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

Background: Patients with locally advanced, surgically unresectable oral squamous cell cancers (SU-OSCC) are often treated with palliative intent. There is limited information on the outcomes of radical intent treatment with radiotherapy (RT) or chemoradiotherapy (CRT).

Methods: We retrospectively examined patients with Stage III/IV previously untreated SU-OSCC treated definitively from 2011 to 2021 in a single institution with RT or CRT with or without neoadjuvant chemotherapy (NACT).

Results: Sixty-nine patients met the inclusion criteria. Oral tongue (38%) and buccal mucosa (32%) were the commonest subsites. T4a, T4b, and N2-3 disease were present in 28 (40.6%), 26 (37.7%), and 39 (56.5%) patients, respectively. Median OS and PFS of the whole group were 16 months and 10 months. The 2-year loco-regional control was 60.4%. Bone involvement or NACT use did not affect outcomes.

Conclusions: Upfront radical RT/CRT in patients with SU-OSCC with good performance status results in good outcomes and should be preferred to a palliative approach.

Background: Dental implantation of bone reconstructions in oncologic situations improves patients' orofacial function and quality of life. There are currently no recommendations on the timing of implantation.

Methods: This systematic review with meta-analysis aimed to compare primary and secondary dental implantation of free bone flaps in reconstructions for malignant tumors of the oral cavity. The primary objective was to evaluate the implant survival rate, with secondary criteria including time to prosthesis placement, postoperative complications, and data on quality of life. Results-Three databases were screened for articles published between January 1990 and April 2024. Out of 2438 studies, 16 met the eligibility criteria, encompassing 284 patients. In total, 319 implants were placed in the primary implantation group and 1108 in the second group. Implant survival rate was 92.5% in the primary implantation group compared to 88.5% in the secondary implantation group. This systematic review underscores a higher success rate for implants placed primarily in patients with oral cancer.

Conclusions: Given the rapid functional and aesthetic improvement offered by prosthetic rehabilitation, primary implantation should be systematically considered in the oncological population.

Background: The geriatric nutritional risk index (GNRI) is a tool to assess preoperative nutritional status that can be calculated simply based on height, weight, and serum albumin. This study assesses the utility of GNRI in predicting postoperative complications in patients undergoing major head and neck cancer (HNC) surgery.

Methods: Retrospective review of the 2016-2020 National Surgical Quality Improvement Program database. Patients were categorized into GNRI > 98 (normal nutritional status), GNRI 92-98 (moderate malnutrition status), and GNRI < 92 (severe malnutrition status). Univariable and multivariable binary logistic regression analyses were performed.

Results: Sixteen thousand seven hundred eight-nine patients undergoing HNC resection were included. On multivariable analysis, moderate and severe malnourishment based on GNRI remained significantly associated with any surgical complication, any medical complication, any complication, Clavien-Dindo grade IV complications, and 30-day mortality.

Conclusions: GNRI may have utility as a potentially modifiable preoperative prognostic factor that can be optimized to improve complications and mortality following HNC resection.

Level of evidence: Level 4.

Background: To describe utilization and outcomes of submandibular gland flap (SGF) reconstruction after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC).

Methods: A multi-institutional retrospective case series of patients who underwent TORS for OPSCC followed by SGF reconstruction with harvest via transcervical approach from 1/1/2016 to 4/1/2023.

Results: In total, 14 patients underwent SGF reconstruction after TORS for OPSCC. All patients had HPV-positive disease, predominantly in early local (N = 10 with pT1/pT2 disease, 71%) and regional stages (N = 11 with pN0/pN1 disease, 79%). Most patients received adjuvant radiation treatment (N = 9, 64%). Median hospital LOS after surgery was 4 days (IQR 2 days) with median functional oral intake scale (FOIS) score of 5 (IQR 0.8) at 1-3 weeks after surgery.

Conclusions: SGF reconstruction is a useful technique for closure of appropriately selected TORS defects requiring reconstruction beyond healing by secondary intention and mobilization of adjacent tissue but not large enough to warrant free flap reconstruction.

Background: This study evaluates the outcomes of intracapsular enucleation using the retroauricular hairline incision (RAHI) approach for treating cervical vagal schwannomas.

Methods: A longitudinal study was conducted on patients with cervical vagal schwannomas. Eleven patients who underwent RAHI-based enucleation were included. Preoperative imaging was performed using contrast-enhanced MRI. Postoperative evaluations assessed pain, neurological function, cosmetic outcomes, voice, and swallowing functions.

Results: Eleven patients underwent surgery. The median tumor size was 4.6 cm. The median operation time was 42 min, with minimal bleeding. Common complications were earlobe numbness (45%) and temporary vocal cord paralysis (27%), which were resolved within a year. Cosmetic satisfaction was high, with median VAS scores of nine for scars and 10 for facial deformities. No significant dysphagia was found. No recurrences were observed over a median follow-up of 79 months.

Conclusions: Intracapsular enucleation using the RAHI approach is a safe and effective method for treating cervical vagal schwannomas.

Background: Infantile fibrosarcoma (IFS) is a rare pediatric tumor of intermediate malignancy with high local aggressiveness that typically presents in young infants. Its occurrence in the head and neck region is rare. Complete non-mutilating surgical resection is often not possible, requiring multimodal treatment. IFS frequently harbors neurotrophic receptor tyrosine kinase (NTRK) fusions. Targeted therapy with NTRK inhibitors is modifying treatment paradigms of IFS.

Methods: Herein, we report the case of a neonate with a giant unresectable congenital ETV6::NTRK3 (+) IFS of the head and neck region without rapid response to chemotherapy who was treated with larotrectinib oral suspension.

Results: Larotrectinib was well tolerated and induced an impressive clinical and radiologic response.

Conclusions: This case illustrates an example of pediatric precision oncology in a neonate with an ETV6::NTRK3 (+) congenital IFS of the head and neck region and provides further reference for the use of larotrectinib in the neonatal period.

Background: To investigate the management of recurrent head and neck squamous cell carcinoma (rHNSCC) and describe survival outcomes.

Methods: Post hoc subgroup analysis of a retrospective national observational cohort was conducted. All patients with rHNSCC who received a definitive treatment decision between September 1, 2021 and November 30, 2021 were included. Survival analysis was stratified according to subsite, primary versus recurrent disease, and surgical versus nonsurgical treatment.

Results: Data from 202 rHNSCC patients were derived from a cohort of 1488 patients submitted by 50 UK centers. Median age was 66 years (IQR 58-74), and 142 (70.3%) were male. The most common recurrence subsites were oropharynx (20.5%), oral cavity (19.5%), larynx (16.4%), and hypopharynx (14.9%). Ninety-three (48.4%) were managed curatively. Surgery was the most common treatment for laryngeal (59.4%), oral cavity (60.5%), hypopharyngeal (44.8%), and oropharyngeal (37.5%) cancers. Two-year overall (OS), disease-free (DFS), disease-specific (DSS), and local recurrence free survival (LRFS) were 41.1%, 39.1%, 42.2%, and 39.3%, respectively. rHNSCC treated with surgery had improved OS (p = 0.0005), DFS (p = 0.012), DSS (p = 0.0003), and LRFS (p = 0.007), over nonsurgical treatments. Compared to primary cancers, rHNSCC presents with more advanced T stage (p < 0.001) and distant metastasis (p < 0.001), receives less curative treatment (p < 0.001), and has worse survival outcomes (all p < 0.001). On multivariate analysis, salvage surgery, radiotherapy, and p16 status were independent prognostic factors of all survival outcomes.

Conclusions: Recurrent HNSCC is associated with high rates of incurable disease and worse survival than primary cancers. Surgery remains the most common curative treatment in rHNSCC, however future studies are necessary to improve patient selection and optimize outcomes following salvage treatment.

Background: The use of liquid biopsy of total cell-free DNA (cfDNA) to identify otherwise undetectable cancers has attracted interest; however, its efficacy remains unknown. We explored whether analysis using total cfDNA is efficacious for Japanese patients with oral squamous cell carcinoma (OSCC).

Methods: We collected total cfDNA from nine patients with OSCC preoperatively, 1 month postoperatively, and every 3 months thereafter to analyze this association. We used a target DNA sequence for genetic mutation analysis of tumor tissues collected from 33 patients, including the aforementioned nine patients.

Results: Patients with good disease control showed negligible changes in preoperative and postoperative total cfDNA concentrations. A rapid increase in total cfDNA concentration was observed in patients who developed systemic metastases. Patients whose tumor tissue DNA showed genetic mutations had the same mutations in preoperative circulating tumor DNA.

Conclusions: Our data suggested that analyzing total cfDNA is efficacious for patients with OSCC.

Objectives: Virtual surgical planning (VSP) allows for optimal reconstruction of maxillary defects with fibula free flaps. Current data are limited regarding long-term complications of patient-specific plates (PSPs) in this setting. Our objective was to determine long-term complications of PSPs in maxillary reconstruction using fibula free flaps.

Methods: A retrospective chart review was performed on patients undergoing maxillary reconstruction with a fibula free flap and PSP between January 2010 to July 2022. The primary outcomes were plate-related complications, which were defined as plate exposure, fracture, removal or evidence of loose screws. Secondary outcomes were wound infection, nonunion, or flap failure.

Results: A total of 39 patients underwent fibular reconstruction of maxillary defects using PSP. The average age was 56 years, with 56% of patients being female. There were 14 (35.8%) patients with plate-related complications, 10 (25.6%) underwent plate removal, 12 (30.8%) developed exposed hardware, 2 (5.1%) had loose screws, and none had a plate fracture. The average time to plate removal was 2.76 ± 1.94 years. With regard to age, sex, tobacco or alcohol use, diabetes, hypothyroidism, preoperative radiation therapy, number of fibula segments, type of cancer, postoperative radiation therapy, or whether the patient underwent orodental rehabilitation, there were no significant differences between patients who did and did not experience plate complications.

Conclusions: VSP allows for patient-specific reconstruction of maxillary defects with a fibula free flap that remains stable in the majority of patients. In the long term, up to 25% of patients may require plate removal, but the reconstruction remains stable.

Level of evidence: Level 4.