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

S. Y. Kim, D. Crook, J. Rosskopf, and J.-H. Lee, “Diagnostic Value of 18F-FDG PET/CT Versus Diffusion-Weighted MRI in Detection of Residual or Recurrent Tumors After Definitive (Chemo) Radiotherapy for Laryngeal and Hypopharyngeal Squamous Cell Carcinoma: A Prospective Study,” Head & Neck 46, no. 9 (2024): 2284–2291, https://doi.org/10.1002/hed.27796.

In the author list section, the order of authors was incorrect. The correct order is “Crook D, Rosskopf J, Kim SY, Lee JH.” Crook D should be the first author, Kim SY and Lee JH should be the co-last authors, co-corresponding authors.

Therefore, the indications of author list and affiliation should read:

David Cook¹, Johannes Rosskopf^2,3, Soung Yung Kim^1,*, Jung-Hyun Lee^4,*

¹Department of Radiology, Spital Muri, Muri, Switzerland

²BKH Günzburg, Günzburg, Germany

³Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany

⁴Department of Life Science, University of Seoul, Seoul, Republic of Korea

*Co-last authors and co-corresponding authors

We apologize for this error.

Background: The current classification of tongue cancers does not discriminate stages based on factors of local spread.

Aim: Integrating factors of local spread that impact disease-specific survival (DSS) in a modified classification to improve prognostication compared with the current staging.

Method: This was a retrospective analysis of 399 previously untreated oral tongue squamous carcinomas operated between 2016 and 2018. Factors related to the local extent of a primary tumor that impacted the DSS were studied. Multivariable analyses adjusted for pT, pN stage, and adjuvant therapy. Candidate staging systems were developed based on factors that significantly impacted DSS, and validated.

Result: Base tongue involvement (p = 0.021), DOI > 20 mm (p value = 0.040), and tumor crossing the midline (p value = 0.047) significantly impacted the DSS. The preferred model included base tongue involvement in T3 stage, and DOI > 20 mm and tumor crossing the midline into T4 stage (Model 2), which was superior to the current classification system in AIC (830.55 vs. 845.43), C-index (0.65 vs. 0.61), and visual inspection of Kaplan-Meier curves.

Conclusion: Identifying and possibly including these clinical factors in addition to the current T-stage criteria could result in better prognostication of tongue cancers.

Significance: Integration of proposed classification could improve the discrimination between stages.

Background: Quantifying head and neck lymphedema and fibrosis (HN-LEF) is crucial in the investigation and management of treatment sequelae in head and neck cancer (HNC).

Methods: The T1- and T2-weighted MRI signal intensity (SI) was examined in relation to HN-LEF categories per physical/tactile examination (No-LEF, A-B = edema, C = edema + fibrosis, D = fibrosis), and MRI structural volumes were examined in relation to a novel 10-point HN-LEF score in the intraoral and submental regions.

Results: We identified differences in ranks among HN-LEF categories in relation to the MRI SI (A-B and C are higher than D and No-LEF for T2 SI, and A-B is the highest for T1). Furthermore, six pairs of FOM volumes on MRI demonstrated a strong negative correlation (p < 0.05) with the HN-LEF score at adjacent palpable sites.

Conclusion: Both MRI SI and structural volumes can potentially be imaging biomarkers of edematous soft tissue states in HNC patients.

Background: The aim of this clinical survey was to assess variations in head and neck squamous cell carcinoma from an unknown primary (HNSCCUP) diagnostic practices across international centers.

Methods: Clinical practice survey of experts nominated by Head and Neck Cancer International Group (HNCIG) and International Federation of Head and Neck Oncologic Societies (IFHNOS).

Results: Responses were received from 48/49 (97.9%) participants. Outpatient laryngoscopy, CT, and 18-FDG-PETCT were used always or most of the time by 81.3%, 77.1%, and 79.2%, but only 50% regularly used MRI. Unilateral and bilateral tonsillectomy were frequently performed in 41.6% and 27.1% of unilateral nodal disease, and in 18.8% and 52.1% for bilateral disease. Ipsilateral Tongue Base Mucosectomy (TBM) was used always or most of the time in 12.5% of unilateral and 6.3% of bilateral HNSCCUP. Bilateral TBM was used in 10.4% for unilateral and 22.9% for bilateral cancers.

Conclusions: While there is broad agreement regarding examination and cross-sectional imaging, there are considerable differences in the surgical strategies used to identify occult primaries.

Background: Flow-through flaps (FTFs) are an advanced technique in which a free flap is anastomosed to the pedicle of another free flap to reconstruct extensive head and neck defects when recipient vessels are scarce.

Methods: A multi-institutional cohort of FTFs used for head and neck reconstruction were reviewed. For comparison, FTF outcomes were compared to free flaps that required vein grafts (VG) to reach distant recipient vessels.

Results: A total of forty-two patients underwent surgery using a FTF configuration, including 32 simultaneous and 10 sequential FTFs. There were no instances of flap failure compared to a 7% flap failure rate in the VG group (n = 54). The overall postoperative complication rate was 28% compared to a 46% complication rate in the VG group (p = 0.093).

Conclusion: FTFs are a reliable option for reconstruction of extensive head and neck defects when recipient blood vessel availability is limited.

Background: The superior thyroid artery (STA) as a recipient vessel in free flap reconstruction may theoretically impact thyroid function. This study aimed to assess whether the use of the STA has an adverse effect on thyroid function.

Methods: Retrospective review of 101 head and neck reconstructive cases. Thyroid function tests were reviewed within 1 year of surgery.

Results: The STA was used in 40 cases. The STA cohort had significantly higher TSH levels than the non-STA cohort (7.34 v. 2.87 mU/L, p = 0.02). About 27.5% developed subclinical post-operative hypothyroidism and 17.5% required new levothyroxine supplementation in the STA group.

Conclusion: This represents the first study to our knowledge assessing the impact of the STA as a recipient vessel on postoperative thyroid function. While we found a statistically significant difference in average TSH after using the STA, the average TSH/FT4 values were subclinical. Post-operative monitoring for hypothyroidism is warranted in this population.

Background: Chondrosarcomas of the larynx, relatively rare tumors with low grade pathology in approximately 95% of cases, can most often be managed with conservation laryngeal procedures. Dedifferentiated chondrosarcomas are much more rare and aggressive requiring more aggressive surgical extirpation.

Methods: A patient underwent three debulking procedures for a laryngeal chondrosarcoma Grade I/II histologically over a 2.5 year period of time during which slow growth was closely monitored. He then presented with relatively rapid onset of hoarseness and shortness of breath. Fiberoptic laryngoscopy demonstrated new bilateral vocal fold fixation with near occlusion of his subglottis by soft tissue mass.

Results: A total laryngectomy was performed that pathologically demonstrated a Grade III dedifferentiated chondrosarcoma. Shortly thereafter, the patient developed regional metastases, then distant metastases and then succumbed to the disease.

Conclusion: This first case of a Grade III dedifferentiating chondrosarcoma arising from closely monitored and multiple debulked previously Grade I/II tumor demonstrates the potential change in aggressiveness in low-grade chondrosarcomas of the larynx. Sudden increase in growth along with a soft tissue component to the tumor based on exam and/or imaging should heighten suspicion for dedifferentiation of the tumor and necessitates a more aggressive surgical resection. However, the chance of cure once dedifferentiation occurs is drastically reduced.

Objectives: To address controversies regarding target volume delineation for adjuvant intensity-modulated radiation therapy for oral cavity squamous cell carcinoma with pedicled flap reconstruction and elective nodal irradiation (ENI).

Materials and methods: During target volume delineation, the primary tumor bed was the pre-surgical gross tumor volume with an additional isotropic margin of 5-10 mm. Additionally, the flap and body tissue junction were given a margin of 5-10 mm (if not already given). An effort was not made to trace the flap for inclusion in the clinical target volume (CTV), except when it traversed through the involved nodal regions. Contralateral ENI was carried out only in tumors crossing the midline when there was a heavy nodal burden at Ia/Ib.

Results: In the 143 patients analyzed, the most common sub-site was buccal mucosa (78, 54.5%). Contralateral ENI was done in 63 patients (36 Tongue, 23 Buccoalveolar). The median follow-up of surviving patients was 24 months. The 2-year Locoregional Control, Disease-Free Survival, and Overall Survival were 77.4%, 64.5%, and 79% respectively. Overall, there were 55 (38.5%) recurrences, of which 35 (24.5%) were either local, regional, or combined locoregional failures, 13 (9.1%) were distant failures alone, and 7 (4.9%) had both locoregional and distant failures. The elective nodal regions had 3 (2.1%) contralateral nodal failures.

Conclusion: The entire flap need not be intentionally covered in the target volume. Contralateral ENI should be considered only for patients with heavy nodal burden at ipsilateral level Ia/Ib, in tumors crossing the midline, or in tumors having a high propensity for contralateral lymph nodal involvement.