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

Objective: To evaluate clinical outcomes and quality of life (QOL) following hypofractionated spot-scanning proton therapy (SSPT) for head and neck malignant mucosal melanoma (HNMM).

Methods: This retrospective study included 39 patients treated with SSPT (60-64 Gy[RBE] in 15-16 fractions) between 2013 and 2023. Endpoints included overall survival (OS), local control (LC), progression-free survival (PFS), toxicities, and QOL.

Results: Most tumors were located in the sinonasal cavity (n = 32). Surgery was performed in 8 patients; 19 received immune checkpoint inhibitors post-SSPT. The 3-year OS, LC, and PFS were 50%, 83%, and 30%, respectively. Larger tumor volumes (≥ 20 cm³) were linked to worse PFS. Grade 3 mucositis occurred in 13%. Late toxicities included sinus disorder, osteonecrosis, and blindness (3%-5%). QOL was largely preserved, with notable declines in pain, swallowing, and mouth opening.

Conclusion: SSPT provides favorable LC with acceptable toxicity. Effective systemic therapies are needed to improve long-term outcomes.

Background: NUT carcinoma is a rare, aggressive malignancy defined by NUTM1 gene rearrangement, with the head and neck as the second most common site. Its prognosis is poor, and current treatment references other cancers. Although radiotherapy is key in managing head and neck tumors, its efficacy and prognostic factors in head and neck NUT carcinoma are unclear.

Methods: We retrospectively analyzed 31 patients with locally advanced or recurrent/metastatic head and neck NUT carcinoma treated with radiotherapy. OS and PFS were estimated by Kaplan-Meier, and prognostic factors were identified using Cox regression.

Results: Among 31 patients (64.5% male, median age 37), nasal cavity/paranasal sinuses were the most common primary site (51.6%). Most received intensity-modulated radiotherapy with ≥ 66 Gy. Median OS and PFS were 18.73 and 3 months, respectively. Nasal cavity/paranasal sinus primaries had the worst prognosis (median OS: 16.7 months). Locally advanced cases had significantly better survival than recurrent/metastatic disease (median OS: 30.43 vs. 13.93 months; PFS: 5.83 vs. 2.3 months). High-dose radiotherapy (≥ 66 Gy) was associated with improved OS, and R0 resection combined with ≥ 66 Gy achieved median OS of 27.9 months. In surgical patients, GTV longest diameter > 3.5 cm independently predicted worse PFS (HR = 5.01, p = 0.01). Recurrent/metastatic status was the most critical independent adverse prognostic factor for both PFS (HR = 4.56) and OS (HR = 10.12). Adjuvant therapy after radiotherapy prolonged PFS, particularly in locally advanced patients. BETi-based regimens before radiotherapy showed potential for improved locoregional and distant control in postoperative recurrence/metastasis.

Conclusions: Prognosis in head and neck NUT carcinoma treated with radiotherapy is affected by disease status, primary site, radiotherapy dose, and adjuvant therapy. Locally advanced patients benefit most from high-dose radiotherapy and adjuvant therapy. GTV > 3.5 cm identifies high-risk populations requiring intensified treatment, while BETi may improve outcomes in postoperative recurrence/metastasis.

Background: This study presents a modified platysma myocutaneous flap technique for reconstructing extensive laryngeal defects in patients with advanced-stage transglottic laryngeal carcinoma.

Methods: A retrospective cohort analysis was conducted on patients undergoing organ-preserving partial laryngectomy followed by reconstruction using a modified platysma flap. Primary endpoints included decannulation rate and 3-year overall survival. Functional recovery of respiration, swallowing, and phonation was evaluated using validated scales.

Results: Sixty patients (mean age: 62.85 ± 6.09 years) were enrolled across two centers. The overall decannulation rate was 85.0%, with significantly higher success rates observed in the partial laryngectomy group (p < 0.05). The 3-year survival rate was 78.3%. Swallowing and phonatory functions were well preserved, with median scores of 2 and 1, respectively. The technique was associated with a low incidence of flap-related complications (13.3%) and favorable mucosalization outcomes.

Conclusion: The modified platysma flap offers a practical and effective reconstructive strategy for laryngeal defects in advanced carcinoma, achieving satisfactory respiratory decannulation and preservation of laryngeal function with minimal morbidity.

Background: To evaluate postoperative health-related quality of life (HRQoL) for pituitary adenoma patients, multidimensional assessment is important. Available data is limited on long-term follow-up.

Methods: Prospectively, 52 nonfunctioning (NFA) and functioning (FA) pituitary adenoma patients were included. The Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES-Q) was completed preoperatively and postoperatively (2 weeks, 3 months, 1 year, 8.5 years). Generalized estimating equations identified variables associated with HRQoL changes over time.

Results: Psychological (p = 0.006) and social HRQoL (p = 0.026) significantly improved after very long-term follow-up, while physical HRQoL and EES-Q scores normalized. Pre- and postoperatively, most inconveniences were reported in the social domain, with a noticeable difference between NFA and FA patients. Female gender negatively impacted physical HRQoL.

Conclusions: Endoscopic endonasal surgery has no very long-term negative impact on HRQoL. Social functioning remained the most affected throughout follow-up. These results highlight the importance of this multidimensional HRQoL tool to improve patient-centered health care.

Background: Postoperative adjuvant therapy strategies are generally determined based on pathological risk stratification in oral cancer. However, the efficacy of postoperative adjuvant therapy in patients with intermediate-risk factors for recurrence of oral cancer such as close surgical margins, pT3-T4 classification, pN2-N3 nodal status, perineural invasion, vascular invasion, lymphatic invasion and pattern of invasion remains unclear, and no standardized treatment guidelines or consensus have been established to date. Therefore, this study retrospectively analyzed the clinical significance of risk factors for pathological recurrence in patients with advanced oral cancer and evaluated the impact of postoperative adjuvant therapy on patient prognosis.

Methods: This retrospective clinical study included 130 patients who underwent initial radical surgical resection for advanced oral squamous cell carcinoma (OSCC) at our institution between January 2010 and December 2023. The postoperative recurrence risk factors included ENE of the cervical lymph nodes, positive surgical margins, close surgical margins, pathological T classification (pT3 or pT4), pathological N classification (pN2 or pN3), metastasis to level IV or V lymph nodes, perineural invasion, vascular invasion, and lymphatic invasion. We analyzed the relationships among the presence of these risk factors, administration of postoperative adjuvant therapy (RT or CRT), occurrence of recurrence or metastasis, and patient prognosis (DFS).

Results: Patients with lymphatic invasion had a significantly lower survival rate than those without lymphatic invasion (66.7% vs. 82.8%, p < 0.05). Although pT4, pN2-N3, perineural invasion-positive and vascular invasion-positive did not reach statistical significance, a trend toward reduced survival was observed in each case. The perineural invasion-positive group had significantly higher recurrence and metastasis rates than the perineural invasion-negative group (51.9% vs. 23.6%, p < 0.05). Multivariate analysis using logistic regression also confirmed the presence of perineural invasion as an independent prognostic factor (HR = 4.496, p = 0.019).

Conclusions: This study demonstrated that perineural invasion is a significant risk factor for recurrence and that lymphatic invasion is a poor prognostic factor in oral cancer. Postoperative adjuvant therapy in patients with perineural or lymphatic invasion-positive disease contributed to reduced recurrence rates and prolonged survival. These findings suggest that the pathological evaluation of perineural and lymphatic invasions is an important indicator in determining the appropriateness of postoperative adjuvant therapy.

Objective: To investigate the frequency of micronuclei (MN) and binucleated (BN) cells in thyroid nodules and adjacent normal tissue, and evaluate their correlation with cytological (Bethesda classification) and histopathological diagnoses to assess their potential utility in preoperative malignancy prediction.

Methods: This prospective study included 39 patients (16 benign, 19 papillary carcinoma, 4 follicular carcinoma) who underwent thyroidectomy. Tissue samples from both nodular and adjacent normal thyroid regions were collected. MN and BN frequencies were evaluated in 1000 cells per sample using May-Grünwald and 5% Giemsa staining. Data were analyzed in relation to Bethesda categories and final surgical pathology using mixed-effects models in R 4.4.1. ROC analysis was conducted to assess the diagnostic performance of MN/BN frequency.

Results: MN and BN frequencies were significantly higher in nodular tissue compared to adjacent normal thyroid tissue (p < 0.05). Malignant lesions showed significantly increased MN/BN frequencies compared to benign ones, although no significant difference was observed between papillary and follicular subtypes (p < 0.05). MN/BN frequencies were also significantly higher in Bethesda categories III-VI compared to categories I-II (p < 0.05). No significant variation was found in normal thyroid tissue across cytological or pathological groups.

Conclusion: MN and BN cell frequencies were elevated in malignant nodules and higher Bethesda categories, supporting their potential role as adjunctive cytogenetic markers in thyroid nodule assessment. While findings are promising, their diagnostic utility in indeterminate nodules remains unclear. Larger, FNAB-based studies are required to validate their feasibility and clinical relevance in routine preoperative evaluation.

Background: Myopericytoma (MPC) is a rare perivascular tumor with myoid differentiation that poses diagnostic and therapeutic challenges in the head and neck.

Methods: We present four cases of oral and sinonasal MPC and conducted a literature review to analyze clinical characteristics, diagnostic approaches, and management.

Results: Sixty-five published cases were identified, yielding a cohort of 69 patients. The oral cavity was the most common site (44.9%) followed by parotid (15.9%), sinonasal (10.1%), neck (10.1%), and other head regions (18.8%). Complete excision was achieved in 95.7% of cases with a 7.2% recurrence rate. Histopathology confirmed MPC in all cases with characteristic perivascular spindle cell proliferation, 95.6% showing positive smooth muscle actin immunostaining.

Conclusion: MPC must be considered in the differential diagnosis of vascular head and neck lesions. Complete surgical excision with negative margins remains the treatment of choice, with immunohistochemistry essential for accurate diagnosis.

Background: Neck spasms or myoclonus are an underreported sequela of HNC treatment, often described following radiation. The frequency of neck spasm following neck dissection is unknown.

Methods: A phone survey was conducted of HNC patients following neck dissection to determine the incidence and severity of neck spasms using the Penn Spasm Frequency Scale and Neck Dissection Impairment Index. Demographic and treatment-related factors were compared between those with and without neck spasms.

Results: 56/136 patients (41.2%) responded with 16 (28.6%) reporting neck spasms. Spasms ranged from mild to severe and were associated with a lower NDII score (85.62 vs. 90.44, p = 0.078) Neck spasms occurred irrespective of shoulder dysfunction due to cranial nerve 11 injury and were not associated with any patient or treatment-related factors, including radiation therapy.

Conclusions: Neck spasms occur after neck dissection irrespective of radiation therapy or spinal accessory nerve injury with a negative impact on quality of life.