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

Background: Head and neck squamous cell carcinoma (HNSCC) often presents with cervical lymph node metastasis, with 1%-4% of cases presenting as cancer of unknown primary (CUP). CUP poses diagnostic and therapeutic challenges and is linked to poorer survival outcomes. Its incidence is expected to rise with the increasing prevalence of HPV-positive HNSCC. This study evaluated the use of MRI, ¹⁸F-FDG PET, examination under anesthesia (EUA), and TORS-assisted tonsillectomy and tongue base mucosectomy (TORS-TE/TBM) in the work-up of CUP.

Methods: This single-center retrospective study included 79 patients with cytologically confirmed CUP (years 2019-2024). HPV-positive (n = 51) and HPV-negative (n = 28) cases were evaluated separately. Primary tumor detection rates for MRI, ¹⁸F-FDG PET and EUA were calculated. For HPV-positive tumors TORS-TE/TBM was additionally evaluated for primary tumor detection.

Results: In HPV-positive cases MRI and ¹⁸F-FDG PET had detection rates of 45% individually (respectively) and 53% combined. Of detected cases, 37% were identified by a single modality. Post-hoc image review increased the detection rate to 63%. Subsequent imaging-guided EUA had a detection rate of 68%. When TORS-TE/TBM was performed after negative EUA, tumor detection occurred in 50% of cases. Multimodal work-up resulted in an over-all detection rate of 75%. In contrast, HPV-negative cases had a lower over-all multimodal detection rate of 39%.

Conclusion: MRI and ¹⁸F-FDG PET each play a pivotal and complimentary role for the detection of primary tumors in HNSCC CUP. Image-guided EUA and, in selected cases, TORS-TE/TBM further improve detection. A multimodal approach including expert imaging interpretation is recommended for optimal tumor identification and treatment planning.

Background: Pharyngeal squamous cell carcinoma (PSCC) is an aggressive subtype of head and neck squamous cell carcinoma (HNSCC) with poor prognosis and low survival rates. Immune checkpoint inhibitors (ICIs) show promise, but less than 20% of HNSCC patients respond positively. Targeted radionuclide therapy (TRT) combines radionuclides with monoclonal antibodies to target tumor cells. This study created a reliable animal model of PSCC for evaluating the therapeutic efficacy of ¹³¹I-aPD-L1.

Methods: Nude mice were subcutaneously implanted with FaDu cells-a human PSCC cell line characterized by high PD-L1 expression. The synthesis of ¹³¹I-aPD-L1 was optimized by varying labeling conditions, achieving a labeling efficiency of over 90%. Mice were divided into experimental and control groups; the experimental group received a single intravenous injection of 500 μCi ¹³¹I-aPD-L1. Accumulation of ¹³¹I-aPD-L1 in tumor tissues was confirmed by animal single-photon emission computed tomography (SPECT). Tumor volume and mouse body weight were measured every 3 days for 30 days. At the end of the study, tumor tissues were stained for histological examination and immunohistochemical analysis of Bcl-2 and Caspase-3 expression levels. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was also performed on tumor tissues.

Results: SPECT verified a significant accumulation of ¹³¹I in FaDu tumor tissue. The experimental group exhibited significantly slower tumor volume increase compared to the control group (t = 2.37, p < 0.05). Additionally, a significant reduction in body weight was observed in the ¹³¹I-aPD-L1 group compared to the control group (t = 5.624, p < 0.01). HE staining showed extensive tumor necrosis in the experimental group. Immunohistochemical analysis revealed negative Bcl-2 expression and higher caspase-3 expression in the experimental group, indicating enhanced apoptosis and necrosis in tumor cells. Furthermore, TUNEL assay further confirmed that ¹³¹I exerted cytotoxic effects by inducing DNA fragmentation.

Conclusions: Collectively, our findings demonstrate the promising therapeutic potential of ¹³¹I-aPD-L1 for PSCC, particularly in patients with drug resistance or recurrent head and neck tumors. However, the use of nude mice may have impacted the full therapeutic efficacy and synergistic potential observed with immunotherapy. Future studies should utilize immunocompetent models to better assess the probe's therapeutic impact and to explore its synergistic effects with immunotherapy and reduce the dose of ¹³¹I to mitigate its toxic effects.

Background: Both endonasal and transoral approaches can provide minimally invasive access to the infratemporal fossa (ITF); however, the appropriate indications for each corridor have not been sufficiently defined. This study aimed to explore the indication for selection of an endonasal or a transoral approach to the ITF.

Methods: Cadaveric dissection was performed on 6 specimens, one side for an endonasal approach and the contralateral side for a transoral approach. A complementary subdivision of the ITF into four quadrants (A-D) based on the crossing line at the lower border of the lateral pterygoid plate was established. Thirty-one patients who underwent endoscopic endonasal (Group 1) or transoral approach (Group 2) to remove tumors in the ITF were retrospectively reviewed. Related indices for each surgical approach were compared.

Results: On cadaveric dissection, both the endonasal and the transoral approaches can provide access to the ITF. In Group 1, 26 patients underwent an endonasal approach, and the main tumor body was located at quadrant A. While patients in Group 2 performed a transoral resection, the tumor was mainly located in quadrant D. No significant difference for indices (e.g., operation length, morbidity) between groups (all p > 0.05), and no recurrence was detected.

Conclusion: The endonasal and transoral corridors are suitable for management of lesions at the medial and lateral or inferolateral aspects of the ITF, respectively. The relative tumor location to the lateral pterygoid plate may constitute an anatomic division tool to determine surgical approach selection.

Objective: To evaluate facial nerve reconstruction's impact on quality of life (QoL) and clinical outcomes in radical parotid malignancy surgery.

Methods: Patients were stratified into the Preservation Group, Reconstruction Group, and Disconnection Group, retrospectively analyzed objective measures (from medical records and operative reports) and subjective measures (using the Sunnybrook Facial Grading System [SFGS] and Facial Clinimetric Evaluation [FaCE] scale) across the three patient groups.

Results: No significant differences in recurrence or mortality were observed between Reconstruction and Disconnection groups (p > 0.05). Facial nerve reconstruction significantly improves outcomes in patients with high-risk parotid malignancies (p < 0.05), despite higher-risk profiles in the reconstruction cohort. This improvement remained stable over time, showing no significant decline (p > 0.05). Venous nerve conduit trap yielded superior facial nerve function and QoL versus end-to-end repair (p < 0.05).

Conclusion: Facial nerve reconstruction effectively improves outcomes in parotid malignancy surgery. Venous nerve conduit trap application is better than end-to-end repair.

Background: Laryngeal stenosis is a significant complication impairing quality of life after partial laryngectomy for laryngeal squamous cell carcinoma (LSCC). This study aimed to evaluate the efficacy of different management strategies (endoscopic vs. open).

Methods: We conducted a retrospective cohort study who developed laryngeal stenosis following partial laryngectomy for LSCC between December 2011 and December 2023. Patient demographics, etiological factors, and therapeutic interventions were systematically analyzed to evaluate clinical outcomes and summarize management experience.

Results: The study cohort comprised 61 patients (4 females, 57 males) aged 25-77 years old. The overall decannulation rate was 52.5% (32/61). Endoscopic treatments included laser, balloon dilation and laser combined with balloon dilation, with a decannulation rate of 64.71%, 33.3%, and 45.45%, respectively. Of the 45 patients who received a single endoscopic treatment, successful decannulation was achieved in 25 cases (55.6%), while among the 11 patients that received multiple endoscopic treatment, only 3 (27.3%) patients attained successful decannulation. In contrast, open laryngotracheal reconstruction (LTR) with T-tube placement showed superior outcomes, with an 80% (4/5) decannulation rate. Among the 61 patients with laryngeal stenosis, those who underwent endoscopic treatment did not require postoperative nasogastric feeding, and their postoperative hospital stay was significantly shorter compared to those who underwent LTR with T-tube.

Conclusion: Laser-assisted endoscopic techniques is recommended as the initial treatment for laryngeal stenosis following partial laryngectomy due to its minimally invasive nature and faster recovery. However, for patients who fail initial endoscopic treatment, LTR with T-tube is often recommended due to its higher decannulation rate, rather than repeated endoscopic attempts.

Background: The gingiva and floor of the mouth are distinct subsites, and oral squamous cell carcinoma (OSCC) originating in these locations warrants further indepth understanding.

Methods: This study enrolled patients with OSCC from 2000 to 2020, and analyzed the clinicopathological characteristics. Kaplan-Meier analysis compared overall survival (OS) and recurrence-free survival (RFS). Univariate analysis and multivariate Cox proportional hazards model examined the risk factors on survival outcomes.

Results: A total of 885 OSCC patients were included, with the most common tumor subsites: oral tongue (41.9%), gingiva (31.8%), and floor of mouth (16.0%). Gingival and floor of mouth showed a higher proportion of advanced stage (65.8%, 66.9%) and significantly poorer OS (3-year: 63.0%, 57.0%; 5-year: 49.8%, 37.3%) and RFS (3-year: 59.1%, 61.3%; 5-year: 55.5%, 57.0%). Neoadjuvant chemotherapy was associated with significantly reduced mortality in gingival cancer (HR = 0.598), while tobacco exposure (HR = 1.952) was associated with a significant increase in mortality in floor of mouth cancer.

Conclusion: Gingival cancer and floor of mouth cancer have a worse prognosis, and thus require greater attention throughout the entire management process.

Background: The HIT-CRAD trial (ISRCTN57028065) is the first to combine home-based non-invasive brain stimulation with high-volume strength and skill training over 8 weeks in patients with chronic radiation-associated dysphagia (CRAD) following primary (chemo)radiotherapy for head and neck cancer.

Methods: Fifty-four patients were randomized into three groups. Group 1 performed 8 weeks of strength training. Groups 2 and 3 combined 4 weeks of strength training with 4 weeks of skill training. Group 3 received high-definition transcranial direct current stimulation (HD-tDCS) during training. Group 2 received sham HD-tDCS.

Results: Overall adherence and exercise adherence remained above 75% across all groups. Home-based HD-tDCS proved safe and feasible, with mild to moderate side effects (tingling, itching, or burning). Median exercise performance levels for strength training exercises ranged from 94% to 100%.

Conclusions: This study confirms the feasibility of high-volume strength and skill training with HD-tDCS in patients with C-RAD. Proactive adherence-supporting factors facilitate high adherence in this population. Both real and sham HD-tDCS proved safe, feasible, and well tolerated.

Trial registration: International Standard Randomized Controlled Trials Number (ISRCTN) registry ID ISRCTN57028065.

Background: Brain metastases (BM) of differentiated thyroid carcinoma (DTC) are associated with unfavorable prognosis. This study evaluated BM management strategies and patients' outcomes.

Methods: A retrospective review of patients diagnosed with DTC and BM at Tel Aviv Sourasky and Rabin Medical Centers between 1985 and 2024. Clinical features, histopathology, treatments, and survival data were collected.

Results: Twenty patients were identified: 11 (55%) had papillary thyroid carcinoma, 8 (40%) had follicular carcinoma and 1 had Hurtle cell carcinoma. BM treatments included neurosurgical resection (n = 9), stereotactic radiosurgery (n = 14), and whole-brain radiotherapy (n = 6). Median survival following BM diagnosis was 16.2 months. Patients who did not undergo surgical resection had significantly shorter survival than those whose BM were resected (13 vs. 80 months, p = 0.03). Survival was also worse among patients receiving systemic therapy at the time BM developed (8.9 vs. 80 months, p = 0.0001).

Conclusion: Unresected BM of DTC and those arising during systemic therapy portend high mortality.

Background: University of Michigan Cancer Center (UMCC) protocol 9520 treated stage III/IV locally advanced squamous cell carcinoma of the larynx (LASCCL) with cisplatin and 5-fluorouracil to select for definitive therapy based on response. Studies have shown that neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) are potential prognostic markers in p16-negative LASCCL. This study analyzes the predictive value of NLR and LMR.

Methods: Samples from 193 LASCCL patients treated with chemotherapy were reviewed. Response to induction chemotherapy was tested with logistic regression. Optimal cut-points were determined by Youden's index. Survival was tested with Cox proportional hazards models.

Results: LMR had a positive association, NLR had a negative association with response to chemotherapy (p = 0.004;0.07). Response was higher in patients with LMR ≥ 2.8 (p = 0.0007) and NLR ≤ 2.8 (p = 0.04). Overall and disease-specific survival improved with LMR ≥ 2.8 (p = 0.0002;0.004) and NLR ≤ 2.8 (p = 0.10;0.03).

Conclusions: Low NLR and high LMR were associated with favorable responses to chemotherapy and survival in LASCCL.

Background: Although laryngeal cancer incidence has declined in the United States, case fatality has risen. The survival equivalence of surgery versus chemoradiotherapy (CRT) for cT4a laryngeal squamous cell carcinoma (LSCC) remains uncertain.

Methods: We conducted a retrospective cohort study of cT4a LSCC patients treated with curative-intent surgery or CRT using the National Cancer Database (2010-2021). Those receiving neoadjuvant or palliative therapy, or with distant metastases were excluded. Survival was assessed using Kaplan-Meier and Cox models after 1:1 propensity score matching.

Results: Among 3569 patients (mean age 61.0, 708 female), 2437 (68.3%) underwent surgery while 1132 (31.7%) received CRT. In the matched cohort (n = 452 per arm), median survival was 52.8 (95% CI: 45.6-62.4) versus 37.6 (95% CI: 29.2-45.4) months for surgery versus CRT. Adjusted HR for CRT relative to surgery was 1.26 (95% CI: 1.02-1.57).

Conclusions: Surgery was associated with improved overall survival compared with definitive CRT in patients with T4a LSCC.