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Journal of Translational Medicine Sep 2021The purpose of this study was to evaluate if HPV status serves as an independent predictor of early and late dysphagia outcomes when considered alongside standard...
PURPOSE
The purpose of this study was to evaluate if HPV status serves as an independent predictor of early and late dysphagia outcomes when considered alongside standard patient characteristics and dose metrics for head and neck cancer patients treated with radiotherapy.
METHODS AND MATERIALS
The age, sex, smoking history, cancer type (oropharyngeal vs non-oropharyngeal), HPV status, and early and late dysphagia outcomes were obtained for 99 retrospective head and neck cancer patients treated at our clinic with radiotherapy. Additionally for each patient, the mean radiation dose to the pharynx, superior/middle/inferior pharyngeal constrictor muscles, and cricopharyngeus was calculated. The predictive power of these clinical characteristics and radiation metrics was evaluated using chi-square tests for categorical variables and t-tests for continuous variables. Then multi-variate logistic models were built for each outcome using a single dose metric at a time, and either HPV status, cancer type, or both. Multi-variate models were built using both top-down and bottom-up technique to establish the most predictive independent covariates.
RESULTS
In the univariate analysis for early dysphagia, cancer type (p = 0.04) and four dose metrics (p ≤ 0.02) were significantly associated with outcome, while for late dysphagia, only cancer type (p = 0.04) was associated with outcome. In the multivariate analysis for early dysphagia, cancer type, smoking history, and mean dose to the five structures were consistently selected as covariates. For late dysphagia, either HPV status or cancer type was selected in each model and the mean dose to the cricopharyngeus was selected in one model.
CONCLUSION
While HPV is a known contributing factor for tumor prognosis in oropharyngeal cancers, its role in normal tissue toxicities for head and neck cancers has not previously been evaluated. Our results indicate having an oropharyngeal cancer may increase a patient's risk of high-grade early and late dysphagia while HPV status was seldom selected.
Topics: Deglutition Disorders; Head and Neck Neoplasms; Humans; Oropharyngeal Neoplasms; Pharyngeal Muscles; Retrospective Studies
PubMed: 34493300
DOI: 10.1186/s12967-021-03047-2 -
American Journal of Otolaryngology 2023Nasopharyngeal stenosis (NPS) is a rare and morbid complication following radiation therapy for nasopharyngeal carcinoma. This review provides an update on management... (Review)
Review
INTRODUCTION
Nasopharyngeal stenosis (NPS) is a rare and morbid complication following radiation therapy for nasopharyngeal carcinoma. This review provides an update on management and prognosis.
METHODS
A comprehensive PubMed review using the terms "nasopharyngeal stenosis," "choanal stenosis," and "acquired choanal stenosis" was performed.
RESULTS
Fourteen studies identified 59 patients who developed NPS after radiotherapy for NPC. 51 patients underwent endoscopic nasopharyngeal stenosis excision by cold technique (80-100% success). The remaining 8 underwent carbon dioxide (CO) laser excision with balloon dilation (40-60% success). Adjuvant therapies included postoperative topical nasal steroids in 35 patients. The need for revision was 62% in the balloon dilation group, vs 17% in the excision group (p-value <0.01).
CONCLUSION
When NPS occurs after radiation, primary excision of scarring is the most effective method of management with less need for revision surgery relative to balloon dilation.
Topics: Humans; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Constriction, Pathologic; Nasopharynx; Nasopharyngeal Diseases; Treatment Outcome
PubMed: 36878173
DOI: 10.1016/j.amjoto.2023.103819 -
The Laryngoscope Sep 2023To examine the clinical usefulness of transoral ultrasonography (US) in determining the invasion depth of superficial pharyngeal carcinoma (SPC). Determining the...
OBJECTIVES
To examine the clinical usefulness of transoral ultrasonography (US) in determining the invasion depth of superficial pharyngeal carcinoma (SPC). Determining the invasion depth of SPC is crucial for transoral surgery including determining treatment strategy. This study aimed to examine the usefulness of transoral US in determining the invasion depth of SPC.
METHODS
Forty-six patients with 51 lesions who underwent both magnifying endoscopy with narrow-band imaging (ME-NBI) and transoral US were included. The primary outcomes were the sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of ME-NBI and transoral US findings for pathological tumor depth in SPCs.
RESULTS
The accuracy (82.4%), sensitivity (85.2%), PPV (82.1%), and NPV (82.6%) rates of US for subepithelial propria (SEP) were higher than those of ME-NBI and macroscopic classification, indicating that transoral US is superior to ME-NBI in determining the invasion depth. All cases where the SEP was clearly invaded (SEP deep) could be diagnosed as SEP by transoral US.
CONCLUSIONS
Transoral US may be useful in determining the invasion depth of SPCs.
LEVEL OF EVIDENCE
3 Laryngoscope, 133:2192-2197, 2023.
Topics: Humans; Retrospective Studies; Neoplasm Invasiveness; Endoscopy; Pharyngeal Neoplasms; Carcinoma, Squamous Cell; Ultrasonography; Narrow Band Imaging
PubMed: 36440626
DOI: 10.1002/lary.30483 -
Esophagus : Official Journal of the... Jan 2021Prediction of the invasive depth is the objective of endoscopic observation for digestive cancer. In superficial esophageal cancer, a close relationship between...
Relationship between the microvascular patterns observed by magnifying endoscopy with narrow-band imaging and the depth of invasion in superficial pharyngeal squamous cell carcinoma.
BACKGROUND
Prediction of the invasive depth is the objective of endoscopic observation for digestive cancer. In superficial esophageal cancer, a close relationship between microvascular patterns observed by magnifying endoscopy with narrow-band imaging (M-NBI) and pathological depth of invasion is well known. The ability of M-NBI to predict the invasion depth in superficial pharyngeal squamous cell carcinoma (SPSCC) has been seldom evaluated. This study aimed to clarify the relationship between the microvasculature patterns and pathological depth in SPSCC.
METHODS
SPSCC lesions evaluated with M-NBI followed by endoscopic resection were analyzed between April 2010 and March 2017. Endoscopic images were classified as microvasculature tumor types B1, B2, and B3 according to the Japan Esophageal Society classification. The pathological depth of invasion was described as either squamous cell carcinoma in situ (Tis) or invasive subepithelial cancer, and the tumor thickness of all lesions was examined. Data were analyzed using the unpaired t, χ, or Mann-Whitney U test.
RESULTS
Type B1 and type B2/B3 (35/3) microvessels were found in 180 lesions (82%) and 39 (18%), respectively. Of the flat lesions, 115 (83%) were classified as Tis and 23 (17%) as subepithelial cancer. Positive and negative predictive values of the B1 vessels were 77% and 82%, respectively. Additional analysis showed that the positive predictive value of the B1 vessels for the flat-type lesions was 87%; the negative predictive value for the elevated lesions was 93%.
CONCLUSIONS
Microvascular patterns observed by M-NBI are an important factor in predicting the pathological depth of invasion.
Topics: Carcinoma, Squamous Cell; Endoscopy, Gastrointestinal; Head and Neck Neoplasms; Humans; Neoplasm Invasiveness; Retrospective Studies
PubMed: 32514752
DOI: 10.1007/s10388-020-00754-5 -
Gastrointestinal Endoscopy Oct 2023Superficial pharyngeal squamous cell carcinoma (PSCC) has received increasing attention as a therapeutic target in the GI field with recent innovations in endoscopic...
BACKGROUND AND AIMS
Superficial pharyngeal squamous cell carcinoma (PSCC) has received increasing attention as a therapeutic target in the GI field with recent innovations in endoscopic submucosal dissection (ESD). However, there are currently no defined criteria for the application of ESD to superficial PSCC. One of the problems encountered during follow-up after ESD is cervical lymph node metastasis (LNM). Identifying the clinicopathologic predictors of cervical LNM can help to provide a basis for the refinement of therapeutic strategies for superficial PSCC.
METHODS
The risk of cervical LNM was evaluated in 331 patients with superficial PSCC who underwent initial ESD between 2008 and 2021. Since tumor size, rather than depth, is the dominant factor in the current TNM classification for PSCC, the correlation between tumor size and thickness was investigated.
RESULTS
The median follow-up period was 4.8 years. The cumulative 5-year cervical LNM rate was 6.1%. Multivariate Cox proportional hazards regression analysis identified tumor thickness ≥1000 μm and lymphatic invasion as significant independent predictors. Among 204 cases with subepithelial invasion, both factors were also revealed to be significant independent predictors, suggesting that tumor thickness was superior to tumor size in predicting cervical LNM. Despite the positive correlation between tumor thickness and size, there was noticeable variability in the values (R = .20), and the current staging was inadequate to identify groups at high risk for cervical LNM.
CONCLUSIONS
Tumor thickness and lymphatic invasion are validated as significant independent predictors for cervical LNM and can be useful indicators to optimize the therapeutic strategies for superficial PSCC.
Topics: Humans; Lymphatic Metastasis; Endoscopic Mucosal Resection; Lymph Nodes; Squamous Cell Carcinoma of Head and Neck; Head and Neck Neoplasms
PubMed: 37150414
DOI: 10.1016/j.gie.2023.04.2095 -
Technology in Cancer Research &... 2020This preliminary simulation study aimed to compare the dosimetric outcomes of carotid arteries (CAs) and pharyngeal constrictor muscle (PCM) in patients with T1N0M0...
BACKGROUND
This preliminary simulation study aimed to compare the dosimetric outcomes of carotid arteries (CAs) and pharyngeal constrictor muscle (PCM) in patients with T1N0M0 glottic carcinoma undergoing helical tomotherapy-intensity modulated radiotherapy (HT-IMRT) and 3-dimensional conformal radiotherapy (3D-CRT) plans.
METHODS
In addition to the clinical target volume (CTV) which was defined as the entire larynx, the CAs and PCM of 11 glottic carcinoma patients were delineated. The CTV was uniformly expanded 5 mm to create a planning target volume (PTV) relative to the PCM and at a distance of 2 mm from the CA. The dosimetric characteristics in HT-IMRT and lateral opposed fields-based 3D-CRT plans were analyzed.
RESULTS
Median Dand V of PTV were significantly higher in HT-IMRT (p < 0.001) compared to 3D-CRT. The right/left CA dosimetric outcomes, including the mean doses (20.7/21.5 Gy versus 48.7/50.5 Gy), D (53.6/52.0 Gy versus 67.4/67.7 Gy), V (25.0/27.1% versus 77.6/80.3%), V (8.0/7.9% versus 74.6/71.9%), and V (2.0/1.2% versus 70.0/71.6%) were also significantly lower in HT-IMRT (p < 0.05), similar to the mean PCM doses (49.6 Gy versus 62.6 Gy for 3D-CRT;p < 0.001), respectively.
CONCLUSIONS
Our present results demonstrated the feasibility of simultaneous sparing of the CAs and PCM in HT-IMRT- compared to 3D-CRT plans in glottic carcinoma patients undergoing definitive radiotherapy.
Topics: Adult; Aged; Aged, 80 and over; Carotid Arteries; Computer Simulation; Female; Glottis; Humans; Laryngeal Neoplasms; Male; Middle Aged; Organ Sparing Treatments; Pharyngeal Muscles; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Conformal; Radiotherapy, Image-Guided; Radiotherapy, Intensity-Modulated; Young Adult
PubMed: 33034277
DOI: 10.1177/1533033820956989 -
Anticancer Research Feb 2021Prognosis plays a vital role in head and neck squamous cell carcinoma (HNSCC) patient management and decision-making. This study aimed to identify the role of BP180 as a...
BACKGROUND/AIM
Prognosis plays a vital role in head and neck squamous cell carcinoma (HNSCC) patient management and decision-making. This study aimed to identify the role of BP180 as a prognostic factor in HNSCC.
PATIENTS AND METHODS
Protein expression of bullous pemphigoid antigen II (BP180) was verified by immunohistochemistry (IHC) in a tissue microarray study of 202 cases.
RESULTS
IHC analysis revealed that protein expression of BP180 among HNSCC patients differed significantly in the presence and absence of neural invasion, and according to T status in laryngeal and pharyngeal cancer subgroups. Overall survival and multivariate analysis showed that positive BP180-IHC and advanced clinical stage were significant independent positive predictors of mortality in HNSCC patients. In addition, in the oral cancer subgroup, independent positive predictors were positive BP180-IHC, advanced N status and neural invasion. In laryngeal and pharyngeal cancer subgroups, predictors were positive BP180-IHC and advanced clinical stage.
CONCLUSION
BP180 is a prognostic factor in head and neck squamous cell carcinoma.
Topics: Adult; Aged; Aged, 80 and over; Autoantigens; Biomarkers, Tumor; Clinical Decision-Making; Female; Gene Expression Regulation, Neoplastic; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Non-Fibrillar Collagens; Prognosis; Squamous Cell Carcinoma of Head and Neck; Survival Analysis; Tissue Array Analysis; Collagen Type XVII
PubMed: 33517320
DOI: 10.21873/anticanres.14867 -
AJNR. American Journal of Neuroradiology Dec 2020T1ρ imaging is a new quantitative MR imaging pulse sequence with the potential to discriminate between malignant and benign tissue. In this study, we evaluated the...
BACKGROUND AND PURPOSE
T1ρ imaging is a new quantitative MR imaging pulse sequence with the potential to discriminate between malignant and benign tissue. In this study, we evaluated the capability of T1ρ imaging to characterize tissue by applying T1ρ imaging to malignant and benign tissue in the nasopharynx and to normal tissue in the head and neck.
MATERIALS AND METHODS
Participants with undifferentiated nasopharyngeal carcinoma and benign hyperplasia of the nasopharynx prospectively underwent T1ρ imaging. T1ρ measurements obtained from the histogram analysis for nasopharyngeal carcinoma in 43 participants were compared with those for benign hyperplasia and for normal tissue (brain, muscle, and parotid glands) in 41 participants using the Mann-Whitney test. The area under the curve of significant T1ρ measurements was calculated and compared using receiver operating characteristic analysis and the Delong test, respectively. A < .05 indicated statistical significance.
RESULTS
There were significant differences in T1ρ measurements between nasopharyngeal carcinoma and benign hyperplasia and between nasopharyngeal carcinoma and normal tissue (all, < .05). Compared with benign hyperplasia, nasopharyngeal carcinoma showed a lower T1ρ mean (62.14 versus 65.45 × ms), SD (12.60 versus 17.73 × ms), and skewness (0.61 versus 0.76) (all < .05), but no difference in kurtosis (= .18). The T1ρ SD showed the highest area under the curve of 0.95 compared with the T1ρ mean (area under the curve = 0.72) and T1ρ skewness (area under the curve = 0.72) for discriminating nasopharyngeal carcinoma and benign hyperplasia (all, < .05).
CONCLUSIONS
Quantitative T1ρ imaging has the potential to discriminate malignant from benign and normal tissue in the head and neck.
Topics: Adult; Aged; Aged, 80 and over; Female; Head; Humans; Hyperplasia; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx; Neck; ROC Curve; Statistics, Nonparametric
PubMed: 33122214
DOI: 10.3174/ajnr.A6828 -
Brazilian Journal of Otorhinolaryngology 2022Confocal laser endomicroscopy is an optical imaging technique that allows in vivo, real-time, microscope-like images of the upper aerodigestive tract's mucosa. The...
INTRODUCTION
Confocal laser endomicroscopy is an optical imaging technique that allows in vivo, real-time, microscope-like images of the upper aerodigestive tract's mucosa. The assessment of morphological tissue characteristics for the correct differentiation between healthy and malignant suspected mucosa requires strict evaluation criteria.
OBJECTIVE
This study aims to validate an eight-point score for the correct assessment of malignancy.
METHODS
We performed confocal laser endomicroscopy between March and October 2020 in 13 patients. 197 sequences (11.820 images) originated from the marginal area of pharyngeal and laryngeal carcinomas. Specimens were taken at corresponding locations and analyzed in H&E staining as a standard of reference. A total of six examiners evaluated the sequences based on a scoring system; they were blinded to the histopathological examination. The primary endpoints are sensitivity, specificity, and accuracy. Secondary endpoints are interrater reliability and receiver operator characteristics.
RESULTS
Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. Confocal laser endomicroscopy of malignant cells demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 83.2%, 81.3%, 85.5%, 86.7%, and 79.7%, respectively, with a κ-value of 0.64, and an area under the curve of 0.86.
CONCLUSION
The results confirm that this scoring system is applicable in the laryngeal and pharyngeal mucosa to classify benign and malignant tissue. A scoring system based on defined and reproducible characteristics can help translate this experimental method to broad clinical practice in head and neck diagnosis.
Topics: Humans; Microscopy, Confocal; Reproducibility of Results; Pharyngeal Neoplasms; Squamous Cell Carcinoma of Head and Neck; Head and Neck Neoplasms; Lasers
PubMed: 34348858
DOI: 10.1016/j.bjorl.2021.06.002 -
HNO Feb 2021The primary goal of surgical resection of oropharyngeal carcinoma (OPSCC) is an R0 resection. The extension of the primary tumor is decisive for selection of access... (Review)
Review
INTRODUCTION
The primary goal of surgical resection of oropharyngeal carcinoma (OPSCC) is an R0 resection. The extension of the primary tumor is decisive for selection of access route, which should be as circumscribed as possible but as radical as necessary. To date, there are no prospective comparative studies that compared functional outcome in terms of surgical access route.
MATERIALS AND METHODS
A selective literature search was carried out for the period from 01/01/2000 to 12/31/2019 to assess the functional result after different surgical approaches in the treatment of OPSCC. The search strategy aimed to identify publications that investigated the functional result of transoral approaches, robot-assisted transoral resections (TORS), and surgical resection using pharyngotomies or transmandibular approaches.
RESULTS
Various measures were identified which enable subjective and objective assessment of swallowing and speaking restrictions. For all surgical access routes, studies were identified that examined the functional aspects of the respective access, but there are no direct comparisons between the individual approaches.
CONCLUSION
There are various surgical approaches available for resection of OPSCC, each of which has been examined in various studies with regard to its oncological and functional results.
Topics: Carcinoma; Deglutition; Humans; Oropharyngeal Neoplasms; Pharynx; Prospective Studies; Robotic Surgical Procedures; Treatment Outcome
PubMed: 32430667
DOI: 10.1007/s00106-020-00887-0