItaly,Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Alberto Deganello
- Unit of Otorhinolaryngology – Head and Neck SurgeryASST Spedali Civili of BresciaBresciaItaly,Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck SurgeryASST Spedali Civili of BresciaBresciaItaly,Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Piero Nicolai
- Section of Otorhinolaryngology – Head and Neck Surgery, Department of NeurosciencesUniversity of Padova – Azienda Ospedale‐Università di PadovaPadovaItaly
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8
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Alessandrini L, Ferrari M, Taboni S, Sbaraglia M, Franz L, Saccardo T, Del Forno BM, Agugiaro F, Frigo AC, Dei Tos AP, Marioni G. Tumor-stroma ratio, neoangiogenesis and prognosis in laryngeal carcinoma. A pilot study on preoperative biopsies and matched surgical specimens. Oral Oncol 2022; 132:105982. [PMID: 35759860 DOI: 10.1016/j.oraloncology.2022.105982] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/02/2022] [Accepted: 06/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The interaction between tumor cells and stroma is critical in tumorigenesis, tumor neo-angiogenesis and cancer progression. The aims of this study were to: (i) evaluate the concordance between tumor-stroma ratio (TSR) and microvascular density (MVD) on paired biopsy and surgical specimens of laryngeal carcinoma (LSCC); (ii) investigate the association of TSR with angiogenesis (CD105- and CD31-assessed MVD); (iii) assess the prognostic role of TSR and MVD evaluated on preoperative biopsies and paired surgical specimens. METHODS TSR, CD105- and CD31-assessed MVD were analyzed in paired biopsies and surgical specimens of 43 consecutive cases. RESULTS TSR showed good agreement between biopsies and surgical specimens (AC1 statistic: 0.7957). In biopsies, TSR low/stroma-rich cases showed higher CD105-assessed MVD (p = 0.0380). In surgical specimens both median CD105- and CD31-assessed MVD were significantly higher in TSR low/stroma-rich than in TSR high/stroma-poor patients (p = 0.0089 and p = 0.0391). In the univariate Cox's model, TSR predicted disease-free survival (DFS) in both biopsies and surgical specimens (p = 0.0003 and p = 0.0002). DFS was associated with CD105- and CD31-assessed MVD in biopsies (p < 0.0001 for both) and surgical specimens (p < 0.0001 for both). Considering biopsies, the multivariate analysis found both TSR (p = 0.0032; HR = 6.112, 95%CI: 1.833-20.378) and CD105-assessed MVD (p = 0.0002; HR = 1.201, 95%CI: 1.090-1.322) as DFS predictor. In paired surgical specimens, both TSR (p = 0.0074; HR = 6.137, 95%CI: 1.626-23.172) and CD105-assessed MVD (p = 0.0005; HR = 1.172 95 %CI 1.071-1.282) retained their significance in multivariate analysis. CONCLUSIONS If confirmed by large prospective studies, TSR and MVD could be proposed as prognostic biomarkers of LSCC for a possible treatment intensification or targeted therapy.
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Affiliation(s)
| | - Marco Ferrari
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy; Technology for Health (PhD program), Department of Information Engineering, University of Brescia, Brescia, Italy; University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada
| | - Stefano Taboni
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy; University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marta Sbaraglia
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy; University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada
| | - Tommaso Saccardo
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | | | - Francesca Agugiaro
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy.
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9
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Ferrari M, Mattavelli D, Schreiber A, Gualtieri T, Rampinelli V, Tomasoni M, Taboni S, Ardighieri L, Battocchio S, Bozzola A, Ravanelli M, Maroldi R, Piazza C, Bossi P, Deganello A, Nicolai P. Does Reorganization of Clinicopathological Information Improve Prognostic Stratification and Prediction of Chemoradiosensitivity in Sinonasal Carcinomas? A Retrospective Study on 145 Patients. Front Oncol 2022; 12:799680. [PMID: 35720015 PMCID: PMC9203696 DOI: 10.3389/fonc.2022.799680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background The classification of sinonasal carcinomas (SNCs) is a conundrum. Consequently, prognosis and prediction of response to non-surgical treatment are often unreliable. The availability of prognostic and predictive measures is an unmet need, and the first logical source of information to be investigated is represented by the clinicopathological features of the disease. The hypothesis of the study was that clinicopathological information on SNC could be exploited to better predict prognosis and chemoradiosensitivity. Methods All patients affected by SNC who received curative treatment, including surgery, at the Unit of Otorhinolaryngology—Head and Neck Surgery of the University of Brescia between October 1998 and February 2019 were included in the analysis. The institutional series was reviewed and a survival analysis was performed. Machine learning and multivariable statistical methods were employed to develop, analyze, and test 3 experimental classifications (classification #1, based on cytomorphological, histomorphological, and differentiation information; classification #2, based on differentiation information; and classification #3, based on locoregional extension) of SNC, based on the inherent clinicopathological information. The association of experimental classifications with prognosis and chemoradiosensitivity was tested. Results The study included 145 patients. From a prognostic standpoint, the machine learning-generated classification of SNC provided better prediction than the current World Health Organization classification. However, the prediction of the chemoradiosensitivity of SNC was not achievable. Conclusions Reorganization of clinicopathological information, with special reference to those related to tumor differentiation, can improve the reliability of prognosis of SNC. Prediction of chemoradiosensitivity remains an unmet need and further research is required.
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Affiliation(s)
- Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedale Università di Padova", Padua, Italy.,Technology for Health (PhD program), Department of Information Engineering, University of Brescia, Brescia, Italy.,Guided Therapeutics Program International Scholar, University Health Network, Toronto, Canada
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD program), Department of Information Engineering, University of Brescia, Brescia, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedale Università di Padova", Padua, Italy.,Guided Therapeutics Program International Scholar, University Health Network, Toronto, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Laura Ardighieri
- Unit of Pathology, "ASST Spedali Civili di Brescia", Brescia, Italy
| | | | - Anna Bozzola
- Unit of Pathology, "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedale Università di Padova", Padua, Italy
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10
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Ferrari M, Mattavelli D, Tomasoni M, Raffetti E, Bossi P, Schreiber A, Orlandi E, Taboni S, Rampinelli V, Gualtieri T, Turri-Zanoni M, Battaglia P, Arosio AD, Bignami M, Tartaro T, Molteni M, Bertazzoni G, Fiaux-Camous D, Jourdaine C, Verillaud B, Eu D, Nair D, Moiyadi A, Shetty P, Ghosh-Laskar S, Budrukkar A, Magrini SM, Guillerm S, Faivre S, Piazza C, Gilbert RW, Irish JC, de Almeida JR, Pai P, Herman P, Castelnuovo P, Nicolai P. The MUSES∗: a prognostic study on 1360 patients with sinonasal cancer undergoing endoscopic surgery-based treatment: ∗MUlti-institutional collaborative Study on Endoscopically treated Sinonasal cancers. Eur J Cancer 2022; 171:161-182. [PMID: 35724468 DOI: 10.1016/j.ejca.2022.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Over the last 2 decades, transnasal endoscopic surgery (TES) has become the most frequently employed surgical technique to treat sinonasal malignancies. The rarity and heterogeneity of sinonasal cancers have hampered large non-population-based analyses. METHODOLOGY All patients receiving TES-including treatment between 1995 and 2021 in 5 referral hospitals were included. A prognostic study was performed, and multivariable models were transformed into nomograms. Training and validation sets were based on results from 3 European and 2 non-European centres, respectively. RESULTS The training and validation set included 940 and 420 patients, respectively. The mean age at surgery, primary-versus-recurrent presentation, histology distribution, type of surgery, T category and type of adjuvant treatment were differently distributed in the training and validation set. In the training set, 5-year overall survival and recurrence-free survival with a 95%-confidence interval were 72.7% (69.5-76.0%) and 66.4% (63.1-69.8%), respectively, significantly varying with histology. At multivariable analyses, age, gender, previous treatment, the extent of resection on the cranial, lateral and posterolateral axes, grade/subtype, T category, nodal status, margin status and adjuvant treatment were all associated with different prognostic outcomes, displaying a heterogeneous significance and effect size according to histology. The internal and external validation of nomograms was satisfactory (optimism-corrected C-index >0.7 and cumulative area under curve >0.7) for all histologies but mucosal melanoma. CONCLUSIONS Outcomes of TES-based treatment of sinonasal cancers vary substantially with histology. This large, non-population-based study provides benchmark data on the prognosis of sinonasal cancers that are deemed suitable for treatment including TES.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; 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 Battaglia
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; 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
| | - Alberto D Arosio
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, "ASST Lariana", University of Insubria, Como, Italy
| | - Tiziana Tartaro
- Department of Medical Oncology, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Marinella Molteni
- Department of Radiotherapy, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | | | | | - Clement Jourdaine
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Benjamin Verillaud
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Donovan Eu
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Deepa Nair
- Department of Head & Neck Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Aliasgar Moiyadi
- Department of Neurosurgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Prakash Shetty
- Department of Neurosurgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Stefano M Magrini
- Unit of Radiation Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Sophie Guillerm
- Department of Radiotherapy Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Sandrine Faivre
- Department of Medical Oncology Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Prathamesh Pai
- Department of Head & Neck Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Philippe Herman
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; 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
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
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11
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Ferrari M, Zanoletti E, Taboni S, Cazzador D, Tealdo G, Schreiber A, Mattavelli D, Rampinelli V, Doglietto F, Fontanella MM, Buffoli B, Vural A, Verzeletti V, Carobbio ALC, Mardighian D, Causin F, Orlandi E, Cenzato M, Rezzani R, Nicolai P. Resection of the internal carotid artery in selected patients affected by cancer of the skull base. Head Neck 2021; 44:1030-1042. [PMID: 34939715 DOI: 10.1002/hed.26967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/09/2021] [Accepted: 12/10/2021] [Indexed: 11/05/2022] Open
Abstract
Invasion of the internal carotid artery (ICA) has been historically considered a criterion of non-resectability of skull base cancer (SBC). Patients affected by SBC who underwent surgery including resection of ICA at two tertiary institutions were included. Demographics, oncologic, and surgical information, complications, and survival outcomes were retrospectively reviewed. Survival outcomes were calculated. Ten patients were included. Three surgical approaches (transnasal endoscopic, transorbital, and transpetrosal) were employed to resect the invaded/abutted tract(s) of the ICA. All patients underwent ICA temporary balloon occlusion test. In two patients, an extracranial-to-intracranial arterial bypass was harvested. Major neuromorbidity was observed in two patients. Perioperative mortality of the series was 10.0%. Mean overall survival was 27.2 months, with 2-year overall and progression-free survival rate of 88.9%. ICA resection is feasible as part of the ablation performed for very advanced SBCs. Survival outcomes are acceptable in adequately selected patients.
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Affiliation(s)
- Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada.,Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Elisabetta Zanoletti
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Diego Cazzador
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Giulia Tealdo
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.,Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Marco Maria Fontanella
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alperen Vural
- Department of Otorhinolaryngology, Erciyes University - Faculty of Medicine, Kayseri, Turkey
| | - Vincenzo Verzeletti
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Andrea Luigi Camillo Carobbio
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Dikran Mardighian
- Neuroradiology Unit, "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Francesco Causin
- Section of Neuroradiology, Department of Diagnostic Imaging and Interventional Radiology, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy ("Fondazione CNAO"), Pavia, Italy
| | - Marco Cenzato
- Neurosurgery Unit, Department of Neuroscience, "ASST Grande Ospedale Metropolitano Niguarda", Milan, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
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12
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Ferrari M, Taboni S, Carobbio ALC, Buffoli B, Rampinelli V, Mattavelli D, Schreiber A, Verzeletti V, Ravanelli M, Daly MJ, Chan HHL, Sahovaler A, Franz L, Gualtieri T, Rezzani R, Maroldi R, Signoroni A, Deganello A, Irish JC, Nicolai P. Development of a cadaveric head and neck cancer model and three-dimensional analysis of margins in surgical navigation-aided ablations. Eur J Surg Oncol 2021; 48:1235-1242. [PMID: 34916084 DOI: 10.1016/j.ejso.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The adequacy of the surgical resection is the main controllable variable that is in the hands of the surgical team. There exists an unmet need to increase the rate of negative margins, particularly in cancers invading the craniofacial area. The study aimed 1) at developing a gross tumor model to be utilized for research, educational, and training purposes and 2) establishing the 3-dimensional relationship between the outer surface of the surgical specimen and tumor surface and test the effect of guiding ablations on cadavers with surgical navigation (SN). MATERIAL AND METHODS Seven cadaver heads were employed to create 24 craniofacial tumor models. Simulation of tumor resections was performed by 8 surgeons. Fourteen and 10 resections were performed with and without SN-guidance, respectively. Gross specimens underwent computed tomography and 3-dimensional analysis through dedicated software. Task load was assessed through a validated questionnaire. Tumor model reliability was studied based on visual analogue scale rate by surgeons and radiologists. RESULTS SN reduced the rate of margin involvement, particularly by decreasing the percentage of the gross specimen outer surface involvement in areas uncovered by normal bony structures. The workload of SN-aided ablations was found to be medium-to-somewhat-high. Tumor model reliability was deemed satisfactory except for the extension to bony structures. CONCLUSIONS A gross tumor model for head and neck cancers involving the craniofacial area was developed and resulted satisfactorily reliable from both a surgical and radiologic standpoint. SN reduced the rate of margin involvement, particularly by improving delineation of bone-uncovered areas.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea L C Carobbio
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Vincenzo Verzeletti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Head & Neck Surgery, University College London Hospitals, London, United Kingdom
| | - Leonardo Franz
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Tommaso Gualtieri
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Signoroni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Jonathan C Irish
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
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13
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Taboni S, Ferrari M, Daly MJ, Chan HHL, Eu D, Gualtieri T, Jethwa AR, Sahovaler A, Sewell A, Hasan W, Berania I, Qiu J, de Almeida J, Nicolai P, Gilbert RW, Irish JC. Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study. Front Oncol 2021; 11:747227. [PMID: 34858824 PMCID: PMC8632239 DOI: 10.3389/fonc.2021.747227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background The resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical navigation with virtual endoscopy (3D-SNVE) may represent a step forward. This study aimed to demonstrate and quantify the benefits of this technology. Material and Method Four maxillary tumor models with critical posterior extension were created in four artificial skulls (Sawbones®). Images were acquired with cone-beam computed tomography and the tumor and carotid were contoured. Eight head and neck surgeons were recruited for the simulations. Surgeons delineated the posterior margin of resection through a transnasal approach and avoided the carotid while establishing an adequate resection margin with respect to tumor extirpation. Three simulations were performed: 1) unguided: based on a pre-simulation study of cross-sectional imaging; 2) tumor-guided: guided by real-time tool tracking with 3D tumor and carotid rendering; 3) carotid-guided: tumor-guided with a 2-mm alert cloud surrounding the carotid. Distances of the planes from the carotid and tumor were classified as follows and the points of the plane were classified accordingly: “red”: through the carotid artery; “orange”: <2 mm from the carotid; “yellow”: >2 mm from the carotid and within the tumor or <5 mm from the tumor; “green”: >2 mm from the carotid and 5–10 mm from the tumor; and “blue”: >2 mm from the carotid and >10 mm from the tumor. The three techniques (unguided, tumor-guided, and carotid-guided) were compared. Results 3D-SNVE for the transnasal delineation of the posterior margin in maxillary tumor models significantly improved the rate of margin-negative clearance around the tumor and reduced damage to the carotid artery. “Green” cuts occurred in 52.4% in the unguided setting versus 62.1% and 64.9% in the tumor- and carotid-guided settings, respectively (p < 0.0001). “Red” cuts occurred 6.7% of the time in the unguided setting versus 0.9% and 1.0% in the tumor- and carotid-guided settings, respectively (p < 0.0001). Conclusions This preclinical study has demonstrated that 3D-SNVE provides a substantial improvement of the posterior margin delineation in terms of safety and oncological adequacy. Translation into the clinical setting, with a meticulous assessment of the oncological outcomes, will be the proposed next step.
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Affiliation(s)
- Stefano Taboni
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, Toronto, ON, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, Toronto, ON, Canada.,Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Donovan Eu
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Tommaso Gualtieri
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Head & Neck Surgery, University College London Hospital, London, United Kingdom
| | - Andrew Sewell
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wael Hasan
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Ilyes Berania
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
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14
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Sahovaler A, Chan HHL, Gualtieri T, Daly M, Ferrari M, Vannelli C, Eu D, Manojlovic-Kolarski M, Orzell S, Taboni S, de Almeida JR, Goldstein DP, Deganello A, Nicolai P, Gilbert RW, Irish JC. Augmented Reality and Intraoperative Navigation in Sinonasal Malignancies: A Preclinical Study. Front Oncol 2021; 11:723509. [PMID: 34790568 PMCID: PMC8591179 DOI: 10.3389/fonc.2021.723509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To report the first use of a novel projected augmented reality (AR) system in open sinonasal tumor resections in preclinical models and to compare the AR approach with an advanced intraoperative navigation (IN) system. Methods Four tumor models were created. Five head and neck surgeons participated in the study performing virtual osteotomies. Unguided, AR, IN, and AR + IN simulations were performed. Statistical comparisons between approaches were obtained. Intratumoral cut rate was the main outcome. The groups were also compared in terms of percentage of intratumoral, close, adequate, and excessive distances from the tumor. Information on a wearable gaze tracker headset and NASA Task Load Index questionnaire results were analyzed as well. Results A total of 335 cuts were simulated. Intratumoral cuts were observed in 20.7%, 9.4%, 1.2,% and 0% of the unguided, AR, IN, and AR + IN simulations, respectively (p < 0.0001). The AR was superior than the unguided approach in univariate and multivariate models. The percentage of time looking at the screen during the procedures was 55.5% for the unguided approaches and 0%, 78.5%, and 61.8% in AR, IN, and AR + IN, respectively (p < 0.001). The combined approach significantly reduced the screen time compared with the IN procedure alone. Conclusion We reported the use of a novel AR system for oncological resections in open sinonasal approaches, with improved margin delineation compared with unguided techniques. AR improved the gaze-toggling drawback of IN. Further refinements of the AR system are needed before translating our experience to clinical practice.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Tommaso Gualtieri
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy
| | - Michael Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Marco Ferrari
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy.,Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - Claire Vannelli
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Donovan Eu
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Mirko Manojlovic-Kolarski
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Susannah Orzell
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Stefano Taboni
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy.,Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
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15
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Zappa F, Madoglio A, Ferrari M, Mattavelli D, Schreiber A, Taboni S, Ferrari E, Rampinelli V, Belotti F, Piazza C, Fontanella MM, Nicolai P, Doglietto F. Hybrid Robotics for Endoscopic Transnasal Skull Base Surgery: Single-Centre Case Series. Oper Neurosurg (Hagerstown) 2021; 21:426-435. [PMID: 34624091 DOI: 10.1093/ons/opab327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Only preclinical studies and case reports have described robotic surgery for endoscopic transnasal skull base surgery. OBJECTIVE To evaluate the role of a novel robotic endoscope holder, developed for transsphenoidal surgery. METHODS Patients were prospectively enrolled for 3 mo at the Neurosurgery Unit of Brescia. Endoscope Robot® was used to assist during the sphenoidal phase of the approach, tumor removal, and skull base reconstruction. A Likert scale questionnaire was given to all surgeons after each procedure. Patients who underwent robotic-assisted surgery were matched with nonrobotic ones for pathology and type of procedure. All surgical videos were evaluated during bimanual phases. RESULTS Twenty-one patients underwent robot-assisted, endoscopic transsphenoidal surgery for different pathologies (16 pituitary adenomas, 3 chordomas, 1 craniopharyngioma, 1 pituitary exploration for Cushing disease) for a total of 23 procedures (1 patient underwent 2 endoscopic revisions of a skull base reconstruction). Subjective advantages reported by surgeons included smoothness of movement, image steadiness, and improvement of maneuvers in narrow spaces and with angled endoscopes; as the main limitation, Endoscope Robot® appeared to be relatively heavy during the initial endoscope positioning. A comparative analysis with a historical matched cohort documented similar clinical outcomes, while endoscope lens cleaning and position readjustments were significantly less frequent in robotic procedures. CONCLUSION Although confirmation in larger studies is needed, Endoscope Robot® was a safe and effective tool, especially advantageous in lengthy interventions through deep and narrow corridors.
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Affiliation(s)
- Francesca Zappa
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alba Madoglio
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Davide Mattavelli
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Erika Ferrari
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Belotti
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Francesco Doglietto
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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16
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Mattavelli D, Fiorentino A, Tengattini F, Colpani A, Agnelli S, Buffoli B, Ravanelli M, Ferrari M, Schreiber A, Rampinelli V, Taboni S, Verzeletti V, Deganello A, Rodella LF, Maroldi R, Ceretti E, Sartore L, Piazza C, Fontanella MM, Nicolai P, Doglietto F. Additive Manufacturing for Personalized Skull Base Reconstruction in Endoscopic Transclival Surgery: A Proof-of-Concept Study. World Neurosurg 2021; 155:e439-e452. [PMID: 34450324 DOI: 10.1016/j.wneu.2021.08.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endoscopic transnasal transclival intradural surgery is limited by a high postoperative cerebrospinal fluid leak rate. The aim of this study was to investigate the role of three-dimensional printing to create a personalized, rigid scaffold for clival reconstruction. METHODS Two different types of clivectomy were performed in 5 specimens with the aid of neuronavigation, and 11 clival reconstructions were simulated. They were repaired with polylactide, three-dimensional-printed scaffolds that were manually designed in a computer-aided environment based either on the real or on the predicted defect. Scaffolds were printed with a fused filament fabrication technique and different offsets. They were positioned and fixed either following the gasket seal technique or with screws. Postdissection radiological evaluation of scaffold position was performed in all cases. In 3 specimens, the cerebrospinal fluid leak pressure point was measured immediately after reconstruction. RESULTS The production process took approximately 30 hours. The designed scaffolds were satisfactory when no offset was added. Wings were added during the design to allow for screw positioning, but broke in 30% of cases. Radiological assessment documented maximal accuracy of scaffold positioning when the scaffold was created on the real defect; accuracy was satisfactory when the predicted clivectomy was performed under neuronavigation guidance. The cerebrospinal fluid leak pressure point was significantly higher when the scaffold was fixed with screws compared with the gasket technique. CONCLUSIONS In this preclinical setting, additive manufacturing allows the creation of customized scaffolds that are effective in reconstructing even large and geometrically complex clival defects.
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Affiliation(s)
- Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Fiorentino
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Francesco Tengattini
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Colpani
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Silvia Agnelli
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Vincenzo Verzeletti
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Elisabetta Ceretti
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Luciana Sartore
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco M Fontanella
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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17
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Ferrari M, Cazzador D, Taboni S, Trimarchi MV, Emanuelli E, Nicolai P. When is a multidisciplinary surgical approach required in sinonasal tumours with cranial involvement? ACTA ACUST UNITED AC 2021; 41:S3-S17. [PMID: 34060516 PMCID: PMC8172110 DOI: 10.14639/0392-100x-suppl.1-41-2021-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
The term “sinonasal tumours” includes a large spectrum of diseases, which are characterized by heterogeneous biological behavior and prognosis, and located in a critical anatomic area. Diagnosis and treatment of sinonasal tumours require the contribution of different disciplines. A narrative review was performed to highlight the role of surgeons in contributing to a multidisciplinary approach to sinonasal tumours. Diagnosis and staging of sinonasal tumours is challenging and requires collaboration between surgeons, radiologists, and pathologists. The identification and management of critical extensions (orbital or intracranial encroachment, vascular abutment or encasement) is fundamental for successful treatment. Most cases of advanced sinonasal tumours can undergo surgical intervention by an adequately trained otorhinolaryngological team. The contribution of neurosurgeons and oculoplastic surgeons is required in selected scenarios. In rare circumstances, multidisciplinary reconstructive strategies can be indicated for complex tissue defects. Furthermore, a multidisciplinary approach is pivotal in the management of perioperative complications. While surgery remains the mainstay of treatment, the role of non-surgical adjuvant or even exclusive treatments is constantly expanding.
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Affiliation(s)
- Marco Ferrari
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy.,Technology for Health (PhD program), Department of Information Engineering, University of Brescia, Brescia, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada
| | - Diego Cazzador
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Vittoria Trimarchi
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Enzo Emanuelli
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
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18
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Vural A, Carobbio ALC, Ferrari M, Rampinelli V, Schreiber A, Mattavelli D, Doglietto F, Buffoli B, Rodella LF, Taboni S, Tomasoni M, Gualtieri T, Deganello A, Hirtler L, Nicolai P. Correction to: Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description. Neurosurg Rev 2021; 44:2943. [PMID: 34390442 DOI: 10.1007/s10143-021-01529-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alperen Vural
- Department of Otorhinolaryngology, Erciyes University Faculty of Medicine, 38039, Kayseri, Turkey. .,Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Andrea Luigi Camillo Carobbio
- Department of Otorhinolaryngology, Erciyes University Faculty of Medicine, 38039, Kayseri, Turkey.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
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19
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Vural A, Carobbio ALC, Ferrari M, Rampinelli V, Schreiber A, Mattavelli D, Doglietto F, Buffoli B, Rodella LF, Taboni S, Tomasoni M, Gualtieri T, Deganello A, Hirtler L, Nicolai P. Response to Letter to the Editor: Nuancing the role of transorbital endoscopic approaches in skull base surgery. Neurosurg Rev 2021; 45:913-914. [PMID: 34309749 DOI: 10.1007/s10143-021-01610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Alperen Vural
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Erciyes University, Erciyes Universitesi, KBB Klinigi, 38039, Kayseri, Turkey. .,Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Andrea Luigi Camillo Carobbio
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Erciyes University, Erciyes Universitesi, KBB Klinigi, 38039, Kayseri, Turkey.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
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20
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Gualtieri T, Ferrari M, Taboni S, Chan H, Townson J, Mattavelli D, Sahovaler A, Eu D, Dey K, Mathews S, Re F, Bernardi S, Borsani E, Viswanathan S, Nicolai P, Sartore L, Russo D, Gilbert R, Irish J. 3D-mapping of mesenchymal stem cells growth on bioengineered scaffolds for maxillofacial skeleton regeneration: a preclinical, in vitro study. Cytotherapy 2021. [DOI: 10.1016/s146532492100517x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Sahovaler A, Chan HHL, Ferrari M, Gualtieri T, Zhang C, Taboni S, Irish JC, Gilbert RW. Objective evaluation of orbito-zygomatic reconstruction with scapular tip free flaps to restore facial projection and orbital volume. Oral Oncol 2021; 117:105268. [PMID: 33848724 DOI: 10.1016/j.oraloncology.2021.105268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/13/2021] [Accepted: 03/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Restoring anatomical contour and position of the malar eminence and orbital rim following ablative mid-face procedures is critical in maintaining facial contour and orbit position. OBJECTIVE To report our reconstructive approach using the scapular tip free-flap (STFF) for orbito-zygomatic defects, evaluating contour and overall shape restoration. METHODS The study included 2 series: a clinical cohort of 15 consecutive patients who underwent an orbito-zygomatic reconstruction with a STFF and a cohort of 10 patients who had CT scan imaging but did not have orbito-zygomatic surgical resection or reconstruction. Using a 3D software, overall conformance (OC) and contour conformance (CC) with respect to the mirrored contralateral (clinical cohort) or native zygoma (preclinical cohort) were analyzed. Postoperative orbital volumes were also measured in the clinical cohort. Mean, median, root-mean-square (RMS), minimum and maximum measurements were obtained both for OC and CC. Conformance values of clinical and preclinical cohort were compared to objectively evaluate the quality of reconstruction in terms of orbito-zygomatic framework restoration (Mann-Whitney test). RESULTS All measurements for OC and CC between scapular tip and the zygoma showed no differences, both on the clinical (RMS: OC 3.29 mm vs CC 3.32 mm -p = NS-) and preclinical (RMS: OC 2.03 mm and CC 2.31 mm -p = NS-) cohorts. Moreover, there were no differences in post-operative orbital volumes in the clinical cohort. Clinical outcomes of the case-series are also reported. CONCLUSION The STFF is highly effective in restoring facial projection and orbital volume in orbito-zygomatic reconstruction.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Marco Ferrari
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - ASST "Spedali Civili di Brescia", Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, University of Padua - Azienda Ospedaliera di Padova, Padua, Italy
| | - Tommaso Gualtieri
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - ASST "Spedali Civili di Brescia", Brescia, Italy
| | - Charlotte Zhang
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Stefano Taboni
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - ASST "Spedali Civili di Brescia", Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, University of Padua - Azienda Ospedaliera di Padova, Padua, Italy
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada.
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22
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Missale F, Taboni S, Carobbio ALC, Mazzola F, Berretti G, Iandelli A, Fragale M, Mora F, Paderno A, Del Bon F, Parrinello G, Deganello A, Piazza C, Peretti G. Validation of the European Laryngological Society classification of glottic vascular changes as seen by narrow band imaging in the optical biopsy setting. Eur Arch Otorhinolaryngol 2021; 278:2397-2409. [PMID: 33710441 PMCID: PMC8165057 DOI: 10.1007/s00405-021-06723-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Purpose In 2016, the European Laryngological Society (ELS) proposed a classification for vascular changes occurring in glottic lesions as visible by narrow band imaging (NBI), based on the dichotomic distinction between longitudinal vessels (not suspicious) and perpendicular ones (suspicious). The aim of our study was to validate this classification assessing the interobserver agreement and diagnostic test performance in detecting the final histopathology. Methods A retrospective study was carried out by reviewing clinical charts, preoperative videos, and final pathologic diagnosis of patients submitted to transoral microsurgery for laryngeal lesions in two Italian referral centers. In each institution, two physicians, independently re-assessed each case applying the ELS classification. Results The cohort was composed of 707 patients. The pathologic report showed benign lesions in 208 (29.5%) cases, papillomatosis in 34 (4.8%), squamous intraepithelial neoplasia (SIN) up to carcinoma in situ in 200 (28.2%), and squamous cell carcinoma (SCC) in 265 (37.5%). The interobserver agreement was extremely high in both institutions (k = 0.954, p < 0.001 and k = 0.880, p < 0.001). Considering the diagnostic performance for identification of at least SIN or SCC, the sensitivity was 0.804 and 0.902, the specificity 0.793 and 0.581, the positive predictive value 0.882 and 0.564, and the negative predictive value 0.678 and 0.908, respectively. Conclusion The ELS classification for NBI vascular changes of glottic lesions is a highly reliable tool whose systematic use allows a better diagnostic evaluation of suspicious laryngeal lesions, reliably distinguishing benign ones from those with a diagnosis of papillomatosis, SIN or SCC, thus paving the way towards confirmation of the optical biopsy concept.
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Affiliation(s)
- Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology, Head and Neck Surgery, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Luigi Camillo Carobbio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy. .,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
| | - Francesco Mazzola
- Department of Otolaryngology, Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Berretti
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Andrea Iandelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Francesco Mora
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | - Alberto Deganello
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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23
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Ferrari M, Migliorati S, Tomasoni M, Crisafulli V, Nocivelli G, Paderno A, Rampinelli V, Taboni S, Schreiber A, Mattavelli D, Lancini D, Gualtieri T, Ravanelli M, Facchetti M, Bozzola A, Ardighieri L, Maroldi R, Bossi P, Farina D, Battocchio S, Deganello A, Nicolai P. Sinonasal cancer encroaching the orbit: Ablation or preservation? Oral Oncol 2021; 114:105185. [PMID: 33517131 DOI: 10.1016/j.oraloncology.2021.105185] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/10/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Encroachment on the orbital cavity represents a challenge in the management of sinonasal cancer. Criteria guiding orbital preservation lack univocal consensus. Stage of orbital involvement is best assessed through magnetic resonance imaging (MRI). METHODS Patients affected by orbit-encroaching sinonasal cancer with available preoperative MRI, receiving surgery-based treatment at the University of Brescia between May 2005 and October 2018 were included. All cases were reviewed by expert radiologists and pathologists. Diagnostic performance of MRI was calculated using pathological information as reference. Survival analysis was performed. RESULTS The study included 123 patients. The orbit was abutted in 53 (43.1%) patients, whereas orbital invasion reached the periorbit in 18 (14.6%), extraconal fat and/or medial lacrimal sac in 29 (23.6%), extrinsic ocular muscles in 7 (5.7%), intraconal compartment in 4 (3.3%), and orbital apex in 12 (9.8%). Seventy-six (61.8%) patients received orbit-sparing surgery, 47 (38.2%) underwent orbital ablation (OA). Accuracy of MRI in detecting involvement by cancer was ≥80.0% for the orbital wall, extraconal fat, and muscles, and <80.0% for the periorbit and intraconal compartment. Previous surgery, neoadjuvant chemotherapy, and perineural invasion decreased MRI accuracy. Age, histology, tumor grade, pT category, N status, perineural invasion, orbital invasion stage, and need for OA were found to affect prognosis. Five-year orbital dysfunction-free survival was 92.8%. CONCLUSION Conservative management of sinonasal cancers encroaching the orbit is feasible. MRI is essential to preoperatively stage orbital invasion, yet with some limitation. Given the dismal prognosis despite aggressive surgery, neoadjuvant non-surgical therapies should be considered in patients requiring OA.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.
| | - Sara Migliorati
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Valentina Crisafulli
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Giorgio Nocivelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Mattia Facchetti
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Anna Bozzola
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Laura Ardighieri
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Davide Farina
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Simonetta Battocchio
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
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Gualtieri T, Verzeletti V, Ferrari M, Perotti P, Morello R, Taboni S, Palumbo G, Ravanelli M, Rampinelli V, Mattavelli D, Paderno A, Buffoli B, Rodella LF, Nicolai P, Deganello A. A new landmark for lingual artery identification during transoral surgery: Anatomic-radiologic study. Head Neck 2021; 43:1487-1498. [PMID: 33496052 DOI: 10.1002/hed.26606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 12/02/2020] [Accepted: 12/30/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A landmark for the identification of the lingual artery (LA) through a transoral perspective can provide surgeons with an easy method to prevent and manage intraoperative bleeding during transoral approach to the base of tongue (BOT). METHODS Thirteen tongue and five head and neck specimens were dissected to identify and assess the reliability of the lingual point (LP) as a new landmark for the LA at BOT. The pathway of 42 LAs was radiologically evaluated; axial depth and vertical offset were measured for each LA. RESULTS Dissection study: a description of LP is provided; the LA was easily identified in all specimens (36/36 sides) using LP as a landmark. Radiologic study: the mean depth of the LA was 4.2 mm, the mean vertical offset was 1.3 mm. CONCLUSIONS LP is a simple and reliable landmark for identification of the LA, potentially helping surgeons to prevent and manage intraoperative bleeding.
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Affiliation(s)
- Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vincenzo Verzeletti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology - Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Riccardo Morello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, ASST Cremona - Ospedale di Cremona, Cremona, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Giovanni Palumbo
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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25
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Mattavelli D, Ferrari M, Taboni S, Morello R, Paderno A, Rampinelli V, Del Bon F, Lombardi D, Grammatica A, Bossi P, Deganello A, Piazza C, Nicolai P. The 8th TNM classification for oral squamous cell carcinoma: What is gained, what is lost, and what is missing. Oral Oncol 2020; 111:104937. [DOI: 10.1016/j.oraloncology.2020.104937] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/08/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
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26
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Taboni S, Paderno A, Giordano D, Albano D, Piana S, Zanetti E, Bertagna F, Grammatica A, Ghidini A, Cappelli C, Bozzola A, Baronchelli C, Nicolai P, Lombardi D. Differentiated Thyroid Cancer: The Role of ATA Nodal Risk Factors in N1b Patients. Laryngoscope 2020; 131:E1029-E1034. [PMID: 33319385 DOI: 10.1002/lary.29057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/12/2020] [Accepted: 08/08/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nodal involvement is frequent in patients with differentiated thyroid cancers (DTCs), but its prognostic relevance is not univocal. Some characteristics of nodal metastases can increase the risk of recurrence. We attempted to quantify the impact on survival of nodal factors included in the American Thyroid Association (ATA) risk stratification system in N1b patients with DTC. STUDY DESIGN Retrospective study. METHODS A retrospective analysis of patients affected by DTC who underwent therapeutic lateral neck dissection (ND) was performed. The impact on the prognosis of the number of positive lymph nodes (LNs), dimension of nodal metastasis, and microscopic and macroscopic extranodal extension (miENE and maENE, respectively) was investigated. RESULTS The study included 347 N1b patients who underwent 401 therapeutic lateral NDs. Mean number of positive LNs was nine, mean nodal ratio was 0.27, and mean diameter of metastasis was 15.5 mm. ENE was detected in 25.9% of patients (22.5% miENE and 3.5% maENE). In univariate analysis, the presence of maENE had an impact on disease specific survival (DSS) (P = .023); increasing number of positive LNs affected DSS and locoregional control (LRC) (P = .009 and =.006, respectively); increasing metastatic node dimension was a risk factors for overall survival, DSS, and metastases free survival (MFS) (P = .05, =.013 and =.016). In multivariate analysis, number of positive LNs and LN dimension were independent risk factors for LRC and MFS, respectively (HR 1.1, P = .028; HR 1.1, P = .026). CONCLUSIONS In our analysis on a cohort of N1b patients, the number of positive LNs and LN dimension were confirmed as independent risk factors for locoregional and distant recurrence, respectively. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1029-E1034, 2021.
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Affiliation(s)
- Stefano Taboni
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Giordano
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Eleonora Zanetti
- Pathology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | | | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Angelo Ghidini
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Cappelli
- Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Anna Bozzola
- Department of Pathology, University of Brescia, Brescia, Italy
| | | | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
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27
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Lombardi D, Ferrari M, Paderno A, Taboni S, Rampinelli V, Barbara F, Schreiber A, Mattavelli D, Tomasoni M, Farina D, Ravanelli M, Maroldi R, Nicolai P. Selection of the surgical approach for lesions with parapharyngeal space involvement: A single-center experience on 153 cases. Oral Oncol 2020; 109:104872. [PMID: 32659725 DOI: 10.1016/j.oraloncology.2020.104872] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The parapharyngeal space (PPS) can harbor a variety of tumors that can be approached through a wide spectrum of surgical routes. A decisional algorithm on the surgical approach to resect PPS lesions was tested in terms of reliability by retrospectively applying it to a large series of patients. METHODS Patients treated at the Unit of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy, for tumor or tumor-like lesions involving the PPS between October 1986 and July 2019 were included in the retrospective analysis. Tumor characteristics, clinical presentation, diagnostic work-up, type of resection, surgical approach, and oncologic and morbidity outcomes were reviewed. Reliability of the algorithm was calculated as the number of cases in which the expected approach was confirmed/total number of cases × 100. RESULTS The analysis included 153 patients. Most lesions (64.1%) were benign. The most frequent complaint at presentation was unilateral oropharyngeal medialization (47.1%), followed by neck/parotid swelling (41.2%). Ninety-two (61.3%) lesions were excised through an enucleation/extracapsular dissection. Wide-margin resection and compartmental resection were performed in 17 (11.3%) and 41 (27.3%) patients, respectively. A single-corridor approach was employed in 132 (87.4%) cases. Combinations of multiple corridors were adopted in 19 (12.6%) patients. Reliability of the decision-making algorithm was 91.2%. Capsular integrity and margin status affected prognosis of pleomorphic adenomas and PPS malignancies, respectively. CONCLUSION The proposed decision-making algorithm can reliably guide approach selection, which should primarily aim at ensuring intact-capsule excision of benign lesions suspicious for pleomorphic adenomas and clear-margins resection of PPS malignancies.
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Affiliation(s)
- Davide Lombardi
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Barbara
- Unit of Otolaryngology and Head and Neck, P.O. "Mons. R. Dimiccoli", Barletta, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Farina
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
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Paderno A, Mattavelli D, Rampinelli V, Grammatica A, Raffetti E, Tomasoni M, Gualtieri T, Taboni S, Zorzi S, Del Bon F, Lombardi D, Deganello A, Redaelli De Zinis LO, Schreiber A. Olfactory and Gustatory Outcomes in COVID-19: A Prospective Evaluation in Nonhospitalized Subjects. Otolaryngol Head Neck Surg 2020; 163:1144-1149. [PMID: 32600175 PMCID: PMC7331108 DOI: 10.1177/0194599820939538] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To prospectively assess the rate and timing of recovery of olfactory (OD) and gustatory (GD) dysfunction in patients affected by COVID-19. STUDY DESIGN Cohort study. SETTING Population-based evaluation in a COVID-19 high-prevalence region. SUBJECTS AND METHODS We analyzed the clinical course of OD and GD in a cohort of home-quarantined SARS-CoV-2-positive patients from Northern Italy. Physicians administered a survey-based questionnaire at recruitment (T0). During follow-up, patients responded to online dedicated surveys modulated according to symptoms at T0. RESULTS A total of 151 patients completed the follow-up survey. OD and/or GD were observed in 83% and 89% of subjects, respectively. Resolution rates of OD and GD at 30 days from onset were 87% and 82%, respectively. Risk factors for late resolution were grade of dysfunction at onset (total vs partial), gender, and presence of nasal congestion. Three (2%) patients previously reporting complete resolution of symptoms complained of subsequent recurrence of OD and/or GD after a mean of 19 days from resolution of the previous episode. CONCLUSION COVID-19-related OD and GD had high rate of resolution in the first month from onset of symptoms. However, in 10% to 15% of patients, these symptoms showed only partial improvement after this period.
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Affiliation(s)
- Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Epidemiology and Public Health Intervention Research group (EPHIR), Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Silvia Zorzi
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Luca Oscar Redaelli De Zinis
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health; University of Brescia, Brescia, Italy
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Paderno A, Schreiber A, Grammatica A, Raffetti E, Tomasoni M, Gualtieri T, Taboni S, Zorzi S, Lombardi D, Deganello A, Redaelli De Zinis LO, Maroldi R, Mattavelli D. Smell and taste alterations in COVID-19: a cross-sectional analysis of different cohorts. Int Forum Allergy Rhinol 2020; 10:955-962. [PMID: 32410386 PMCID: PMC7272886 DOI: 10.1002/alr.22610] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Olfactory (OD) and gustatory (GD) dysfunction have been proven to be a typical symptom of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. However, their prevalence in different patient populations still needs to be clarified. METHODS A cross-sectional study was performed from March 27 to April 1, 2020, in Northern Italy. Physicians administered a survey-based questionnaire to SARS-CoV-2-positive patients with the aim of assessing symptoms, focusing on OD and GD. Two groups were studied: group A, patients hospitalized at Azianda Socio Sanitaria Territoriale (ASST) Spedali Civili University Hospital of Brescia; and group B, home-quarantined subjects. RESULTS A total of 508 patients were enrolled: 295 in group A and 213 in group B. Mean age ± standard deviation (SD) was 55 ± 15 years; 56% were men. Overall, OD and GD were present in 56% (95% confidence interval [CI], 51% to 60%) and 63% (95% CI, 59% to 67%) of cases, respectively. In group A, the prevalence of OD and GD was 44% (95% CI, 38% to 50%) and 52% (95% CI, 46% to 58%), respectively. In group B, the prevalence of OD and GD was 72% (95% CI, 65% to 79%) and 79% (95% CI, 73% to 84%), respectively. In the entire cohort, total loss of olfaction and taste was reported in 64% and 60% of cases, respectively. OD and GD occurred as the first symptom in 10% and 11% of cases, respectively; in the remaining cases, they occurred after a mean of 4 ± 3 days following the first symptom. At the time of the questionnaire, complete resolution of OD and GD was reported in 52% and 55% of cases, respectively (mean duration, 9 ± 5 days in both). CONCLUSION OD and GD are more prevalent in home-quarantined subjects, and they are independently associated with younger age and female gender.
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Affiliation(s)
- Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Epidemiology and Public Health Intervention Research Group (EPHIR), Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Silvia Zorzi
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luca Oscar Redaelli De Zinis
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Azianda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Azianda Socio Sanitaria Territoriale (ASST), Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
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Rampinelli V, Mattavelli D, Gualtieri T, Paderno A, Taboni S, Berretti G, Deganello A. Reshaping head and neck reconstruction policy during the COVID-19 pandemic peak: Experience in a front-line institution. Auris Nasus Larynx 2020; 47:489-491. [PMID: 32362453 PMCID: PMC7177088 DOI: 10.1016/j.anl.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25121 Brescia, Italy.
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
| | - Giulia Berretti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
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Ferrari M, Daly MJ, Douglas CM, Chan HHL, Qiu J, Deganello A, Taboni S, Thomas CM, Sahovaler A, Jethwa AR, Hasan W, Nicolai P, Gilbert RW, Irish JC. Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study. Oral Oncol 2019; 99:104463. [PMID: 31683173 DOI: 10.1016/j.oraloncology.2019.104463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. MATERIALS AND METHODS Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. RESULTS The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). CONCLUSION This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting - with rigorous assessment of oncological outcomes - would be the proposed next step.
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Affiliation(s)
- Marco Ferrari
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Catriona M Douglas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Carissa M Thomas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Ashok R Jethwa
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Wael Hasan
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
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Lombardi D, Taboni S, Paderno A, Giordano D, Bertagna F, Albano D, Barbieri V, Spriano G, Mercante G, Piana S, Bellafiore S, Cappelli C, Nicolai P. LATERAL NECK DISSECTION FOR AGGRESSIVE VARIANTS OF WELL-DIFFERENTIATED THYROID CANCER. Endocr Pract 2019; 25:328-334. [PMID: 30995431 DOI: 10.4158/ep-2018-0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Well-differentiated thyroid cancer (WDTC) is characterized by favorable disease course and excellent survival. However, some histologic subtypes, known as aggressive histologic variants (AHVs), present a more aggressive behavior than conventional WDTC. The aim of this study was to evaluate the pattern of nodal involvement and factors influencing prognosis in N1b patients with AHVs. Methods: A multicentric retrospective analysis of patients who underwent therapeutic lateral neck dissection (ND) for WDTC between 1994 and 2015 was accomplished. AHVs included the following subtypes: tall cell, Hürtle cell, diffuse sclerosing, and poorly differentiated papillary thyroid cancer. Results: The study included a total of 352 N1b patients, 40 (11.4%) of whom had AHVs. AHVs present a similar distribution of positive nodes if compared with conventional WDTC. In AHV patients, 5-year overall survival (OS), disease-specific survival (DSS), locoregional control, and metastasis-free survival were 82.2%, 93.6%, 80.3%, and 87.3%, respectively. Advanced age (>55 years) was the only significant factor affecting survival (OS, P<.001; DSS, P = .011) in this group. In the AHV group, there were 9 (22.5%) recurrences; patients with regional recurrence and without distant metastases were effectively treated by surgery. Conclusion: The distribution of positive lymph nodes in case of AHVs is similar to that of conventional WDTC, with only level V at a relatively greater risk of harboring metastases in the former group. Survival outcomes in N1b patients with AHVs remain optimal. Total thyroidectomy, ND, and adjuvant radioiodine administration have been demonstrated to be effective treatments in the setting of AHVs. Abbreviations: AHV = aggressive histologic variant; DOD = died of disease; DSS = disease-specific survival; DSV = diffuse sclerosing variant; ETE = extrathyroidal extension; HCC = Hürthle cell carcinoma; LRC = locoregional control; LVI = lymphovascular invasion; MFS = metastasis-free survival; ND = neck dissection; NED = no evidence of disease; OS = overall survival; PDA = poorly differentiated areas; PTC = papillary thyroid carcinoma; RAI = radioiodine therapy; TCV = tall cell variant; WDTC = well-differentiated thyroid cancer.
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Del Bon F, Piazza C, Lancini D, Paderno A, Bosio P, Taboni S, Morello R, Montalto N, Missale F, Incandela F, Marchi F, Filauro M, Deganello A, Peretti G, Nicolai P. Open Partial Horizontal Laryngectomies for T3⁻T4 Laryngeal Cancer: Prognostic Impact of Anterior vs. Posterior Laryngeal Compartmentalization. Cancers (Basel) 2019; 11:cancers11030289. [PMID: 30832209 PMCID: PMC6468624 DOI: 10.3390/cancers11030289] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/23/2019] [Accepted: 02/24/2019] [Indexed: 01/16/2023] Open
Abstract
Open partial horizontal laryngectomies (OPHLs) are well-established and oncologically safe procedures for intermediate–advanced laryngeal cancers (LC). T–N categories are well-known prognosticators: herein we tested if “anterior” vs. “posterior” tumor location (as defined in respect to the paraglottic space divided according to a plane passing through the arytenoid vocal process, perpendicular to the ipsilateral thyroid lamina) may represent an additional prognostic factor. We analyzed a retrospective cohort of 85 T3–4a glottic LCs, treated by Type II or III OPHL (according to the European Laryngological Society classification) from 2005 to 2017 at two academic institutions. Five-year overall survival (OS), disease-specific survivals (DSS), and recurrence-free survivals (RFS) were compared according to tumor location and pT category. Anterior and posterior tumors were 43.5% and 56.5%, respectively, 78.8% of lesions were T3 and 21.2% were T4a. Five-year OS, DSS, and RFS for T3 were 74.1%, 80.5%, and 63.4%, respectively, and for T4a 71.8%, 71.8%, and 43%, respectively (p not significant). In relation to tumor location, the survival outcomes were 91%, 94.1%, and 72.6%, respectively, for anterior tumors, and 60.3%, 66.3%, and 49.1%, respectively, for posterior lesions (statistically significant differences). These data provide evidence that laryngeal compartmentalization is a valid prognosticator, even more powerful than the pT category.
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Affiliation(s)
- Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Davide Lancini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Paolo Bosio
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Stefano Taboni
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Riccardo Morello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Nausica Montalto
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Francesco Missale
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Filippo Marchi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Marta Filauro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Alberto Deganello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
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Ferrari M, Vural A, Schreiber A, Mattavelli D, Gualtieri T, Taboni S, Bertazzoni G, Rampinelli V, Tomasoni M, Buffoli B, Doglietto F, Rodella LF, Deganello A, Nicolai P. Side-Door Temporoparietal Fascia Flap: A Novel Strategy for Anterior Skull Base Reconstruction. World Neurosurg 2019; 126:e360-e370. [PMID: 30822581 DOI: 10.1016/j.wneu.2019.02.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/10/2019] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The armamentarium for anterior skull base (ASB) reconstruction includes a variegate spectrum of grafts, endonasal pedicled flaps, regional pedicled flaps, and free flaps, which are selected to face specific scenarios. The use of a vascularized flap in case of large ABS defects ensures an adequate blood supply. The aim of this study was to evaluate the possible role of temporoparietal fascia flap (TPFF) in ASB reconstruction. METHODS Eight fresh-frozen head specimens were dissected to evaluate the adequacy of TPFF and pericranial flap (PF) for the reconstruction of ASB defects. The percentage of coverage of the ASB was calculated for TPFF and PF. An anatomic-radiologic analysis was performed to provide useful practical information for flap harvesting and positioning. RESULTS The TPFF was easily transposed to the ABS defect through an epidural corridor; the edges of the TPFF were successfully placed in the intradural space, in the epidural space, or on the extracranial surface of the ABS defect. The PF was particularly adequate for median defects, and the TPFF was shown to be useful also in cases with paramedian-supraorbital extension. The median percentage of coverage of the ASB was significantly higher for TPFF (85.1%) than PF (65.7%) (P = 0.018). CONCLUSIONS The supraorbital epidural corridor is a possible novel pathway for transposition of the TPFF for ASB reconstruction. Side-door TPFF was shown to be an ideal choice for large ASB defect with lateral supraorbital extension and could be useful in the scenario of salvage reconstruction for recurrent ABS cerebrospinal fluid leak.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Alperen Vural
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Department of Otorhinolaryngology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giacomo Bertazzoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Piazza C, Filauro M, Paderno A, Marchi F, Perotti P, Morello R, Taboni S, Parrinello G, Incandela F, Iandelli A, Missale F, Peretti G. Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy. Front Oncol 2018; 8:175. [PMID: 29872643 PMCID: PMC5972218 DOI: 10.3389/fonc.2018.00175] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/04/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction The Union for International Cancer Control–American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcategories according to tumor local extension and determine oncologic outcomes after treatment by transoral laser microsurgery (TLM) alone. Methods We retrospectively evaluated 410 patients affected by previously untreated pT1-pT3 glottic SCC treated by TLM alone from January 2005 to December 2015 at the Departments of Otorhinolaryngology—Head and Neck Surgery, Universities of Genoa and Brescia, Italy. All patients had at least 2 years of follow-up. Clinical, radiological, surgical, and histopathological data were reviewed and tumors divided into six subcategories: I, pT1a not involving the anterior commissure (AC); II, pT1b involving the AC; III, pT2 extending superficially to the supraglottis or the subglottis; IV, pT2 infiltrating the vocal muscle; V, pT3 involving the anterior paraglottic space; VI, pT2 or pT3 with vertical extension across the AC with/without involvement of the pre-epiglottic space. Recurrence-free survival (RFS), local control with laser alone (LCL), and organ preservation (OP) were defined as the primary oncologic outcomes. Results The 2, 5, and 10-year RFS for the entire series were 85.7, 80.3, and 73.8%, LCL rates 93.8, 92.1, and 89.6%, and OP rates 96.8, 95.9, and 93.5%, respectively. However, when comparing the rates of RFS, LCL, and OP for each subcategory, important differences emerged. In particular, subcategories V and VI showed a significantly increased risk of local recurrence [hazard ratio (HR) = 9.2 and 13.3, respectively]. These subcategories also had a significantly reduced probability to achieve LCL (HR: 73.6 and 93.5, respectively) and OP (HR: 6.4 and 8.1, respectively). Conclusion The present classification in subcategories allows introducing the concept of a three-dimensional map of isoprognostic zones in glottic SCC treated by TLM alone as a useful tool in its management by a multidisciplinary tumor board.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Marta Filauro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Riccardo Morello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Giampiero Parrinello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Fabiola Incandela
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Andrea Iandelli
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Francesco Missale
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
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Lombardi D, Paderno A, Giordano D, Barbieri D, Taboni S, Piazza C, Cappelli C, Bertagna F, Barbieri V, Piana S, Bellafiore S, Spriano G, Mercante G, Nicolai P. Therapeutic lateral neck dissection in well-differentiated thyroid cancer: Analysis on factors predicting distribution of positive nodes and prognosis. Head Neck 2017; 40:242-250. [PMID: 28963802 DOI: 10.1002/hed.24936] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 07/10/2017] [Accepted: 07/27/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Neck dissection is considered the treatment of choice in patients with lateral neck metastases from well-differentiated thyroid cancer. METHODS A multicenter, retrospective review of patients who underwent therapeutic lateral neck dissection for well-differentiated thyroid carcinoma was carried out. RESULTS The study included a total of 405 lateral neck dissections performed in 352 patients; 197 women (56%) and 155 men (44%). When considering ipsilateral neck metastases, levels IIa, IIb, III, IV, Va, Vb, and V (not otherwise specified) were involved in 42%, 6%, 73%, 67%, 11%, 31%, and 35% of cases, respectively. Five-year and 10-year overall survival (OS) were 93% and 81%, respectively. Age >55 years, pathologic T (pT)4 category, tumor diameter >4 cm, aggressive variants of well-differentiated thyroid carcinoma, endovascular invasion, and number of positive nodes >5 turned out to be the most important prognostic factors. CONCLUSION Neck dissection is a valid treatment option in the presence of neck metastasis from well-differentiated thyroid carcinoma. Levels IIa, III, IV, and Vb should always be removed.
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Affiliation(s)
- Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Giordano
- Otolaryngology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Diego Barbieri
- Department of Otorhinolaryngology - Head and Neck Surgery, University "San Raffaele", Milan, Italy
| | - Stefano Taboni
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | | | - Verter Barbieri
- Otolaryngology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | | | - Giuseppe Spriano
- Department of Otorhinolaryngology - Head and Neck Surgery, Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | - Giuseppe Mercante
- Department of Otorhinolaryngology - Head and Neck Surgery, Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
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