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

Background: To correlate between immunohistochemical expression of tumor-infiltrating lymphocytes (TILs), tumor-associated macrophages (TAMs), and natural killer (NK) cells with the AJCC 8th edition TNM staging system and other disease-modifying clinico-pathological variables.

Methods: The representative histology sections of tumor invasive margin (IM) and tumor core (TC) were selected according to the International Immuno-Oncology Biomarker Working Group and were subjected to immunohistochemistry with antibodies for TILs (CD3, CD8, FOXP3), NK Cells (CD57), TAMs (CD68, CD163) and pan-leukocyte marker (CD45). Histo-immuno-density-intensity (HIDI) scoring was calculated as a product of the proportion and intensity of staining. Ordinal-ordinal and continuous-ordinal variables were correlated using Kendall's tau-b (τb), and binary-ordinal variables were correlated using Rank-Biserial (r_rb) statistics.

Results: A total of 111 patients were included in the study. None of the clinical and pathological parameters showed a strong correlation with any of the immune infiltrates including TNM staging.

Conclusion: We hypothesize an independent activity of tumor immunology in the disease prognosis.

Trial registration: CTRI/2020/07/026335.

Background: Radiotherapy (RT) in head and neck cancer (HNC) can cause multiple side effects such as nausea, pain, taste loss, fatigue, oral mucositis, xerostomia, and acute radiation-associated dysphagia (RAD). These factors threaten patients' oral intake (OI) during this RT. Reduced OI can cause weight loss, dehydration, malnutrition, and various comorbidities. On top, reduced OI significantly affects quality of life and may contribute to RAD through the disuse of swallowing muscles. With the aim of maximizing the retention of a patient's OI, it is important to gain an insight into the factors that have the greatest impact. Therefore, this study aims to identify the impact of contributing factors on decreased OI during RT.

Methods: During their treatment, 55 HNC patients completed an OI questionnaire at 5 different time points: during weeks 1, 2, 3, and 4 and at the end of RT (week 7). First, patients rated the OI compared to pre-RT on a 100 mm visual analogue scale (VAS). Subsequently, patients reported on separate VAS the degree to which pain, fatigue, loss of taste, loss of smell, loss of interest in food, nausea, and loss of hunger contributed to the decrease in OI (0: no contribution; 100: complete contribution). SPSS version 27 was used to analyze the results.

Results: OI decreased over time during RT, with the lowest OI at the end of RT. During the first 4 weeks of RT, the impact of all factors with pain, loss of taste, loss of interest in food, and loss of hunger pointed out as strongest contributing factors to a decreased OI. The most important patient-reported impacting factor on OI was loss of taste. At the end of RT, the importance of pain and nausea still increases, while the contribution of the other factors drops slightly.

Conclusion: This cohort study shows that several factors contribute to a decreased OI in HNC patients during RT. This study is the first prospective analysis to identify self-reported factors contributing to reduced OI. Results demonstrate that taste has the greatest impact on OI followed by loss of interest in food, loss of hunger, and pain.

Purpose: Blood-borne, cell-free DNA has been proposed as a means of individualizing the management of human papillomavirus (HPV)-positive oropharyngeal carcinoma.

Methods and materials: This study was designed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. A comprehensive literature search of peer-reviewed publications from January 2013 to January 2024 was undertaken to identify prospective studies pertaining to the use of circulating HPV-DNA for oropharyngeal carcinoma.

Results: A total of 11 prospective studies were identified and differed in their clinical design, methods, and endpoints. Five included patients treated by chemoradiation; 3 by surgery; 2 by both; and 1 not specified. The timing and frequency of HPV-DNA draws was highly variable. The sample size ranged from 16 to 262 (mean, 99 patients).

Conclusions: While interest is growing with integrating circulating HPV-DNA into clinical practice, the supporting evidence is limited by the heterogeneity of the evidence.

Background: Supraglottic squamous cell carcinoma (SCC) is a significant portion of head and neck cancers, with the management of clinically negative necks (cN0) through selective neck dissection (SND) being debated due to potential morbidities and low metastasis rates in levels IIb and IV.

Methods: This study is a retrospective, multicenter examination of the potential feasibility of limited neck dissection (LND), including only levels IIa and III in cN0 supraglottic SCC patients. It analyzed occult metastasis rates and explored relapse occurrences alongside potential predictors of lymph node metastasis.

Results: Among 425 patients, predominantly male (85.6%) with a mean age of 63 years, the occult metastasis rate was 28.9%, and 13.7% experienced relapses during a mean follow-up of 52 months. Advanced clinical stage, higher grading, and other risk factors emerged as predictors of occult lymph node metastasis at level IIb.

Conclusions: The study supports LND potential feasibility for cN0 supraglottic SCC, suggesting level IIb dissection can be omitted in specific early-stage cases to reduce morbidity without affecting outcomes.

Objectives: Reconstruction of total pharyngolaryngectomy defects may restore pharyngeal function and enable tracheoesophageal speech after resection of locoregionally advanced malignancy. Little remains known about variations in the practices and preferences of surgeons across differing global regions.

Methods: A survey was sent to reconstructive head and neck surgeons across three continents with responses analyzed to evaluate trends.

Results: Of 155 respondents, 79.4% (n = 123) completed the survey including surgeons from North America (USA/Canada), the Indian Subcontinent (India/Bangladesh) and Australia/New Zealand. Among surgeons trained in pedicle flap reconstruction, only 47.5% performed these procedures after completion of training. Pedicle flaps were performed most frequently by surgeons from the Indian subcontinent. The anterolateral thigh flap was most popular among surgeons for free flap reconstruction, 58.5% (n = 72).

Conclusion: This study demonstrates significant region-based variation in preferred reconstructive modality, suggesting location of practice and institutional experience influence the reconstructive algorithms of head and neck surgeons.

Background: In sinonasal cancer (SNC), treatment with proton therapy (PT) provides excellent local control, especially after gross total resection. Because of the heterogeneity and rarity of this disease site, a comprehensive assessment of toxicity, survival, and control rates is lacking. Our primary objective was to assess the toxicity outcomes of PT in SNC patients, with a secondary aim of assessing survival and tumor control after PT.

Methods: PubMed, Embase, EBSCO, Scopus, Science Direct, Web of Science, Ovid, Proquest, and Cochrane Library were searched from inception to August 2024 reporting PT acute and late toxicity, survival, and tumor control outcomes in SNC patients. A random-effect meta-analysis was used to assess the pooled safety, survival, and tumor control outcomes. The primary analysis was to report acute and late toxicity. The secondary aims included overall survival (OS), disease-free survival (DFS), local control (LC), regional control (RC), and distant metastasis control (DMC) rate.

Results: Fourteen studies were included for qualitative analysis. We pooled data from 756 patients who received PT for SNC. Among acute toxicity (AT), there was a 31.9% occurrence rate of grade ≥ 3 events, whereas within late toxicity (LT), grade ≥ 3 events occurred at a rate of 35.3%. Most LT (62.1%) were classified as grade 2, with the most frequent being ocular (24.8%) or neurological (18.4%) toxicities. The most common grade ≥ 3 toxicities were mucositis (15.3%) in AT and ocular toxicity (9.6%) in LT. The pooled 5-year OS, DFS, LC, RC, and DMC were 36.8%, 34.2%, 35.6%, 28.6%, and 54.3%, respectively.

Conclusion: Our analysis demonstrates that PT-treated SNC patients experience acceptable rates of acute and LT consistent with other published outcomes with highly conformal radiation techniques. PT demonstrates favorable OS and DFS. Further prospective and comparative effectiveness research is needed to better quantify the magnitude of the benefit of PT or other forms of radiation modalities.

Background: Ewing sarcoma of the head and neck (ES-HN) is a rare subsite of ES, where therapeutic outcomes need to be explored further.

Methods: This retrospective study includes ES-HN patients registered at our center between 2003 and 2019. Demographic details and treatment outcomes were recorded from the hospital database. Prognostic factors for survival were identified by Cox regression.

Results: Eighty-five patients were included. Metastatic disease was seen in nine patients (10.59%). Local therapy included radiotherapy alone (n = 38; 44.7%), surgery plus radiotherapy (n = 15; 17.6%), or surgery alone (n = 8; 9.4%). The median overall survival (OS) was 37.4 months. On multivariable analysis, osseous primary (HR 0.40; p = 0.009) and male sex (HR 0.43; p = 0.023) were associated with superior OS. Leucocytosis (HR 3.46; p = 0.001) was associated with inferior OS.

Conclusions: ES-HN has favorable biology with metastases being rare at baseline. However, leucocytosis, extra-osseous disease, and female sex are poor prognostic factors. In resource-challenged settings, difficulties in administering local therapy may contribute to inferior outcomes.

Background: Chronic lingual tonsillitis (CLT) entails persistent inflammation of the lingual tonsils (LT), presenting in recurrent infections, throat discomfort, dyspnea, dysphagia, and LT hypertrophy.

Methods: A retrospective observational study at a nonacademic general hospital described outcomes of CLT patients undergoing base of tongue (BOT) reduction via transoral robotic surgery (TORS). Primary outcomes were changes in patient-reported quality of swallowing and life and were assessed at baseline, 3, 6, and 12 months post-TORS. Secondary outcomes were tonsillitis complaints, LT Friedman grade, and postoperative complications.

Results: Thirty-three patients were included, 5 patients were lost to follow-up at 6 and 12 months. Improved swallowing experience and enhanced quality of life were observed. Tonsillitis scores decreased significantly (mean 7.8 to 1.65 p < 0.001). LT Friedman grade reduced, with 69.7% achieving grade 0 at 12-months follow-up. Two patients experienced postoperative bleeding.

Conclusions: TORS appears effective and safe for treating CLT improving swallowing, and overall quality of life for patients and reducing tonsillitis complaints.

Background: Locoregional external beam radiotherapy (EBRT) is selectively used in thyroid cancer patients to induce locoregional control. However, despite technological advances, EBRT remains associated with toxicities. We evaluated thyroid-cancer specific toxicities and long-term Quality of Life (QoL) post-EBRT.

Methods: EBRT-treated thyroid cancer patients at Universal Medical Centre Groningen (2007-2023) were retrospectively evaluated (n = 66). Acute (< 6 weeks) and late (≥ 3 months) toxicities and QLQ-H&N35 results, prospectively collected as standard patient care, were analyzed (available in 24/66). Additionally, 17/66 living patients cross-sectionally completed the QLQ-H&N43 [renewed QLQ-H&N35] and SF-36-RAND-36.

Results: In 24/66 patients who completed questionnaires during EBRT treatment, most severe acute toxicities occurred around week 6 (91% dermatitis, 74% pain, 70% hoarseness, 65% dysphagia). Late toxicities included persisting acute toxicities and fibrosis. Six months post-treatment, only QLQ-H&N35 domains "social eating" (p = 0.031) and "dry mouth/sticky saliva" (p = 0.025) were affected, in comparison to pre-radiation. In the 10/17 patients who completed the QLQ-H&N35 6 months post-radiation and the cross-sectionally performed QLQ-H&N43, no long-term mitigation of assessed domains was identified in a longitudinal analysis. The most advanced EBRT technique was associated with better QLQ-H&N43 scores (p = 0.047).

Conclusions: EBRT causes acute and late toxicities in most thyroid cancer patients and may be associated with a decreased QoL. As these patients generally survive for multiple years, there is a compelling need to minimize toxicities with more refined radiation techniques, such as proton therapy.

Objectives: We aimed to compare the outcomes of patients with T1-T2N0M0 glottic squamous cell carcinoma who underwent either partial laryngectomy (PL) or radiotherapy (RT).

Methods: A retrospective analysis of 562 patients treated with RT (n = 151) or PL (n = 411) was conducted. The Kaplan-Meier method was used to estimate outcomes. The risk factors were identified using univariate and multivariate Cox regression analyses. Propensity score matching (PSM) was used to adjust for baseline variations.

Results: Post-PSM, the 5-year overall survival (89.4% vs. 88.4%, p = 0.879), 5-year cancer-specific survival (91.9% vs. 90.1%, p = 0.554), and 5-year local relapse-free survival (87.2% vs. 89.3%, p = 0.487) rates did not differ significantly between the two groups. However, the 5-year regional relapse-free survival rate was significantly higher in the RT group than that in the PL group (99.3% vs. 93.3%, p = 0.009). Recurrence was most likely to occur in the lymph nodes at levels II and III. Supraglottic engagement has emerged as an independent prognostic factor for regional relapse in T2 stage diagnosed PL. The RT group demonstrated significantly superior speech function (mean: 6.065) compared to the PL group (mean: 10.650, p < 0.0001).

Conclusions: RT yielded survival rates, local control, and laryngeal preservation comparable to PL. RT is associated with a higher regional control rate in T2 patients. Supraglottic involvement is an independent risk factor for regional relapse in patients with T2 disease after PL. The RT group exhibited extremely low complication rates and significantly improved speech function.