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Annals of Medicine Dec 2023To investigate the treatment of intractable epistaxis after radiotherapy for nasopharyngeal carcinoma (NPC). This review focuses on the anatomy and pathophysiology,... (Review)
Review
To investigate the treatment of intractable epistaxis after radiotherapy for nasopharyngeal carcinoma (NPC). This review focuses on the anatomy and pathophysiology, mechanism, and clinical treatments of epistaxis after NPC radiotherapy. For treating NPC, radiation therapy is the primary therapeutic modality. However, radiotherapy can lead to varied degrees of harm to the neighboring tissues and is correlated with numerous complications. Among these complications, epistaxis is a common occurrence after NPC radiotherapy, owing to damage to the surrounding tissues caused by radiotherapy. Unfortunately, epistaxis, particularly carotid blowout, can have a dangerous course and a high mortality rate. Accurate understanding of epistaxis following radiotherapy, prompt bleeding cessation, and reduction of bleeding volume are key considerations. Nasal tamponade is a crucial rescue treatment, while tracheotomy is an active and effective method. Intravascular balloon embolization is a reliable and effective treatment method for ICA hemorrhage, and vascular embolization is the primary approach for treating external carotid artery maxillary bleeding. Implantation of a covered stent can achieve hemostasis without altering hemodynamics. A comprehensive approach utilizing these methods can improve the success rate of treating nosebleeds following NPC radiotherapy.HighlightsThe mortality rate for carotid blowout following radiotherapy for NPC is high.Radiation therapy and tumor condition are correlated with epistaxis in NPC.Treatment methods for NPC-related epistaxis include posterior nostril tamponade, endoscopic hemostasis, DSA, selective vascular embolization, and stent implantation.The use of a covered stent for NPC-related carotid blowout achieves hemostasis without altering blood perfusion.Effective and timely application of various hemostasis methods is key to improving the success rate of rescue, considering the characteristics of NPC-related epistaxis.
Topics: Humans; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Epistaxis; Carotid Arteries; Embolization, Therapeutic
PubMed: 37074291
DOI: 10.1080/07853890.2023.2200257 -
Brazilian Journal of Otorhinolaryngology 2024
Topics: Humans; Lipoma; Laryngeal Neoplasms; Pharyngeal Neoplasms; Tomography, X-Ray Computed; Male; Female; Middle Aged
PubMed: 38442639
DOI: 10.1016/j.bjorl.2024.101407 -
MSMR Jul 2021The purpose of this study was to determine the incidence of oral cavity and pharynx (OCP) cancer among service members in the active component military (i.e., Army, Air...
The purpose of this study was to determine the incidence of oral cavity and pharynx (OCP) cancer among service members in the active component military (i.e., Army, Air Force, Navy, and Marine Corps) from 2007 through 2019, and to provide an overview of the rates and trends throughout this period. There were 443 cases of oral cavity and pharynx cancer in the active component during those 13 years. The overall male incidence rate (2.7 per 100,000 service members) was greater than the female incidence rate (1.3 per 100,000 service members). Service members 40 years or older had the highest overall incidence rate (11.3 per 100,000 service members) which was 3.4 times the next highest rate (3.3 per 100,000 service members) observed among those aged 35-39. The Army had the greatest number of cases (n=201) followed by the Air Force (n=103), Navy (n=102), and Marine Corps (n=37). The Army had the highest overall 13-year incidence rate (3.0 per 100,000 service members) when compared to the Air Force (2.4 per 100,000 service members), Navy (2.4 per 100,000 service members), and Marine Corps (1.5 per 100,000 service members). By anatomical location, cancer of the parotid gland accounted for the highest percentage of cases (16.3%).
Topics: Female; Humans; Incidence; Male; Military Personnel; Mouth; Pharyngeal Neoplasms; Population Surveillance; United States
PubMed: 34542258
DOI: No ID Found -
Current Opinion in Immunology Aug 2023Epstein-Barr virus (EBV) contributes to oncogenesis and immune evasion in nasopharyngeal carcinoma (NPC). At present, an aggregated, higher-level view on the impact of... (Review)
Review
Epstein-Barr virus (EBV) contributes to oncogenesis and immune evasion in nasopharyngeal carcinoma (NPC). At present, an aggregated, higher-level view on the impact of EBV genes toward the immune microenvironment of NPC is lacking. To this end, we have interrogated tumor-derived RNA sequences of 106 treatment-naive NPC patients for 98 EBV transcripts, and captured the presence of 10 different immune cell populations as well as 23 different modes of T-cell evasion. We discovered 3 clusters of EBV genes that each associate with distinct immunophenotypes of NPC. Cluster 1 associated with gene sets related to immune cell recruitment, such as those encoding for chemoattractants and their receptors. Cluster 2 associated with antigen processing and presentation, such as interferon-related genes, whereas cluster 3 associated with presence of M1-like macrophages, absence of CD4+ T cells, and oncogenic pathways, such as the nuclear factor kappa light-chain enhancer of activated B-cell pathway. We discuss these 3 EBV clusters regarding their potential for stratification for T-cell immunity in NPC together with the next steps needed to validate such therapeutic value.
Topics: Humans; Nasopharyngeal Carcinoma; Herpesvirus 4, Human; Epstein-Barr Virus Infections; Carcinoma; Nasopharyngeal Neoplasms; Transcriptome; Tumor Microenvironment
PubMed: 37235920
DOI: 10.1016/j.coi.2023.102335 -
Cancer Cell Mar 2024The AJCC/UICC TNM classification describes anatomic extent of tumor progression and guides treatment decisions. Our comprehensive analysis of 8,834 newly diagnosed...
The AJCC/UICC TNM classification describes anatomic extent of tumor progression and guides treatment decisions. Our comprehensive analysis of 8,834 newly diagnosed patients with non-metastatic Epstein-Barr virus related nasopharyngeal carcinoma (NPC) from six Chinese centers indicates certain limitations in the current staging system. The 8th edition of the AJCC/UICC TNM classification inadequately differentiates patient outcomes, particularly between T2 and T3 categories and within the N classification. We propose reclassifying cases of T3 NPC with early skull-base invasion as T2, and elevating N1-N2 cases with grade 3 image-identified extranodal extension (ENE) to N3. Additionally, we suggest combining T2N0 with T1N0 into a single stage IA. For de novo metastatic (M1) NPC, we propose subdivisions of M1a, defined by 1-3 metastatic lesions without liver involvement, and M1b, characterized by >3 metastatic lesions or liver involvement. This proposal better reflects responses of NPC patients to the up-to-date treatments and their evolving risk profiles.
Topics: Humans; Nasopharyngeal Carcinoma; Neoplasm Staging; Herpesvirus 4, Human; Prognosis; Nasopharyngeal Neoplasms; Epstein-Barr Virus Infections; Carcinoma; Retrospective Studies
PubMed: 38242125
DOI: 10.1016/j.ccell.2023.12.020 -
BMC Cancer Mar 2022Cancers of the oral cavity and pharynx encompass a heterogeneous group of cancers for which known risk factors include smoking, alcohol consumption and human papilloma...
BACKGROUND
Cancers of the oral cavity and pharynx encompass a heterogeneous group of cancers for which known risk factors include smoking, alcohol consumption and human papilloma virus (HPV) infection but their influence is site-specific with HPV mainly influencing oropharyngeal cancer. Their incidence and survival rates are not well known over extended periods of time.
PATIENTS/METHODS
Data were obtained for Finnish (FI) and Swedish (SE) patients from the Nordcan database recently updated through 2019. Age-adjusted incidence trends (FI from 1953, SE from 1960) and relative survival rates for years 1970 through 2019 were calculated.
RESULTS
We observed a prominent increase in oral and oropharyngeal cancers in FI and SE men and women but the trend for oral cancer was interrupted for SE men in 1985 and possibly also for FI and SE women in 2015. The trend changes in male and female oral cancer was confirmed in data for Denmark and Norway. Relative survival for these cancers has improved overall but they differed for one cluster of oral, oropharyngeal and nasopharyngeal cancers with 60-70% 5-year survival in the last period and hypopharyngeal cancer with 25% male survival. In all these cancers, survival for old patients was unfavorable.
DISCUSSION/CONCLUSION
We hypothesize that reduction in smoking prevalence helped to stop the increase in oral cancer especially in men. As the prevalence of smoking is decreasing, HPV is becoming a dominant risk factor, particularly for the increasing oropharyngeal cancer. Prevention needs to emphasize sexual hygiene and HPV vaccination.
Topics: Aged; Alcohol Drinking; Female; Finland; Humans; Incidence; Male; Middle Aged; Mouth Neoplasms; Oropharyngeal Neoplasms; Papillomavirus Infections; Pharyngeal Neoplasms; Registries; Risk Factors; Smoking; Sweden
PubMed: 35236321
DOI: 10.1186/s12885-022-09337-2 -
EBioMedicine Oct 2023Dysbiosis of the oral mycobiome has been linked to some diseases, including cancers. However, the role of oral fungal communities in nasopharyngeal carcinoma (NPC)...
BACKGROUND
Dysbiosis of the oral mycobiome has been linked to some diseases, including cancers. However, the role of oral fungal communities in nasopharyngeal carcinoma (NPC) carcinogenesis has not previously been investigated.
METHODS
We characterized the oral salivary fungal mycobiome in 476 untreated incident NPC patients and 537 population-based controls using fungal internal transcribed spacer (ITS)-2 sequencing. The relationship between oral fungal mycobiome and the risk of NPC was assessed through bioinformatic and biostatistical analyses.
FINDINGS
We found that lower fungal alpha diversity was associated with an increased odds of NPC [lower vs. higher: observed features (adjusted odds ratio [OR] = 5.81, 95% confidence interval [CI] = 3.60-9.38); Simpson diversity (1.53, 1.03-2.29); Shannon diversity (2.03, 1.35-3.04)]. We also observed a significant difference in global fungal community patterns between cases and controls based on Bray-Curtis dissimilarity (P < 0.001). Carriage of oral fungal species, specifically, Saccharomyces cerevisiae, Candida tropicalis, Lodderomyces elongisporus, Candida albicans, and Fusarium poae, was associated with significantly higher odds of NPC, with ORs ranging from 1.56 to 4.66. Individuals with both low fungal and low bacterial alpha diversity had a profoundly elevated risk of NPC.
INTERPRETATION
Our results suggest that dysbiosis in the oral mycobiome, characterized by a loss of fungal community diversity and overgrowth of several fungal organisms, is associated with a substantially increased risk of NPC.
FUNDING
This work was funded by the US National Institutes of Health, the Swedish Research Council, the High-level Talents Research Start-up Project of Fujian Medical University, and the China Scholarship Council.
Topics: Humans; Nasopharyngeal Carcinoma; Dysbiosis; Case-Control Studies; Mycobiome; Saccharomyces cerevisiae; Nasopharyngeal Neoplasms
PubMed: 37776725
DOI: 10.1016/j.ebiom.2023.104813 -
Ear, Nose, & Throat Journal Dec 2021The transoral approach for parapharyngeal space tumors has been criticized due to its restrictive exposure and increased rate of vascular and nerve injuries. However,...
OBJECTIVES
The transoral approach for parapharyngeal space tumors has been criticized due to its restrictive exposure and increased rate of vascular and nerve injuries. However, for certain tumors-namely those that are prestyloid, benign, and well-encapsulated-the transoral approach reduces overall morbidity while providing direct access. Transoral surgeons can rely on this approach for select tumors seen clearly on intraoral examination in the bulging lateral pharynx. In this article and with a supplemental operative technique video, we demonstrate our transoral approach in these select patients.
METHODS
We reviewed our 26 cases using this approach and chose a representative case of a 50-year-old man who presented with a large, prestyloid, encapsulated parapharyngeal mass affecting his voice and swallowing. A transoral approach to the parapharyngeal tumor is illustrated.
RESULTS
A vertical curvilinear incision is completed from the hamulus to below the inferior extent of the tumor. Blunt dissection of the tumor capsule proceeds inferiorly. Controlled violation of the tumor capsule can aid in visualization. After tumor delivery, the wound is irrigated and closed.
CONCLUSIONS
In our experience, the transoral approach is an effective method to access well-encapsulated, prestyloid parapharyngeal space tumors. Patient selection is important when considering a transoral approach.
Topics: Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Otorhinolaryngologic Surgical Procedures; Pharyngeal Neoplasms; Retrospective Studies; Salivary Gland Neoplasms
PubMed: 32425121
DOI: 10.1177/0145561320923171 -
Nature Communications Apr 2022Polygenic risk scores (PRS) have the potential to identify individuals at risk of diseases, optimizing treatment, and predicting survival outcomes. Here, we construct...
Polygenic risk scores (PRS) have the potential to identify individuals at risk of diseases, optimizing treatment, and predicting survival outcomes. Here, we construct and validate a genome-wide association study (GWAS) derived PRS for nasopharyngeal carcinoma (NPC), using a multi-center study of six populations (6 059 NPC cases and 7 582 controls), and evaluate its utility in a nested case-control study. We show that the PRS enables effective identification of NPC high-risk individuals (AUC = 0.65) and improves the risk prediction with the PRS incremental deciles in each population (P ranging from 2.79 × 10 to 4.79 × 10). By incorporating the PRS into EBV-serology-based NPC screening, the test's positive predictive value (PPV) is increased from an average of 4.84% to 8.38% and 11.91% in the top 10% and 5% PRS, respectively. In summary, the GWAS-derived PRS, together with the EBV test, significantly improves NPC risk stratification and informs personalized screening.
Topics: Case-Control Studies; Genome-Wide Association Study; Humans; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Risk Assessment; Risk Factors
PubMed: 35414057
DOI: 10.1038/s41467-022-29570-4 -
Asian Nursing Research May 2023To evaluate the incidence and identify the risk factors for radiotherapy-induced oral mucositis among patients with nasopharyngeal carcinoma. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the incidence and identify the risk factors for radiotherapy-induced oral mucositis among patients with nasopharyngeal carcinoma.
METHODS
A meta-analysis was conducted. Eight electronic databases (Medline, Embase, Cochrane Library, CINAHL Plus with Full Text, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journals Database) were systematically searched from inception to 4 March 2023 for relevant studies. Study selection and data extraction were conducted by two independent authors. The Newcastle‒Ottawa scale was used for quality assessment among the included studies. Data synthesis and analyses were performed in R software package version 4.1.3 and Review Manager Software 5.4. The pooled incidence was calculated using proportions with 95% confidence intervals (CIs), and the risk factors were evaluated using the odds ratio (OR) with 95% CIs. Sensitivity analysis and predesigned subgroup analyses were also conducted.
RESULTS
A total of 22 studies published from 2005 to 2023 were included. The results of the meta-analysis showed that the incidence of radiotherapy-induced oral mucositis was 99.0% among nasopharyngeal carcinoma patients, and the incidence of severe radiotherapy-induced oral mucositis was 52.0%. Poor oral hygiene, overweight before radiotherapy, oral pH < 7.0, the use of oral mucosal protective agents, smoking, drinking, combined chemotherapy, and the use of antibiotics at early treatment stage are risk factors for severe radiotherapy-induced oral mucositis. Sensitivity analysis and subgroup analyses also revealed that our results are stable and reliable.
CONCLUSIONS
Almost all patients with nasopharyngeal carcinoma have suffered from radiotherapy-induced oral mucositis, and more than half of patients have experienced severe oral mucositis. Facilitating oral health might be the key focus of reducing the incidence and severity of radiotherapy-induced oral mucositis among nasopharyngeal carcinoma patients.
REGISTRATION NUMBER
CRD42022322035.
Topics: Humans; Incidence; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Risk Factors; Stomatitis
PubMed: 37094771
DOI: 10.1016/j.anr.2023.04.002