Head and Neck-Journal for the Sciences and Specialties of the Head and Neck最新文献

Background: Adenoid cystic carcinoma (ACC) is a slow-growing tumor with variable outcomes, making follow-up protocols challenging. This review analyzed outcomes in ACC, focusing on patterns and factors related to adverse prognoses.

Methods: A search was conducted on March 25, 2024, in MEDLINE, PubMed, Scopus, and EMBASE. Studies analyzing ACC survival were included, while those lacking these data or focusing on a single ACC site were excluded. The Joanna Briggs Institute's Critical Appraisal tool was used to assess the risk of bias, and the metanalysis was performed using R software.

Results: Among 57 studies (17 497 patients), ACC predominantly affected women (mean age: 52.69 years) and occurred mainly in minor salivary glands. Distant metastasis was the most frequent adverse outcome, occurring at 34.8 months on average. Locoregional metastasis and local recurrence occurred at 27.5 and 31.3 months, respectively. Five-, 10-, 15-, and 20-year survival rates were 73.8%, 48.5%, 42.3%, and 26.5%, respectively. Poor survival predictors included advanced T stage, positive lymph nodes, solid tumors, distant metastasis, and positive surgical margins.

Conclusions: Distant metastasis is the most frequent adverse outcome in ACC, and prognostic factors are related to advanced and residual tumors.

Background: The traditional radial forearm free flap (TRFFF) combined with split-thickness skin grafting (STSG) for repairing oral defects presents unavoidable donor area complications, such as delayed healing and scar hyperplasia. This study introduces a modified radial forearm free flap, known as the butterfly flap, which enables primary closure of the forearm donor area.

Methods: The study included 35 patients who received the butterfly flap and 40 patients who received TRFFF combined with STSG between March 2022 and March 2024. We compared subjective evaluations of postoperative pain and scar degree in the donor area as well as objective assessments of preoperative and postoperative grip strength, key pinch strength, and postoperative donor area complications between the two groups.

Results: The delayed wound healing rate was 5.7% (2/35) in the butterfly flap group and 25.0% (10/40) in the TRFFF group, with a significant difference between the two groups (p = 0.023). The postoperative scar score of the donor site in the butterfly flap group was significantly lower than that in the TRFFF group (5.57 ± 1.24 vs. 7.10 ± 1.24, p < 0.05). No significant differences were observed in pain severity scores, incidence of other donor complications, and changes in grip and key pinch strength.

Conclusion: The radial forearm butterfly flap can directly close the donor area wound without skin grafting, reducing scar formation and the delayed healing rate of the donor area.

Background: Literature about ocular toxicity after head and neck cancer (HNC) treatment is scarce. This study aimed to describe visual function and ocular symptoms among HNC patients.

Methods: The study used a cross-sectional design. Two surveys, The National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) and an Ocular Symptom Scale, were sent to participants via e-mail. Descriptive statistics were used to describe the sample in the vision change and non-vision change groups. Chi-square and t-tests were used to compare groups.

Results: Of the 485 HNC patients emailed, 126 responded to the survey (26%). Of those, 114 completed the surveys. The scores of NEI-VFQ were significantly lower in the vision change group than in the non-vision change group (p < 0.001). Similarly, all ocular symptoms were significantly different between the two groups (p < 0.05).

Conclusions: These findings and a scarcity of literature suggest that vision screening after HNC treatment is warranted.

Background: Paraganglioma (PGL) is a rare neuroendocrine tumor. In the head and neck region, surgical resection of PGL is extremely difficult due to its proximity to many vital blood vessels, nerves, and organs. There is still some controversy about whether preoperative embolization is salutary.

Methods: We present a case of a giant left common carotid artery PGL with nodular goiter, which needs surgical resection combined with interventional and endovascular treatments.

Results: The patient recovered well after the operation without vascular and nerve injury complications. His chest tightness and dysphagia also resolved after the surgery.

Conclusions: This case highlights the importance and effectiveness of interventional and endovascular treatments in complex head and neck PGL (HNPGL), particularly in cases involving important blood vessels and organs.

Purpose: Hypercalcemia is the most common metabolic disorder in cancer, affecting 10%-20% of patients with advanced malignancies, including squamous cell carcinoma of the head and neck (HNSCC), though its prognostic significance remains poorly studied. This study aimed to evaluate the prognostic impact of hypercalcemia at diagnosis in patients with locally advanced or metastatic HNSCC and to explore underlying mechanisms and treatment options.

Methods: We conducted a bicentric, retrospective analysis of patients diagnosed between 2015 and 2021, including those with locally advanced or metastatic HNSCC undergoing chemotherapy. Hypercalcemia at diagnosis was defined as an albumin-corrected serum calcium level > 2.6 mmol/L, equivalent to 10.4 mg/dL. The primary outcome was overall survival (OS), compared between hypercalcemic and non-hypercalcemic patients using multivariate analysis. Progression-free survival (PFS), along with clinical, biological, and therapeutic characteristics were also evaluated.

Results: The study included 286 HNSCC patients, 225 (78.7%) of whom were male. Hypercalcemia incidence was 17.8%. The median OS for the cohort was 7.9 months (95% CI = 6.8-10.6). Hypercalcemic patients had a median OS of 5.9 months (95% CI = 3.8-7.9), compared to 9.1 months (95% CI = 7.3-11.7) in non-hypercalcemic patients (p = 0.002). In multivariate analysis, hypercalcemia was associated with worse OS (HR = 1.73, 95% CI = 1.17-2.56, p = 0.006). Median PFS was 4.3 months (95% CI = 3.6-5.5) for all patients. Hypercalcemic patients had a significantly shorter PFS of 2.4 months (95% CI = 1.9-4.8) compared to 4.7 months (95% CI = 3.8-5.9) in non-hypercalcemic patients (p = 0.0025). Multivariate analysis identified hypercalcemia and oral cavity tumors as negative prognostic factors, with HRs of 1.76 and 1.86, respectively. Bone metastasis rates were similar (17.6% vs. 16.2%), but local osteolysis was significantly higher in hypercalcemic patients (54.1% vs. 27.2%, p = 0.003). Bisphosphonates were administered to 38% of hypercalcemic patients.

Conclusion: In this study, hypercalcemia was an independent negative prognostic factor of survival and rapid progression in patients with locally advanced or metastatic HNSCC.

Background: The influence of COVID-19 vaccination before chemoradiotherapy on nonmetastatic nasopharyngeal carcinoma (NPC) is not known.

Methods: Propensity score matching was used to minimize potential selection bias between groups. Primary endpoints were treatment-related adverse events (TRAEs). The Kaplan-Meier method and Cox proportional hazards models were performed to conduct survival analysis. The Benjamini-Hochberg false discovery rate control procedure was used to adjust for multiple comparisons.

Results: Eight hundred ninety-three patients with newly diagnosed nonmetastatic NPC were enrolled. On propensity score matching analysis, the vaccinated group exhibited a higher prevalence of neutropenia (p = 0.045) and fatigue (p = 0.010) during induction chemotherapy and a higher prevalence of fatigue (p = 0.015) during radiotherapy after adjustment for multiple comparisons. No significant differences were observed in 2-year OS, PFS, DMFS, and LRRFS in matched groups. Additionally, vaccinated patients exhibited a high and comparable absolute lymphocyte count.

Conclusions: COVID-19 vaccination before chemoradiotherapy increases the prevalence of acute TRAEs, while no significant influence is observed on the oncologic outcomes of patients with nonmetastatic NPC.

Background and purpose: Full-dose postoperative external beam radiation therapy (EBRT)/chemoradiation is the standard of care in patients with resected, unirradiated head and neck cancer (HNC). This study aims to determine the long-term results of adjuvant high-dose rate (HDR) brachytherapy ± intermediate-dose postoperative external beam radiation therapy (EBRT)/chemoradiation in this HNC patient population.

Materials and methods: From 2000 to 2018, a total of 152 patients diagnosed with HNC were treated with surgery and adjuvant HDR brachytherapy alone (n = 32) or combined with EBRT ± chemotherapy (n = 120). Patients treated with brachytherapy alone received 32 or 40 Gy in 8 or 10 b.i.d. fractions. Combined modality patients received 16 or 24 Gy of HDR brachytherapy in 4-6 b.i.d. fractions followed by EBRT 45 Gy in 25 fractions ± chemotherapy.

Results: Median follow-up was 8.1 years (range, 0.1-21.6). Forty patients (26.3%) developed RTOG grade ≥ 3 adverse events, mainly soft tissue necrosis (11.2%) and osteoradionecrosis (6.6%). The 5-year local and locoregional control rates were 85.5% and 74.9%, respectively. Five-year disease-free survival and overall survival rates were 54.9% and 62.2%, respectively.

Conclusion: Adjuvant HDR brachytherapy alone or combined with EBRT is an adequate treatment option for HNC patients who are candidates to receive postoperative radiation/chemoradiation. The results obtained in terms of toxicity and locoregional control are comparable to standard chemoradiation. In addition, this study identifies a subset of patients that may benefit from adjuvant HDR in terms of reduced toxicity, provided that the high-risk CTV does not exceed 15 cm³ and is treated to EQD2-DVH TV₁₀₀ doses of less than 87 Gy, together with a mandible_2cm3 of less than 61 Gy.

Background: Data connecting PTEN mutations with thyroid cancer risk for indeterminate nodules remain limited due to the rare nature of these mutations. The aim of this study was to determine the relationship between PTEN mutations identified in cytologically indeterminate nodules and final pathology and clinical outcomes.

Methods: This 8-year retrospective study includes adults with indeterminate thyroid nodules positive for a PTEN mutation and available correlative surgical histopathology.

Results: Twenty-three patients with 24 total nodules met the inclusion criteria. The cytology specimens were characterized as Bethesda III (n = 19) and Bethesda IV (n = 5). Specific PTEN mutations detected are described in detail. Final histopathology included the following: benign (n = 18, 75.0%), papillary thyroid carcinoma (n = 3, 12.5%), follicular thyroid carcinoma (n = 2, 8.3%), and poorly differentiated thyroid carcinoma (n = 1, 4.2%).

Conclusions: Together, our data suggest that PTEN mutations in indeterminate thyroid nodules result in a 25.0% risk of malignancy (Bethesda III: 16.7% and Bethesda IV: 60%).

Background: This study demonstrates the role of the deltoid branch artery as a donor vessel for microvascular reconstruction in various free flaps in the vessel-depleted neck.

Methods: This is a cohort study that reports our experience with 12 patients treated between January 5, 2020 and January 12, 2020 with free flap reconstruction utilizing the deltoid artery as a donor.

Results: All patients had vessel-depleted necks secondary to previous surgery (75%), radiotherapy (100%), and/or chemotherapy (66%). Donor sites included radial forearm (n = 4), anterolateral thigh (n = 5), and latissimus dorsi (n = 3). All patients had complete flap survival, and none experienced major increases in morbidity.

Conclusion: Our cohort demonstrated success using the deltoid artery for microvascular anastomosis in patients with vessel-depleted necks. It remains viable despite previous therapies. These data support the deltoid branch with a pectoral-sparing approach as a promising first-line arterial donor for various free flap reconstructions in patients with vessel-depleted necks.

Objective: To investigate the efficacy and safety of local intra-arterial chemotherapy combined with immune checkpoint inhibitors in the treatment of unresectable head and neck squamous cell carcinoma (HNSCC).

Methods: A retrospective analysis was conducted on the clinical data of eight patients diagnosed with unresectable HNSCC at our hospital from January to December 2023. All patients were diagnosed by pathological diagnosis and treated with intra-arterial chemotherapy combined with immune checkpoint inhibitors. The overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse reactions were observed.

Results: The study cohort consisted of seven men and one woman, with a median age of 58.4 ± 13.1 years. Five patients were at stage IVA, one at stage IVB, and two at stage IVC. One patient was lost to follow-up, and among the 7 patients with complete data, the ORR was 85.7%. The median PFS and OS in the overall population were not achieved, and the patient tolerated the treatment well with no significant adverse effects.

Conclusion: Local intra-arterial chemotherapy combined with immune checkpoint inhibitors is an important future exploration direction for the treatment of unresectable HNSCC.