Background: Research focused on the addition of immune checkpoint inhibitors (ICIs) to radiotherapeutic regimens in patients with cancer has become increasingly common, revealing promising improvements in efficacy outcomes. In patients with locoregionally advanced nasopharyngeal carcinoma (NPC), combining immunotherapy with chemoradiotherapy can facilitate the significant prolongation of survival, emphasizing the need for pharmacoeconomic studies focused on the clinical uptake of these innovative treatment regimens.
Methods: A three-state Markov model was developed based on clinical data from the randomized phase 3 CONTINUUM trial and used to compare the cost-effectiveness of chemoradiotherapy plus sintilimab (sintilimab group) to chemoradiotherapy alone (standard group), analyzing outcomes including incremental cost-effectiveness ratio (ICER), incremental net monetary benefit (INMB), and incremental net-health benefit (INHB) values at a willingness-to-pay (WTP) threshold corresponding to three times the Chinese GDP per capita ($37 035 per quality-adjusted life year [QALY]).
Results: The total costs for patients in the sintilimab and standard groups (QALYs [LYs]) were $92 116 (6.68 [10.03]) and $53 255 (3.75 [5.55]), respectively, for an ICER of $13 230/QALY ($8672/LY), an INMB of $70 021 with INHB of 1.89 QALYs. Using the selected WTP threshold. On the standard WTP threshold, the prevalence of sintilimab group as the primary treatment was 90.55% in China. The establishment of the model is stable.
Conclusions: Adding sintilimab to chemoradiotherapeutic regimens represents an innovative and cost-effective means for patients with locoregionally advanced NPC management in China.
{"title":"Chemoradiotherapy plus immunotherapy for locoregionally advanced nasopharyngeal carcinoma: A cost-effectiveness analysis.","authors":"Kun Liu, Youwen Zhu, Shan Li, Hong Zhu","doi":"10.1002/hed.27932","DOIUrl":"https://doi.org/10.1002/hed.27932","url":null,"abstract":"<p><strong>Background: </strong>Research focused on the addition of immune checkpoint inhibitors (ICIs) to radiotherapeutic regimens in patients with cancer has become increasingly common, revealing promising improvements in efficacy outcomes. In patients with locoregionally advanced nasopharyngeal carcinoma (NPC), combining immunotherapy with chemoradiotherapy can facilitate the significant prolongation of survival, emphasizing the need for pharmacoeconomic studies focused on the clinical uptake of these innovative treatment regimens.</p><p><strong>Methods: </strong>A three-state Markov model was developed based on clinical data from the randomized phase 3 CONTINUUM trial and used to compare the cost-effectiveness of chemoradiotherapy plus sintilimab (sintilimab group) to chemoradiotherapy alone (standard group), analyzing outcomes including incremental cost-effectiveness ratio (ICER), incremental net monetary benefit (INMB), and incremental net-health benefit (INHB) values at a willingness-to-pay (WTP) threshold corresponding to three times the Chinese GDP per capita ($37 035 per quality-adjusted life year [QALY]).</p><p><strong>Results: </strong>The total costs for patients in the sintilimab and standard groups (QALYs [LYs]) were $92 116 (6.68 [10.03]) and $53 255 (3.75 [5.55]), respectively, for an ICER of $13 230/QALY ($8672/LY), an INMB of $70 021 with INHB of 1.89 QALYs. Using the selected WTP threshold. On the standard WTP threshold, the prevalence of sintilimab group as the primary treatment was 90.55% in China. The establishment of the model is stable.</p><p><strong>Conclusions: </strong>Adding sintilimab to chemoradiotherapeutic regimens represents an innovative and cost-effective means for patients with locoregionally advanced NPC management in China.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oh-Hyeong Lee, Jooin Bang, Geun-Jeon Kim, Dong-Il Sun, Sang-Yeon Kim
This systematic review and meta-analysis investigated the impact of salvage surgery on 5-year overall survival (OS) and prognostic factors in recurrent oral cavity cancer (rOCC) patients. Relevant literature before May 2022 was reviewed, including retrospective cohort studies and observational studies comparing salvage surgery to other treatments. Risk-of-bias assessments were conducted using the Newcastle-Ottawa scale. Statistical and subgroup analyses assessed the impact of salvage surgery on 5-year OS and prognostic factors. 3036 documents were initially retrieved, with 14 retrospective cohort studies (2069 participants) included. Meta-analysis of 5-year OS in salvage surgery patients yielded a rate of 43.0%. Subgroup analysis showed higher OS in Asians (49.9% vs. 36.9%, p = 0.003) and late-relapse (63.8% vs. 30.0%, p = 0.004) groups. Prognostic factors revealed hazards associated with nodal recurrence, extranodal extension, and perineural invasion. Salvage surgery is a viable option for rOCC patients, showing favorable 5-year OS outcomes. Low publication bias enhances study reliability, but its single-arm design limits conclusions on salvage surgery superiority over other treatments.
{"title":"Clinical outcome of salvage surgery in patients with recurrent oral cavity cancer: A systematic review and meta-analysis.","authors":"Oh-Hyeong Lee, Jooin Bang, Geun-Jeon Kim, Dong-Il Sun, Sang-Yeon Kim","doi":"10.1002/hed.27928","DOIUrl":"https://doi.org/10.1002/hed.27928","url":null,"abstract":"<p><p>This systematic review and meta-analysis investigated the impact of salvage surgery on 5-year overall survival (OS) and prognostic factors in recurrent oral cavity cancer (rOCC) patients. Relevant literature before May 2022 was reviewed, including retrospective cohort studies and observational studies comparing salvage surgery to other treatments. Risk-of-bias assessments were conducted using the Newcastle-Ottawa scale. Statistical and subgroup analyses assessed the impact of salvage surgery on 5-year OS and prognostic factors. 3036 documents were initially retrieved, with 14 retrospective cohort studies (2069 participants) included. Meta-analysis of 5-year OS in salvage surgery patients yielded a rate of 43.0%. Subgroup analysis showed higher OS in Asians (49.9% vs. 36.9%, p = 0.003) and late-relapse (63.8% vs. 30.0%, p = 0.004) groups. Prognostic factors revealed hazards associated with nodal recurrence, extranodal extension, and perineural invasion. Salvage surgery is a viable option for rOCC patients, showing favorable 5-year OS outcomes. Low publication bias enhances study reliability, but its single-arm design limits conclusions on salvage surgery superiority over other treatments.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amara Naseer, Sinead Brennan, Denise MacCarthy, John Edward O'Connell, Eleanor O'Sullivan, Michelle Leech
Background: Osteoradionecrosis is a long-term, serious side effect of head and neck radiation therapy and is associated with significant morbidity and quality of life issues.
Methods: This paper sought to determine consensus on the prevention and management of osteoradionecrosis by an international panel of multidisciplinary professionals expert in the management of patients with head and neck cancer using a Delphi methodology. Unique to this work is our direct inclusion of the views of patients and carers in our findings.
Results: This study reached consensus on the importance of pre and post oral health assessment and education for patients with head and neck cancer. This was also noted by the patients and carers who took part in the study.
Conclusions: This work highlights the need for a standardized oral health assessment tool and multidisciplinary care of patients to prevent and manage osteoradionecrosis.
{"title":"Prevention of osteoradionecrosis in patients with head and neck cancer treated with radiation therapy.","authors":"Amara Naseer, Sinead Brennan, Denise MacCarthy, John Edward O'Connell, Eleanor O'Sullivan, Michelle Leech","doi":"10.1002/hed.27927","DOIUrl":"https://doi.org/10.1002/hed.27927","url":null,"abstract":"<p><strong>Background: </strong>Osteoradionecrosis is a long-term, serious side effect of head and neck radiation therapy and is associated with significant morbidity and quality of life issues.</p><p><strong>Methods: </strong>This paper sought to determine consensus on the prevention and management of osteoradionecrosis by an international panel of multidisciplinary professionals expert in the management of patients with head and neck cancer using a Delphi methodology. Unique to this work is our direct inclusion of the views of patients and carers in our findings.</p><p><strong>Results: </strong>This study reached consensus on the importance of pre and post oral health assessment and education for patients with head and neck cancer. This was also noted by the patients and carers who took part in the study.</p><p><strong>Conclusions: </strong>This work highlights the need for a standardized oral health assessment tool and multidisciplinary care of patients to prevent and manage osteoradionecrosis.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: With the development of endoscopic imaging, superficial pharyngeal squamous cell carcinoma can now be detected during routine endoscopy. Recently, the effectiveness of endoscopic resection for superficial pharyngeal squamous cell carcinoma have been reported.
Methods: This study had a retrospective single-center design that included patients with superficial pharyngeal squamous cell carcinoma who underwent endoscopic resection. A total 47 patients with 53 lesions were analyzed.
Results: En bloc and R0 resection rates were 83.0% and 56.6%. Local recurrence and cervical lymph node metastasis (CLNM) were detected in 1 and 3 patients during follow-up. The macroscopic type 0-I was an independent factor for CLNM. The 3-year cumulative incidence of metachronous pharyngeal squamous cell carcinoma following endoscopic resection was 33.0%, and the 5-year overall survival rate was 89.2%.
Conclusions: Endoscopic resection is an effective treatment for superficial pharyngeal squamous cell carcinomas, and the macroscopic type 0-I is a useful predictor of CLNM.
{"title":"Effectiveness and outcomes of endoscopic resection for superficial pharyngeal squamous cell carcinomas.","authors":"Naohiro Nakamura, Tomofumi Sakagami, Minaki Shimizu, Kensuke Suzuki, Takuo Fujisawa, Takuya Shijimaya, Sanshiro Kobayashi, Yu Takahashi, Tomomitsu Tahara, Yuri Noda, Koji Tsuta, Makoto Naganuma","doi":"10.1002/hed.27924","DOIUrl":"https://doi.org/10.1002/hed.27924","url":null,"abstract":"<p><strong>Background: </strong>With the development of endoscopic imaging, superficial pharyngeal squamous cell carcinoma can now be detected during routine endoscopy. Recently, the effectiveness of endoscopic resection for superficial pharyngeal squamous cell carcinoma have been reported.</p><p><strong>Methods: </strong>This study had a retrospective single-center design that included patients with superficial pharyngeal squamous cell carcinoma who underwent endoscopic resection. A total 47 patients with 53 lesions were analyzed.</p><p><strong>Results: </strong>En bloc and R0 resection rates were 83.0% and 56.6%. Local recurrence and cervical lymph node metastasis (CLNM) were detected in 1 and 3 patients during follow-up. The macroscopic type 0-I was an independent factor for CLNM. The 3-year cumulative incidence of metachronous pharyngeal squamous cell carcinoma following endoscopic resection was 33.0%, and the 5-year overall survival rate was 89.2%.</p><p><strong>Conclusions: </strong>Endoscopic resection is an effective treatment for superficial pharyngeal squamous cell carcinomas, and the macroscopic type 0-I is a useful predictor of CLNM.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carly Fassler, Pratyusha Yalamanchi, Marina Aweeda, Julie Rezk, Barbara Murphy, Natalie A Lockney, Ryan Whitaker, Ryan Rigsby, Joseph Aulino, Emily Hosokawa, Mitra Mehrad, Kim Ely, James S Lewis, Evan Derman, Ed LaHood, Sarah L Rohde, Robert J Sinard, Eben L Rosenthal, Michael C Topf
Purpose: Multidisciplinary tumor boards (TB) are the standard for discussing complex head and neck cancer cases. During TB, imaging and microscopic pathology is reviewed, but there is typically no visualization of the resected cancer.
Methods: A pilot study was conducted to investigate the utility of visual pathology reports at weekly TB for 10 consecutive weeks. Faculty-level participants completed a pre-survey and post-survey to assess understanding of resected cancer specimens.
Results: Providers (n = 25) across seven medical specialties completed pre-survey and post-survey. Following intervention, providers reported significant improvement in understanding of anatomic orientation of the specimen and sites of margin sampling (mean 47.4-96.1, p < 0.001), ability to locate the site of a positive margin (mean 69.5-91.1, p < 0.001), and confidence in treatment plans created (mean 69.5-89.2, p < 0.001) with the addition of visual pathology reports.
Conclusions: Visual pathology reports improve provider understanding of resected cancer specimens at multidisciplinary TB.
{"title":"Visual pathology reports for improved collaboration at multidisciplinary head and neck tumor board.","authors":"Carly Fassler, Pratyusha Yalamanchi, Marina Aweeda, Julie Rezk, Barbara Murphy, Natalie A Lockney, Ryan Whitaker, Ryan Rigsby, Joseph Aulino, Emily Hosokawa, Mitra Mehrad, Kim Ely, James S Lewis, Evan Derman, Ed LaHood, Sarah L Rohde, Robert J Sinard, Eben L Rosenthal, Michael C Topf","doi":"10.1002/hed.27926","DOIUrl":"https://doi.org/10.1002/hed.27926","url":null,"abstract":"<p><strong>Purpose: </strong>Multidisciplinary tumor boards (TB) are the standard for discussing complex head and neck cancer cases. During TB, imaging and microscopic pathology is reviewed, but there is typically no visualization of the resected cancer.</p><p><strong>Methods: </strong>A pilot study was conducted to investigate the utility of visual pathology reports at weekly TB for 10 consecutive weeks. Faculty-level participants completed a pre-survey and post-survey to assess understanding of resected cancer specimens.</p><p><strong>Results: </strong>Providers (n = 25) across seven medical specialties completed pre-survey and post-survey. Following intervention, providers reported significant improvement in understanding of anatomic orientation of the specimen and sites of margin sampling (mean 47.4-96.1, p < 0.001), ability to locate the site of a positive margin (mean 69.5-91.1, p < 0.001), and confidence in treatment plans created (mean 69.5-89.2, p < 0.001) with the addition of visual pathology reports.</p><p><strong>Conclusions: </strong>Visual pathology reports improve provider understanding of resected cancer specimens at multidisciplinary TB.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sonja Steen, Dominik Horn, Christa Flechtenmacher, Jürgen Hoffmann, Kolja Freier, Oliver Ristow, Jochen Hess, Julius Moratin
Background: Lately SOX2 and SOX9, transcription factors associated with stemness-like phenotypes of cancer cells, have been linked to tumor growth, metastasis, and resistance to therapy.
Methods: This study aimed on evaluating the expression of SOX2 and SOX9 in a large cohort of patients with OSCC including primary and recurrent tumors and corresponding lymph node metastases. Semiautomatic digital pathology scoring was used to determine protein expression and survival analysis was performed to evaluate its prognostic significance.
Results: We found a significant downregulation of SOX9 from primary disease to lymph node metastases (p < 0.001). SOX9 expression and the subgroup SOX2lowSOX9high were significantly correlated with worse overall survival (p < 0.05). Additionally, SOX2lowSOX9high expression pattern was confirmed as independent prognosticator for overall survival.
Conclusions: These results indicate the relevant role of SOX2 and SOX9 in patients with OSCC and show the clinical relevance for further investigation on the molecular mechanisms underlying SOX-related gene expression.
{"title":"Expression analysis of SOX2 and SOX9 in patients with oral squamous cell carcinoma.","authors":"Sonja Steen, Dominik Horn, Christa Flechtenmacher, Jürgen Hoffmann, Kolja Freier, Oliver Ristow, Jochen Hess, Julius Moratin","doi":"10.1002/hed.27925","DOIUrl":"https://doi.org/10.1002/hed.27925","url":null,"abstract":"<p><strong>Background: </strong>Lately SOX2 and SOX9, transcription factors associated with stemness-like phenotypes of cancer cells, have been linked to tumor growth, metastasis, and resistance to therapy.</p><p><strong>Methods: </strong>This study aimed on evaluating the expression of SOX2 and SOX9 in a large cohort of patients with OSCC including primary and recurrent tumors and corresponding lymph node metastases. Semiautomatic digital pathology scoring was used to determine protein expression and survival analysis was performed to evaluate its prognostic significance.</p><p><strong>Results: </strong>We found a significant downregulation of SOX9 from primary disease to lymph node metastases (p < 0.001). SOX9 expression and the subgroup SOX2<sup>low</sup>SOX9<sup>high</sup> were significantly correlated with worse overall survival (p < 0.05). Additionally, SOX2<sup>low</sup>SOX9<sup>high</sup> expression pattern was confirmed as independent prognosticator for overall survival.</p><p><strong>Conclusions: </strong>These results indicate the relevant role of SOX2 and SOX9 in patients with OSCC and show the clinical relevance for further investigation on the molecular mechanisms underlying SOX-related gene expression.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammed Holkom, Karim A Sakran, Hui Zhao, Abdo A S Mohammed, Xu Chen, Edres A Mohammed, Ke Liu, Zhengjun Shang
Objective: This study investigates the unsatisfactory outcomes observed in mandibular reconstruction procedures attributed to improper condylar positioning in the Temporomandibular Joint. It also proposes a systematic classification for post-reconstruction condylar positioning dissatisfaction.
Methods: A retrospective analysis was conducted on 337 patients who underwent tumor removal and mandibular reconstruction with vascularized osteocutaneous flaps. Reconstruction techniques included conventional surgery (43.3%) and 3D technology-guided procedures (56.7%). Evaluation utilized preoperative and postoperative CT scans to assess mandibular vertical ramus length (V) and condylar alignment in both sagittal (S) and coronal (C) planes. Accordingly, a classification system for condylar positioning was developed and abbreviated as VSC. It includes four classes: Class I, proper condylar reconstruction; Class II, short ramus length; Class III, one or two aspects of sagittal/coronal condylar positions dissatisfaction; and Class IV, two or three aspects dissatisfaction.
Results: The overall success rate for condylar reconstruction was 85.16%. Though not statistically significant, the success rate was marginally higher in the 3D-assisted group (85.86%) compared to the conventional group (84.25%). In terms of the VSC classification, the distribution of cases across Class I, II, III, and IV were 287, 4, 9, and 37 cases, respectively. Notably, condylar dislocation was significantly associated with the defect site, particularly the body and condyle (p < 0.001, OR = 49.734, 95% CI 12.995-190.342), and the number of reconstructed segments (p = 0.025, OR = 3.480, 95% CI 1.173-10.328).
Conclusion: The findings highlight the importance of accurate reconstruction methods and reveal implications of the defect site and the number of reconstructed segments in condylar dislocation. Consequently, we propose a classification system to refine condylar positioning assessment and enhance surgical outcomes in mandibular reconstruction.
{"title":"Analysis of condylar positioning in the temporomandibular joint following mandibular reconstruction: Introduction of a new classification system and assessment of influencing factors on displacement.","authors":"Mohammed Holkom, Karim A Sakran, Hui Zhao, Abdo A S Mohammed, Xu Chen, Edres A Mohammed, Ke Liu, Zhengjun Shang","doi":"10.1002/hed.27918","DOIUrl":"https://doi.org/10.1002/hed.27918","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the unsatisfactory outcomes observed in mandibular reconstruction procedures attributed to improper condylar positioning in the Temporomandibular Joint. It also proposes a systematic classification for post-reconstruction condylar positioning dissatisfaction.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 337 patients who underwent tumor removal and mandibular reconstruction with vascularized osteocutaneous flaps. Reconstruction techniques included conventional surgery (43.3%) and 3D technology-guided procedures (56.7%). Evaluation utilized preoperative and postoperative CT scans to assess mandibular vertical ramus length (V) and condylar alignment in both sagittal (S) and coronal (C) planes. Accordingly, a classification system for condylar positioning was developed and abbreviated as VSC. It includes four classes: Class I, proper condylar reconstruction; Class II, short ramus length; Class III, one or two aspects of sagittal/coronal condylar positions dissatisfaction; and Class IV, two or three aspects dissatisfaction.</p><p><strong>Results: </strong>The overall success rate for condylar reconstruction was 85.16%. Though not statistically significant, the success rate was marginally higher in the 3D-assisted group (85.86%) compared to the conventional group (84.25%). In terms of the VSC classification, the distribution of cases across Class I, II, III, and IV were 287, 4, 9, and 37 cases, respectively. Notably, condylar dislocation was significantly associated with the defect site, particularly the body and condyle (p < 0.001, OR = 49.734, 95% CI 12.995-190.342), and the number of reconstructed segments (p = 0.025, OR = 3.480, 95% CI 1.173-10.328).</p><p><strong>Conclusion: </strong>The findings highlight the importance of accurate reconstruction methods and reveal implications of the defect site and the number of reconstructed segments in condylar dislocation. Consequently, we propose a classification system to refine condylar positioning assessment and enhance surgical outcomes in mandibular reconstruction.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikhil Bellamkonda, Evan L Tooker, Anne Naumer, Luke O Buchmann, Wendy Kohlmann, Hilary C McCrary, Neil S Patel, Mana Espahbodi
Background: Bilateral head and neck paragangliomas (HNPGLs) require nuanced management to balance tumor control with functional preservation.
Methods: All patients seen at a single-institution for bilateral paraganglioma between 1983 and 2023 were retrospectively reviewed. Demographics, genetic testing results, and tumor characteristics were analyzed and compared to treatment modality and cranial nerve outcomes.
Results: There were 49 patients with 116 tumors (90 carotid body tumors [CBTs], 15 vagal paragangliomas [VPs], and 11 jugular paragangliomas [JPs]). Twenty-six patients had SDH pathologic variants (PV). Surgical management was more commonly utilized in younger patients (OR: 0.97, 95% CI: 0.950-0.992) and for JPs (OR: 9, 95% CI: 1.386-58.443). In surgical cases, CBTs had a lower risk of postoperative cranial nerve deficits compared to JPs and VPs (OR: 0.095, 95% CI: 0.013-0.692).
Conclusions: Younger patients with bilateral HNPGLs, especially those with JP and CBT, are more often treated with surgery. CBTs have lowest risk of cranial nerve deficits after surgery.
{"title":"Management of bilateral head and neck paragangliomas at a single-institution across four decades.","authors":"Nikhil Bellamkonda, Evan L Tooker, Anne Naumer, Luke O Buchmann, Wendy Kohlmann, Hilary C McCrary, Neil S Patel, Mana Espahbodi","doi":"10.1002/hed.27923","DOIUrl":"https://doi.org/10.1002/hed.27923","url":null,"abstract":"<p><strong>Background: </strong>Bilateral head and neck paragangliomas (HNPGLs) require nuanced management to balance tumor control with functional preservation.</p><p><strong>Methods: </strong>All patients seen at a single-institution for bilateral paraganglioma between 1983 and 2023 were retrospectively reviewed. Demographics, genetic testing results, and tumor characteristics were analyzed and compared to treatment modality and cranial nerve outcomes.</p><p><strong>Results: </strong>There were 49 patients with 116 tumors (90 carotid body tumors [CBTs], 15 vagal paragangliomas [VPs], and 11 jugular paragangliomas [JPs]). Twenty-six patients had SDH pathologic variants (PV). Surgical management was more commonly utilized in younger patients (OR: 0.97, 95% CI: 0.950-0.992) and for JPs (OR: 9, 95% CI: 1.386-58.443). In surgical cases, CBTs had a lower risk of postoperative cranial nerve deficits compared to JPs and VPs (OR: 0.095, 95% CI: 0.013-0.692).</p><p><strong>Conclusions: </strong>Younger patients with bilateral HNPGLs, especially those with JP and CBT, are more often treated with surgery. CBTs have lowest risk of cranial nerve deficits after surgery.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giacomo Bertazzoni, Alessandro Vinciguerra, Domitille Camous, Marco Ferrari, Davide Mattavelli, Mario Turri-Zanoni, Alberto Schreiber, Stefano Taboni, Vittorio Rampinelli, Alberto Daniele Arosio, Benjamin Verillaud, Cesare Piazza, Paolo Battaglia, Maurizio Bignami, Alberto Deganello, Paolo Castelnuovo, Piero Nicolai, Philippe Herman
Introduction: In the management of sinonasal malignancies treatment-induced morbidity and mortality is gaining relevance both for surgical approaches (endoscopic and open resection) and non-surgical therapies. The aim of this multicenter study is to assess complications associated with endoscopic surgery and non-surgical treatments (neoadjuvant and/or adjuvant) for malignant sinonasal tumors.
Methods: All patients with nasoethmoidal malignancies treated with curative intent with endoscopic or endoscopic-assisted surgery at three referral centers with uniform management policies were included. Neo- and/or adjuvant (chemo)radiotherapy was administered according to histology and pathological report. Demographics, treatment characteristics, and complications related both to the surgical and non-surgical approaches were retrieved. The data were analyzed with univariate and multivariate statistics to assess independent predictors of complications.
Results: Nine hundred and forty patients were included, 643 males (68%) and 297 females (32%). A total of 225 complications were identified in 187 patients (19.9%): cerebrospinal fluid (CSF) leak (3.5%), mucocele (2.3%), surgical site bleeding (2.0%), epiphora (2.0%), and radionecrosis (2.0%) were the most common. Treatment-related mortality was 0.4%. Variables independently associated with complications at multivariate analysis were principally dural resection (OR 1.92), cranioendoscopic or multiportal resection (OR 2.93), dural repair with multilayer technique with less than three layers (OR 2.17), and graft different from iliotibial tract (OR 3.29).
Conclusion: Our study shows that modern endoscopic treatments and radiotherapy for sinonasal malignancies are associated with limited morbidity and treatment-related mortality. CSF leak and radionecrosis, although rare, remain the most frequent complications and should be further addressed by future research efforts.
{"title":"Morbidity of multimodal treatments including endoscopic surgery for sinonasal malignancies: Results of an international collaborative study on 940 patients (MUSES).","authors":"Giacomo Bertazzoni, Alessandro Vinciguerra, Domitille Camous, Marco Ferrari, Davide Mattavelli, Mario Turri-Zanoni, Alberto Schreiber, Stefano Taboni, Vittorio Rampinelli, Alberto Daniele Arosio, Benjamin Verillaud, Cesare Piazza, Paolo Battaglia, Maurizio Bignami, Alberto Deganello, Paolo Castelnuovo, Piero Nicolai, Philippe Herman","doi":"10.1002/hed.27916","DOIUrl":"https://doi.org/10.1002/hed.27916","url":null,"abstract":"<p><strong>Introduction: </strong>In the management of sinonasal malignancies treatment-induced morbidity and mortality is gaining relevance both for surgical approaches (endoscopic and open resection) and non-surgical therapies. The aim of this multicenter study is to assess complications associated with endoscopic surgery and non-surgical treatments (neoadjuvant and/or adjuvant) for malignant sinonasal tumors.</p><p><strong>Methods: </strong>All patients with nasoethmoidal malignancies treated with curative intent with endoscopic or endoscopic-assisted surgery at three referral centers with uniform management policies were included. Neo- and/or adjuvant (chemo)radiotherapy was administered according to histology and pathological report. Demographics, treatment characteristics, and complications related both to the surgical and non-surgical approaches were retrieved. The data were analyzed with univariate and multivariate statistics to assess independent predictors of complications.</p><p><strong>Results: </strong>Nine hundred and forty patients were included, 643 males (68%) and 297 females (32%). A total of 225 complications were identified in 187 patients (19.9%): cerebrospinal fluid (CSF) leak (3.5%), mucocele (2.3%), surgical site bleeding (2.0%), epiphora (2.0%), and radionecrosis (2.0%) were the most common. Treatment-related mortality was 0.4%. Variables independently associated with complications at multivariate analysis were principally dural resection (OR 1.92), cranioendoscopic or multiportal resection (OR 2.93), dural repair with multilayer technique with less than three layers (OR 2.17), and graft different from iliotibial tract (OR 3.29).</p><p><strong>Conclusion: </strong>Our study shows that modern endoscopic treatments and radiotherapy for sinonasal malignancies are associated with limited morbidity and treatment-related mortality. CSF leak and radionecrosis, although rare, remain the most frequent complications and should be further addressed by future research efforts.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manuela Burggraf, Stefan Schiele, Rubens Thölken, Francisco José Farfán López, Noran Elawany, Johannes Zenk, Johannes Doescher
Induction chemotherapy (IC) recently gained importance for treatment of sinonasal undifferentiated carcinoma (SNUC). We analyzed our SNUC cases and performed a meta-analysis with focus on survival-rates stratified by treatment. SNUC cases at our institution were retrospectively evaluated. A systematic literature review was conducted to analyze treatment and outcome of SNUC. To calculate 5-year and 2-year overall survival (OS), individual patient data (IPD) were analyzed using Kaplan-Meier estimators and Cox proportional hazard regression to identify associations between types of therapy and survival. A random effects model for pooled estimates of 5-year survival was applied to studies without IPD data. Five-year OS of our SNUC cases (n = 9) was 44.4%. The IPD analysis (n = 192) showed a significantly better 5-year OS for patients who received induction chemotherapy (72.6% vs. 44.5%). The pooled 5-year OS of 13 studies identified in the literature search was 43.8%. IC should be considered in every patient diagnosed with SNUC.
{"title":"Contemporary treatment and outcome of sinonasal undifferentiated carcinoma: A meta-analysis.","authors":"Manuela Burggraf, Stefan Schiele, Rubens Thölken, Francisco José Farfán López, Noran Elawany, Johannes Zenk, Johannes Doescher","doi":"10.1002/hed.27910","DOIUrl":"https://doi.org/10.1002/hed.27910","url":null,"abstract":"<p><p>Induction chemotherapy (IC) recently gained importance for treatment of sinonasal undifferentiated carcinoma (SNUC). We analyzed our SNUC cases and performed a meta-analysis with focus on survival-rates stratified by treatment. SNUC cases at our institution were retrospectively evaluated. A systematic literature review was conducted to analyze treatment and outcome of SNUC. To calculate 5-year and 2-year overall survival (OS), individual patient data (IPD) were analyzed using Kaplan-Meier estimators and Cox proportional hazard regression to identify associations between types of therapy and survival. A random effects model for pooled estimates of 5-year survival was applied to studies without IPD data. Five-year OS of our SNUC cases (n = 9) was 44.4%. The IPD analysis (n = 192) showed a significantly better 5-year OS for patients who received induction chemotherapy (72.6% vs. 44.5%). The pooled 5-year OS of 13 studies identified in the literature search was 43.8%. IC should be considered in every patient diagnosed with SNUC.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}