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Experimental and Clinical... Apr 2024Posttransplant lymphoproliferative disorder is a life-threatening complication after solid-organ transplants. In adults, recipients of heart transplants have the highest...
Posttransplant lymphoproliferative disorder is a life-threatening complication after solid-organ transplants. In adults, recipients of heart transplants have the highest risk, whereas renal transplant recipients have the lowest risk among all solid-organ transplants. The most common site for posttransplant lymphoproliferative disorders are gastrointestinal tract followed by the graft itself. Airway involvement in posttransplant lymphoproliferative disorder is rarely encountered. We report a case of a 26-year-old renal allograft recipient who presented to the emergency room with airway obstruction necessitating an emergency tracheostomy. Imaging revealed a left tonsillar mass extending into the nasopharynx and retropharyngeal space causing complete oropharyngeal occlusion. Endoscopic biopsy from nasopharyngeal mass showed a diffuse large B-cell lymphoma and was Ebstein-Barr virus positive. Reduction in immunosuppression and treatment with posttransplant lymphoproliferative disorder-1 risk-stratified approach resulted in complete remission.
Topics: Humans; Kidney Transplantation; Adult; Treatment Outcome; Airway Obstruction; Immunosuppressive Agents; Male; Lymphoma, Large B-Cell, Diffuse; Acute Disease; Biopsy; Epstein-Barr Virus Infections; Tracheostomy; Remission Induction; Immunocompromised Host; Nasopharyngeal Neoplasms
PubMed: 38742322
DOI: 10.6002/ect.2024.0061 -
Journal of Medical Economics Apr 2024Infections are responsible for approximately 13% of cancer cases worldwide and many of these infections can be prevented by vaccination. Human papillomavirus (HPV) and...
BACKGROUND
Infections are responsible for approximately 13% of cancer cases worldwide and many of these infections can be prevented by vaccination. Human papillomavirus (HPV) and hepatitis B virus (HBV) are among the most common infections that cause cancer deaths globally, despite effective prophylactic vaccines being available. This analysis aims to estimate the global burden and economic impact of vaccine-preventable cancer mortality across World Health Organization (WHO) regions.
METHODS
The number of deaths and years of life lost (YLL) due to five different vaccine-preventable cancer forms (oral cavity, liver, laryngeal, cervical, and oropharyngeal cancer) in each of the WHO regions (African, Eastern Mediterranean, European, the Americas, South-East Asia Pacific, and Western Pacific) were obtained from the Institute for Health Metrics Evaluation global burden of disease dataset. Vaccine-preventable mortality was estimated considering the fraction attributable to infection, to estimate the number of deaths and YLL potentially preventable through vaccination. Data from the World Bank on GDP per capita were used to estimate the value of YLL (VYLL). The robustness of these results was explored with sensitivity analysis. Given that several Epstein-Barr virus (EBV) vaccines are in development, but not yet available, the impact of a potential vaccine for EBV was evaluated in a scenario analysis.
RESULTS
In 2019, there were 465,740 potentially vaccine-preventable cancer deaths and 14,171,397 YLL across all WHO regions. The estimated economic impact due to this mortality was $106.3 billion globally. The sensitivity analysis calculated a range of 403,025-582,773 deaths and a range in productivity cost of $78.8-129.0 billion. In the scenario analysis EBV-related cancer mortality increased the global burden by 159,723 deaths and $32.4 billion.
CONCLUSION
Overall, the findings from this analysis illustrate the high economic impact of premature cancer mortality that could be potentially preventable by vaccination which may assist decision-makers in allocating limited resources among competing priorities. Improved implementation and increased vaccination coverage of HPV and HBV should be prioritized to decrease this burden.
Topics: Humans; Neoplasms; Global Health; Female; Male; Global Burden of Disease; Cost of Illness; Vaccine-Preventable Diseases; Middle Aged; Adult; Models, Econometric; Papillomavirus Infections; Quality-Adjusted Life Years
PubMed: 38721643
DOI: 10.1080/13696998.2024.2350877 -
British Journal of Cancer Jun 2024Gut microbiome modulation to boost antitumor immune responses is under investigation.
Prospective manipulation of the gut microbiome with microbial ecosystem therapeutic 4 (MET4) in HPV-related locoregionally-advanced oropharyngeal cancer squamous cell carcinoma (LA-OPSCC) undergoing primary chemoradiation: ROMA2 study.
BACKGROUND
Gut microbiome modulation to boost antitumor immune responses is under investigation.
METHODS
ROMA-2 evaluated the microbial ecosystem therapeutic (MET)-4 oral consortia, a mixture of cultured human stool-derived immune-responsiveness associated bacteria, given with chemoradiation (CRT) in HPV-related oropharyngeal cancer patients. Co-primary endpoints were safety and changes in stool cumulative MET-4 taxa relative abundance (RA) by 16SRNA sequencing. Stools and plasma were collected pre/post-MET-4 intervention for microbiome and metabolome analysis.
RESULTS
Twenty-nine patients received ≥1 dose of MET-4 and were evaluable for safety: drug-related adverse events (AEs) occurred in 13/29 patients: all grade 1-2 except one grade 3 (diarrhea). MET-4 was discontinued early in 7/29 patients due to CRT-induced toxicity, and in 1/29 due to MET-4 AEs. Twenty patients were evaluable for ecological endpoints: there was no increase in stool MET-4 RA post-intervention but trended to increase in stage III patients (p = 0.06). MET-4 RA was higher in stage III vs I-II patients at week 4 (p = 0.03) and 2-month follow-up (p = 0.01), which correlated with changes in plasma and stool targeted metabolomics.
CONCLUSIONS
ROMA-2 did not meet its primary ecologic endpoint, as no engraftment was observed in the overall cohort. Exploratory findings of engraftment in stage III patients warrants further investigation of microbiome interventions in this subgroup.
Topics: Humans; Oropharyngeal Neoplasms; Male; Gastrointestinal Microbiome; Female; Middle Aged; Chemoradiotherapy; Aged; Papillomavirus Infections; Prospective Studies; Squamous Cell Carcinoma of Head and Neck; Adult; Feces
PubMed: 38714747
DOI: 10.1038/s41416-024-02701-y -
Journal of Robotic Surgery May 2024Perioperative enoxaparin is often avoided in patients undergoing transoral robotic (TORS) oropharyngectomy. Our goal was to quantify the risk of postoperative hemorrhage...
Perioperative enoxaparin is often avoided in patients undergoing transoral robotic (TORS) oropharyngectomy. Our goal was to quantify the risk of postoperative hemorrhage (POH) in patients receiving enoxaparin after TORS oropharyngectomy. This was a retrospective database cohort study set up in 89 separate healthcare organizations. The TriNetX electronic database was queried for patients with OPSCC who underwent TORS oropharyngectomy. Propensity-score matching was used to create two cohorts, one receiving and one not receiving perioperative enoxaparin. Outcome measures were the POH rate within 1 day of surgery ("primary") and POH rate within 2-30 days of surgery ("secondary"). 1109 patients undergoing TORS for OPSCC were identified, 400 of which received perioperative enoxaparin. One-to-one propensity score matching resulted in 310 patients per cohort. After matching, the primary POH rates between patients receiving and not receiving enoxaparin were 3.23% for both cohorts (OR 1.000, 95% CI 0.410 to 2.438). The secondary POH rates between those receiving and not receiving enoxaparin were 5.47% vs. 3.54% (OR 1.577, 95% CI 0.726 to 3.424). The number needed to harm (NNH) with perioperative enoxaparin use for secondary POH after TORS was 53; no difference was found in primary POH rates. While not statistically significant, the use of perioperative enoxaparin after TORS is associated with increased odds of secondary POH with a NNH of 53; no difference was found in rates of primary POH. For patients undergoing TORS, enoxaparin use requires careful weighing of the risks and benefits.
Topics: Humans; Enoxaparin; Male; Retrospective Studies; Postoperative Hemorrhage; Female; Middle Aged; Robotic Surgical Procedures; Aged; Anticoagulants; Propensity Score; Oropharyngeal Neoplasms; Perioperative Care; Oropharynx
PubMed: 38713415
DOI: 10.1007/s11701-024-01965-z -
Acta Otorhinolaryngologica Italica :... Jun 2024Studies have demonstrated that tonsillectomy may alter the risk of oropharyngeal cancer (OPC). We systematically reviewed the evidence and pooled data to examine such an... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Studies have demonstrated that tonsillectomy may alter the risk of oropharyngeal cancer (OPC). We systematically reviewed the evidence and pooled data to examine such an association.
METHODS
PubMed, Embase, and Scopus were searched up to 25 April 2023. Studies reporting an association between tonsillectomy and oropharyngeal cancer risk at any site were included.
RESULTS
Five studies were eligible. All examined the risk of tonsillar and base of the tongue (BOT) cancer with prior history of tonsillectomy. On meta-analysis of the data, prior history of tonsillectomy was associated with a significantly decreased risk of tonsillar cancer. The second meta-analysis showed that history of tonsillectomy did not significantly alter the risk of BOT cancer. However, after exclusion of one study, the results showed an increased risk of BOT cancer with a history of tonsillectomy.
CONCLUSIONS
The scarce data available in the literature suggests that tonsillectomy may reduce the risk of tonsillar cancer but does not alter the risk of BOT cancer. Further studies are needed to explore the association between tonsillectomy and the risk of OPC.
Topics: Humans; Oropharyngeal Neoplasms; Risk Assessment; Risk Factors; Tonsillar Neoplasms; Tonsillectomy
PubMed: 38712770
DOI: 10.14639/0392-100X-N2790 -
American Journal of Otolaryngology 2024TORS is a minimally invasive surgical alternative to chemoradiotherapy for oropharyngeal malignancies. While early postoperative oropharyngeal dysphagia is linked to...
OBJECTIVE
TORS is a minimally invasive surgical alternative to chemoradiotherapy for oropharyngeal malignancies. While early postoperative oropharyngeal dysphagia is linked to TORS, this study explores both subjective and objective swallowing outcomes.
STUDY DESIGN
Retrospective and prospective review of the patients who underwent TORS for oropharyngeal malignancy from 2018 to 2023.
SETTING
Single tertiary referral center.
METHODS
Postoperative transnasal feeding tubes were administered to 142 patients undergoing TORS. Data on oncological, clinical, surgical, and pathological parameters, including VFSS records, pain with swallow, and feeding tube removal timing, were collected. Clinical swallow exam (CSE) was conducted on POD-1, with a formal swallow study pursued if inconclusive. Once a safe swallow was confirmed, oral diets were initiated, and the feeding tube removed, with most patients discharged on POD-2.
RESULTS
At an average age of 59.3 years on the day of operation, the palatine tonsil (N = 101) was the predominant subsite. A dobhoff feeding tube was intraoperatively placed in 98 % of patients (N = 139). On POD-1, CSE was conducted in 119 patients, with 26 % (37/119) cleared for total oral diet (NOMS ≥ 4). Additionally, 30 out of 73 VFSS patients were cleared for total oral diet. A total of 54.9 % (78/142) had the feeding tube removed before discharge on POD-2, with a mean time of 6.5 ± 6.6 days. Overall, 71.1 % (101/142) achieved a total oral diet within one week after TORS.
CONCLUSION
Early post-TORS swallowing is vital for oropharyngeal malignancies. VFSS assesses post-operative swallowing safety, allowing most patients to resume total oral nutrition shortly after TORS.
Topics: Humans; Oropharyngeal Neoplasms; Middle Aged; Male; Female; Deglutition Disorders; Retrospective Studies; Prospective Studies; Aged; Deglutition; Fluoroscopy; Enteral Nutrition; Postoperative Complications; Minimally Invasive Surgical Procedures; Video Recording; Adult
PubMed: 38704947
DOI: 10.1016/j.amjoto.2024.104336 -
American Journal of Otolaryngology 2024Human papillomavirus (HPV) status plays a major role in predicting oropharyngeal squamous cell carcinoma (OPSCC) survival. This study assesses the accuracy of a fully...
BACKGROUND
Human papillomavirus (HPV) status plays a major role in predicting oropharyngeal squamous cell carcinoma (OPSCC) survival. This study assesses the accuracy of a fully automated 3D convolutional neural network (CNN) in predicting HPV status using CT images.
METHODS
Pretreatment CT images from OPSCC patients were used to train a 3D DenseNet-121 model to predict HPV-p16 status. Performance was evaluated by the ROC Curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score.
RESULTS
The network achieved a mean AUC of 0.80 ± 0.06. The best-preforming fold had a sensitivity of 0.86 and specificity of 0.92 at the Youden's index. The PPV, NPV, and F1 scores are 0.97, 0.71, and 0.82, respectively.
CONCLUSIONS
A fully automated CNN can characterize the HPV status of OPSCC patients with high sensitivity and specificity. Further refinement of this algorithm has the potential to provide a non-invasive tool to guide clinical management.
Topics: Humans; Oropharyngeal Neoplasms; Tomography, X-Ray Computed; Machine Learning; Male; Papillomavirus Infections; Female; Sensitivity and Specificity; Middle Aged; Imaging, Three-Dimensional; Predictive Value of Tests; Papillomaviridae; Neural Networks, Computer; Carcinoma, Squamous Cell; Aged
PubMed: 38703612
DOI: 10.1016/j.amjoto.2024.104357 -
American Journal of Otolaryngology 2024This study compared treatment and outcomes for patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) based on their travel distance to treatment...
PURPOSE
This study compared treatment and outcomes for patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) based on their travel distance to treatment facility.
MATERIALS AND METHODS
Patients with cT1-4, N0-3, M0 HPV-positive OPSCC in the National Cancer Database from 2010 to 2019 were identified and split into four quartiles based on distance to facility, with quartile 4 representing patients with furthest travel distances. Multivariable-adjusted logistic regression and Cox proportional hazards modeling were used to analyze the primary outcome of treatment received, and secondary outcomes of clinical stage, overall survival, surgical approach (i.e., TORS versus other), and 30-day surgical readmissions.
RESULTS
17,207 patients with HPV-positive OPSCC were evenly distributed into four quartiles. Compared to patients in quartile 1, patients in quartile 4 were 40 % less likely to receive radiation versus surgery (OR = 0.60; 95 % CI = 0.54-0.66). Among the patients who received surgery, quartile 4 had a higher odds of receiving TORS treatment compared to quartile 1 (4v1: OR = 2.38; 95 % CI = 2.05-2.77), quartile 2 (4v2: OR = 2.31, 95 % CI = 2.00-2.66), and quartile 3 (4v3: OR = 1.75; 95 % CI = 1.54-1.99). Quartile 4 had a decreased odds of mortality compared to Quartile 1 (4v1: OR = 0.87; 95 % CI = 0.79-0.97). There were no differences among the quartiles in presenting stage and 30-day readmissions.
CONCLUSIONS
This study found that patients with furthest travel distance to facility were more often treated surgically over non-surgical management, with TORS over open surgery, and had better overall survival. These findings highlight potential disparities in access to care for patients with HPV-positive OPSCC.
Topics: Humans; Male; Female; Oropharyngeal Neoplasms; Middle Aged; Aged; Papillomavirus Infections; Treatment Outcome; Health Services Accessibility; Neoplasm Staging; Survival Rate; Carcinoma, Squamous Cell; Travel; Time Factors
PubMed: 38703611
DOI: 10.1016/j.amjoto.2024.104356 -
Cancer Imaging : the Official... May 2024This study aimed to compare the diagnostic value of [ Ga]Ga-DOTA-FAPI-04 and [F]FDG PET/CT imaging for primary lesions and metastatic lymph nodes in patients with... (Comparative Study)
Comparative Study
BACKGROUND
This study aimed to compare the diagnostic value of [ Ga]Ga-DOTA-FAPI-04 and [F]FDG PET/CT imaging for primary lesions and metastatic lymph nodes in patients with tonsil cancer.
METHOD
Twenty-one tonsil cancer patients who underwent [ Ga]Ga-DOTA-FAPI-04 and [F]FDG PET/CT scans within two weeks in our centre were retrospectively enrolled. The maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR) of the two tracers were compared by using the Mann‒Whitney U test. In addition, the sensitivity, specificity, and accuracy of the two methods for diagnosing metastatic lymph nodes were analysed.
RESULTS
In detecting primary lesions, the efficiency was higher for [ Ga]Ga-DOTA-FAPI-04 PET/CT (20/22) than for [F]FDG PET/CT (9/22). Although [ Ga]Ga-DOTA-FAPI-04 uptake (SUVmax, 5.03 ± 4.06) was lower than [F]FDG uptake (SUVmax, 7.90 ± 4.84, P = 0.006), [ Ga]Ga-DOTA-FAPI-04 improved the distinction between the primary tumor and contralateral normal tonsillar tissue. The TBR was significantly higher for [ Ga]Ga-DOTA-FAPI-04 PET/CT (3.19 ± 2.06) than for [F]FDG PET/CT (1.89 ± 1.80) (p < 0.001). In lymph node analysis, SUVmax and TBR were not significantly different between [ Ga]Ga-DOTA-FAPI-04 and [F]FDG PET/CT (7.67 ± 5.88 vs. 8.36 ± 6.15, P = 0.498 and 5.56 ± 4.02 vs. 4.26 ± 3.16, P = 0.123, respectively). The specificity and accuracy of [ Ga]Ga-DOTA-FAPI-04 PET/CT were higher than those of [F]FDG PET/CT in diagnosing metastatic cervical lymph nodes (all P < 0.05).
CONCLUSION
The availability of [ Ga]Ga-DOTA-FAPI-04 complements the diagnostic results of [F]FDG by improving the detection rate of primary lesions and the diagnostic accuracy of cervical metastatic lymph nodes in tonsil cancer compared to [F]FDG.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Male; Female; Retrospective Studies; Lymphatic Metastasis; Middle Aged; Aged; Tonsillar Neoplasms; Radiopharmaceuticals; Adult; Gallium Radioisotopes; Organometallic Compounds; Lymph Nodes
PubMed: 38702821
DOI: 10.1186/s40644-024-00699-3 -
Oral Oncology Jun 2024
Topics: Humans; Oropharyngeal Neoplasms; Papillomavirus Infections; Carcinoma, Squamous Cell; Papillomaviridae; Head and Neck Neoplasms; Human Papillomavirus Viruses
PubMed: 38702227
DOI: 10.1016/j.oraloncology.2024.106824