-
Laryngoscope Investigative... Apr 2021To compare the impact on survival and late radiation toxicity of patients with squamous cell carcinoma of unknown primary who were treated with ipsilateral neck...
OBJECTIVES
To compare the impact on survival and late radiation toxicity of patients with squamous cell carcinoma of unknown primary who were treated with ipsilateral neck dissection and ipsilateral postoperative radiotherapy (PORT) and patients treated with ipsilateral neck dissection and PORT to both sides of the neck plus the pharyngeal axis.
METHODS
Retrospective cohort study performed at the Erasmus University Medical Center in which 78 patients with squamous cell carcinoma of unknown primary were identified. Thirty-nine patients received PORT to both sides of the neck plus the pharyngeal axis (BILAX) and another 39 patients were irradiated on the ipsilateral neck (IPSI) only. The endpoints of the present study were 3-year overall survival (OS), 3-year disease-free survival (DFS), and overall late radiation toxicity.
RESULTS
The 3-year OS rate of the entire group of 78 patients was 74.2% and the 3-year DFS rate was 72.7%. The 3-year OS rates for the IPSI and the BILAX groups were 74.4% and 74.1%, respectively ( = .654). The most common late radiation toxicity experienced was xerostomia (64.8%), which was significantly more often seen in the BILAX group than in the IPSI group (83.8% and 44.1%, respectively, = .001). Overall late radiation toxicity was significantly higher in the BILAX group ( = .003).
CONCLUSION
There was no significant difference in OS and DFS rates between the IPSI and the BILAX group. Late radiation toxicity was significantly higher in the BILAX group.
LEVEL OF EVIDENCE
Level 2b: Individual retrospective cohort study.
PubMed: 33869753
DOI: 10.1002/lio2.539 -
Ear, Nose, & Throat Journal Jan 2020The laryngopharyngeal reconstruction in patients with pyriform sinus carcinoma continues to be a challenge for surgeons. In this article, we describe our experience with...
The laryngopharyngeal reconstruction in patients with pyriform sinus carcinoma continues to be a challenge for surgeons. In this article, we describe our experience with laryngopharyngeal reconstruction in patients with pyriform sinus carcinoma using the modified infrahyoid myocutaneous flap (IHMCF). The modified incision design for the modified IHMCF and clinical outcomes are also detailed here. Between January 2012 and February 2018, 10 patients with hypopharyngeal squamous cell carcinoma who underwent laryngopharyngeal reconstruction using the modified IHMCF after hemicricolaryngopharyngectomy were included in this study. The drainage vessels of the modified IHMCF, oncological outcomes, and functional reservation of the larynx were recorded. All of the flaps survived well. No flap necrosis or other major complications occurred during follow-up. None of the patients remained on nasogastric feeding for more than 4 weeks postoperatively. The follow-up period ranged from 12 to 73 months (mean, 36 months). In our series, 6 patients were successfully decannulated and 5 had received radiation therapy. We roughly assessed the speech and swallowing functions, and the outcomes seemed acceptable in all of the patients after surgery. Laryngoscopic examination showed that the modified IHMCF survived well and the new glottis provided excellent function and good ventilation results. In our experience, the modified IHMCF is a safe and viable procedure that can serve as a valid alternative to free flaps and the pectoralis major myocutaneous flap to reconstruct laryngopharyngeal defects.
Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Humans; Hyoid Bone; Hypopharyngeal Neoplasms; Hypopharynx; Laryngoplasty; Larynx; Male; Middle Aged; Myocutaneous Flap; Plastic Surgery Procedures; Treatment Outcome
PubMed: 31079475
DOI: 10.1177/0145561319849947 -
Human Vaccines & Immunotherapeutics Nov 2022Head and neck squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide, and prevalence is still substantially higher in men than in women. Causative...
BACKGROUND
Head and neck squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide, and prevalence is still substantially higher in men than in women. Causative factors include smoking and alcohol use, while human papillomavirus (HPV) infection is causally related to a subset of oropharyngeal cancers. In this retrospective study, we aimed to provide estimates on the clinical and economic burden of HNSCC in Spain.
METHODS
We used the discharge reports from the Spanish Minimum Basic Data Set (MBDS), to retrospectively analyze hospital discharge data in individuals with a diagnosis of HNSCC in any diagnostic position, based on the ICD coding system (ICD-9-CM and ICD10 CM), from 2009 to 2019.
RESULTS
A total of 175,340 admissions and 14,498 deaths due to laryngeal, pharyngeal and oral cavity cancer were recorded in Spain, of which 85% occurred in men. The most prevalent diagnoses were laryngeal cancer in men (50.9%) and oral cavity cancer in women (49.1%). In general, the hospitalization and death rates for all major head and neck cancer sites decreased in men and increased or remained stable in women during the study period. However, the corresponding rates for tonsil cancer, strongly associated with HPV infection, increased significantly in men. Overall, the economic burden of HNSCC during the study period was estimated at 100 million euros per year on average.
CONCLUSION
HNSCC still places an important clinical and economic burden on the health system in Spain. Prevention strategies should be prioritized, and vaccination programs against HPV in both sexes should be reinforced.
Topics: Male; Humans; Female; Squamous Cell Carcinoma of Head and Neck; Papillomavirus Infections; Retrospective Studies; Spain; Head and Neck Neoplasms; Hospitalization; Papillomaviridae
PubMed: 35930449
DOI: 10.1080/21645515.2022.2082192 -
Frontiers in Oncology 2021Early-stage squamous cell cancer (SCC) of the glottis has a good prognosis. Therefore, patients have long survival outcomes and may potentially suffer from late... (Review)
Review
Early-stage squamous cell cancer (SCC) of the glottis has a good prognosis. Therefore, patients have long survival outcomes and may potentially suffer from late toxicities of radiotherapy. Radiotherapy with a conventional parallel-opposed-pair or anterior-oblique beam arrangements for stage 1 and 2 glottic SCC have field borders that traditionally cover the entire larynx, exposing organs-at-risk (e.g. carotid arteries, contralateral vocal cord, contralateral arytenoid and inferior pharyngeal constrictor muscles) to high radiation doses. The potential long-term risk of cerebrovascular events has attracted much attention to the dose that carotid arteries receive. Swallow and respiratory motion of laryngeal structures has been an important factor that previously limited reduction of the radiation treatment volume. Motion has been evaluated using multiple imaging modalities and this information has been used to calculate PTV margins for generation of more limited target volumes. This review discusses the current literature surrounding dose-effect relationships for various organs-at-risk and the late toxicities that are associated with them. This article also reviews the currently available data and effects of laryngeal motions on dosimetry to the primary target. We also review the current limitations and benefits of a more targeted approach of radiotherapy for early-stage glottic SCCs and the evolution of CT-based IGRT and MR-guided radiotherapy techniques that may facilitate a shift away from a conventional 3D-conformal radiotherapy approach.
PubMed: 34616688
DOI: 10.3389/fonc.2021.753908 -
Dental and Medical Problems 2021Recent advances have attributed carcinogenic potential to pharmacotherapy. Cancers of the head and neck region are no exception. (Review)
Review
BACKGROUND
Recent advances have attributed carcinogenic potential to pharmacotherapy. Cancers of the head and neck region are no exception.
OBJECTIVES
This descriptive investigation aimed to identify studies reporting on drugs that have contributed to cancer development in the head and neck region.
MATERIAL AND METHODS
Online databases were searched for relevant articles and their data were summarized, including age, gender, main drug classification and name, additional drugs, primary disorders, drug-related cancers, and the site of each drug-related cancer.
RESULTS
The mean age of the patients included in this analysis was 52.9 years. However, drug-related head and neck cancers (DR HNCs) were most prevalent in persons over 60 years of age. Overall, these cancers were more prevalent in females than in males (1.33/1). The HNC-related drugs could mainly be categorized into 3 groups, namely, immunomodulatory/immunosuppressive, chemotherapeutic and chemoprotective drugs, while the most frequently used additional drugs across the studies were corticosteroids. The 5 most prevalent primary conditions for which the patients had received pharmacotherapy were organ transplantations, lymphoproliferative disorders (LPD), rheumatoid arthritis (RA), Epstein-Barr virus (EBV) infection, and bone sarcoma. The most prevalent HNCs were squamous cell carcinoma (SCCs), thyroid cancers (including papillary and follicular thyroid carcinomas), LPD, and mucoepidermoid/acinic cell carcinomas, which occurred mostly in the oral cavity, neck, salivary glands, pharynx/larynx, and head/face.
CONCLUSIONS
This study was the first of its kind to analyze and discuss the aforementioned findings regarding the head and neck region in depth. Clinicians should familiarize themselves with DR HNC cases to effectively screen suspected patients.
Topics: Aged; Epstein-Barr Virus Infections; Female; Head and Neck Neoplasms; Herpesvirus 4, Human; Humans; Male; Middle Aged; Pharmaceutical Preparations
PubMed: 34176247
DOI: 10.17219/dmp/131116 -
Exploration of Targeted Anti-tumor... 2022Head and neck squamous cell carcinomas (HNSCCs) represent the most common epithelial tumors that arise from mucosa of the oral cavity, pharynx, and larynx. The... (Review)
Review
Head and neck squamous cell carcinomas (HNSCCs) represent the most common epithelial tumors that arise from mucosa of the oral cavity, pharynx, and larynx. The development of HNSCCs is usually associated with tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. Most HNSCCs are diagnosed in advanced states, leading to a worse clinical outcome. Screening tests based on potential biomarkers associated with HNSCCs could improve this scenario. Liquid biopsy has emerged as a promising area of cancer investigation, offering a minimally invasive approach to track circulating biomarkers in body fluids that could potentially contribute to the diagnosis, predict prognosis, and monitor response to treatment. This review will discuss translational studies describing the clinical applications of liquid biopsy in HPV-negative and HPV-positive HNSCCs focused on circulating nucleic acids [cell-free DNA (cfDNA) and cell-free RNA (cfRNA)], circulating tumor cells (CTCs), and extracellular vesicles (EVs), which can be found in plasma, serum, and saliva.
PubMed: 36071985
DOI: 10.37349/etat.2022.00099 -
Translational Cancer Research Jul 2021The study aims to retrospectively evaluate disparate reconstructive choices for defects in patients with primary hypopharyngeal carcinoma undergoing tumor resection.
BACKGROUND
The study aims to retrospectively evaluate disparate reconstructive choices for defects in patients with primary hypopharyngeal carcinoma undergoing tumor resection.
METHODS
One hundred and twenty-five patients of primary hypopharyngeal carcinamo conducted with hypopharynx reconstruction for restoring the defects causing by tumor ablation from 2003 to 2016 at Eye & ENT Hospital of Fudan University were reviewed. Most of them were treated with the following three techniques (n=115): gastric pull-up (GPU), the pedicled pectoralis major myocutaneous flap (PMMF) and the radial forearm free flap (RFFF). GPU was used for those with cervical esophagus invasion requiring esophageal resection in our institution. We focus on the postoperative complication morbidity, function of deglutition 1 month after hospital discharge and disease-free survival (DFS) outcomes.
RESULTS
One month after operation, 56 of 65 (86.2%) achieved solid or semisolid diet with normal swallowing function for GPU, 8 of 12 (66.7%) for RFFF and 20 of 33 (60.6%) for PMMF respectively. Postoperative complications occured in 15 (23.1%), 8 (66.7%), 16 (48.5%) for GPU, RFFF and PMMF respectively, including flap/anastomotic necrsis, pharyngeal fistula, wound infection (both recipient and donor sites), pulmonary and cardiovascular complications.
CONCLUSIONS
GPU showed satisfactory outcomes for reconstruction of patients with hypopharyngeal carcinoma requiring esophageal resection. For patients without cervical esophagus invasion and underwent partial or total pharyngectomy, both PMMF and RFFF can afford good coverage and reliable functional and survival outcome as well as postoperative complication morbidity. Moreover, the only predictive factor for incidence of postoperative complication was extent of surgery, as total hypopharyngectomy was more likely to develop complications after surgery than partial hypopharyngectomy.
PubMed: 35116630
DOI: 10.21037/tcr-20-2910 -
World Journal of Otorhinolaryngology -... Mar 2020Nasopharyngeal cancer (NPC) has distinct characteristics regarding its global prevalence, initial presentation, management and patient outcomes compared to other...
OBJECTIVE
Nasopharyngeal cancer (NPC) has distinct characteristics regarding its global prevalence, initial presentation, management and patient outcomes compared to other subtypes of head and neck cancer (HNC). The mainstay of NPC treatment is chemo-radiation (C/RT) and while dysphagia is a known early and late toxicity of C/RT treatment, the nature of dysphagia post NPC treatment has had limited investigation. The objective of this review is to summarise the existing evidence regarding dysphagia following NPC to inform the future research agenda for this population. Dysphagia incidence, characteristic deficits observed across the phases of swallowing, efficacy of current dysphagia interventions, and effect on quality of life will be explored.
DATA SOURCES
Databases including MEDLINE, CINAHL, Embase, Scopus and Web of Science were included.
METHODS
A scoping review was conducted according to PRISMA-ScR guidelines. Two independent reviewers screened selected full text articles.
RESULTS
Of the initial 2495 articles found, 28 articles were included. Reports of penetration and aspiration varied widely (0%-91.6%), with high rates of silent aspiration identified in 2 studies (42%, 66%). Oral, pharyngeal and upper esophageal phase impairments were reported. Of these, upper esophageal stasis and multiple pharyngeal stage deficits were most prevalent. The pharyngeal constrictors were found to have a significant dose-effect relationship and shielding to the anterior neck field was effective to preserve swallowing function. Six treatment studies were identified with limited evidence supporting the use of neuromuscular electrical stimulation, dilatation and swallowing exercises. Quality of life was adversely affected.
CONCLUSIONS
Dysphagia is a prevalent early and late problem post NPC treatment, with impairments across all phases of the swallow. Studies on preventing dysphagia and treatment efficacy remain limited. More systematic study of the nature of dysphagia and the efficacy of treatment in this population is warranted.
PubMed: 32426699
DOI: 10.1016/j.wjorl.2020.02.005 -
Oncology Reports Mar 2024Head and neck squamous cell carcinoma (HNSCC) is the seventh most commonly diagnosed cancer globally. HNSCC develops from the mucosa of the oral cavity, pharynx and...
Head and neck squamous cell carcinoma (HNSCC) is the seventh most commonly diagnosed cancer globally. HNSCC develops from the mucosa of the oral cavity, pharynx and larynx. Methylation levels of septin 9 () and short stature homeobox 2 () genes in circulating cell‑free DNA (ccfDNA) are considered epigenetic biomarkers and have shown predictive value in preliminary reports in HNSCC. Liquid biopsy is a non‑invasive procedure that collects tumor‑derived molecules, including ccfDNA. In the present study, a droplet digital PCR (ddPCR)‑based assay was developed to detect DNA methylation levels of circulating and in the plasma of patients with HNSCC. The assay was first set up using commercial methylated and unmethylated DNA. The dynamic changes in the methylation levels of and were then quantified in 20 patients with HNSCC during follow‑up. The results highlighted: i) The ability of the ddPCR‑based assay to detect very low copies of methylated molecules; ii) the significant decrease in and methylation levels in the plasma of patients with HNSCC at the first time points of follow‑up with respect to T; iii) a different trend of longitudinally DNA methylation variations in small groups of stratified patients. The absolute and precise quantification of and methylation levels in HNSCC may be useful for studies with translational potential.
Topics: Humans; Squamous Cell Carcinoma of Head and Neck; DNA Methylation; Genes, Homeobox; Carcinoma, Squamous Cell; Homeodomain Proteins; Polymerase Chain Reaction; Cytoskeletal Proteins; Cell-Free Nucleic Acids; Head and Neck Neoplasms; Biomarkers, Tumor
PubMed: 38299234
DOI: 10.3892/or.2024.8711 -
Journal of Cancer Research and... Apr 2023This study aimed to estimate the fitting parameters of sigmoidal dose-response (SDR) curve of radiation-induced acute oral and pharyngeal mucositis in head-and-neck (H...
PURPOSE/OBJECTIVE(S)
This study aimed to estimate the fitting parameters of sigmoidal dose-response (SDR) curve of radiation-induced acute oral and pharyngeal mucositis in head-and-neck (H and N) cancer patients treated with Intensity Modulated Radiation Therapy (IMRT) for the calculation of normal tissue complication probability (NTCP).
MATERIALS AND METHODS
Thirty H-and-N cancer patients were enrolled to model the SDR curve for oral and pharyngeal mucositis. The patients were evaluated weekly for acute radiation-induced (ARI) oral and pharyngeal mucositis toxicity, and their scoring was performed as per the common terminology criteria adverse events version 5.0. The radiobiological parameters, namely n, m, TD50, and γ50 were calculated from the fitted SDR curve obtained from the clinical data of H-and-N cancer patients.
RESULTS
ARI toxicity for oral and pharyngeal mucosa in carcinoma of H-and-N cancer patients was calculated for the endpoint oral mucositis and pharyngeal mucositis. The n, m, TD50, and γ50 parameters from the SDR curve of Grade 1 and Grade 2 oral mucositis were found to be [0.10, 0.32, 12.35 ± 3.90 (confidence interval [CI] 95%) and 1.26] and [0.06, 0.33, 20.70 ± 6.95 (CI 95%) and 1.19] respectively. Similarly for pharyngeal mucositis, n, m, TD50, and γ50 parameters for Grade 1 and Grade 2 were found to be [0.07, 0.34, 15.93 ± 5.48 (CI. 95%) and 1.16 ] and [0.04, 0.25, 39.02 ± 9.98(CI. 95%) and 1.56] respectively.
CONCLUSION
This study presents the fitting parameters for NTCP calculation of Grade 1 and Grade 2 ARI toxicity for the endpoint of oral and pharyngeal mucositis. The provided nomograms of volume versus complication and dose versus complication for different grades of oral mucositis and pharyngeal mucositis help radiation oncologists to decide the limiting dose to reduce the acute toxicities.
Topics: Humans; Mucositis; Stomatitis; Head and Neck Neoplasms; Radiotherapy, Intensity-Modulated; Radiation Injuries; Mouth Mucosa; Carcinoma, Squamous Cell
PubMed: 37147947
DOI: 10.4103/jcrt.jcrt_504_21