Oral oncology最新文献

Background: Depth of invasion (DOI) significantly influences prognosis and treatment strategies in oral squamous cell carcinoma (OSCC). Accurate preoperative imaging, such as contrast-enhanced computed tomography (CECT), alongside postoperative histopathological evaluations, aids in determining DOI. This study evaluates the correlation between radiological DOI (rDOI), macroscopic DOI (PDOI), and microscopic DOI (pDOI) in OSCC.

Methods: This study included 54 OSCC patients from April 2022 to November 2023. rDOI was assessed using preoperative CECT, while PDOI and pDOI were measured through histopathological examination of resected specimens. Spearman correlation analysis and Bland-Altman plots assessed agreement between DOI measurements, with statistical significance set at p < 0.05.

Results: Strong correlations were found between rDOI and PDOI (r = 0.713), rDOI and pDOI (r = 0.688), and PDOI and pDOI (r = 0.897, p < 0.001 for all). CECT overestimated DOI in T1 and T2 lesions, particularly in ulcerative tumors. Bland-Altman analysis showed mean differences of 1.86 mm (rDOI-PDOI) and 3.3 mm (rDOI-pDOI). Higher correlations were observed in the presence of perineural invasion (PNI), lymphovascular invasion (LVI), and worst pattern of invasion 5 (WPOI 5), with r values up to 0.948 (rDOI-PDOI) and 0.980 (PDOI-pDOI).

Conclusion: While rDOI correlates strongly with pathological DOI, overestimations in smaller and ulcerative lesions necessitate cautious interpretation. Pathological risk factors, including PNI, LVI, and WPOI 5, were associated with greater DOI and enhanced agreement between radiological and pathological assessments. Overall, CECT is a reliable tool for preoperative evaluation of DOI.

Objectives: Osteoradionecrosis (ORN) following radiation therapy (RT) is a serious complication for patients undergoing head and neck cancer treatment. Recent literature has found an association between ipsilateral external carotid artery (ECA) diameter and the development of ORN. This study evaluates microvascular free-flap arterial anastomosis diameter and the development of ORN.

Materials and methods: Sixty-six patients underwent fibular free-flap reconstruction followed by RT between 2012-2019 at the University of Florida. Anastomosis and ECA diameters pre- and post-RT were measured from computed tomography images. Multivariate regression analysis identified significant factors in the development of ORN.

Results: Incidence of ORN was 33.3 % (N = 22/66). Mean post-RT anastomosis diameters were 2.3 and 2.2 for the ORN group and no-ORN group, respectively (p = 0.548). Mean post-RT ipsilateral ECA diameters were 4.7 and 4.2 for the ORN group and no-ORN groups, respectively (p = 0.040). The change in pre-RT versus post-RT ipsilateral ECA diameters was different in patients with RT dose above and below 55 Gy (p = 0.041). Neither post-RT anastomosis (OR = 1.78, 95% CI: 0.43, 8.65, p = 0.434), nor ECA (OR = 1.44, 95% CI: 0.78, 2.83, p = 0.250) diameters were associated with development of ORN while controlling RT dose (OR = 1.15, 95% CI: 1.04, 1.28, p = 0.006), post-operative fistula (OR = 9.11, 95% CI: 1.65, 93.7, p = 0.010), and post-operative infection (OR = 3.48. 95% CI = 1.01, 12.7, p = 0.048), and CCI (OR = 0.61, 95 % CI: 0.36, 0.96, p = 0.031).

Conclusion: A higher degree of narrowing in ipsilateral ECA following RT may be linked to development of ORN. RT doses ≥ 55 Gy were associated with a high risk of ORN.

Objectives: This study aimed to develop a prediction model for feeding tube dependence in a large homogenous cohort of HPV-associated oropharyngeal squamous cell carcinoma (HPV + OPSCC) patients receiving chemoradiotherapy (CRT). We further aimed to externally validate three previously published feeding tube prediction models on this cohort.

Materials and methods: p16-confirmed HPV + OPSCC patients treated with definitive CRT at a tertiary cancer centre between April 2017 and February 2022 were identified. The primary endpoint was G-tube dependence, defined as enteral feeding for ≥ 4 weeks following CRT. Clinical and dosimetric data were extracted from electronic patient records. Multivariable analyses (MVA) assessed the associations of potential predictors with G-tube dependence. The discriminatory performance of three previously published models was assessed on this cohort using the area under the receiver operating curve (AUC), and calibration was evaluated with calibration plots.

Results: A total of 291 patients were included (TNM8 stage I: 129; II:67; III: 95). MVA identified Dmean to the superior pharyngeal constrictor muscle, D70% to the middle pharyngeal constrictor muscle, and modified diet texture at baseline as predictive for G-tube dependence, with the AUC of 0.68. External validation of three existing models yielded an AUC of 0.60, 0.63, and 0.67, with no evidence of good calibration.

Conclusion: Despite a sizable cohort and comprehensive capture of dosimetric information, our prediction model, and external validation of previously published models, showed moderate performance. This suggests that additional factors beyond disease and treatment may need to be considered in future models to refine nutrition support decisions.

Objective: This trial was aimed at investigating the effects of progressive functional training on hip mobility, lower-limb stability, quality of life, and hip complications in patients who have undergone jaw defect reconstruction using vascularized iliac flaps.

Methods: Patients who underwent reconstruction surgery with vascularized iliac flaps were randomly divided into control and training groups. The control group, according to routine nursing practice, only received activity and safety guidance after the operation. The training group received progressive functional training for functional exercise. The primary outcomes were donor area function-Harris hip score and the timed "Up and Go" test. Secondary outcomes were patients' quality of life, the hip visual analog scale, and other complications. Observations and evaluations were performed before the surgery and on postoperative day 7 and at months 1, 3, 6, and 12.

Results: The donor area function and quality of life of the patients in the training group were significantly improved at 1, 3, 6, and 12 months after surgery, and the differences were statistically significant. The load-dependent pain in the training group was significantly reduced compared with that in the control group. The incidence rates of gait disturbance at postoperative months 3, and 6 in the training group were significantly lower than the corresponding rates in the control group (P < 0.05).

Conclusion: Progressive functional training can accelerate the restoration of hip function and stability of lower-limb movement, alleviate gait disorders, relieve pain, and improve patients' quality of life.

Background: The feasibility and outcomes of neoadjuvant doublet chemotherapy with cisplatin and docetaxel followed by surgical resection of residual disease (NAC + S) for patients with newly diagnosed, resectable p16 positive (+) oropharyngeal squamous cell carcinoma (OPSCC) has been reported from a single institution. Here, we report pathologic responses, need for adjuvant treatment and recurrence-free survival (RFS) following this treatment from a second large academic institution.

Methods: A retrospective cohort study of patients with p16 + OPSCC receiving NAC + S and risk-adjusted adjuvant treatment between January 2017 and March 2024 was performed.

Results: Of the 76 patients who met the inclusion criteria, 43 (57%) patients developed clinical-to-pathologic downstaging; all remaining patients had clinical and pathologic stage I disease (AJCC 8th). Thirty-seven (49%) patients experienced complete pathologic response (pCR). Sixty-four (89%) patients avoided adjuvant treatment. Two-year overall survival (OS) and RFS were 93.7% and 75.4%, respectively. Development of a pCR did not statistically associate with improved RFS, but only 8 patients developed disease relapse. Of the 8 (11%) patients that recurred, 3 had developed a pCR and 5 had not.

Conclusions: Using risk-adjusted criteria from pathologic analysis, a high proportion of patients with newly diagnosed, resectable p16 + OPSCC appear to be able to avoid adjuvant treatment following the NAC + S treatment regimen without sacrificing disease control. Prospective clinical study of the NAC + S treatment strategy with clearly defined inclusion and adjuvant treatment criteria is warranted to determine whether this approach strategy can be safely offered to patients that wish to minimize the need for adjuvant radiation.

Background: There are significant racial disparities in head and neck cancer (HNC) outcomes. Racial differences in survival may be explained by differential access to high-quality care. The goal of this study was to evaluate the association of race and ethnicity with the quality of the treating hospital, and receipt of guideline-compliant care among HNC patients.

Methods: Retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics. The study cohort included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Outcome measures included the quality of treating hospital, and NCCN guideline-compliant care.

Results: Black (OR 0.76, 95 % CI 0.67 to 0.85) and Hispanic (OR 0.68, 95 % CI 0.63 to 0.74) patients were less likely to be treated in top-quality hospitals compared with non-Hispanic White patients, after adjusting for demographic, and clinical factors. This association disappeared for Black patients, but persisted for Hispanic patients, after additionally adjusting for socioeconomic status and insurance status. Black patients with advanced-stage disease were less likely to be treated with dual-modality therapy (OR 0.82, 95 % CI 0.70 to 0.96), however, this association disappeared after adjusting for demographic, and clinical factors, and hospital quality.

Conclusion: There are significant racial and ethnic disparities in quality of care for patients with HNC. Our findings suggest that differential access to high-quality care may account for some of the racial disparities in HNC survival, and highlight the need for continued investigation into the drivers of racial disparities in HNC outcomes.