Tyler G Chan, Jaime Wicks, Ila Sethi, Jennifer Becker, David Brandon, Nicole C Schmitt, Azeem Kaka, Brian Boyce, Harry Michael Baddour, Mark W El-Deiry, Mihir R Patel, Jennifer H Gross
Introduction: Occult nodal disease (OND) during clinically-N0 salvage total laryngectomy (TL) can be detected with the Neck-Imaging-Reporting-and-Data-Systems (NI-RADS). However, some patients will still have OND revealed on final pathology.
Methods: A retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features.
Results: Among 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length [SD] was 0.6 cm [0.3]. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUVmax below blood pool. One patient scored NI-RADS 2; the rest scored 1.
Conclusions: On re-review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information.
{"title":"Radiologic findings of occult nodal metastasis during clinically-N0 salvage total laryngectomy.","authors":"Tyler G Chan, Jaime Wicks, Ila Sethi, Jennifer Becker, David Brandon, Nicole C Schmitt, Azeem Kaka, Brian Boyce, Harry Michael Baddour, Mark W El-Deiry, Mihir R Patel, Jennifer H Gross","doi":"10.1002/hed.27889","DOIUrl":"https://doi.org/10.1002/hed.27889","url":null,"abstract":"<p><strong>Introduction: </strong>Occult nodal disease (OND) during clinically-N0 salvage total laryngectomy (TL) can be detected with the Neck-Imaging-Reporting-and-Data-Systems (NI-RADS). However, some patients will still have OND revealed on final pathology.</p><p><strong>Methods: </strong>A retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features.</p><p><strong>Results: </strong>Among 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length [SD] was 0.6 cm [0.3]. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUV<sub>max</sub> below blood pool. One patient scored NI-RADS 2; the rest scored 1.</p><p><strong>Conclusions: </strong>On re-review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information.</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":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876763","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}
Claudio Sampieri, Eleonora Cioccoloni, Andrea Costantino, Dahee Kim, Kyuin Lee, Giuseppe Meccariello, Giovanni Cammaroto, Claudio Vicini, Se-Heon Kim
Background: Transoral robotic surgery (TORS) performed after neoadjuvant chemotherapy (NAC) is a promising treatment for advanced-stage oropharyngeal carcinoma (OPSCC) able to reduce the adjuvant therapy administration rate.
Methods: A retrospective bi-centric study was conducted to analyze NAC + TORS versus upfront TORS patients. A 1:1 propensity score matching was used to compare the two groups.
Results: Among the 300 patients with stage III-IV OPSCC, 204 patients were matched for comparing NAC + TORS versus upfront TORS. Between the two groups, no significant difference was observed in recurrences and in survival for RFS, OS, and DSS. In the NAC + TORS p16-positive population, adjuvant therapy could be spared in 51% versus 16% in the upfront surgery cohort (p < 0.001) due to the lower frequency of pathological risk factors after NAC.
Conclusions: NAC followed by TORS for locoregionally advanced OPSCC demonstrated to achieve non-inferior survival outcomes to upfront surgery, while in the p16-positive population allowed to significantly spare adjuvant therapy.
{"title":"Neoadjuvant chemotherapy followed by transoral robotic surgery versus upfront surgery for locoregionally advanced oropharyngeal carcinoma: A propensity score matched analysis.","authors":"Claudio Sampieri, Eleonora Cioccoloni, Andrea Costantino, Dahee Kim, Kyuin Lee, Giuseppe Meccariello, Giovanni Cammaroto, Claudio Vicini, Se-Heon Kim","doi":"10.1002/hed.27904","DOIUrl":"https://doi.org/10.1002/hed.27904","url":null,"abstract":"<p><strong>Background: </strong>Transoral robotic surgery (TORS) performed after neoadjuvant chemotherapy (NAC) is a promising treatment for advanced-stage oropharyngeal carcinoma (OPSCC) able to reduce the adjuvant therapy administration rate.</p><p><strong>Methods: </strong>A retrospective bi-centric study was conducted to analyze NAC + TORS versus upfront TORS patients. A 1:1 propensity score matching was used to compare the two groups.</p><p><strong>Results: </strong>Among the 300 patients with stage III-IV OPSCC, 204 patients were matched for comparing NAC + TORS versus upfront TORS. Between the two groups, no significant difference was observed in recurrences and in survival for RFS, OS, and DSS. In the NAC + TORS p16-positive population, adjuvant therapy could be spared in 51% versus 16% in the upfront surgery cohort (p < 0.001) due to the lower frequency of pathological risk factors after NAC.</p><p><strong>Conclusions: </strong>NAC followed by TORS for locoregionally advanced OPSCC demonstrated to achieve non-inferior survival outcomes to upfront surgery, while in the p16-positive population allowed to significantly spare adjuvant therapy.</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":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861730","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}
Kerstin Petersson, Caterina Finizia, Nina Pauli, Lisa Tuomi
Background: Radiation-induced dysphagia and restricted mouth opening are common problems among patients with head and neck cancer. The aim of the present randomized controlled trial was to determine if an exercise protocol could prevent swallowing and mouth opening impairment.
Methods: Eighty-nine participants were randomly assigned to either an active group performing preventive swallowing and mouth opening exercises (n = 45) or to a control group (n = 44). Outcome measures were collected at baseline before radiotherapy and approximately 1-month post-treatment. Primary endpoints were changes in swallowing function according to the Penetration Aspiration Scale and mouth opening ability measured in millimeters. Intention-to-treat analysis was used.
Results: Swallowing function and mouth opening deteriorated in both groups, with no statistically significant positive effect of the protocol detected at follow-up. Among patients who completed >75% of exercises, there was a trend toward better outcomes.
Conclusions: Preventive exercises did not improve short-term swallowing function and mouth opening after radiotherapy.
{"title":"Preventing radiation-induced dysphagia and trismus in head and neck cancer-A randomized controlled trial.","authors":"Kerstin Petersson, Caterina Finizia, Nina Pauli, Lisa Tuomi","doi":"10.1002/hed.27886","DOIUrl":"https://doi.org/10.1002/hed.27886","url":null,"abstract":"<p><strong>Background: </strong>Radiation-induced dysphagia and restricted mouth opening are common problems among patients with head and neck cancer. The aim of the present randomized controlled trial was to determine if an exercise protocol could prevent swallowing and mouth opening impairment.</p><p><strong>Methods: </strong>Eighty-nine participants were randomly assigned to either an active group performing preventive swallowing and mouth opening exercises (n = 45) or to a control group (n = 44). Outcome measures were collected at baseline before radiotherapy and approximately 1-month post-treatment. Primary endpoints were changes in swallowing function according to the Penetration Aspiration Scale and mouth opening ability measured in millimeters. Intention-to-treat analysis was used.</p><p><strong>Results: </strong>Swallowing function and mouth opening deteriorated in both groups, with no statistically significant positive effect of the protocol detected at follow-up. Among patients who completed >75% of exercises, there was a trend toward better outcomes.</p><p><strong>Conclusions: </strong>Preventive exercises did not improve short-term swallowing function and mouth opening after radiotherapy.</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":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876762","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: Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive disease with ambiguous management and poor prognosis. This study aimed to evaluate the role of radiation therapy (RT) and explore the optimal treatment sequence.
Methods: Retrospective analysis of survival trends of 410 SNUC patients between 1973 and 2015.
Results: The 5-year cancer-specific survival (CSS) rate (45.1%) and overall survival (OS) rates (38.1%) were reported in the 84-month median follow-up. Radiotherapy was a prognosticator for improving CSS (hazard ratio [HR] = 0.425, 95% confidence interval [CI]: 0.299-0.603, p = 0.000) and OS (HR = 0.415, 95% CI: 0.303-0.570, p = 0.000), either with surgery (p = 0.000) or without surgery (p = 0.000). However, in a combined therapy of surgery and RT, preoperative and postoperative RT (5-year OS rates were 47.1% and 45.6%, respectively, p = 0.486) were not significantly different.
Conclusions: Radiotherapy plays a key role in improving SNUC survival rates. No significant difference in survival rates was observed in preoperative and postoperative RT treatment.
背景:鼻窦未分化癌(SNUC)是一种罕见的侵袭性疾病,治疗不明确,预后差。本研究旨在评估放射治疗(RT)的作用,并探索最佳治疗顺序:方法:对1973年至2015年间410例SNUC患者的生存趋势进行回顾性分析:结果:在84个月的中位随访中,5年癌症特异性生存率(CSS)为45.1%,总生存率(OS)为38.1%。放疗是改善 CSS 的预后指标(危险比 [HR] = 0.425,95% 置信区间 [CI]:0.299-0.603):0.299-0.603, p = 0.000)和OS(HR = 0.415, 95% CI: 0.303-0.570, p = 0.000)。然而,在手术和 RT 的联合治疗中,术前和术后 RT(5 年 OS 率分别为 47.1% 和 45.6%,p = 0.486)没有显著差异:结论:放疗在提高SNUC生存率方面发挥着关键作用。结论:放疗在提高SNUC生存率方面发挥着关键作用,术前和术后RT治疗在生存率方面无明显差异。
{"title":"The role of radiotherapy in the treatment of sinonasal undifferentiated carcinoma: A population-based analysis.","authors":"Xin Zhao, Ziqi Pei, Xiang Song, Gang Jin","doi":"10.1002/hed.27862","DOIUrl":"https://doi.org/10.1002/hed.27862","url":null,"abstract":"<p><strong>Background: </strong>Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive disease with ambiguous management and poor prognosis. This study aimed to evaluate the role of radiation therapy (RT) and explore the optimal treatment sequence.</p><p><strong>Methods: </strong>Retrospective analysis of survival trends of 410 SNUC patients between 1973 and 2015.</p><p><strong>Results: </strong>The 5-year cancer-specific survival (CSS) rate (45.1%) and overall survival (OS) rates (38.1%) were reported in the 84-month median follow-up. Radiotherapy was a prognosticator for improving CSS (hazard ratio [HR] = 0.425, 95% confidence interval [CI]: 0.299-0.603, p = 0.000) and OS (HR = 0.415, 95% CI: 0.303-0.570, p = 0.000), either with surgery (p = 0.000) or without surgery (p = 0.000). However, in a combined therapy of surgery and RT, preoperative and postoperative RT (5-year OS rates were 47.1% and 45.6%, respectively, p = 0.486) were not significantly different.</p><p><strong>Conclusions: </strong>Radiotherapy plays a key role in improving SNUC survival rates. No significant difference in survival rates was observed in preoperative and postoperative RT treatment.</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":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861731","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}
Filippo Marchi, Andrea Iandelli, Gian Marco Pace, Elisa Bellini, Alessandro Tirrito, Andrea Costantino, Luca Cerri, Antonio Greco, Antonella Polimeni, Giampiero Parrinello, Giorgio Peretti, Armando De Virgilio
Objective: This study aims to evaluate the efficacy of the profunda artery perforator (PAP) flap in head and neck reconstruction.
Methods: A single arm meta-analysis was performed for flap survival rate (primary outcome), reoperation for major complication, and overall complication rates (secondary outcomes).
Results: The search strategy yielded a total of 295 potentially relevant publications, of which 13 were included. A total of 305 patients (males: 80.8%, n = 232/281), with a median age of 56.1 years (n = 305/305; 95% CI 53.9-63), who underwent a total of 307 PAP flap reconstructions for head and neck defects were included. Flap survival rate was 100% (n = 306/307; 95% CI 99.6%-100%), with a reoperation rate for major complications of 3.7% (n = 15/307; 95% CI 1.85%-6.1%) and an overall complication rate of 26.5% (n = 92/307; 95% CI 15.7%-38.9%). Notable postoperative complications included wound dehiscence (n = 15/307, 4.9%), delayed healing (n = 14/307, 4.6%), and wound infection (n = 12/307, 3.9%). Partial flap necrosis and hematoma occurred in 2.6% of cases (n = 8/307), while arterial and venous thrombosis were documented in 0.7% (n = 2/307) and 1.3%, respectively (n = 4/307).
Conclusion: The application of the PAP flap in head and neck reconstructions showed several favorable aspects, such as an exceptionally low flap failure rate, versatility in achieving variable dimensions, and a relatively low incidence of complications. PAP flap might be considered as a compelling alternative to the traditionally employed soft tissue free flaps in head and neck reconstruction.
研究目的本研究旨在评估深动脉穿孔器(PAP)皮瓣在头颈部重建中的疗效:方法:对皮瓣存活率(主要结果)、主要并发症再手术率和总体并发症发生率(次要结果)进行单臂荟萃分析:搜索策略共搜索到 295 篇潜在相关文献,其中 13 篇被纳入。共纳入 305 名患者(男性:80.8%,n = 232/281),中位年龄为 56.1 岁(n = 305/305;95% CI 53.9-63),他们因头颈部缺损接受了 307 例 PAP 皮瓣重建术。皮瓣存活率为 100%(n = 306/307;95% CI 99.6%-100%),主要并发症的再手术率为 3.7%(n = 15/307;95% CI 1.85%-6.1%),总并发症率为 26.5%(n = 92/307;95% CI 15.7%-38.9%)。显著的术后并发症包括伤口开裂(n = 15/307,4.9%)、延迟愈合(n = 14/307,4.6%)和伤口感染(n = 12/307,3.9%)。部分皮瓣坏死和血肿发生率为 2.6%(8/307),动脉和静脉血栓形成率分别为 0.7%(2/307)和 1.3%(4/307):结论:PAP皮瓣在头颈部重建中的应用显示出多个有利方面,如皮瓣失败率极低、可实现不同尺寸的多功能性以及并发症发生率相对较低。在头颈部重建中,PAP皮瓣可被视为传统软组织游离皮瓣的替代品。
{"title":"Surgical outcomes of profunda artery perforator flap in head and neck reconstruction: A systematic review and meta-analysis.","authors":"Filippo Marchi, Andrea Iandelli, Gian Marco Pace, Elisa Bellini, Alessandro Tirrito, Andrea Costantino, Luca Cerri, Antonio Greco, Antonella Polimeni, Giampiero Parrinello, Giorgio Peretti, Armando De Virgilio","doi":"10.1002/hed.27891","DOIUrl":"https://doi.org/10.1002/hed.27891","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the efficacy of the profunda artery perforator (PAP) flap in head and neck reconstruction.</p><p><strong>Methods: </strong>A single arm meta-analysis was performed for flap survival rate (primary outcome), reoperation for major complication, and overall complication rates (secondary outcomes).</p><p><strong>Results: </strong>The search strategy yielded a total of 295 potentially relevant publications, of which 13 were included. A total of 305 patients (males: 80.8%, n = 232/281), with a median age of 56.1 years (n = 305/305; 95% CI 53.9-63), who underwent a total of 307 PAP flap reconstructions for head and neck defects were included. Flap survival rate was 100% (n = 306/307; 95% CI 99.6%-100%), with a reoperation rate for major complications of 3.7% (n = 15/307; 95% CI 1.85%-6.1%) and an overall complication rate of 26.5% (n = 92/307; 95% CI 15.7%-38.9%). Notable postoperative complications included wound dehiscence (n = 15/307, 4.9%), delayed healing (n = 14/307, 4.6%), and wound infection (n = 12/307, 3.9%). Partial flap necrosis and hematoma occurred in 2.6% of cases (n = 8/307), while arterial and venous thrombosis were documented in 0.7% (n = 2/307) and 1.3%, respectively (n = 4/307).</p><p><strong>Conclusion: </strong>The application of the PAP flap in head and neck reconstructions showed several favorable aspects, such as an exceptionally low flap failure rate, versatility in achieving variable dimensions, and a relatively low incidence of complications. PAP flap might be considered as a compelling alternative to the traditionally employed soft tissue free flaps in head and neck 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":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857170","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}
Zhichao Zuo, Jie Ma, Mi Yan, Wu Ge, Ting Yao, Lu Zhou, Ying Zeng, Yang Liu
Background: Early detection of high-risk nasopharyngeal carcinoma (NPC) recurrence is essential. We created a machine learning-derived prognostic signature (MLDPS) by combining three machine learning (ML) models to predict progression-free survival (PFS) in patients with non-metastatic NPC.
Methods: A cohort of 653 patients with non-metastatic NPC was divided into a training (n = 457) and validation (n = 196) dataset (7:3 ratio). The study included clinicopathological characteristics, hematologic markers, and MRI findings in three machine learning models-random forest (RF), extreme gradient boosting (XGBoost), and least absolute shrinkage and selection operator (LASSO)-to predict progression-free survival (PFS). A Venn diagram identified the overlapping signatures from the three ML algorithms. Cox proportional hazard analysis determined the MLDPS for PFS.
Results: The RF, XGBoost, and LASSO algorithms identified six consensus factors from the 33 signatures. Cox proportional hazards analysis showed that the MLDPS includes age, lymphocyte count, number of positive lymph nodes, and regional lymph node density. Additionally, MLDPS effectively stratified prognosis, with low-risk individuals showing better PFS than high-risk individuals (p < 0.001).
Conclusion: MLDPS, based on clinicopathological characteristics, hematologic markers, and MRI findings, is crucial for guiding clinical management and personalizing treatments for patients with non-metastatic NPC.
{"title":"Machine learning-derived prognostic signature for progression-free survival in non-metastatic nasopharyngeal carcinoma.","authors":"Zhichao Zuo, Jie Ma, Mi Yan, Wu Ge, Ting Yao, Lu Zhou, Ying Zeng, Yang Liu","doi":"10.1002/hed.27895","DOIUrl":"https://doi.org/10.1002/hed.27895","url":null,"abstract":"<p><strong>Background: </strong>Early detection of high-risk nasopharyngeal carcinoma (NPC) recurrence is essential. We created a machine learning-derived prognostic signature (MLDPS) by combining three machine learning (ML) models to predict progression-free survival (PFS) in patients with non-metastatic NPC.</p><p><strong>Methods: </strong>A cohort of 653 patients with non-metastatic NPC was divided into a training (n = 457) and validation (n = 196) dataset (7:3 ratio). The study included clinicopathological characteristics, hematologic markers, and MRI findings in three machine learning models-random forest (RF), extreme gradient boosting (XGBoost), and least absolute shrinkage and selection operator (LASSO)-to predict progression-free survival (PFS). A Venn diagram identified the overlapping signatures from the three ML algorithms. Cox proportional hazard analysis determined the MLDPS for PFS.</p><p><strong>Results: </strong>The RF, XGBoost, and LASSO algorithms identified six consensus factors from the 33 signatures. Cox proportional hazards analysis showed that the MLDPS includes age, lymphocyte count, number of positive lymph nodes, and regional lymph node density. Additionally, MLDPS effectively stratified prognosis, with low-risk individuals showing better PFS than high-risk individuals (p < 0.001).</p><p><strong>Conclusion: </strong>MLDPS, based on clinicopathological characteristics, hematologic markers, and MRI findings, is crucial for guiding clinical management and personalizing treatments for patients with non-metastatic NPC.</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":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794160","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}
Shaghauyegh S Azar, Courtney B Shires, Karuna Dewan, Dinesh K Chhetri
Objectives: Tracheoesophageal prosthesis (TEP) is a common method for post-laryngectomy speech rehabilitation. Despite its common use, some patients ultimately fail TEP rehabilitation. TEP dysfunction negatively affects quality of life due to poor voice quality and need for repeated interventions to restore TEP function. Occasionally, voice rehabilitation with TEP is completely unsuccessful. We performed a scoping review to characterize the main reasons for total TEP failure, in hopes of guiding selection of optimal TEP candidates.
Study design: Scoping review using PubMed of all English language articles from 1990 to 2020 addressing causes of TEP failure.
Methods: This scoping review followed the population, intervention, comparison, outcome and study (PICOS) guidelines. Total TEP failure was defined as complete loss or abandonment of TEP voice or tract. A comprehensive search strategy using PubMed's MeSH subject headings and keywords was created. Causes and rates of failure were reviewed.
Results: Among 544 peer-reviewed journal articles reviewed for inclusion. Seventy articles met inclusion criteria, resulting in a total of 4928 TEP voice restoration patients for analysis. 15.2% of these patients had total TEP failure. The most common reasons for failure were dissatisfaction with voice (26.3%), leakage (17.9%), inadequate patient motivation (14.7%), comorbidities (14.2%), stoma problems (11.6%), and abandonment of TEP after dislodgement (10.6%).
Conclusion: Common reasons for TEP failure included voice dissatisfaction, leakage, lack of patient motivation, patient comorbidities, and stoma problems. These factors should be considered when selecting candidates for TEP voice restoration.
目的:气管食管假体(TEP)是喉切除术后语言康复的常用方法。尽管这种方法很常用,但一些患者最终还是无法通过 TEP 进行康复治疗。由于嗓音质量差,且需要反复干预以恢复 TEP 功能,TEP 功能障碍对生活质量造成了负面影响。有时,使用 TEP 进行嗓音康复完全不成功。我们对 TEP 完全失败的主要原因进行了范围界定,希望能为选择最佳 TEP 候选者提供指导:研究设计:使用 PubMed 对 1990 年至 2020 年间所有涉及 TEP 失败原因的英文文章进行范围界定:该范围界定审查遵循人群、干预、比较、结果和研究(PICOS)指南。TEP完全失败的定义是TEP声音或声道完全丧失或放弃。利用 PubMed 的 MeSH 主题词和关键词制定了全面的搜索策略。结果:在 544 篇同行评审期刊论文中,有 70 篇符合纳入标准。有 70 篇文章符合纳入标准,因此共有 4928 名 TEP 语音恢复患者可供分析。其中 15.2% 的患者 TEP 完全失败。最常见的失败原因是对嗓音不满意(26.3%)、渗漏(17.9%)、患者动力不足(14.7%)、合并症(14.2%)、造口问题(11.6%)以及脱落后放弃 TEP(10.6%):TEP失败的常见原因包括嗓音不满意、渗漏、患者缺乏动力、患者合并症和造口问题。在选择 TEP 恢复嗓音的候选者时应考虑这些因素。
{"title":"Total tracheoesophageal puncture failure: A scoping review of patient characteristics and etiologies.","authors":"Shaghauyegh S Azar, Courtney B Shires, Karuna Dewan, Dinesh K Chhetri","doi":"10.1002/hed.27901","DOIUrl":"https://doi.org/10.1002/hed.27901","url":null,"abstract":"<p><strong>Objectives: </strong>Tracheoesophageal prosthesis (TEP) is a common method for post-laryngectomy speech rehabilitation. Despite its common use, some patients ultimately fail TEP rehabilitation. TEP dysfunction negatively affects quality of life due to poor voice quality and need for repeated interventions to restore TEP function. Occasionally, voice rehabilitation with TEP is completely unsuccessful. We performed a scoping review to characterize the main reasons for total TEP failure, in hopes of guiding selection of optimal TEP candidates.</p><p><strong>Study design: </strong>Scoping review using PubMed of all English language articles from 1990 to 2020 addressing causes of TEP failure.</p><p><strong>Methods: </strong>This scoping review followed the population, intervention, comparison, outcome and study (PICOS) guidelines. Total TEP failure was defined as complete loss or abandonment of TEP voice or tract. A comprehensive search strategy using PubMed's MeSH subject headings and keywords was created. Causes and rates of failure were reviewed.</p><p><strong>Results: </strong>Among 544 peer-reviewed journal articles reviewed for inclusion. Seventy articles met inclusion criteria, resulting in a total of 4928 TEP voice restoration patients for analysis. 15.2% of these patients had total TEP failure. The most common reasons for failure were dissatisfaction with voice (26.3%), leakage (17.9%), inadequate patient motivation (14.7%), comorbidities (14.2%), stoma problems (11.6%), and abandonment of TEP after dislodgement (10.6%).</p><p><strong>Conclusion: </strong>Common reasons for TEP failure included voice dissatisfaction, leakage, lack of patient motivation, patient comorbidities, and stoma problems. These factors should be considered when selecting candidates for TEP voice restoration.</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":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794161","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}
Amanda J Bastien, Luv Amin, Missael Vasquez, Iris Cong, Michael Luu, Meghan Laszlo, Saori Yen, Heather Thompson, Elana L Teitelbaum, Julie K Jang, Alain C Mita, Kevin S Scher, Justin Moyers, Jon Mallen-St Clair, Evan S Walgama, Zachary S Zumsteg, Allen S Ho
Background: As a surrogate of malnutrition, degree of weight loss and recovery from head and neck cancer (HNC) treatment is understudied. The influence of modifiable factors that affect weight, including speech/language pathology (SLP) and nutrition counseling, is also poorly defined. We characterize weight loss trends, baseline weight recovery (BWR), and the impact of interdisciplinary care on oncologic outcomes.
Methods: Retrospective cohort study assessing 266 newly diagnosed patients with HNC who completed curative-intent radiation (definitive or adjuvant) between January 2016 to January 2022. Relevant treatment factors were analyzed using multivariable Cox regression models.
Results: Altogether, 266 patients completed full-course radiation therapy (RT), encompassing definitive chemoRT (53.0%), surgery with chemoRT (18.4%), surgery with RT (17.7%), and RT alone (10.9%). Patient weight reached a nadir at median 3.0 months (IQR 3.0-11.3) after radiation, with a median weight loss of 12.6% (IQR 7.9-18.7). Notably, only 47.4% exhibited BWR. For those who recovered, median time to BWR was 10.5 months (IQR 3.0-24.0). On multivariable analysis, BWR by 6 months was significantly associated with overall survival (HR 0.28 [95% CI 0.10-0.76], p = 0.013), as was SLP consultation (HR 0.40 [95% CI 0.17-0.92], p = 0.031) and nutrition consultation (HR 0.34 [95% CI 0.13-0.89], p = 0.028).
Conclusion: A high proportion of patients with HNC fail to recover baseline weight after treatment; those that do can take longer than expected to return. Failure to recover baseline weight is associated with a notable decrease in survival. Similarly, SLP and nutrition consultation are independent, modifiable determinants correlated with outcomes, supporting the emphasis on multidisciplinary management. Measures to promote BWR may reduce mortality.
{"title":"Baseline weight recovery and mortality risk in head and neck cancer.","authors":"Amanda J Bastien, Luv Amin, Missael Vasquez, Iris Cong, Michael Luu, Meghan Laszlo, Saori Yen, Heather Thompson, Elana L Teitelbaum, Julie K Jang, Alain C Mita, Kevin S Scher, Justin Moyers, Jon Mallen-St Clair, Evan S Walgama, Zachary S Zumsteg, Allen S Ho","doi":"10.1002/hed.27898","DOIUrl":"https://doi.org/10.1002/hed.27898","url":null,"abstract":"<p><strong>Background: </strong>As a surrogate of malnutrition, degree of weight loss and recovery from head and neck cancer (HNC) treatment is understudied. The influence of modifiable factors that affect weight, including speech/language pathology (SLP) and nutrition counseling, is also poorly defined. We characterize weight loss trends, baseline weight recovery (BWR), and the impact of interdisciplinary care on oncologic outcomes.</p><p><strong>Methods: </strong>Retrospective cohort study assessing 266 newly diagnosed patients with HNC who completed curative-intent radiation (definitive or adjuvant) between January 2016 to January 2022. Relevant treatment factors were analyzed using multivariable Cox regression models.</p><p><strong>Results: </strong>Altogether, 266 patients completed full-course radiation therapy (RT), encompassing definitive chemoRT (53.0%), surgery with chemoRT (18.4%), surgery with RT (17.7%), and RT alone (10.9%). Patient weight reached a nadir at median 3.0 months (IQR 3.0-11.3) after radiation, with a median weight loss of 12.6% (IQR 7.9-18.7). Notably, only 47.4% exhibited BWR. For those who recovered, median time to BWR was 10.5 months (IQR 3.0-24.0). On multivariable analysis, BWR by 6 months was significantly associated with overall survival (HR 0.28 [95% CI 0.10-0.76], p = 0.013), as was SLP consultation (HR 0.40 [95% CI 0.17-0.92], p = 0.031) and nutrition consultation (HR 0.34 [95% CI 0.13-0.89], p = 0.028).</p><p><strong>Conclusion: </strong>A high proportion of patients with HNC fail to recover baseline weight after treatment; those that do can take longer than expected to return. Failure to recover baseline weight is associated with a notable decrease in survival. Similarly, SLP and nutrition consultation are independent, modifiable determinants correlated with outcomes, supporting the emphasis on multidisciplinary management. Measures to promote BWR may reduce mortality.</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":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794159","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}
Dan P Zandberg, Serafettin Zenkin, Murat Ak, Priyadarshini Mamindla, Vishal Peddagangireddy, Ronan Hsieh, Jennifer L Anderson, Greg M Delgoffe, Ashely Menk, Heath D Skinner, Umamaheswar Duvvuri, Robert L Ferris, Rivka R Colen
Background: We retrospectively evaluated radiomics as a predictor of the tumor microenvironment (TME) and efficacy with anti-PD-1 mAb (IO) in R/M HNSCC.
Methods: Radiomic feature extraction was performed on pre-treatment CT scans segmented using 3D slicer v4.10.2 and key features were selected using LASSO regularization method to build classification models with XGBoost algorithm by incorporating cross-validation techniques to calculate accuracy, sensitivity, and specificity. Outcome measures evaluated were disease control rate (DCR) by RECIST 1.1, PFS, and OS and hypoxia and CD8 T cells in the TME.
Results: Radiomics features predicted DCR with accuracy, sensitivity, and specificity of 76%, 73%, and 83%, for OS 77%, 86%, 70%, PFS 82%, 75%, 89%, and in the TME, for high hypoxia 80%, 88%, and 72% and high CD8 T cells 91%, 83%, and 100%, respectively.
Conclusion: Radiomics accurately predicted the efficacy of IO and features of the TME in R/M HNSCC. Further study in a larger patient population is warranted.
{"title":"Evaluation of radiomics as a predictor of efficacy and the tumor immune microenvironment in anti-PD-1 mAb treated recurrent/metastatic squamous cell carcinoma of the head and neck patients.","authors":"Dan P Zandberg, Serafettin Zenkin, Murat Ak, Priyadarshini Mamindla, Vishal Peddagangireddy, Ronan Hsieh, Jennifer L Anderson, Greg M Delgoffe, Ashely Menk, Heath D Skinner, Umamaheswar Duvvuri, Robert L Ferris, Rivka R Colen","doi":"10.1002/hed.27878","DOIUrl":"10.1002/hed.27878","url":null,"abstract":"<p><strong>Background: </strong>We retrospectively evaluated radiomics as a predictor of the tumor microenvironment (TME) and efficacy with anti-PD-1 mAb (IO) in R/M HNSCC.</p><p><strong>Methods: </strong>Radiomic feature extraction was performed on pre-treatment CT scans segmented using 3D slicer v4.10.2 and key features were selected using LASSO regularization method to build classification models with XGBoost algorithm by incorporating cross-validation techniques to calculate accuracy, sensitivity, and specificity. Outcome measures evaluated were disease control rate (DCR) by RECIST 1.1, PFS, and OS and hypoxia and CD8 T cells in the TME.</p><p><strong>Results: </strong>Radiomics features predicted DCR with accuracy, sensitivity, and specificity of 76%, 73%, and 83%, for OS 77%, 86%, 70%, PFS 82%, 75%, 89%, and in the TME, for high hypoxia 80%, 88%, and 72% and high CD8 T cells 91%, 83%, and 100%, respectively.</p><p><strong>Conclusion: </strong>Radiomics accurately predicted the efficacy of IO and features of the TME in R/M HNSCC. Further study in a larger patient population is warranted.</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":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857169","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}
Christopher D Goodman, Franco DeMonte, Theresa P Nguyen, Adam S Garden, Catherine He Wang, Xin A Wang, Kevin Diao, Anna Lee, Jay Reddy, Amy Moreno, Michael Spiotto, Clifton D Fuller, David Rosenthal, Renata Ferrarotto, Shaan M Raza, Shirley Y Su, Andrew Warner, Ehab Hanna, Jack Phan
Background: Treatment for dural recurrence of olfactory neuroblastoma (ONB) is not standardized. We assess the outcomes of stereotactic body radiotherapy (SBRT) in this population.
Methods: ONB patients with dural recurrences treated between 2013 and 2022 on a prospective registry were included. Tumor control, survival, and patient-reported quality of life were analyzed.
Results: Fourteen patients with 32 dural lesions were evaluated. Time to dural recurrence was 58.3 months. Thirty lesions (94%) were treated with SBRT to a median dose of 27 Gy in three fractions. Two patients (3 of 32 lesions; 9%) developed in-field radiographic progression, five patients (38%) experienced progression in non-contiguous dura. Two-year local control was 85% (95% CI: 51-96%). There were no >grade 3 acute toxicities and 1 case of late grade 3 brain radionecrosis.
Conclusion: In this largest study of SBRT reirradiation for ONB dural recurrence to date, high local control rates with minimal toxicity were attainable.
{"title":"A prospective cohort study on stereotactic radiotherapy in the management of dural recurrence of olfactory neuroblastoma.","authors":"Christopher D Goodman, Franco DeMonte, Theresa P Nguyen, Adam S Garden, Catherine He Wang, Xin A Wang, Kevin Diao, Anna Lee, Jay Reddy, Amy Moreno, Michael Spiotto, Clifton D Fuller, David Rosenthal, Renata Ferrarotto, Shaan M Raza, Shirley Y Su, Andrew Warner, Ehab Hanna, Jack Phan","doi":"10.1002/hed.27887","DOIUrl":"https://doi.org/10.1002/hed.27887","url":null,"abstract":"<p><strong>Background: </strong>Treatment for dural recurrence of olfactory neuroblastoma (ONB) is not standardized. We assess the outcomes of stereotactic body radiotherapy (SBRT) in this population.</p><p><strong>Methods: </strong>ONB patients with dural recurrences treated between 2013 and 2022 on a prospective registry were included. Tumor control, survival, and patient-reported quality of life were analyzed.</p><p><strong>Results: </strong>Fourteen patients with 32 dural lesions were evaluated. Time to dural recurrence was 58.3 months. Thirty lesions (94%) were treated with SBRT to a median dose of 27 Gy in three fractions. Two patients (3 of 32 lesions; 9%) developed in-field radiographic progression, five patients (38%) experienced progression in non-contiguous dura. Two-year local control was 85% (95% CI: 51-96%). There were no >grade 3 acute toxicities and 1 case of late grade 3 brain radionecrosis.</p><p><strong>Conclusion: </strong>In this largest study of SBRT reirradiation for ONB dural recurrence to date, high local control rates with minimal toxicity were attainable.</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":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789953","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}