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Fujima N, Nakagawa J, Ikebe Y, Kameda H, Harada T, Shimizu Y, Tsushima N, Kano S, Homma A, Kwon J, Yoneyama M, Kudo K. Improved image quality in contrast-enhanced 3D-T1 weighted sequence by compressed sensing-based deep-learning reconstruction for the evaluation of head and neck. Magn Reson Imaging 2024; 108:111-115. [PMID: 38340971 DOI: 10.1016/j.mri.2024.02.006] [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: 07/18/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To assess the utility of deep learning (DL)-based image reconstruction with the combination of compressed sensing (CS) denoising cycle by comparing images reconstructed by conventional CS-based method without DL in fat-suppressed (Fs)-contrast enhanced (CE) three-dimensional (3D) T1-weighted images (T1WIs) of the head and neck. MATERIALS AND METHODS We retrospectively analyzed the cases of 39 patients who had undergone head and neck Fs-CE 3D T1WI applying reconstructions based on conventional CS and CS augmented by DL, respectively. In the qualitative assessment, we evaluated overall image quality, visualization of anatomical structures, degree of artifacts, lesion conspicuity, and lesion edge sharpness based on a five-point system. In the quantitative assessment, we calculated the signal-to-noise ratios (SNRs) of the lesion and the posterior neck muscle and the contrast-to-noise ratio (CNR) between the lesion and the adjacent muscle. RESULTS For all items of the qualitative analysis, significantly higher scores were awarded to images with DL-based reconstruction (p < 0.001). In the quantitative analysis, DL-based reconstruction resulted in significantly higher values for both the SNR of lesions (p < 0.001) and posterior neck muscles (p < 0.001). Significantly higher CNRs were also observed in images with DL-based reconstruction (p < 0.001). CONCLUSION DL-based image reconstruction integrating into the CS-based denoising cycle offered superior image quality compared to the conventional CS method. This technique will be useful for the assessment of patients with head and neck disease.
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Affiliation(s)
- Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan.
| | - Junichi Nakagawa
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - Yohei Ikebe
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan; Center for Cause of Death investigation, Faculty of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Hiroyuki Kameda
- Faculty of Dental Medicine Department of Radiology Hokkaido University, N13 W7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - Taisuke Harada
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - Yukie Shimizu
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - Nayuta Tsushima
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita ku, Sapporo 060-8638, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita ku, Sapporo 060-8638, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita ku, Sapporo 060-8638, Japan
| | - Jihun Kwon
- Philips Japan, 3-37 Kohnan 2-chome, Minato-ku, Tokyo 108-8507, Japan
| | - Masami Yoneyama
- Philips Japan, 3-37 Kohnan 2-chome, Minato-ku, Tokyo 108-8507, Japan
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan; Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan; Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan; Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N14 W5, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
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Wang H, Yang J, Lee A, Phan J, Lim TY, Fuller CD, Han EY, Rhee DJ, Salzillo T, Zhao Y, Chopra N, Pham M, Castillo P, Sobremonte A, Moreno AC, Reddy JP, Rosenthal D, Garden AS, Wang X. MR-guided stereotactic radiation therapy for head and neck cancers. Clin Transl Radiat Oncol 2024; 46:100760. [PMID: 38510980 PMCID: PMC10950743 DOI: 10.1016/j.ctro.2024.100760] [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: 08/31/2023] [Revised: 02/01/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
Purpose MR-guided radiotherapy (MRgRT) has the advantage of utilizing high soft tissue contrast imaging to track daily changes in target and critical organs throughout the entire radiation treatment course. Head and neck (HN) stereotactic body radiation therapy (SBRT) has been increasingly used to treat localized lesions within a shorter timeframe. The purpose of this study is to examine the dosimetric difference between the step-and-shot intensity modulated radiation therapy (IMRT) plans on Elekta Unity and our clinical volumetric modulated arc therapy (VMAT) plans on Varian TrueBeam for HN SBRT. Method Fourteen patients treated on TrueBeam sTx with VMAT treatment plans were re-planned in the Monaco treatment planning system for Elekta Unity MR-Linac (MRL). The plan qualities, including target coverage, conformity, homogeneity, nearby critical organ doses, gradient index and low dose bath volume, were compared between VMAT and Monaco IMRT plans. Additionally, we evaluated the Unity adaptive plans of adapt-to-position (ATP) and adapt-to-shape (ATS) workflows using simulated setup errors for five patients and assessed the outcomes of our treated patients. Results Monaco IMRT plans achieved comparable results to VMAT plans in terms of target coverage, uniformity and homogeneity, with slightly higher target maximum and mean doses. The critical organ doses in Monaco IMRT plans all met clinical goals; however, the mean doses and low dose bath volumes were higher than in VMAT plans. The adaptive plans demonstrated that the ATP workflow may result in degraded target coverage and OAR doses for HN SBRT, while the ATS workflow can maintain the plan quality. Conclusion The use of Monaco treatment planning and online adaptation can achieve dosimetric results comparable to VMAT plans, with the additional benefits of real-time tracking of target volume and nearby critical structures. This offers the potential to treat aggressive and variable tumors in HN SBRT and improve local control and treatment toxicity.
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Affiliation(s)
- He Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Lee
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Tze Yee Lim
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D. Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Eun Young Han
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Dong Joo Rhee
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Travis Salzillo
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Yao Zhao
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Nitish Chopra
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Pham
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Pam Castillo
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Angela Sobremonte
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C. Moreno
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jay P. Reddy
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - David Rosenthal
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S. Garden
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Xin Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
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Maia Segundo LB, Mello SMBD, Furlan MV, de Rosis Sobrinho A, Abrahao-Machado LF. Giant cell tumor of paralaryngeal soft tissues, extending to the laryngeal cartilage. Radiol Case Rep 2024; 19:1575-1578. [PMID: 38317703 PMCID: PMC10839768 DOI: 10.1016/j.radcr.2024.01.024] [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: 08/18/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
Paralaryngeal mass with secondary extension to the thyroid cartilage involving confluent cysts, subjected to conservative surgical treatment with a diagnosis of giant cell tumor of soft tissues, a neoplasm morphologically similar but genetically unrelated to osseous giant cell tumors.
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Affiliation(s)
- Leomar Benicio Maia Segundo
- Head and Neck Radiology department - Hospital Beneficência Portuguesa. Rua Maestro Cardim, 637, São Paulo, Brazil
| | | | - Marcus Vinícius Furlan
- Head and Neck Surgical department - Hospital Beneficência Portuguesa. Rua Maestro Cardim, 637, São Paulo, Brazil
| | - Antonio de Rosis Sobrinho
- Head and Neck Surgical department - Hospital Beneficência Portuguesa. Rua Maestro Cardim, 637, São Paulo, Brazil
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Lavalle S, Lechien JR, Chiesa-Estomba C, Cocuzza S, Maniaci A. Diagnostic and therapeutic standardization still lacking in parotid lymphoma: elucidating the evidence gaps in a rare entity. Eur Arch Otorhinolaryngol 2024; 281:2049-2050. [PMID: 38233692 DOI: 10.1007/s00405-023-08419-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Salvatore Lavalle
- Faculty of Medicine and Surgery, University of Enna "Kore", 94100, Enna, Italy
| | - Jerome Rene Lechien
- Department of Human Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000, Mons, Belgium
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000, Paris, France
| | - Carlos Chiesa-Estomba
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000, Paris, France
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia-Biodguipuzcoa Research Institute, 20014, Donostia, Spain
- Otorhinolaryngology Department, Faculty of Medicine, Deusto University, 48001, Bilbao, Spain
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", ENT Section, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, 95124, Catania, Italy
| | - Antonino Maniaci
- Faculty of Medicine and Surgery, University of Enna "Kore", 94100, Enna, Italy.
- Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, 75000, Paris, France.
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Faulkner J, Arora A, McCulloch P, Robertson S, Rovira A, Ourselin S, Jeannon JP. Prospective development study of the Versius Surgical System for use in transoral robotic surgery: an IDEAL stage 1/2a first in human and initial case series experience. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08564-6. [PMID: 38530463 DOI: 10.1007/s00405-024-08564-6] [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: 12/04/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Transoral robotic surgery is well established in the treatment paradigm of oropharyngeal pathology. The Versius Surgical System (CMR Surgical) is a robotic platform in clinical use in multiple specialities but is currently untested in the head and neck. This study utilises the IDEAL framework of surgical innovation to prospectively evaluate and report a first in human clinical experience and single centre case series of transoral robotic surgery (TORS) with Versius. METHODS Following IDEAL framework stages 1 and 2a, the study evaluated Versius to perform first in human TORS before transitioning from benign to malignant cases. Iterative adjustments were made to system setup, instrumentation, and technique, recorded in accordance with IDEAL recommendations. Evaluation criteria included successful procedure completion, setup time, operative time, complications, and subjective impressions. Further evaluation of the system to perform four-arm surgery was conducted. RESULTS 30 TORS procedures were successfully completed (15 benign, 15 malignant) without intraoperative complication or conversion to open surgery. Setup time significantly decreased over the study period. Instrumentation challenges were identified, urging the need for TORS-specific instruments. The study introduced four-arm surgery, showcasing Versius' unique capabilities, although limitations in distal access were observed. CONCLUSIONS TORS is feasible with the Versius Surgical System. The development of TORS-specific instruments would benefit performance and wider adoption of the system. 4-arm surgery is possible however further evaluation is required. Multicentre evaluation (IDEAL stage 2b) is recommended.
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Affiliation(s)
- Jack Faulkner
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Asit Arora
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter McCulloch
- Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
| | - Stephen Robertson
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aleix Rovira
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jean-Pierre Jeannon
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Kojima F, Ohno K, Fushimi N, Takahashi R, Tasaki A, Asakage T. Functional vagal paraganglioma developing 15 years after resection of a retroperitoneal paraganglioma. Auris Nasus Larynx 2024; 51:425-428. [PMID: 38520971 DOI: 10.1016/j.anl.2023.12.002] [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: 06/19/2023] [Revised: 09/20/2023] [Accepted: 12/06/2023] [Indexed: 03/25/2024]
Abstract
The patient, a 40-year-old woman, was diagnosed as having a functional right vagal paraganglioma (PGL) 15 years after undergoing resection for a retroperitoneal PGL. 123I-MIBG scintigraphy showed no accumulation, but as the blood noradrenaline and urinary normetanephrine concentrations were elevated, the tumor was judged as being functional, and surgery was scheduled. The patient was started on doxazosin infusion and embolization of the tumor feeding vessel was performed before the surgery. Intraoperative examination showed that the tumor was contiguous with the vagal nerve, necessitating combined resection of the vagal nerve with the tumor. Postoperatively, the catecholamine levels returned to normal range. Histopathologically, the tumor was diagnosed as a moderately differentiated, intermediate-malignant-grade PGL, with a GAPP score of 4 to 6. No non-chromaffin tissue was observed in the tumor background, so that the functional vagal PGL was considered as a sporadic metachronous tumor rather than as a metastasis from the retroperitoneal PGL. More than half of head and neck paragangliomas (HNPGLs) are reported to arise in the carotid body, and about 5% from the vagal nerve. In addition, HNPGLs rarely produce catecholamines. Herein, we consider the relationship with the previously resected retroperitoneal PGL based on a review of the literature.
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Affiliation(s)
- Fumiya Kojima
- Tokyo Medical and Dental University, Department of the Head and Neck Surgery, 1-5-45 Yusima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kazuchika Ohno
- Tokyo Medical and Dental University, Department of the Head and Neck Surgery, 1-5-45 Yusima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Naoki Fushimi
- Tokyo Medical and Dental University, Department of the Head and Neck Surgery, 1-5-45 Yusima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Ryosuke Takahashi
- Tokyo Medical and Dental University, Department of the Head and Neck Surgery, 1-5-45 Yusima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Akihisa Tasaki
- Tokyo Medical and Dental University, Department of the Head and Neck Surgery, 1-5-45 Yusima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Takahiro Asakage
- Tokyo Medical and Dental University, Department of the Head and Neck Surgery, 1-5-45 Yusima, Bunkyo-ku, Tokyo 113-8510, Japan
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Rigney GH, King AH, Chung J, Ghoshal S, Jain A, Shi Z, Razak S, Hirsch JA, Lev MH, Buch K, Succi MD. Trends in non-focal neurological chief complaints and CT angiography utilization among adults in the emergency department. Intern Emerg Med 2024:10.1007/s11739-024-03569-9. [PMID: 38512433 DOI: 10.1007/s11739-024-03569-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024]
Abstract
Prudent imaging use is essential for cost reduction and efficient patient triage. Recent efforts have focused on head and neck CTA in patients with emergent concerns for non-focal neurological complaints, but have failed to demonstrate whether increases in utilization have resulted in better care. The objective of this study was to examine trends in head and neck CTA ordering and determine whether a correlation exists between imaging utilization and positivity rates. This is a single-center retrospective observational study at a quaternary referral center. This study includes patients presenting with headache and/or dizziness to the emergency department between January 2017 and December 2021. Patients who received a head and neck CTA were compared to those who did not. The main outcomes included annual head and neck CTA utilization and positivity rates, defined as the percent of scans with attributable acute pathologies. Among 24,892 emergency department visits, 2264 (9.1%) underwent head and neck CTA imaging. The percentage of patients who received a scan over the study period increased from 7.89% (422/5351) in 2017 to 13.24% (662/5001) in 2021, representing a 67.4% increase from baseline (OR, 1.14; 95% CI 1.11-1.18; P < .001). The positivity rate, or the percentage of scans ordered that revealed attributable acute pathology, dropped from 16.8% (71/422) in 2017 to 10.4% (69/662) in 2021 (OR, 0.86; 95% CI 0.79-0.94; P = .001), a 38% reduction in positive examinations. Throughout the study period, there was a 67.4% increase in head and neck CTA ordering with a concomitant 38.1% decrease in positivity rate.
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Affiliation(s)
- Grant H Rigney
- Harvard Medical School, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Alexander H King
- Harvard Medical School, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Janice Chung
- Harvard Medical School, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Soham Ghoshal
- Harvard Medical School, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Aditya Jain
- Harvard Medical School, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Zhuo Shi
- Harvard Medical School, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Shahaan Razak
- Harvard Medical School, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Joshua A Hirsch
- Harvard Medical School, Boston, USA
- Department of Radiology, Massachusetts General Hospital, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Michael H Lev
- Harvard Medical School, Boston, USA
- Department of Radiology, Massachusetts General Hospital, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Karen Buch
- Harvard Medical School, Boston, USA
- Department of Radiology, Massachusetts General Hospital, Boston, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA
| | - Marc D Succi
- Harvard Medical School, Boston, USA.
- Department of Radiology, Massachusetts General Hospital, Boston, USA.
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA.
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Fong PY, Loh TKS, Shen L, Eu DKC, Lim CM. Patterns of recurrence in HNSCC patients treated definitively with upfront surgery, chemoradiation. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08556-6. [PMID: 38498191 DOI: 10.1007/s00405-024-08556-6] [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: 10/29/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Locally-advanced oropharynx (LA-OPSCC) and hypopharynx/larynx (LA-HPLSCC) cancers may be treated with surgical or non-surgical modalities. While survival outcomes are comparable, patterns of disease recurrence are not well established. METHODS Retrospective review of 98 consecutive patients with LA-OPSCC or LA-HPLSCC treated by either surgery plus adjuvant therapy (S-POAT, n = 48) or chemoradiation (CRT, n = 50). RESULTS CRT-treated patients had higher recurrence risk (42% vs 14.6%, p = 0.003). This was significant only among LA-OPSCC (p = 0.002) but not LA-HPLSCC patients (p = 0.159). Median time to recurrence in LA-OPSCC was 16.8 vs 11.6 months, and 16.6 vs 15.1 months in LA-HPLSCC, comparing surgically treated and CRT cohorts. Surgically-treated p16-negative LA-OPSCC experienced improved locoregional control than CRT-treated patients (100% vs 12.5%, p = 0.045) and 3-year RFS (83.0% vs 33.3%, p < 0.001). CONCLUSION Locoregional control and RFS benefit was observed in surgically treated p16 negative LA-OPSCC patients. Locoregional recurrence is the main reason of treatment failure in LA-HNSCC, occurring commonly within the first 2 years post-treatment, regardless of treatment option.
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Affiliation(s)
- Pei Yuan Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Thomas Kwok Seng Loh
- Department of Otolaryngology- Head and Neck Surgery, National University Health System, 1E Kent Ridge Road, Level 7 NUHS Tower Block, Singapore, 119228, Singapore
- National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Donovan Kum Chuen Eu
- Department of Otolaryngology- Head and Neck Surgery, National University Health System, 1E Kent Ridge Road, Level 7 NUHS Tower Block, Singapore, 119228, Singapore.
- National University Cancer Institute, National University Health System, Singapore, Singapore.
| | - Chwee Ming Lim
- Department of Otolaryngology-Head and Neck Surgery, Singapore General Hospital, 20 College Road, Level 5 Academia, Singapore, 169856, Singapore.
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Skálová A, Agaimy A, Bradova M, Poorten VV, Hanna E, Guntinas-Lichius O, Franchi A, Hellquist H, Simpson RHW, Lopéz F, Nuyts S, Chiesa-Estomba C, Ng SP, Homma A, Teng Y, Leivo I, Ferlito A. Molecularly defined sinonasal malignancies: an overview with focus on the current WHO classification and recently described provisional entities. Virchows Arch 2024:10.1007/s00428-024-03775-y. [PMID: 38491228 DOI: 10.1007/s00428-024-03775-y] [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: 01/06/2024] [Revised: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
Classification of tumors of the head and neck has evolved in recent decades including a widespread application of molecular testing in tumors of the sinonasal tract, salivary glands, and soft tissues with a predilection for the head and neck. The availability of new molecular techniques has allowed for the definition of multiple novel tumor types unique to head and neck sites. Moreover, an expanding spectrum of immunohistochemical markers specific to genetic alterations facilitates rapid identification of diagnostic molecular abnormalities. As such, it is currently possible for head and neck pathologists to benefit from a molecularly defined tumor classification while making diagnoses that are still based largely on histopathology and immunohistochemistry. This review covers the principal molecular alterations in sinonasal malignancies, such as alterations in DEK, AFF2, NUTM1, IDH1-2, and SWI/SNF genes in particular, that are important from a practical standpoint for diagnosis, prognosis, and prediction of response to treatment.
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Affiliation(s)
- Alena Skálová
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic.
- Bioptic Laboratory, Ltd., Pilsen, Czech Republic.
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Martina Bradova
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic
- Bioptic Laboratory, Ltd., Pilsen, Czech Republic
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, 3000, Louvain, Belgium
- Department of Oncology, Section Head and Neck Oncology, Leuven Cancer Institute, KU Leuven, Louvain, Belgium
| | - Ehab Hanna
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alessandro Franchi
- Department of Translational Research, School of Medicine, University of Pisa, Pisa, Italy
| | - Henrik Hellquist
- Faculty of Medicine and Biomedical Sciences (FMCB), Biomedical Center Research Institute (ABC-RI), University of Algarve, Faro, Portugal
| | | | - Fernando Lopéz
- Department of Otolaryngology, ISPA, IUOPA, CIBERONC, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000, Louvain, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000, Louvain, Belgium
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, Donostia-San Sebastian, Guipuzkoa-Basque Country, Spain
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Yong Teng
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Mutsaers A, Abugharib A, Poon I, Loblaw J, Bayley A, Zhang L, Chin L, Galapin M, Erler D, Sahgal A, Higgins K, Enepekides D, Eskander A, Karam I. Stereotactic body radiotherapy for distant metastases to the head and neck. Support Care Cancer 2024; 32:230. [PMID: 38488881 DOI: 10.1007/s00520-024-08419-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE To report clinical outcomes for patients with metastatic disease to the head and neck (HN) treated with stereotactic body radiation therapy (SBRT). METHODS A retrospective review of patients treated with SBRT to HN sites from 2012 to 2020 was conducted. Treatment indications included the following: oligometastases, oligoprogression, and control a dominant area of progression (DAP). Kaplan-Meier method was used to estimate local control (LC), regional control (RC), overall survival (OS), and progression-free survival (PFS). Univariable (UVA) and multivariable analyses (MVA) were performed. Grade 3-4 acute and late toxicities were reported by the Common Terminology Criteria for Adverse Events v5.0. RESULTS Fifty-six patients (58 lesions) were analysed with a median follow-up of 16 months. Primary sites included lung (25.0%), kidney (19.6%), breast (19.6%) and other (35.8%). SBRT indications were as follows: oligometastases (42.9%), oligoprogression (19.6%) and local control of a dominant area of progression (37.5%). Most patients received SBRT to a single neck node (n = 47, 81.0%). Median SBRT dose was 40 Gy (range 25-50 Gy) in five fractions, with a median biologically effective dose (BED10) of 72 Gy (range 37.5-100 Gy). One- and 2-year LC and RC rates were 97.6% and 72.7% as well as 100% and 86.7%, respectively. Median OS was 19.2 months (95% [CI] 14.8-69.4), and median PFS was 7.4 months (95% [CI] 5.2-11.9). The 1-year OS and PFS rates for oligometastases, oligoprogression and DAP were 95.8%, 63.6% and 38.1% (p = 0.0039) as well as 56.5%, 27.3% and 19.1% (p = 0.0004), respectively. On MVA, treatment indication and histology were predictive for OS, while indication and prior systemic therapy were predictive for PFS. Cumulative late grade 3 + toxicity rate was 11.3%, without grade 5 events. CONCLUSION The use of SBRT for metastatic disease to the HN provided excellent LC rates with low rates of regional failure and an acceptable toxicity profile, highlighting its utility in these patients. Patients with oligometastatic disease had better OS and PFS than others.
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Affiliation(s)
- Adam Mutsaers
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ahmed Abugharib
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Clinical Oncology, Sohag University, Sohag, Egypt
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Joshua Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Liying Zhang
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lee Chin
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Madette Galapin
- Department of Radiation Therapy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Darby Erler
- Department of Radiation Therapy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kevin Higgins
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Danny Enepekides
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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11
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Zhao D, Zhou F, Liu W, Huang Z, Xu X, Zheng B, Liu C, Bai C, Liu J, Sun Y, Wang W, Xiao S. Adult head and neck rhabdomyosarcoma: radiotherapy- based treatment, outcomes, and predictors of survival. BMC Cancer 2024; 24:340. [PMID: 38486204 PMCID: PMC10938762 DOI: 10.1186/s12885-024-12079-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Adult head and neck rhabdomyosarcoma (HNRMS) is an exceptionally rare malignancy, and there is a paucity of data and research dedicated to understanding its characteristics and management in adult populations. This study aimed to assess the outcomes and identify survival predictors in adult HNRMS. METHODS We retrospectively evaluated 42 adult patients (> 16 years) with HNRMS who received radiotherapy (RT)-based treatment at our institute between 2008 and 2022. We analysed the clinical characteristics and prognosis of these patients, including the locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS), using the Kaplan-Meier method. The chi-square and Fisher's exact tests were used to analyse differences between groups for dichotomous and categorical variables, respectively. Survival rates were calculated using the Kaplan-Meier method. Prognostic variables were assessed through univariate Cox analyses. RESULTS The median patient age was 28 years (range, 16-82 years). Alveolar RMS was the most common histological type, observed in 21 patients (50.0%), followed by embryonal in 16 patients (38.1%). The anatomic sites of origin were orbital in one (2.4%), parameningeal in 26 (61.9%), and non-orbital/non-parameningeal in 15 (35.7%) patients. Nineteen patients (45.2%) had regional lymph node metastasis, and five patients (11.9%) presented with distant metastatic disease. Distant metastasis (n = 17) was the primary cause of treatment failure. At a median follow-up of 47.0 months, the 5-year LRFS, PFS, and OS rates were 69.0%, 39.7%, and 41.0%, respectively. Univariate analysis revealed that tumour size, lymph node involvement, and the local treatment pattern (surgery and RT vs. RT alone) were significant predictors of survival. CONCLUSIONS The main failure pattern in patients with HNRMS receiving RT-based treatment was distant metastasis. Tumour size > 5 cm and lymph node involvement were predictors of worse LRFS. Multimodality local treatment, combining surgery and RT, is effective and provides survival benefits.
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Affiliation(s)
- Dan Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China
| | - Fang Zhou
- Department of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong, P.R. China
| | - Weixin Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China
| | - Zhou Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China
| | - Xiaolong Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China
| | - Baomin Zheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China
| | - Changqing Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China
| | - Chujie Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China
| | - Jiayong Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China
| | - Yan Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China.
| | - Shaowen Xiao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, 100142, Beijing, P.R. China.
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12
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Mackeprang PH, Bryjova K, Heusel AE, Henzen D, Scricciolo M, Elicin O. Consideration of image guidance in patterns of failure analyses of intensity-modulated radiotherapy for head and neck cancer: a systematic review. Radiat Oncol 2024; 19:30. [PMID: 38444011 PMCID: PMC10916111 DOI: 10.1186/s13014-024-02421-w] [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: 05/09/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) is considered standard of care for head and neck squamous cell carcinoma (HNSCC). Improved conformity of IMRT and smaller margins, however, have led to concerns of increased rates of marginal failures. We hypothesize that while patterns of failure (PoF) after IMRT for HNSCC have been published before, the quality of patient positioning and image guided radiotherapy (IGRT) have rarely been taken into account, and their importance remains unclear. This work provides a systematic review of the consideration of IGRT in PoF studies after IMRT for HNSCC. MATERIALS AND METHODS A systematic literature search according to PRISMA guidelines was performed on PubMed for HNSCC, IMRT and PoF terms and conference abstracts from ESTRO and ASTRO 2020 and 2021 were screened. Studies were included if they related PoF of HNSCC after IMRT to the treated volumes. Data on patient and treatment characteristics, IGRT, treatment adaptation, PoF and correlation of PoF to IGRT was extracted, categorized and analyzed. RESULTS One-hundred ten studies were included. The majority (70) did not report any information on IGRT. The remainder reported daily IGRT (18), daily on day 1-3 or 1-5, then weekly (7), at least weekly (12), or other schemes (3). Immobilization was performed with masks (78), non-invasive frames (4), or not reported (28). The most common PoF classification was "in-field/marginal/out-of-field", reported by 76 studies. Only one study correlated PoF in nasopharyngeal cancer patients to IGRT. CONCLUSION The impact of IGRT on PoF in HNSCC is severely underreported in existing literature. Only one study correlated PoF to IGRT measures and setup uncertainty. Further, most PoF studies relied on outdated terminology ("in/out-of-field"). A clearly defined and up-to-date PoF terminology is necessary to evaluate PoFs properly, as is systematic and preferably prospective data generation. PoF studies should consistently and comprehensively consider and report on IGRT.
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Affiliation(s)
- Paul-Henry Mackeprang
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
- Division of Medical Radiation Physics, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
| | - Katarina Bryjova
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - Astrid E Heusel
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - Dominik Henzen
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
- Division of Medical Radiation Physics, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - Melissa Scricciolo
- Radiation Oncology Division, Clinical Radiology Department, Ospedale dell'Angelo, Via Paccagnella 11, 30174, Venezia, Italy
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
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13
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Chung CF, Huang BS, Wang YM, Huang YT, Chen SC. Quality of life in patients with nasopharyngeal carcinoma receiving IMRT vs IMPT: a multicenter prospective longitudinal study. Support Care Cancer 2024; 32:203. [PMID: 38430411 DOI: 10.1007/s00520-024-08412-7] [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: 10/04/2023] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Nasopharyngeal carcinoma (NPC) patients may experience symptom distress and depression during and after radiation therapy, which negatively impacts quality of life (QOL). We sought to identify trajectories of symptom distress, depression, social support, and QOL in patients with NPC receiving intensity-modulated radiation therapy (IMRT) vs intensity-modulated proton therapy (IMPT). METHODS A multicenter prospective longitudinal study recruited NPC patients from two leading medical centers in Taiwan. The 121 NPC patients were followed from before RT (T0), at 4 weeks after beginning RT (T1), at 6 weeks of RT or the end of treatment (T2), and at 4 weeks post-RT (T3). Generalized estimating equation analysis was used to identify the factors related to QOL. RESULTS Patients' symptom distress and depression increased from T0, peaked at T2, and decreased at T3. Physical-QOL and psychosocial-QOL decreased from T0 to T2, then increased by T3. Patients who had early-stage cancer, received a lower RT dose, had less symptom distress, and had less depression were more likely to have better QOL. Greater physical-QOL was associated with IMPT receipt, higher education level, early cancer stage, lower radiation dose, less symptom distress, and less depression. Patients who had good physical performance, received a lower radiation dose, had less symptom distress, and had less depression were more likely to have better psychosocial-QOL. CONCLUSION Radiation dose, symptom distress, and depression were the most important factors affecting QOL in patients with NPC. Understanding the factors associated with the trajectory of QOL can guide care during radiation treatment.
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Affiliation(s)
- Ching-Fang Chung
- Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
| | - Bing-Shen Huang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Department of Radiation Oncology, and Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
| | - Yu-Ming Wang
- Department of Radiation Oncology, and Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
- Department of Medicine, College of Medicine, Chang Gung University, Kaohsiung, Taiwan, Republic of China
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
| | - Shu-Ching Chen
- Department of Radiation Oncology, and Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.
- School of Nursing and Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, Republic of China.
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
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Bal M, Deshpande V. Advancements in diagnosing IgG4-related disease of the head and neck: Navigating diagnostic pitfalls. Semin Diagn Pathol 2024; 41:54-65. [PMID: 38185595 DOI: 10.1053/j.semdp.2023.12.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
IgG4-related disease (IgG4-RD) is an immune-mediated condition affecting nearly any organ. This review focuses on the nuances of diagnosing IgG4-RD affecting the head and neck. Salivary gland involvement, especially of the submandibular glands, often permits a definitive diagnosis on biopsy. However, elevated IgG4+ plasma cells are nonspecific and can be seen in chronic sialadenitis, lymphoma, and other mimics. Careful correlation of clinical and pathological findings is essential. Given the significant overlap with chronic sinusitis, IgG4-RD of the sinonasal region is difficult to diagnose histologically. Laryngeal and pharyngeal involvement appears rare as an isolated finding of IgG4-RD. Mastoid disease is uncommon and remains a diagnosis of exclusion. Thyroid manifestations pose challenges given unclear diagnostic criteria - Riedel's thyroiditis likely represents IgG4-RD, but the fibrosing variant of Hashimoto's thyroiditis as a form of the so-called 'IgG4-related thyroiditis' requires better characterisation. Eosinophilic angiocentric fibrosis, despite histologic similarities, only partially overlaps with IgG4-RD. This review aims to guide diagnosing IgG4-RD in the head and neck through a systematic, organ-focused discussion of the clinical context, the utility of immunostaining, histological mimics, and controversial issues that pose diagnostic pitfalls. Increased awareness of the nuances and difficulties diagnosing IgG4-RD affecting the head and neck will improve recognition of this protean disease.
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Affiliation(s)
- Munita Bal
- Department of Pathology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharastra, India
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15
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Carsuzaa F, Chary E, Thariat J, Dufour X, Favier V. Obstructive sleep apnea syndrome: A frequent and difficult-to-detect complication of radiotherapy for oropharyngeal cancers. Radiother Oncol 2024; 192:110109. [PMID: 38280437 DOI: 10.1016/j.radonc.2024.110109] [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: 12/01/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
This pilot study reveals a higher prevalence of obstructive sleep apnea syndrome (OSAS) in patients treated for oropharyngeal squamous cell carcinoma with radiotherapy compared to the general population. OSAS indicators such as the Epworth Sleepiness Scale seem insufficient in the diagnostic approach to OSAS in this population and systematic screenings should be considered.
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Affiliation(s)
- Florent Carsuzaa
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Eléonore Chary
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier de La Rochelle, La Rochelle, France
| | - Juliette Thariat
- Département de radiothérapie, Centre François Baclesse, Caen, France
| | - Xavier Dufour
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Valentin Favier
- Département ORL et chirurgie cervico-faciale, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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16
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Souza SS, Stephens EM, Bourdillon AT, Bhethanabotla R, Farzal Z, Plonowska-Hirschfeld K, Qualliotine JR, Heaton CM, Ha PK, Ryan WR. Circulating tumor HPV DNA assessments after surgery for human papilloma virus-associated oropharynx carcinoma. Am J Otolaryngol 2024; 45:104184. [PMID: 38101135 DOI: 10.1016/j.amjoto.2023.104184] [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: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE To understand the utility of circulating tumor human papillomavirus DNA (ctHPVDNA) blood testing for HPV-associated oropharynx squamous cell carcinoma (HPV + OPSCC) after definitive surgery. MATERIALS AND METHODS Prospective cohort study of HPV(+)OPSCC patients with ctHPVDNA test data to assess its accuracy in detecting biopsy-confirmed disease at various post-treatment time points. Eligible patients had p16(+)/HPV(+) OPSCC and ctHPVDNA testing performed at any time pre-operatively and/or postoperatively. In cases of recurrence, patients were excluded from analysis if ctHPVDNA testing was not performed within 6 months of biopsy. RESULTS 196 all-treatment-type patients had at least one PT ctHPVDNA test. The initial post-treatment (PT) ctHPVDNA sensitivity, specificity, PPV, and NPV were 69.2 % (9/13), 96.7 % (177/183), 60.0 % (9/15), and 97.8 % (177/181). 61 surgery alone (SA) patients underwent 128 PT tests. The initial PT SA ctHPVDNA sensitivity, specificity, PPV, and NPV were 100 % (2/2), 96.0 % (48/50), 50 % (2/4), and 100 % (48/48). 35 of 61 (57.4 %) SA patients had NCCN-based histopathologic indications for adjuvant (chemo)radiation but declined. 3 of 35 (8.57 %) had a positive PT ctHPVDNA test of which 1 of 3 (33 %) had biopsy-proven recurrence. Prospectively, ten patients had a PreT positive ctHPVDNA, underwent SA, refused adjuvant treatment, had an undetectable ctHPVDNA within 2 weeks of SA, and remained free of disease (mean 10.3 months). CONCLUSION The high specificity and NPV of ctHPVDNA after SA suggest ctHPVDNA may have a role in determining the omission of PT adjuvant (chemo)radiation in select patients.
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Affiliation(s)
- Spenser S Souza
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, United States of America
| | - Erika M Stephens
- School of Medicine, University of California-San Francisco, United States of America
| | - Alexandra T Bourdillon
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, United States of America
| | | | - Zainab Farzal
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, United States of America
| | - Karolina Plonowska-Hirschfeld
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, United States of America
| | - Jesse R Qualliotine
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, United States of America
| | - Chase M Heaton
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, United States of America
| | - Patrick K Ha
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, United States of America
| | - William R Ryan
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, United States of America.
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Koike Y, Ohira S, Yamamoto Y, Miyazaki M, Konishi K, Nakamura S, Tanigawa N. Artificial intelligence-based image-domain material decomposition in single-energy computed tomography for head and neck cancer. Int J Comput Assist Radiol Surg 2024; 19:541-551. [PMID: 38219257 DOI: 10.1007/s11548-023-03058-y] [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: 06/29/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE While dual-energy computed tomography (DECT) images provide clinically useful information than single-energy CT (SECT), SECT remains the most widely used CT system globally, and only a few institutions can use DECT. This study aimed to establish an artificial intelligence (AI)-based image-domain material decomposition technique using multiple keV-output learning of virtual monochromatic images (VMIs) to create DECT-equivalent images from SECT images. METHODS This study involved 82 patients with head and neck cancer. Of these, the AI model was built with data from the 67 patients with only DECT scans, while 15 patients with both SECT and DECT scans were used for SECT testing. Our AI model generated VMI50keV and VMI100keV from VMI70keV equivalent to 120-kVp SECT images. We introduced a loss function for material density images (MDIs) in addition to the loss for VMIs. For comparison, we trained the same model with the loss for VMIs only. DECT-equivalent images were generated from SECT images and compared with the true DECT images. RESULTS The prediction time was 5.4 s per patient. The proposed method with the MDI loss function quantitatively provided more accurate DECT-equivalent images than the model trained with the loss for VMIs only. Using real 120-kVp SECT images, the trained model produced precise DECT images of excellent quality. CONCLUSION In this study, we developed an AI-based material decomposition approach for head and neck cancer patients by introducing the loss function for MDIs via multiple keV-output learning. Our results suggest the feasibility of AI-based image-domain material decomposition in a conventional SECT system without a DECT scanner.
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Affiliation(s)
- Yuhei Koike
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
- Division of Radiation Oncology, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuki Yamamoto
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
- Division of Radiation Oncology, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
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18
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Rosti A, Ammar A, Pignatti M, Molteni G, Franchi A, Cipriani R, Presutti L, Fermi M. SCIP flap in head and neck reconstruction after oncologic ablative surgery: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:1083-1093. [PMID: 37855885 DOI: 10.1007/s00405-023-08287-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In the surgical treatment of head and neck locally advanced malignancies, microvascular free flaps represent the most valuable solution to reconstruct the tissue defect after resection of the primary neoplasm. In particular, microvascular free flaps allow to restore the functional and aesthetical features of the head and neck compartments. The superficial circumflex iliac perforator (SCIP) flap represents, as an evolution of the groin flap, a valid alternative to the radial fasciocutaneous free (RFFF) flap or the anterolateral thigh (ALT) flap. METHODS This systematic review adhered to the recommendations of the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) 2009 guidelines. A computerized MEDLINE search was performed using the PubMed service of the U.S. National Library of Medicine ( www.pubmed.org ) and Scopus database ( www.scopus.com ). Two authors screened the articles, then selected and extracted data on malignancies characteristics, reconstructive techniques, outcomes, and complications. RESULTS A total of 25 articles were selected and reviewed among the 39 identified through the search string. Six out of the selected 25 articles were case reports, while the remaining 19 articles were retrospective case series. The whole study population was represented by 174 oncologic patients undergoing ablation of a head and neck tumor and reconstruction with a SCIP flap. The site of reconstruction was the oral cavity in 125 (71.0%) patients, being the tongue the most common subsite in 73 (41.5%) patients, the pharynx in 10 (5.7%) cases, the larynx in 3 (1.7%) and head and neck skin in 36 (20.4%) patients. Only two cases of total flap loss were reported. Partial flap loss or shrinkage requiring minor surgical revisions was observed in 11 patients (6.32%). Primary closure of the donor site was achieved in the whole study population, according to the available data. CONCLUSIONS In head and neck postoncological reconstruction, despite the caliber and the length of the pedicle, SCIP flap offers a pliable and thin skin paddle, allowing single-stage resurfacing, medium to large skin paddle, possibility of composite-fashion harvest and a well-concealed donor site.
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Affiliation(s)
- Alessandro Rosti
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy.
| | - Alessandro Ammar
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Marco Pignatti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gabriele Molteni
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Alberto Franchi
- Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Riccardo Cipriani
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
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19
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Dang R, Hanba C. A large language model's assessment of methodology reporting in head and neck surgery. Am J Otolaryngol 2024; 45:104145. [PMID: 38103488 DOI: 10.1016/j.amjoto.2023.104145] [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: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The aim of this study was to assess the ability of a Large Language Model - ChatGPT 3.5 to appraise the quality of scientific methodology reporting in head and neck specific scientific literature. METHODS Authors asked ChatGPT 3.5 to create a grading system for scientific reporting of research methods. The language model produced a system with a max of 60 points. Individual scores were provided for Study Design and Description, Data Collection and Measurement, Statistical Analysis, Ethical Considerations, and Overall Clarity and Transparency. Twenty articles were selected at random from The American Head and Neck Society's (AHNS) fellowship curriculum 2.0 for interrogation and each 'Methods' section was input into ChatGPT 3.5 for scoring. Analysis of variance (ANOVA) was performed between different scoring categories and a post-hoc tukey HSD test was performed. RESULTS Twenty articles were assessed, eight were categorized as very good and nine as good based on cumulative score. Lowest mean score was noted with category of statistical analysis (Mean = 0.49, SD = 0.02). On ANOVA a significant difference between means of the different scoring categories was noted, F(4, 95) = 13.4, p ≤ 0.05. On post-hoc Tukey HSD test, mean scores for categories of data collection (Mean = 0.58, SD = 0.06) and statistical analysis (Mean = 0.49, SD = 0.02) were significantly lower when compared to other categories. CONCLUSION This article showcases the feasibility of employing a large language model such as ChatGPT 3.5 to assess the methods sections in head and neck academic writing. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Rushil Dang
- Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial surgery, Boston Medical Center, Boston, MA, USA
| | - Curtis Hanba
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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20
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Hillebrand G, Gartmeier M, Weiss N, Engelmann L, Stenzl A, Johnson F, Hofauer B. [Virtual DEGUM-certified course in the head and neck region-a useful complement to conventional course formats?]. HNO 2024; 72:154-160. [PMID: 38353674 PMCID: PMC10879222 DOI: 10.1007/s00106-023-01413-8] [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] [Accepted: 12/14/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Training in clinical ultrasound has become highly relevant for working as an otorhinolaryngologist. While there is a high demand for standardized and certified training courses, until recently, there was no possibility to attend web-based and exclusively virtual head and neck ultrasound courses certified by the Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM; German Society for Ultrasound in Medicine). OBJECTIVE The aim of this study was to provide a qualitative and semi-quantitative analysis of the first purely virtual DEGUM-certified head and neck ultrasound courses. MATERIALS AND METHODS In 2021, three purely web-based DEGUM-certified head and neck ultrasound courses were carried out and then qualitatively analyzed using questionnaires including an examination. RESULTS The purely virtual implementation of head and neck ultrasound courses proved to be a viable alternative to the conventional course format, with a high level of acceptance among the participants. The lack of practice among the participants remains a relevant criticism. CONCLUSION A more dominant role of web-based and remote ultrasound training is likely and should be considered as an alternative depending on existing conditions. Nevertheless, acquisition of practical sonographic skills remains a major hurdle if courses are purely digital.
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Affiliation(s)
- Gabriel Hillebrand
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Martin Gartmeier
- TUM Medical Education Center, Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung, Fakultät für Medizin, Klinikum rechts der Isar, Nigerstraße 3, 81675, München, Deutschland
| | - Nora Weiss
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Luca Engelmann
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Anna Stenzl
- Klinik für Hals, Nasen und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Felix Johnson
- Klinik für Hals, Nasen und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Benedikt Hofauer
- Klinik für Hals, Nasen und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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21
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Salem A, Wu Y, Albarracin CT, Middleton LP, Kalhor N, Peng Y, Huang X, Aung PP, Chen H, Sahin AA, Ding Q. A Comparative Evaluation of TRPS1 and GATA3 in adenoid cystic, secretory, and acinic cell carcinomas of the breast and salivary gland. Hum Pathol 2024; 145:42-47. [PMID: 38262580 DOI: 10.1016/j.humpath.2024.01.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
GATA3 is the most used marker to determine tumors' breast origin, but its diagnostic value in triple-negative breast cancer (TNBC) is limited. The newly identified TRPS1 is highly sensitive and specific for breast carcinoma, especially TNBC. Here, we compared the utility of TRPS1 and GATA3 expression in a subset of salivary gland-type breast tumors (including adenoid cystic, acinic cell, and secretory carcinomas [AdCC, ACC, and SC, respectively]), and we compared TRPS1 and GATA3 expression of such tumors with head and neck (H&N) and AdCC of upper respiratory tumors. TRPS1 was strongly expressed in basaloid TNBC and AdCCs with solid components, including 100 % of mixed and solid breast AdCCs. However, TRPS1 was positive in only 50 % cribriform AdCCs. Expression patterns of TRPS1 in H&N and upper respiratory AdCC were similar. TRPS1 was positive in 30 % of H&N cribriform AdCCs but was strongly expressed in mixed AdCC (67 %) and solid AdCC (100 %). In the upper respiratory AdCCs, TRPS1 was positive in 58.4 % of cribriform AdCCs and positive in 100 % of AdCCs with solid components. On the contrary, GATA3 was negative in predominant AdCCs of the breast, H&N, and upper respiratory tract. These data show that GATA3 and TRPS1 expression varies AdCCs. In addition, TRPS1 and GATA3 expression patterns were similar SC and ACC of breast and H&N. Both markers were positive in SC and negative in ACC. Therefore, TRPS1 and GATA3 cannot be used to differentiate salivary gland-type carcinomas of breast origin from those of upper respiratory or H&N origin.
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Affiliation(s)
- Alireza Salem
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Yun Wu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Constance T Albarracin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lavinia P Middleton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Neda Kalhor
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yan Peng
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Xiao Huang
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Hui Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Aysegul A Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Qingqing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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22
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Faber J, Schuster F, Hartmann S, Brands RC, Fuchs A, Straub A, Fischer M, Müller-Richter U, Linz C. Successful microvascular surgery in patients with thrombophilia in head and neck surgery: a case series. J Med Case Rep 2024; 18:119. [PMID: 38414080 PMCID: PMC10900673 DOI: 10.1186/s13256-024-04403-8] [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: 12/24/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND In this case series, a perioperative anticoagulation protocol for microvascular head and neck surgery in patients with thrombophilia is presented. Microvascular free-flap surgery is a standard procedure in head and neck surgery with high success rates. Nevertheless, flap loss-which is most often caused by thrombosis-can occur and has far-reaching consequences, such as functional impairment, prolonged hospitalization, and increased costs. The risk of flap loss owing to thrombosis is significantly increased in patients with thrombophilia. Therefore, perioperative anticoagulation is mandatory. To date, no perioperative anticoagulation protocol exists for these high-risk patients. CASE PRESENTATION We present three exemplary male Caucasian patients aged 53-57 years with free flap loss owing to an underlying, hidden thrombophilia. CONCLUSION We present a modified anticoagulation protocol for microvascular surgery in these high-risk patients, enabling successful microsurgical reconstruction.
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Affiliation(s)
- Julian Faber
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Cologne, 50937, Cologne, Germany.
| | - Frank Schuster
- Department of Anaesthesia and Critical Care, Donau-Isar-Klinikum, 94469, Deggendorf, Germany
| | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, 97070, Würzburg, Germany
| | - Roman C Brands
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, 97070, Würzburg, Germany
| | - Andreas Fuchs
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, 97070, Würzburg, Germany
| | - Anton Straub
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, 97070, Würzburg, Germany
| | - Markus Fischer
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, 97070, Würzburg, Germany
| | - Urs Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, 97070, Würzburg, Germany
| | - Christian Linz
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Cologne, 50937, Cologne, Germany
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23
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Tendron A, Atallah S, Wagner I, Baujat B, Dauzier E. Varying ENT practices in adult post-intubation laryngotracheal stenosis after the COVID epidemic in France: A CHERRIES analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00025-5. [PMID: 38423860 DOI: 10.1016/j.anorl.2024.02.008] [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] [Indexed: 03/02/2024]
Abstract
AIM The SARS-CoV-2 pandemic may increase the incidence of iatrogenic laryngotracheal stenosis (LTS), whereas management is not well defined. The aim of this study was to survey a panel of French otorhinolaryngologists about their practices and to evaluate their needs. METHOD A national-level survey of the management of iatrogenic LTS was conducted using a 41-item questionnaire, in 4 sections, sent to a panel of French otorhinolaryngologists between July and December 2022. The main endpoint was heterogeneity in responses between 55 proposals on LTS management. RESULTS The response rate was 20% (52/263). The response heterogeneity rate was 69% (38/55). Heterogeneity concerned general questions on diagnosis (7/12, 58%) and management (7/10, 70%), LTS case management (22/27, 81%), and otorhinolaryngologists' expectations (33%, 2/6). Quality of training was considered good or excellent by only 21% of respondents. More than 80% were strongly in favor of creating national guidelines, expert centers and a national database. DISCUSSION This study demonstrated the heterogeneity of adult post-intubation LTS management between otorhinolaryngologists in France. Training quality was deemed poor or mediocre by a majority of respondents. They were in favor of creating national guidelines and expert centers in LTS.
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Affiliation(s)
- A Tendron
- Service d'Oto-rhino-laryngologie et Chirurgie Cervicofaciale, Hôpital Tenon, AP-HP, Université Paris Sorbonne, Paris, France
| | - S Atallah
- Service d'Oto-rhino-laryngologie et Chirurgie Cervicofaciale, Hôpital Tenon, AP-HP, Université Paris Sorbonne, Paris, France
| | - I Wagner
- Service d'Oto-rhino-laryngologie et Chirurgie Cervicofaciale, Hôpital Tenon, AP-HP, Université Paris Sorbonne, Paris, France
| | - B Baujat
- Service d'Oto-rhino-laryngologie et Chirurgie Cervicofaciale, Hôpital Tenon, AP-HP, Université Paris Sorbonne, Paris, France
| | - E Dauzier
- Service d'Oto-rhino-laryngologie et Chirurgie Cervicofaciale, Hôpital Tenon, AP-HP, Université Paris Sorbonne, Paris, France.
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24
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Gervais C, Auclin E, Saltel-Fulero A, Clair G, Oudard S, Mirghani H. Nivolumab immunotherapy rechallenge for progressive laryngeal squamous cell carcinoma after failure of conventional treatment: A CARE case report. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00020-6. [PMID: 38418356 DOI: 10.1016/j.anorl.2024.02.003] [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] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Analysis of rechallenge with nivolumab as 5th-line therapy for locally and nodally failed laryngeal squamous cell carcinoma following conventional therapeutic modalities: radiotherapy, surgery and chemotherapy. OBSERVATION A 70-year-old male, with local and nodal progression of laryngeal squamous cell carcinoma after treatment with chemoradiotherapy and surgery, was initially treated for recurrence with carboplatin, 5-fluorouracile (FU) and cetuximab, followed by second-line nivolumab, and then two lines of conventional chemotherapy with paclitaxel and cetuximab followed by carboplatin and cetuximab. He underwent rechallenge with nivolumab in 5th line, achieving 12months' response, ongoing at the time of writing, and 42.5months' survival since initiation of exclusive systemic management after failure of conventional treatment. CONCLUSION This case report highlights the benefit of nivolumab rechallenge in 5th line following previous failure as stand-alone therapy in 2nd line for a patient with laryngeal squamous cell carcinoma locally and nodally uncontrolled after conventional treatment. Clinical trials evaluating the efficacy of this approach are necessary to assess its contribution, as it is currently not a standard therapeutic option.
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Affiliation(s)
- C Gervais
- Université Paris Cité, Service d'Oncologie Médicale, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - E Auclin
- Université Paris Cité, Service d'Oncologie Médicale, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Saltel-Fulero
- Université Paris Cité, Service d'Imagerie, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - G Clair
- Université Paris Cité, Service d'Anatomopathologie, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - S Oudard
- Université Paris Cité, Service d'Oncologie Médicale, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Inserm U970, PARCC, Paris, France
| | - H Mirghani
- Université Paris Cité, Service d'Oto-Rhino-Laryngologie et Chirurgie Cervicofaciale, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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25
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Franchi A, Agaimy A. Granulation tissue-like spindle cell (sarcomatoid) carcinoma of the head and neck: a deceptively bland-looking underdiagnosed malignancy. Virchows Arch 2024:10.1007/s00428-024-03770-3. [PMID: 38403668 DOI: 10.1007/s00428-024-03770-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
The diagnosis of head and neck spindle cell squamous carcinoma (SC-SCC) is often challenging. Lesions with a prominent inflammatory infiltrate and reactive vessels may have a granulation tissue-like appearance, therefore being difficult to distinguish from reactive lesions, like contact ulcers, post-intubation granulomas, inflammatory pseudotumors, or benign vascular lesions. In this study, we analyzed the clinicopathological features of a series of 17 head and neck SC-SCC with granulation tissue-like appearance. All patients, but two, were males, ranging in age between 57 and 80 years. The larynx was the most frequently affected site (n = 12), followed by the tongue (n = 4). One tumor was hypopharyngeal. Most consult cases were submitted with benign suggestion or because of unexpected recurrences of granulation tissue polyps. Histologically, all lesions consisted of an ulcerated polypoid proliferation of moderately to markedly atypical spindle cells, with a minor component of conventional invasive or in situ squamous carcinoma. At least one cytokeratin cocktail was positive in 13 cases. The staining was limited to a few neoplastic cells in most cases. Positivity for p63, p40, and cytokeratins 5/6 was detected only in the conventional squamous cell carcinoma component, when present. ALK1 was negative in all cases. Sixteen cases were tested for p53 and all showed aberrant expression (12 diffusely positive and 4 of null-phenotype). The diagnosis of granulation tissue-like SC-SCC is challenging due to the close clinical and histological overlap with several benign conditions. Since the expression of epithelial markers is limited, the use of an immunohistochemical panel including p53 is recommended.
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Affiliation(s)
- Alessandro Franchi
- Section of Anatomic Pathology, Department of Translational Research, University of Pisa, 56124, Pisa, Italy.
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Comprehensive Cancer Center (CCC) Erlangen-EMN, 91054, Erlangen, Germany
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26
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Sripodok P, Kouketsu A, Kuroda K, Miyashita H, Sugiura T, Kumamoto H. Primary Oral Mixed Neuroendocrine-Non-neuroendocrine Neoplasm (MiNEN): A Rare Case Report and Review of the Literature. Head Neck Pathol 2024; 18:13. [PMID: 38393494 PMCID: PMC10891016 DOI: 10.1007/s12105-024-01613-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/10/2024] [Indexed: 02/25/2024]
Abstract
Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are rare tumors recently characterized by the presence of both neuroendocrine and non-neuroendocrine components within the same tumor tissue. Although MiNEN found their place in the WHO classification for various organs, this composite tumor in the head and neck region remains exceptionally rare. We present a case of primary oral MiNEN in a 64-year-old male located on the left side of lower gingiva. Biopsy raised suspicion of neuroendocrine carcinoma (NEC) and the patient underwent partial mandibulectomy. The resected specimen showed two distinct components of NEC and squamous cell carcinoma (SCC) with the confirmation of immunohistochemical markers. There has been no sign of recurrence nor metastasis 6 years after the surgery. In addition, we have conducted a review of published cases with potential relevance to this entity, resulting in five cases. The diverse terminology reinforces the need for a standardized classification system of oral/head and neck MiNENs.
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Affiliation(s)
- Pawat Sripodok
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan.
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
| | - Atsumu Kouketsu
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Kanako Kuroda
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Hitoshi Miyashita
- Department of Dentistry and Oral Surgery, Tohoku Medical and Pharmaceutical University Hospital, Miyagi, Japan
| | - Tsuyoshi Sugiura
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Hiroyuki Kumamoto
- Division of Oral Pathology, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
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27
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Mannelli G, Bassani S, Cosi G, Fermi M, Gazzini L, Liberale C, Mazzetti L, Parrinello G, Saibene AM, Molteni G, Comini LV. Global frequency and distribution of head and neck sarcomas in adulthood: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08477-4. [PMID: 38381151 DOI: 10.1007/s00405-024-08477-4] [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: 09/26/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Head and neck sarcomas (HNS) constitute a rare and heterogeneous cancer entity. Management remains a challenge due their rarity and different biological behaviour among tens of subtypes. This systematic review aimed to describe HNS global frequency and distribution in adulthood. METHODS A systematic review was performed using PICOTS search strategies for qualitative question and it was written in accordance with PRISMA 2020 Statement. 70,653 publications were identified, and 15 variables were evaluated for a total of 2428 patients. RESULTS We identified 47 studies from 21 different countries from 5 different continents. Most of studies (83.3%) were performed in single institutions and America and Asia overruled for number of papers included (21 and 10, respectivelly). Osteosarcoma was more frequent, followed by chondrosarcoma, angiosarcoma and malignant fibrous histiocytoma. Early stage accounted for almost 80% of cases; advanced stage prevailed in developing countries. 1783 patients (90.1%) underwent surgery and 780 (39.4%) had adjuvant therapy. 50.8% of patients experienced tumour recurrence and the lowest mortality rate was reported in Europe (29.9%). CONCLUSIONS HNS holds a relative poor prognosis possibly explained by the heterogeneity of the disease. Treatment of HNS has shown to be highly diverse among different countries, underlining the importance of uniformed treatment guidelines to achieve better patient management and to improve survival outcomes.
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Affiliation(s)
- Giuditta Mannelli
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Bassani
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Ginevra Cosi
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Fermi
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Luca Gazzini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Carlotta Liberale
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Luca Mazzetti
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giampiero Parrinello
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Martino Polyclinc Hospital, Genoa, Italy
| | - Alberto Maria Saibene
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otolaryngology Department, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università Degli Studi di Milano, Milan, Italy
| | - Gabriele Molteni
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Lara Valentina Comini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria.
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale, 142-KM 3.95, 10060, Candiolo, TO, Italy.
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Baba A, Kurokawa R, Kurokawa M, Rivera-de Choudens R, Srinivasan A. Apparent diffusion coefficient for differentiation between extra-nodal lymphoma and squamous cell carcinoma in the head and neck: a systematic review and meta-analysis. Acta Radiol 2024:2841851241228487. [PMID: 38377681 DOI: 10.1177/02841851241228487] [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] [Indexed: 02/22/2024]
Abstract
BACKGROUND Radiological differentiation between extra-nodal lymphoma and squamous cell carcinoma in the head and neck is often difficult due to their similarities. PURPOSE To evaluate the diagnostic benefit of apparent diffusion coefficient (ADC) calculated from diffusion-weighted imaging (DWI) in differentiating the two. MATERIAL AND METHODS A systematic review was performed by searching the MEDLINE, Scopus, and Embase databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Forest plots and the pooled mean difference of ADC values were calculated to describe the relationship between extra-nodal lymphoma and squamous cell carcinoma in the head and neck. Heterogeneity among studies was evaluated using the Cochrane Q test and I2 statistic. RESULTS The review identified eight studies with 440 patients (441 lesions) eligible for meta-analysis. Among all studies, the mean ADC values of squamous cell carcinoma was 0.88 × 10-3mm2/s and that of lymphoma was 0.64 × 10-3mm2/s. In the meta-analysis, the ADC value of lymphoma was significantly lower than that of squamous cell carcinoma (pooled mean difference = 0.235, 95% confidence interval [CI] = 0.168-0.302, P <0.0001). The Cochrane Q test (chi-square = 55.7, P <0.0001) and I2 statistic (I2 = 87.4%, 95% CI = 77.4-93.0%) revealed significant heterogeneity. CONCLUSION This study highlights the value of quantitative assessment of ADC for objective and reliable differentiation between extra-nodal lymphoma and squamous cell carcinoma in the head and neck. Conclusions should be interpreted with caution due to heterogeneity in the study data.
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Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Department of Radiology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Department of Radiology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Department of Radiology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | | | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Aristophanous M, Aliotta E, Lichtenwalner P, Abraham S, Nehmeh M, Caringi A, Zhang P, Hu YC, Zhang P, Cervino L, Gelblum D, McBride S, Riaz N, Chen L, Yu Y, Zakeri K, Lee N. Clinical Experience with an Offline ART Head and Neck Program: Dosimetric Benefits and Opportunities for Patient Selection. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00326-2. [PMID: 38373657 DOI: 10.1016/j.ijrobp.2024.02.016] [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: 05/16/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE To develop a LINAC-based adaptive radiotherapy (ART) workflow for head and neck that is informed by automated image tracking to identify major anatomic changes warranting adaptation. In this study we report our initial clinical experience with the program and an investigation into potential trigger signals for ART. METHODS AND MATERIALS Offline ART was systematically performed on patients receiving radiotherapy for head and neck cancer on C-arm LINACs. Adaptations were performed at a single timepoint during treatment with resimulation approximately 3 weeks into treatment. Throughout treatment, all patients were tracked using an automated image tracking system called the IN_HOUSE_SOFTWARE*. IN_HOUSE_SOFTWARE measures volumetric changes in gross tumor volumes (GTV) and selected normal tissues via cone-beam computed tomography (CBCT) scans and deformable registration. The benefit of ART was determined by comparing adaptive plan dosimetry and normal tissue complication probabilities (NTCP) against the initial plans recalculated on resimulation CT scans. Dosimetric differences were then correlated with IN_HOUSE_SOFTWARE-measured volume changes to identify patient-specific triggers for ART. Candidate trigger variables were evaluated using receiver operator characteristic (ROC) analysis. RESULTS N=46 patients received ART in this study. Amongst these patients, we observed a significant decrease in dose to the submandibular glands (mean ± standard deviation: -219.2±291.2cGy, p-value<10-5), parotids (-68.2±197.7cGy, p-value=0.001) and oral cavity (-238.7±206.7cGy, p-value<10-5) with the adaptive plan. NTCPs for xerostomia computed from mean parotid doses also decreased significantly with the adaptive plans (p-value=0.008). We also observed systematic intra-treatment volume reductions (ΔV) for GTVs and normal tissues. Candidate triggers were identified which did predict significant improvement with ART including parotid ΔV=7%, neck ΔV=2%, and nodal GTV ΔV=29%. CONCLUSIONS Systematic offline head and neck ART was successfully deployed on conventional LINACs and reduced doses to critical salivary structures and oral cavity. Automated CBCT tracking provided information regarding anatomic changes that may aid patient-specific triggering for ART. (*Anonymized for review).
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Affiliation(s)
| | - Eric Aliotta
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Shira Abraham
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mohammad Nehmeh
- Department of Applied Physics, Columbia University, New York, NY
| | - Amanda Caringi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yu-Chi Hu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Laura Cervino
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daphna Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Linda Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kaveh Zakeri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Applied Physics, Columbia University, New York, NY; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Zaitoun A, Fata M, Shafei ME, Abdeldayem M, Koraitim M. Application of supraclavicular island flap in oral and maxillofacial reconstruction. Oral Maxillofac Surg 2024:10.1007/s10006-024-01225-2. [PMID: 38355871 DOI: 10.1007/s10006-024-01225-2] [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: 02/01/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
Several surgical modalities are available for maxillofacial reconstruction as locoregional or microvascular free flaps. PURPOSE (a) Evaluate the reliability of the supraclavicular flap in cervico-orofacial region; (b) investigate the role of computed tomography angiography (CTA) in predicting the post-operative viability of the flap; (c) assess the speech, feeding, and esthetics after reconstruction using this flap. METHODS Eleven patients included in this study underwent either conventional or delayed harvesting of the supraclavicular flap (SCF). All the patients had diagnostic computed tomography angiography (CTA) of the supraclavicular flap before the surgery. RESULTS The mean harvesting time of the flap was 45.45 ± 4.16 min. The average length of the flap was 22.64 ± 1.12 cm, whereas the mean width of the flap was 6.14 ± 1.14 cm. The flap survived in 9 patients, while two patients had complete flap loss. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. Only two patients complained of weakness in the donor site. None of the patients reported that the weakness or pain at the donor site affected their daily activities or quality of life. CONCLUSION The pedicled SCF represents a safe and feasible option that can be used to reconstruct a wide array of maxillofacial oncologic defects. However, a study with a larger sample size is recommended to achieve more reliable clinical results for the modified delayed technique modification in terms of their effect on the survival of the supraclavicular flap.
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Affiliation(s)
- Abdalla Zaitoun
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Mohamed Fata
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed El Shafei
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Abdeldayem
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Koraitim
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Vishak MS, Haritha GH, Raja K. Assessing the Efficacy of Steroids as a Single Modality Treatment for Kimura Disease: A Retrospective Analysis. Indian J Otolaryngol Head Neck Surg 2024; 76:683-686. [PMID: 38440515 PMCID: PMC10909021 DOI: 10.1007/s12070-023-04250-x] [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: 09/02/2023] [Accepted: 09/21/2023] [Indexed: 03/06/2024] Open
Abstract
Kimura disease is an idiopathic chronic inflammatory disorder, that usually affects the head and neck sites. The use of steroid for its management has been long reviewed in literature alongside immune suppression, but there are only few studies that compare the efficacy of steroid as a single modality treatment for the same. A middle-aged patient, hailing from southern state of India, presented to our outpatient clinic with right sided facial swelling for 2 years. Patient was diagnosed as a case of kimura disease of head and neck with cytological analysis and other investigations. Patient was managed medically with low dose oral corticosteroids and followed up for 6 months. This is a retrospective analysis of the efficacy of this single modality treatment. Patients with Kimura disease with no renal involvement, low dose oral corticosteroids can be tried as a single modality treatment, provided there are no contra indications for the same. Although long term follow up is essential to look for recurrence rates and associated long term benefits for the same.
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Affiliation(s)
- M. S. Vishak
- Department of Otorhinolaryngology, JIPMER, Puducherry, India
| | - G. H. Haritha
- Department of Otorhinolaryngology, JIPMER, Puducherry, India
| | - Kalaiarasi Raja
- Department of Otorhinolaryngology, JIPMER, Puducherry, India
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32
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Purohit S, Ahlawat P, Tandon S, Bellige AR, Gairola M. Myxofibrosarcoma of Head and Neck Region - A Rare Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:1174-1177. [PMID: 38440645 PMCID: PMC10909039 DOI: 10.1007/s12070-023-04200-7] [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: 07/26/2023] [Accepted: 08/28/2023] [Indexed: 03/06/2024] Open
Abstract
Myxofibrosarcoma (MFS) is a rare subtype of soft tissue sarcoma that usually occurs in the extremities of the body. Its location in the head and neck region is unique. Surgery is the primary treatment for all non-metastatic MFS. It has high rates of local recurrence and metastasis. Like other soft tissue sarcomas, the aim of adjuvant treatment is to decrease the chances of local recurrence or metastasis in MFS. Due to its rarity, there is a lack of data showing the benefit of adjuvant treatment in MFS of the head and neck region. We are presenting a case report and literature review on MFS in the head and neck.
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Affiliation(s)
- Sandeep Purohit
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
| | - Akash Raghavan Bellige
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110082 India
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Das D, Sardar S, Nivetaa R. A Study on Clinico-Pathological Presentation and Management Prospective of Venolymphatic Malformation. Indian J Otolaryngol Head Neck Surg 2024; 76:687-694. [PMID: 38440618 PMCID: PMC10908698 DOI: 10.1007/s12070-023-04253-8] [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: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 03/06/2024] Open
Abstract
To evaluate the clinical perspective of Veno lymphatic malformation and definitive management in respect to outcome. (1) To discuss clinical presentation, symptomatology of Veno lymphatic malformation. (2) Demonstration of radiological features, diagnosis and management of Veno lymphatic malformation with its complication. This prospective study was conducted on four patients attending ENT-OPD of R.G.Kar Medical College, Kolkata, India who had presented with suspected vascular malformation. The study was conducted from March 2021 to March 2023 for a period of 2 years. The patients were subjected to detailed history and examination. The diagnosis of the Veno lymphatic malformation was based on the results of Doppler ultrasonography, computed tomography and magnetic resonance imaging. In our study there was male predominance. Most of the patients belonged to the 2nd and 3rd decade of life. The main sites of involvement were lateral neck followed by parotid region. The lesion size ranged in between 3.5 × 3.5 cm and 7 × 5 cm. The patient with parotid lesion was found to have phlebolith. Since most of the lesions were small with well-defined margins, we were able to excise the lesions completely without leaving any residue. Out of four cases one patient developed temporary paresis of spinal accessory nerve which resolved eventually. Veno lymphatic malformations are rare and there is no definitive protocol for management and to be individualized. Our study will be helpful for furthering the existing knowledge regarding the management of Veno lymphatic lesion emphasizing the need of multimodality approach in surgical decision making.
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Affiliation(s)
- Debabrata Das
- Department of E.N.T, R.G. Kar Medical College, Kolkata, India
| | - Subhadip Sardar
- Department of E.N.T, R.G. Kar Medical College, Kolkata, India
| | - R. Nivetaa
- Department of E.N.T, R.G. Kar Medical College, Kolkata, India
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Skálová A, Bradová M, Michal M, Mosaieby E, Klubíčková N, Vaněček T, Leivo I. Molecular pathology in diagnosis and prognostication of head and neck tumors. Virchows Arch 2024; 484:215-231. [PMID: 38217715 PMCID: PMC10948559 DOI: 10.1007/s00428-023-03731-2] [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: 10/17/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024]
Abstract
Classification of head and neck tumors has evolved in recent decades including a widespread application of molecular testing in tumors of the salivary glands, sinonasal tract, oropharynx, nasopharynx, and soft tissue. Availability of new molecular techniques allowed for the definition of multiple novel tumor types unique to head and neck sites. Moreover, the expanding spectrum of immunohistochemical markers facilitates a rapid identification of diagnostic molecular abnormalities. As such, it is currently possible for head and neck pathologists to benefit from a molecularly defined classifications, while making diagnoses that are still based largely on histopathology and immunohistochemistry. This review highlights some principal molecular alterations in head and neck neoplasms presently available to assist pathologists in the practice of diagnosis, prognostication and prediction of response to treatment.
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Affiliation(s)
- Alena Skálová
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic.
- Bioptic Laboratory, Ltd, Pilsen, Czech Republic.
| | - Martina Bradová
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic
- Bioptic Laboratory, Ltd, Pilsen, Czech Republic
| | - Michael Michal
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic
- Bioptic Laboratory, Ltd, Pilsen, Czech Republic
| | - Elaheh Mosaieby
- Molecular and Genetic Laboratory, Bioptic Laboratory, Ltd, Pilsen, Czech Republic
| | - Natálie Klubíčková
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic
- Bioptic Laboratory, Ltd, Pilsen, Czech Republic
| | - Tomáš Vaněček
- Molecular and Genetic Laboratory, Bioptic Laboratory, Ltd, Pilsen, Czech Republic
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
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Tonneau M, Nebbache R, Larnaudie A, Thureau S, Pointreau Y, Blanchard P, Thariat J. Management of head and neck carcinomas with synchronous or metachronous oligometastatic disease: Role of locoregional radiotherapy and metastasis-directed radiotherapy. Cancer Radiother 2024; 28:83-92. [PMID: 37620212 DOI: 10.1016/j.canrad.2023.03.004] [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: 12/31/2022] [Revised: 02/19/2023] [Accepted: 03/28/2023] [Indexed: 08/26/2023]
Abstract
Head and neck carcinomas are initially metastatic in about 15% of cases. Radiotherapy is a cornerstone in the multimodal strategy at the locoregional phase. In patients with head and neck cancer, often heavily pretreated and with comorbidities, who relapse locoregionally or at distant sites, radiotherapy has also become increasingly important at the metastatic phase. Data on the optimal sequence of systemic treatments and metastasis-directed treatments including stereotactic irradiation are still lacking. Several randomized head and neck trials have been initiated that should provide important answers, including one recent GORTEC trial.
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Affiliation(s)
- M Tonneau
- Service d'oncologie radiothérapie, CRLCC Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - R Nebbache
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - A Larnaudie
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France
| | - S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, Rouen, France; Unité QuantIF Litis EA 4108, université de Rouen, Rouen, France; Département d'imagerie, centre Henri-Becquerel, Rouen, France
| | - Y Pointreau
- Institut inter-régional de cancérologie (ILC), centre Jean-Bernard, centre de cancérologie de la Sarthe (CCS), 64, rue de Degré, 72000 Le Mans, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy, université Paris Saclay, Inserm U1018 Oncostat, Villejuif, France
| | - J Thariat
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France; Laboratoire de physique corpusculaire/IN2P3-CNRS UMR 6534, Unicaen-université de Normandie, 14000 Caen, France.
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Noy R, Habashi N, Akrish S, Cohen J, Shkedy Y. Preoperative tracheostomy is associated with thyroid gland invasion and poorer prognosis in laryngectomized patients. Eur Arch Otorhinolaryngol 2024; 281:935-943. [PMID: 37880425 DOI: 10.1007/s00405-023-08302-4] [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: 06/17/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Patients with laryngeal cancer may necessitate tracheostomy placement to alleviate compromised airways. However, the impact of tracheostomy on thyroid gland invasion and its implications for prognosis in individuals who further undergo total laryngectomy remains unclear. This study aimed to assess thyroid gland invasion rates and explore the 5-years disease-free and overall survival in laryngectomized patients stratified by preoperative tracheostomy. METHODS All patients who underwent total laryngectomy for laryngeal cancer between 2003 and 2023 at a tertiary referral center were retrospectively reviewed. Logistic univariable and multivariable regressions were performed to identify factors associated with thyroid gland invasion. Survival analyses were performed using the Kaplan-Meier estimator. RESULTS A total of 119 laryngectomized patients were included (mean age: 63 ± 10 years, range 35-89, 110 [92.4%] males); 27 (22.7%) underwent preoperative tracheostomy. In 16 (13.4%) patients, tumor cells were found within the thyroid gland. In a multivariable analysis, thyroid gland invasion was independently associated with preoperative tracheostomy (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.45-6.19), pN2 + (OR 2.13, 95% CI 1.8-5.14), positive margins (OR 1.36, 95% CI 1.01-1.77), lower 5-year disease-free survival (38% vs. 57%, p = 0.01), and lower 5-year overall survival (40% vs. 56%, p = 0.03). CONCLUSION Preoperative tracheostomy is an independent predictive factor for thyroid gland invasion and has adverse oncological outcomes in laryngectomized patients. Conversely, the rates of thyroid gland invasion are low when tracheostomy was not performed beforehand.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel.
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Nadeem Habashi
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sharon Akrish
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Jacob Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Guinot JL, Diezhandino P, de Frutos JM, Fuentemilla N, Gonzalez-Perez V, Gutierrez C, Herreros A, Martinez-Monge R, Perez-Echagüen S, Pino F, Roldán S, Rovirosa A, Santos MA, Sanz-Freire CJ, Villafranca E. Status of head and neck brachytherapy in Spain in 2022. Clin Transl Oncol 2024; 26:456-460. [PMID: 37548869 DOI: 10.1007/s12094-023-03265-8] [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: 05/12/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Brachytherapy (BT) has been used for many years for disease control in tumours of the head and neck area (H&N). It is currently performed with high dose rate (HDR) or pulsed dose rate (PDR), but its use has been reduced due to the implementation of new non-invasive external beam radiotherapy techniques such as intensity modulation (IMRT) and volumetric modulated arc therapy (VMAT) and the improvement of surgical techniques. METHODS The Spanish Brachytherapy Group (GEB) has carried out a survey to find out the number of centres in Spain that continue to use BT in H&N and its indications and expectations for the future. RESULTS The results were presented at the XX GEB Consensus Meeting held on October 21, 2022, in Valencia (Spain) and it was confirmed that, although there are fewer and fewer centres that use BT in H&N, there are still units with extensive experience in this technique that should be positioned as referral centres. CONCLUSION It is necessary to carry out continuous work with other specialities involved, such as H&N surgeons, and other radiation oncologists, to improve the training of residents, both oncologists and medical physicists.
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Affiliation(s)
- Jose Luis Guinot
- Radiation Oncology Department, Fundacion Instituto Valenciano de Oncologia (I.V.O.), C/Profesor Beltran Baguena 8, 46009, Valencia, Spain.
| | - Patricia Diezhandino
- Radiation Oncology Department, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jesus Maria de Frutos
- Radiation Oncology Department, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Naiara Fuentemilla
- Radiation Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Victor Gonzalez-Perez
- Department of Medical Physics, Fundacion Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain
| | - Cristina Gutierrez
- Department of Radiation Oncology, Institut Català d'Oncologia, Barcelona, Spain
| | - Antonio Herreros
- Radiation Oncology Department, Hospital Clínic Universitari, Barcelona, Spain
| | | | - Susana Perez-Echagüen
- Radiation Oncology Department, CIBIR - Complejo Hospitalario San Pedro La Rioja, Logroño, Spain
| | - Francisco Pino
- Department of Medical Physics, Institut Català d'Oncologia, Barcelona, Spain
| | - Susana Roldán
- Radiation Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Angels Rovirosa
- Radiation Oncology Department, Hospital Clínic Universitari, Barcelona, Spain
| | - Miguel Angel Santos
- Radiation Oncology Department, Fundacion Instituto Valenciano de Oncologia (I.V.O.), C/Profesor Beltran Baguena 8, 46009, Valencia, Spain
| | - Camilo Jose Sanz-Freire
- Medical Physics Department, CIBIR - Complejo Hospitalario San Pedro La Rioja, Logroño, Spain
| | - Elena Villafranca
- Radiation Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
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Nakagawa J, Fujima N, Hirata K, Harada T, Wakabayashi N, Takano Y, Homma A, Kano S, Minowa K, Kudo K. Diagnosis of skull-base invasion by nasopharyngeal tumors on CT with a deep-learning approach. Jpn J Radiol 2024:10.1007/s11604-023-01527-7. [PMID: 38280100 DOI: 10.1007/s11604-023-01527-7] [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: 11/10/2023] [Accepted: 12/24/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE To develop a convolutional neural network (CNN) model to diagnose skull-base invasion by nasopharyngeal malignancies in CT images and evaluate the model's diagnostic performance. MATERIALS AND METHODS We divided 100 malignant nasopharyngeal tumor lesions into a training (n = 70) and a test (n = 30) dataset. Two head/neck radiologists reviewed CT and MRI images and determined the positive/negative skull-base invasion status of each case (training dataset: 29 invasion-positive and 41 invasion-negative; test dataset: 13 invasion-positive and 17 invasion-negative). Preprocessing involved extracting continuous slices of the nasopharynx and clivus. The preprocessed training dataset was used for transfer learning with Residual Neural Networks 50 to create a diagnostic CNN model, which was then tested on the preprocessed test dataset to determine the invasion status and model performance. Original CT images from the test dataset were reviewed by a radiologist with extensive head/neck imaging experience (senior reader: SR) and another less-experienced radiologist (junior reader: JR). Gradient-weighted class activation maps (Grad-CAMs) were created to visualize the explainability of the invasion status classification. RESULTS The CNN model's diagnostic accuracy was 0.973, significantly higher than those of the two radiologists (SR: 0.838; JR: 0.595). Receiver operating characteristic curve analysis gave an area under the curve of 0.953 for the CNN model (versus 0.832 and 0.617 for SR and JR; both p < 0.05). The Grad-CAMs suggested that the invasion-negative cases were present predominantly in bone marrow, while the invasion-positive cases exhibited osteosclerosis and nasopharyngeal masses. CONCLUSIONS This CNN technique would be useful for CT-based diagnosis of skull-base invasion by nasopharyngeal malignancies.
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Affiliation(s)
- Junichi Nakagawa
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kenji Hirata
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
- Medical AI Research and Development Center, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Taisuke Harada
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Naoto Wakabayashi
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yuki Takano
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita Ku, Sapporo, 060-8638, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita Ku, Sapporo, 060-8638, Japan
| | - Kazuyuki Minowa
- Faculty of Dental Medicine Department of Radiology, Hokkaido University, N13 W7, Kita-Ku, Sapporo, Hokkaido, 060-8586, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
- Medical AI Research and Development Center, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
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Argyris PP, Challa B, Satturwar S, VanKoevering KK, Wakely PE. SMARCB1-Deficient Skull Base Chondrosarcoma with 12p Duplication Presenting as Somatic-Type Malignancy Arising from Metastatic Seminoma. Head Neck Pathol 2024; 18:1. [PMID: 38236556 PMCID: PMC10796880 DOI: 10.1007/s12105-023-01610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
Somatic-type malignancy (STM) can occur infrequently within a primary or metastatic testicular germ cell tumor (TGCT) and is associated with dismal prognosis and survival. STM with chondrosarcomatous features is exceedingly rare and head and neck involvement has not been previously documented. A 39-year-old white man presented with nasal obstruction and epistaxis. Imaging disclosed a 6.9-cm expansile tumor involving the nasal cavity and skull base with intraorbital and intracranial extension. The histopathologic properties of the tumor were compatible with chondrosarcoma, grade II-III. Immunohistochemically, malignant cells were strongly and diffusely positive for S100 and epithelial markers, and showed loss of SMARCB1 expression. IDH1/2 mutations were not detected. Following whole-body PET scan, a 7.0-cm left testicular mass was discovered and diagnosed as seminoma with syncytiotrophoblastic cells, stage pT3NXM1b. Extensive retroperitoneal, mediastinal, and supraclavicular lymphadenopathy was also noticed. Histopathologic examination of the left supraclavicular lymph node revealed metastatic seminoma. By FISH, most metastatic nodal seminoma cells harbored 1 to 4 copies of isochromosome 12p, while the chondrosarcoma featured duplication of 12p. Presence of a malignant TGCT with disseminated supradiaphragmatic lymphadenopathy, the unique immunophenotypic properties of the skull-based chondrosarcoma and lack of IDH1/2 aberrations with gain of 12p strongly support the diagnosis of STM chondrosarcoma arising from metastatic TGCT. The patient did not respond to chemotherapy and succumbed three months after diagnosis. Although exceedingly uncommon, metastasis to the head and neck may occur in patients with TGCT. This case of STM chondrosarcoma demonstrated divergent immunophenotypic and molecular characteristics compared to "typical" examples of head and neck chondrosarcoma. High index of suspicion is advised regarding the diagnosis of lesions that present with otherwise typical histomorphology but unexpected immunohistochemical or molecular features.
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Affiliation(s)
- Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Postle Hall, Room 2191 305 W. 12th Ave, Columbus, OH, 43210, USA.
| | - Bindu Challa
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Swati Satturwar
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio-State University Wexner Medical Center, Columbus, OH, USA
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
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León X, López S, Pérez M, Valero C, Holgado A, Quer M, Vega C. Results of surgical treatment of lymph node metastases in patients with cutaneous squamous cell carcinoma of the head and neck. Acta Otorrinolaringol Esp (Engl Ed) 2024:S2173-5735(24)00011-5. [PMID: 38224869 DOI: 10.1016/j.otoeng.2023.07.005] [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: 04/29/2023] [Accepted: 07/31/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Out of all cutaneous squamous cell carcinomas originating in the head and neck (HNCSCC), 2-4% are associated with parotid or cervical lymph node metastasis. The aim of this study is to analyse the prognostic factors of patients with HNCSCC with lymph node involvement treated surgically. Additionally, we aim to compare the prognostic capacity of the classification of these patients according to the 8th edition of the TNM, and an alternative classification proposed by O'Brien et al. PATIENTS AND METHODS: Retrospective review of 65 patients with HNCSCC with lymph node metastasis treated surgically during the period 2000-2020. RESULTS During the study period we carried out 13 neck dissections and 52 parotidectomies + neck dissection in patients with lymph node metastases from a HNCSCC. The great majority of patients (89,2%) received post-operative radiotherapy. The 5 year disease-specific survival was 69,9%, and the overall survival it was 42,8%. The classification proposed by O'Brien et al, based on the parotid or cervical location of the lymph node metastases, and the size and number of the metastatic lymph nodes, had a better prognostic capacity than the TNM classification. CONCLUSIONS The surgical treatment of lymph node metastases in patients with HNCSCC achieved a high disease control. The classification based on the location, size and number of lymph node metastases proposed by O'Brien et al had better prognostic capacity than the TNM classification.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
| | - Susana López
- Servicio de Cirugía Plástica. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Pérez
- Servicio de Cirugía Plástica. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Valero
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Holgado
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Carmen Vega
- Servicio de Cirugía Plástica. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Bini A, Derka S, Stavrianos S. Management of head & neck sarcomas in adults: A retrospective study. J Craniomaxillofac Surg 2024:S1010-5182(24)00014-3. [PMID: 38443189 DOI: 10.1016/j.jcms.2024.01.005] [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: 12/20/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 03/07/2024] Open
Abstract
The research purpose is to review the surgical approach and evaluate the results in adult patients with head and neck sarcomas. The histopathology varied, including two leiomyosarcomas, six malignant fibrous histiocytomas, two malignant peripheral nerve sheath tumors, four dermatofibrosarcomas protuberans, three osteosarcomas, two angiosarcomas, one liposarcoma, one Ewing sarcoma, one synovial sarcoma, two unclassified/non-differentiated sarcomas and one solitary fibrous tumor. Surgical resection included maxillectomy, mandibulectomy, craniectomy, parotidectomy, scalp resection, face skin resection and laminectomy. The reconstruction was performed with one rectus abdominis flap, four radial forearm flaps, two latissimus dorsi flaps, two vascularized fibula flaps, two pectoralis major myocutaneous flaps, two trapezius flaps, two temporalis flaps, seven scalp flaps and two nasolabial flaps. The total patient number was 24. The hospitalization was uncomplicated, followed by postoperative radiotherapy in the majority of cases. In a mean 15-year follow-up period, 11 patients are still alive and disease-free. There were four recurrences treated with palliative radiotherapy. The surgical approach for head and neck sarcomas, including the achievement of a functionally acceptable result by organ sparing techniques, remains challenging. Wide resection combined with the appropriate reconstruction, particularly with microsurgical techniques, and followed by adjuvant radiotherapy or chemotherapy offer improved prognosis and quality of life.
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Affiliation(s)
- Aikaterini Bini
- Plastic and Reconstructive Surgery Department, Athens General Anticancer - Oncology Hospital "Aghios Savvas", 171 Alexandras Ave, 11522, Athens, Greece.
| | - Spyridoula Derka
- Plastic and Reconstructive Surgery Department, Athens General Anticancer - Oncology Hospital "Aghios Savvas", 171 Alexandras Ave, 11522, Athens, Greece.
| | - Spyridon Stavrianos
- Plastic and Reconstructive Surgery Department, Athens General Anticancer - Oncology Hospital "Aghios Savvas", 171 Alexandras Ave, 11522, Athens, Greece.
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Guberina M, Guberina N, Hoffmann C, Gogishvili A, Freisleben F, Herz A, Hlouschek J, Gauler T, Lang S, Stähr K, Höing B, Pöttgen C, Indenkämpen F, Santiago A, Khouya A, Mattheis S, Stuschke M. Prospects for online adaptive radiation therapy (ART) for head and neck cancer. Radiat Oncol 2024; 19:4. [PMID: 38191400 PMCID: PMC10775598 DOI: 10.1186/s13014-023-02390-6] [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: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The aim of the present study is to examine the impact of kV-CBCT-based online adaptive radiation therapy (ART) on dosimetric parameters in comparison to image-guided-radiotherapy (IGRT) in consecutive patients with tumors in the head and neck region from a prospective registry. METHODS The study comprises all consecutive patients with tumors in the head and neck area who were treated with kV-CBCT-based online ART or IGRT-modus at the linear-accelerator ETHOS™. As a measure of effectiveness, the equivalent-uniform-dose was calculated for the CTV (EUDCTV) and organs-at-risk (EUDOAR) and normalized to the prescribed dose. As an important determinant for the need of ART the interfractional shifts of anatomic landmarks related to the tongue were analyzed and compared to the intrafractional shifts. The latter determine the performance of the adapted dose distribution on the verification CBCT2 postadaptation. RESULTS Altogether 59 consecutive patients with tumors in the head-and-neck-area were treated from 01.12.2021 to 31.01.2023. Ten of all 59 patients (10/59; 16.9%) received at least one phase within a treatment course with ART. Of 46 fractions in the adaptive mode, irradiation was conducted in 65.2% of fractions with the adaptive-plan, the scheduled-plan in the remaining. The dispersion of the distributions of EUDCTV-values from the 46 dose fractions differed significantly between the scheduled and adaptive plans (Ansari-Bradley-Test, p = 0.0158). Thus, the 2.5th percentile of the EUDCTV-values by the adaptive plans amounted 97.1% (95% CI 96.6-99.5%) and by the scheduled plans 78.1% (95% CI 61.8-88.7%). While the EUDCTV for the accumulated dose distributions stayed above 95% at PTV-margins of ≥ 3 mm for all 8 analyzed treatment phases the scheduled plans did for margins ≥ 5 mm. The intrafractional anatomic shifts of all 8 measured anatomic landmarks were smaller than the interfractional with overall median values of 8.5 mm and 5.5 mm (p < 0.0001 for five and p < 0.05 for all parameters, pairwise comparisons, signed-rank-test). The EUDOAR-values for the larynx and the parotid gland were significantly lower for the adaptive compared with the scheduled plans (Wilcoxon-test, p < 0.001). CONCLUSIONS The mobile tongue and tongue base showed considerable interfractional variations. While PTV-margins of 5 mm were sufficient for IGRT, ART showed the potential of decreasing PTV-margins and spare dose to the organs-at-risk.
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Affiliation(s)
- Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
| | - C Hoffmann
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Gogishvili
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - F Freisleben
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Herz
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - J Hlouschek
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - T Gauler
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - K Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - B Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - C Pöttgen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - F Indenkämpen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Santiago
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Khouya
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - M Stuschke
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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Gaffney J, Ramzan A, Dinizulu T, Maley C, Onamusi O, Motamedi-Ghahfarokhi G, Price G, Metcalf R, Garcez K, Hughes C, Lee L, Thomson D, Price J, Jain Y, McPartlin A. Association of follow-up imaging frequency with temporal incidence and patterns of distant failure following (chemo) radiotherapy for HPV related oropharyngeal cancer. Oral Oncol 2024; 148:106645. [PMID: 37992488 DOI: 10.1016/j.oraloncology.2023.106645] [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: 07/24/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Emerging data supports radical intent therapy for oligometastatic (OM) relapsed human papilloma virus (HPV+) related oropharyngeal cancer (OPC). We assess the association of follow-up imaging frequency amongst HPV + OPC, with temporal and spatial patterns of distant relapse, to inform rationalisation of routine post-treatment imaging. MATERIALS AND METHODS A retrospective single centre cohort study was carried out of consecutive HPV + OPC patients treated with radical intent (chemo)radiotherapy ((CT)RT) between 2011 and 2019. OM state was defined as ≤ 5 metastasis, none larger than 3 cm (OMs) or, if interval from last negative surveillance imaging > 6-months, then ≤ 10 metastasis, none larger than 5 cm, (OMp). Patients not meeting OMs / OMp criteria were deemed to have incurable diffuse metastatic disease (DMdiffuse). RESULTS 793 HPV-OPC patients were identified with median follow-up 3.15years (range 0.2-8.9). 52 (6.6 %) patients had radiologically identified DM at first failure and were considered for analysis. The median time to recurrence was 15.1 months (range: 2.6-63 months). 87 % of distant metastasis (DM) occurred in the first two years after treatment. Twenty-seven (52 %) patients had OM (OMs or OMp) at time of failure, with 31 % having OMs. The median time from completion of treatment to diagnosis of DMdiffuse vs OM was 22.2 months (range: 2.6-63.1 months) vs 11.6 months (range: 3.5-32.5 months). The probability of being diagnosed with OM vs DMdiffuse increased with reducing interval from last negative surveillance scan to imaging identifying DM (≤6 months 88.9 %, 7-12 months 71.4 %, 13-24 months 35 %, > 24 months 22.2 %). CONCLUSION We demonstrate that a reduced interval between last negative imaging and subsequent radiological diagnosis of DM is associated with increased likelihood of identification of OM disease. Consideration of increased frequency of surveillance imaging during the first two years of follow up is supported, particularly for patients at high risk of distant failure.
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Affiliation(s)
- John Gaffney
- The Christie NHS Foundation Trust, Manchester, UK.
| | | | | | | | | | | | - Gareth Price
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | | | - Kate Garcez
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Lip Lee
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - James Price
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - Yatin Jain
- The Christie NHS Foundation Trust, Manchester, UK
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Amstutz F, Krcek R, Bachtiary B, Weber DC, Lomax AJ, Unkelbach J, Zhang Y. Treatment planning comparison for head and neck cancer between photon, proton, and combined proton-photon therapy - From a fixed beam line to an arc. Radiother Oncol 2024; 190:109973. [PMID: 37913953 DOI: 10.1016/j.radonc.2023.109973] [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: 01/11/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND PURPOSE This study investigates whether combined proton-photon therapy (CPPT) improves treatment plan quality compared to single-modality intensity-modulated radiation therapy (IMRT) or intensity-modulated proton therapy (IMPT) for head and neck cancer (HNC) patients. Different proton beam arrangements for CPPT and IMPT are compared, which could be of specific interest concerning potential future upright-positioned treatments. Furthermore, it is evaluated if CPPT benefits remain under inter-fractional anatomical changes for HNC treatments. MATERIAL AND METHODS Five HNC patients with a planning CT and multiple (4-7) repeated CTs were studied. CPPT with simultaneously optimized photon and proton fluence, single-modality IMPT, and IMRT treatment plans were optimized on the planning CT and then recalculated and reoptimized on each repeated CT. For CPPT and IMPT, plans with different degrees of freedom for the proton beams were optimized. Fixed horizontal proton beam line (FHB), gantry-like, and arc-like plans were compared. RESULTS The target coverage for CPPT without adaptation is insufficient (average V95%=88.4 %), while adapted plans can recover the initial treatment plan quality for target (average V95%=95.5 %) and organs-at-risk. CPPT with increased proton beam flexibility increases plan quality and reduces normal tissue complication probability of Xerostomia and Dysphagia. On average, Xerostomia NTCP reductions compared to IMRT are -2.7 %/-3.4 %/-5.0 % for CPPT FHB/CPPT Gantry/CPPT Arc. The differences for IMPT FHB/IMPT Gantry/IMPT Arc are + 0.8 %/-0.9 %/-4.3 %. CONCLUSION CPPT for HNC needs adaptive treatments. Increasing proton beam flexibility in CPPT, either by using a gantry or an upright-positioned patient, improves treatment plan quality. However, the photon component is substantially reduced, therefore, the balance between improved plan quality and costs must be further determined.
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Affiliation(s)
- Florian Amstutz
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | - Reinhardt Krcek
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | - Jan Unkelbach
- Department of Radiation Oncology, University Hospital Zurich, Switzerland
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland.
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Modi N, Shah I, Shah P, Bhatt C, Jain A. Tuberculosis of head and neck region, our experience at a tertiary care center in Gujarat. Indian J Tuberc 2024; 71:27-29. [PMID: 38296386 DOI: 10.1016/j.ijtb.2023.03.006] [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: 06/22/2022] [Accepted: 03/15/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Head and neck lesions of tuberculosis, though not uncommon are often difficult to diagnose and require a unique management protocol. These lesions are often misdiagnosed as bacterial infections, malignancies or other granulomatous diseases. Hence in our study we endeavor to gain a better understanding of the diagnostic and management protocols of tuberculosis in otorhinolaryngology. METHODS We have performed an observational study at our institute, the patient's details were obtained from patient record forms and noted in a standard proforma. Results were calculated as percentage and Chi square analysis was performed. RESULTS We found cervical tuberculous lymphadenitis to be the most common manifestation 76.97%, with a significant association with pulmonary tuberculosis. Neck swelling was the most common presenting complaint, 65.35%. 26-50 years of age was the most commonly involved age group. CONCLUSION FNAC, PCR and histopathology are the modalities for bacteriological diagnosis for tuberculosis of Head and Neck. Anti-tuberculous therapy is uniformly found to be useful in all the patients, with surgical intervention used as and when required.
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Affiliation(s)
- Niral Modi
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India
| | - Ishita Shah
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India.
| | - Priyanshi Shah
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India
| | - Chandni Bhatt
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India
| | - Apoorva Jain
- Department of E.N.T., G.G. Hospital, Jamnagar, Gujarat, India
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Mohamed AS, Martin GV, Ng SP, Takiar V, Beadle BM, Zafereo M, Garden AS, Frank SJ, David Fuller C, Brandon Gunn G, Morrison WH, Rosenthal DI, Reddy J, Moreno A, Lee A, Phan J. Patterns of failure for recurrent head and neck squamous cell carcinoma treated with salvage surgery and postoperative IMRT reirradiation. Clin Transl Radiat Oncol 2024; 44:100700. [PMID: 38058404 PMCID: PMC10695834 DOI: 10.1016/j.ctro.2023.100700] [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: 05/18/2023] [Revised: 10/21/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose/Objectives The purpose of this study was to evaluate patterns of locoregional recurrence (LRR) after surgical salvage and adjuvant reirradiation with IMRT for recurrent head and neck squamous cell cancer (HNSCC). Materials/Methods Patterns of LRR for 61 patients treated consecutively between 2003 and 2014 who received post-operative IMRT reirradiation to ≥ 60 Gy for recurrent HNSCC were determined by 2 methods: 1) physician classification via visual comparison of post-radiotherapy imaging to reirradiation plans; and 2) using deformable image registration (DIR). Those without evaluable CT planning image data were excluded. All recurrences were verified by biopsy or radiological progression. Failures were defined as in-field, marginal, or out-of-field. Logistic regression analyses were performed to identify predictors for LRR. Results A total of 55 patients were eligible for analysis and 23 (42 %) had documented LRR after reirradiation. Location of recurrent disease prior to salvage surgery (lymphatic vs. mucosal) was the most significant predictor of LRR after post-operative reirradiation with salvage rate of 67 % for lymphatic vs. 33 % for mucosal sites (p = 0.037). Physician classification of LRR yielded 14 (61 %) in-field failures, 3 (13 %) marginal failures, and 6 (26 %) out-of-field failures, while DIR yielded 10 (44 %) in-field failures, 4 (17 %) marginal failures, and 9 (39 %) out-of-field failures. Most failures (57 %) occurred within the original site of recurrence or first echelon lymphatic drainage. Of patients who had a free flap placed during salvage surgery, 56 % of failures occurred within 1 cm of the surgical flap. Conclusion Our study highlights the role of DIR in enhancing the accuracy and consistency of POF analysis. Compared to traditional visual inspection, DIR reduces interobserver variability and provides more nuanced insights into dose-specific and spatial parameters of locoregional recurrences. Additionally, the study identifies the location of the initial recurrence as a key predictor of subsequent locoregional recurrence after salvage surgery and re-IMRT.
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Affiliation(s)
- Abdallah S.R. Mohamed
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Geoffrey V. Martin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, Austin Health, Melbourne, Australia
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, OH, USA
| | - Beth M. Beadle
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S. Garden
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J. Frank
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - C. David Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - G. Brandon Gunn
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - William H. Morrison
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - David I. Rosenthal
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jay Reddy
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Moreno
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Lee
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Evans J, Chang C, Jones C, Anderson I, Berner JE, Crowley TP, Ragbir M. Clinical characteristics and treatment outcomes of angiosarcoma of the head and neck: A 17-year single-centre experience. J Plast Reconstr Aesthet Surg 2024; 88:452-456. [PMID: 38091688 DOI: 10.1016/j.bjps.2023.11.039] [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: 08/17/2023] [Revised: 11/05/2023] [Accepted: 11/26/2023] [Indexed: 01/02/2024]
Abstract
INTRODUCTION Angiosarcomas in the head and neck region are aggressive tumours associated with high local recurrence and metastatic rates. We present our 17-year experience at the North of England Bone and Soft Tissue Tumour Service. METHODS A retrospective review of our prospectively maintained database was undertaken, looking for patients diagnosed with angiosarcomas affecting the head and neck. Data were gathered using a pre-defined proforma to include demographics, histological characteristics, treatment modalities, adjuvant therapies, local recurrence, distant spread, and disease-specific survival. RESULTS A total of 23 patients (17 males, 6 females) were identified, with a mean age of 76 years at presentation. Fourteen presented with scalp lesions, whereas the remainder arose on the face. Eighteen patients underwent resection with curative intent, whereas three received palliative radiotherapy and two received comfort-based care only. Of the patients undergoing surgery, 12 had local flap reconstruction and 6 underwent free tissue transfer. Clear resection margins were obtained in nine cases (50%). Fourteen patients (78%) presented with local recurrence after surgery, and 11 (61%) developed distant metastases. The median disease-specific survival time for patients treated with curative intent was 38 months. Eight patients had mapping biopsies ahead of their resection; however, complete resection was achieved in only two cases. DISCUSSION Angiosarcomas of the head and neck are associated with a poor prognosis, with most patients rapidly developing local recurrence, resulting in adverse clinical outcomes. Mapping biopsies do not demonstrate a clear advantage for achieving complete surgical resection. A radical surgical approach is warranted, given the aggressiveness of the pathology. However, there remains no consensus on optimal surgical management; we recommend further synthesising studies to determine the most appropriate treatment pathway.
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Affiliation(s)
- Jonathan Evans
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Chad Chang
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Christopher Jones
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Iain Anderson
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Juan Enrique Berner
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Michael AI, Ugwu EO, Olawoye OA, Ademola SA, Oluwatosin OM. Presentation, Clinical Outcome, and Quality of Life of Patients Treated for Head and Neck Skin Cancer at the University College Hospital, Ibadan. J West Afr Coll Surg 2024; 14:63-68. [PMID: 38486655 PMCID: PMC10936885 DOI: 10.4103/jwas.jwas_67_23] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/22/2023] [Indexed: 03/17/2024]
Abstract
Introduction Patients with head and neck skin cancer experience adverse functional, psychosocial, and financial impacts as a result of the disease and/or its treatment. This study aimed at evaluating the pattern of presentation, clinical outcomes, and quality of life of patients with head and neck skin cancer. Materials and Methods A retrospective cross-sectional study of patients with head and neck skin cancer presenting to the Department of Plastic, Reconstructive & Aesthetic Surgery of the University College Hospital, Ibadan, from January 2017 to December 2021. Data obtained from the clinical records included sociodemographic characteristics, clinical and surgical details, as well as clinical outcomes. Quality of life was assessed using EORTC QLQ-C30 questionnaires. Data were summarized using descriptive statistics. Results Nineteen patients were reviewed with a median age of 38 years (ranging from 18 to 85 years) and a male-to-female ratio of 1:1.4. Eight (42.1%) of the patients were albinos. Squamous cell carcinoma was the predominant histologic type (63.2%), while the scalp was the commonest location (42.1%). Only one patient (5.3%) presented with metastatic disease. A greater percentage of treated patients, eight (61.5%), had surgery as the only treatment modality. After a mean follow-up period of 33 months, a recurrence rate of 10.5% (two patients) and a mortality rate of 15.8% (three patients) were recorded. Quality of life assessment revealed an adverse financial impact of the disease on our patients. Conclusion Although albinism is a recognized risk factor for skin cancers, head and neck skin cancers can occur in the dark-skinned.
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Affiliation(s)
- Afieharo I Michael
- Department of Plastic, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ebere O Ugwu
- Department of Plastic, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria
| | - Olayinka A Olawoye
- Department of Plastic, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Samuel A Ademola
- Department of Plastic, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Odunayo M Oluwatosin
- Department of Plastic, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Noy R, Shkedy Y, Habashi N, Billan S, Cohen J. Oncological outcomes and failure patterns of laser cordectomy in recurrent glottic cancer. Am J Otolaryngol 2024; 45:104109. [PMID: 37948822 DOI: 10.1016/j.amjoto.2023.104109] [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: 08/23/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Laser cordectomy is a widely accepted treatment modality for selected cases of early glottic cancers, but its role as a salvage treatment remains unclear. We aimed to investigate the oncological outcomes and failure patterns of salvage cordectomy. MATERIALS AND METHODS This was a retrospective cohort study of patients who underwent cordectomy for early glottic cancer between 2013 and 2022 at a tertiary referral center. The main outcome measures were overall survival, larynx-preservation rate, tracheostomy dependency rate, and disease-free survival. RESULTS A total of 142 patients (mean age: 63 years, interquartile range [IQR]: 45-72, 123[86.9 %] males) were analyzed. There were 38 (26.8 %) recurrences after a mean of 22 months (IQR: 17-26). Among them, 25 (17.6 %) underwent salvage cordectomy, while 13 (9.1 %) received other salvage treatments (11[7.7 %] (chemo)radiotherapy and 2[1.4 %] total laryngectomy). In comparison to the other salvage treatments, salvage cordectomy demonstrated lower tracheostomy rates (0 vs. 31 %, p = 0.05), comparable 5-year disease-free survival (62 % vs. 54 %, p = 0.4), higher 5-year larynx preservation rate (92 % vs. 54 %, p = 0.02), and improved 5-year overall survival rate (84 % vs. 62 %, p = 0.01). Factors associated with salvage cordectomy failure were age >60 years (odds ratio [OR]: 1.3, 95 % confidence interval [CI]: 1.15-1.53), smoking continuation (OR: 3.73, 95 % CI: 3.5-4.4), heavy smoking (OR: 1.24, 95 % CI:1.07-2.15), and pT1b + (OR: 2.26, 95 % CI: 2.1-2.9). CONCLUSIONS Salvage cordectomy offers favorable larynx preservation rates and oncological outcomes for recurrent disease amenable to conservative surgery. Smoking, advanced age, and advanced tumor stages are associated with salvage cordectomy failure.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nadeem Habashi
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Salem Billan
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Oncology Radiation Division, Rambam Health Care Campus, Haifa, Israel.
| | - Jacob Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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陈 超, 刘 云, 徐 加, 姜 献, 郑 传, 葛 明, 程 康. [Accurate tissue flap reconstruction method based on the quadratic surface developability for head and neck soft tissue defects]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2023; 40:1175-1184. [PMID: 38151941 PMCID: PMC10753305 DOI: 10.7507/1001-5515.202305011] [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] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/31/2023] [Indexed: 12/29/2023]
Abstract
Soft tissue defects resulting from head and neck tumor resection seriously impact the physical appearance and psychological well-being of patients. The complex curvature of the human head and neck poses a formidable challenge for maxillofacial surgeons to achieve precise aesthetic and functional restoration after surgery. To this end, a normal head and neck volunteer was selected as the subject of investigation. Employing Gaussian curvature analysis, combined with mechanical constraints and principal curvature analysis methods of soft tissue clinical treatment, a precise developable/non-developable area partition map of the head and neck surface was obtained, and a non-developable surface was constructed. Subsequently, a digital design method was proposed for the repair of head and neck soft tissue defects, and an in vitro simulated surgery experiment was conducted. Clinical verification was performed on a patient with tonsil tumor, and the results demonstrated that digital technology-designed flaps improved the accuracy and aesthetic outcome of head and neck soft tissue defect repair surgery. This study validates the feasibility of digital precision repair technology for soft tissue defects after head and neck tumor resection, which effectively assists surgeons in achieving precise flap transplantation reconstruction and improves patients' postoperative satisfaction.
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Affiliation(s)
- 超 陈
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术教育部/浙江省重点实验室(杭州 310023)Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术国家级国际联合研究中心(杭州 310023)National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 云峰 刘
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术教育部/浙江省重点实验室(杭州 310023)Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术国家级国际联合研究中心(杭州 310023)National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 加杰 徐
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 献峰 姜
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术教育部/浙江省重点实验室(杭州 310023)Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 传铭 郑
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 明华 葛
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 康杰 程
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术教育部/浙江省重点实验室(杭州 310023)Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术国家级国际联合研究中心(杭州 310023)National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, P. R. China
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