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Alternative Therapies in Health and... Nov 2023Nasopharyngeal carcinoma (NPC) is a malignant tumor with a high incidence. Regional lymph node metastasis (RLNM) affects the benefits to and prognosis of patients after...
CONTEXT
Nasopharyngeal carcinoma (NPC) is a malignant tumor with a high incidence. Regional lymph node metastasis (RLNM) affects the benefits to and prognosis of patients after treatment. Researchers speculate that CRNDE expression might have a correlation with NPC lymph node metastasis (LNM), but studies on the subject are relatively few.
OBJECTIVE
The study intended to explore the predictive value of the level of serum colorectal neoplasia differentially expressed (CRNDE) for RLNM in NPC patients and to analyze the effects of RLNM on their long-term prognosis after radiotherapy and chemotherapy, to provide a reference for early prediction, diagnosis, and treatment of RLNM in NPC.
DESIGN
The research team performed a retrospective case-control study.
SETTING
The study took place at Taizhou People's Hospital in Taizhou, China.
PARTICIPANTS
Participants were 80 NPC patients who received treatment using radiotherapy and chemotherapy at the hospital between January 2014 and December 2017.
GROUPS
The research team divided participants into two groups: (1) an observation group diagnosed with RLNM, with 52 participants, and a control group that had no RLNM, with 28 participants.
OUTCOME MEASURES
The research team: (1) determined the level of colorectal neoplasia differentially expressed (CRNDE) in participants' serum to predict the risk of RLNM, (2) compared clinical total response rates (TRRs) between the groups, and (3) analyzed the five-year overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS).
RESULTS
Compared with control group, the observation group's CRNDE level was significantly higher, and its five-year OS and DMFS rates were significantly lower (all P < .01). No significant differences existed in the TRR and five-year LRFS rate between the observation and control groups (P > .05). The cut-off value for serum CRNDE was set at 3.540, the area under curve (AUC) value for the observation group was 0.805, and the 95% confidence interval (CI) was 0.715-0.889. In addition, the sensitivity was 88.5%, specificity was 57.1%, and Yoden index was 0.463. The five-year OS rates were significant lower in the observation group patients with metastatic lymph nodes > 2 in number (P = .025) and > 6 cm in diameter (P = .002) and with posterior pharyngeal LNM (P = .049).
CONCLUSIONS
An abnormal increase in serum CRNDE can be a basis to diagnose RLNM in NPC patients. RLNM affected the long-term prognosis of NPC patients, and the number and diameter of lymph nodes and posterior pharyngeal metastasis were the factors affecting patients' long-term. The current study's findings can provide a reference for the realization of the early diagnosis of NPC RLNM, formulating the treatment schemes and improving the long-term survival outcome of NPC patients.
PubMed: 37944952
DOI: No ID Found -
Technical Innovations & Patient Support... Dec 2023In this simulation study, we examined the effects of a de-escalation strategy with a reduced dose to subclinical nodal regions in patients with human papillomavirus...
INTRODUCTION
In this simulation study, we examined the effects of a de-escalation strategy with a reduced dose to subclinical nodal regions in patients with human papillomavirus (HPV)-associated oropharyngeal carcinoma (OPC).
METHODS
We created two patterns of intensity-modulated radiotherapy for 16 patients with HPV-associated OPC. In the standard and de-escalation plans, the initial field including elective nodal regions received 46 and 30 Gy, followed by 20 and 36 Gy to the cutdown field, respectively. Comparison metrics were set for each organ at risk (OAR). We compared these metric values and the probability of adverse effects based on the normal tissue complication probability (NTCP) model between the two plans.
RESULTS
Both plans generally met the dose constraints for the targets and all OAR. Among the comparison metrics, the mean doses to the brain, pharyngeal constrictor muscle, thyroid, and skin and the dose to a 1 % volume of the skin were higher in the standard plan than in the de-escalation plan ( = 0.031, 0.007, < 0.001, < 0.001, and 0.006, respectively). NTCP analyses revealed that the probability of adverse effects in the ipsilateral parotid gland and thyroid was higher in the standard plan than in the de-escalation plan (standard vs. de-escalation plans: ipsilateral parotid gland, 6.4 % vs. 5.0 %, = 0.016; thyroid, 3.3 % vs. 0.5 %, < 0.001).
CONCLUSIONS
A de-escalation strategy with elective nodal regions is a promising treatment to prevent a decline in the quality of life in patients with HPV-associated OPC, particularly xerostomia, dysphagia, and hypothyroidism.
PubMed: 37886016
DOI: 10.1016/j.tipsro.2023.100221 -
Strahlentherapie Und Onkologie : Organ... Jan 2024
Meta-Analysis
Topics: Humans; Network Meta-Analysis; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx
PubMed: 37857814
DOI: 10.1007/s00066-023-02164-9 -
Radiotherapy and Oncology : Journal of... Dec 2023Given the central role that radiation has in the management of head and neck squamous cell carcinoma of unknown primary origin, it is imperative to review how treatment...
PURPOSE
Given the central role that radiation has in the management of head and neck squamous cell carcinoma of unknown primary origin, it is imperative to review how treatment paradigms have been refined and continue to evolve in the modern era.
METHODS AND MATERIALS
This study was designed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. A literature search of peer-reviewed publications was undertaken to identify works pertaining to the use of radiation for squamous cell carcinoma of unknown primary origin presenting as cervical lymph node metastases. Articles published from January 2002 to January 2023 with full text available on PubMed and restricted to the English language and human subjects were included. The full bibliographies of identified articles were reviewed and irrelevant studies were removed.
RESULTS
While such breakthroughs as intensity-modulated radiotherapy, positron emission tomography, biomarker testing with immune-histochemistry, and minimally invasive surgical techniques such as transoral robotic surgery have fundamentally changed the approach to this disease in recent decades, controversies still exist with respect to the manner in which radiation is delivered. Although the incidence of head and neck unknown primary cancer is relatively low, questions regarding the necessity of comprehensive radiation using the age-old standard method of targeting the bilateral necks and entire pharyngeal axis to encompass all putative sites of mucosal disease persist.
CONCLUSIONS
Prospective evidence is lacking, and the available studies have been complicated by such factors as the relatively limited sample sizes, as well as the variability in work-up, treatment, inclusion criteria, and follow-up. Regardless, advances in science and technology have ushered in more precise approaches with a high degree of customization, particularly given the increased proportion of patients presenting with human papillomavirus-related disease.
Topics: Humans; Head and Neck Neoplasms; Human Papillomavirus Viruses; Meta-Analysis as Topic; Neoplasms, Unknown Primary; Papillomavirus Infections; Systematic Reviews as Topic
PubMed: 37844736
DOI: 10.1016/j.radonc.2023.109952 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Oct 2023Adenoid cystic carcinoma usually occurs in the salivary glands of the head and neck. It is a malignant tumor with a high degree of malignancy, resistance to radiotherapy...
Adenoid cystic carcinoma usually occurs in the salivary glands of the head and neck. It is a malignant tumor with a high degree of malignancy, resistance to radiotherapy and chemotherapy and poor prognosis. The clinical course of adenoid cystic carcinoma is slow and easy to be misdiagnosed. The main diagnosis and treatment means are individualized and precise treatment under the multi-disciplinary consultation mode, that is, surgical treatment and radiotherapy and chemotherapy. Adenoid cystic carcinoma is prone to relapse and hematologic metastasis, and the traditional radiotherapy and chemotherapy based therapies have not achieved satisfactory efficacy in the past three decades. How to detect, diagnose and treat early is an urgent task faced by clinicians.
Topics: Humans; Carcinoma, Adenoid Cystic; Neoplasm Recurrence, Local; Neck; Oropharynx; Diagnostic Errors
PubMed: 37828891
DOI: 10.13201/j.issn.2096-7993.2023.10.015 -
Medicine Oct 2023Head and neck squamous cell carcinoma (HNSCC) develops from the mucosal epithelium of the oral cavity, pharynx, and larynx, and is the most common malignancy of the head... (Review)
Review
Head and neck squamous cell carcinoma (HNSCC) develops from the mucosal epithelium of the oral cavity, pharynx, and larynx, and is the most common malignancy of the head and neck, the incidence of which continues to rise. The epidermal growth factor receptor is thought to play a key role in the pathogenesis of HNSCC. Inhibition of epidermal growth factor receptor has been identified as an effective target for the treatment of HNSCC. Many phytochemicals have emerged as potential new drugs for the treatment of HNSCC. A systematic search was conducted for research articles published in PubMed, and Medline on relevant aspects. This review provides an overview of the available literature and reports highlighting the in vitro effects of phytochemicals on epidermal growth factor in various HNSCC cell models and in vivo in animal models and emphasizes the importance of epidermal growth factor as a current therapeutic target for HNSCC. Based on our review, we conclude that phytochemicals targeting the epidermal growth factor receptor are potentially effective candidates for the development of new drugs for the treatment of HNSCC. It provides an idea for further development and application of herbal medicines for cancer treatment.
Topics: Animals; Squamous Cell Carcinoma of Head and Neck; Carcinoma, Squamous Cell; Head and Neck Neoplasms; ErbB Receptors; Epidermal Growth Factor; Phytochemicals; Cell Line, Tumor
PubMed: 37800790
DOI: 10.1097/MD.0000000000034439 -
Plastic and Reconstructive Surgery Oct 2023There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, the authors developed a novel risk model for predicting dysphagia after tongue...
BACKGROUND:
There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, the authors developed a novel risk model for predicting dysphagia after tongue reconstruction.
METHODS:
This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical, or OPERA, group across 31 cancer centers and university hospitals in Japan. A total of 532 patients [390 (73.3%) men and 142 (26.7%) women; median age at surgery, 60 years (range, 15 to 88 years)] who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included. Independent risk factors were identified using univariate regression analysis and converted to a binary format for multivariate analysis. An integer value was assigned to each risk factor to calculate a total score capable of quantifying the risk of feeding tube dependence.
RESULTS:
Overall, 54 patients (10.2%) required a feeding tube at the time of evaluation. Predictive factors for feeding tube dependence were advanced age, lower American Society of Anesthesiologists physical status, low body mass index, lower serum albumin, comorbid hypertension and diabetes, extended tongue defect, resection beyond the tongue, laryngeal suspension, postoperative radiation therapy, and no functional teeth. In multivariate logistic regression analysis, age greater than or equal to 58.5 years, postoperative radiation therapy, wider tongue defect, and body mass index less than 21.27 kg/m earned 6, 4, 3, and 2 points, respectively, for a maximum total score of 15.
CONCLUSION:
The authors’ risk model provides a mathematical tool for estimating the individual risk of postoperative feeding tube dependence before tongue reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
PubMed: 37768217
DOI: 10.1097/PRS.0000000000010661 -
BMC Medical Imaging Sep 2023Artificial intelligence has been widely investigated for diagnosis and treatment strategy design, with some models proposed for detecting oral pharyngeal,...
PROBLEM
Artificial intelligence has been widely investigated for diagnosis and treatment strategy design, with some models proposed for detecting oral pharyngeal, nasopharyngeal, or laryngeal carcinoma. However, no comprehensive model has been established for these regions.
AIM
Our hypothesis was that a common pattern in the cancerous appearance of these regions could be recognized and integrated into a single model, thus improving the efficacy of deep learning models.
METHODS
We utilized a point-wise spatial attention network model to perform semantic segmentation in these regions.
RESULTS
Our study demonstrated an excellent outcome, with an average mIoU of 86.3%, and an average pixel accuracy of 96.3%.
CONCLUSION
The research confirmed that the mucosa of oral pharyngeal, nasopharyngeal, and laryngeal regions may share a common appearance, including the appearance of tumors, which can be recognized by a single artificial intelligence model. Therefore, a deep learning model could be constructed to effectively recognize these tumors.
Topics: Humans; Artificial Intelligence; Respiratory System; Carcinoma; Semantics
PubMed: 37749498
DOI: 10.1186/s12880-023-01076-5 -
BMC Oral Health Sep 2023Nasopharyngeal carcinoma (NPC) is more common in men aged 40 to 59, and radiotherapy is an effective treatment. Nasopharyngeal lymphoma (NPL) is rare, and the... (Review)
Review
BACKGROUND
Nasopharyngeal carcinoma (NPC) is more common in men aged 40 to 59, and radiotherapy is an effective treatment. Nasopharyngeal lymphoma (NPL) is rare, and the coexistence of nasopharyngeal mantle cell lymphoma (MCL) and NPC is even rarer. A collision tumor is a rare type of tumor that refers to two or more different tumors occurring in the same organ. No reports to date have described a collision tumor of NPC and MCL occurring within the same nasopharyngeal mass. We herein report the successful treatment of a unique case of synchronous coexistence of NPC and MCL occurring in the nasopharynx of a Chinese man.
CASE PRESENTATION
A 58-year-old man presented with a 5-month history of swallowing discomfort. Biopsy was performed under nasopharyngeal endoscopy, and histopathology revealed NPC. Magnetic resonance imaging revealed lesions in the nasopharynx, oropharynx, and tonsils, as well as enlarged lymph nodes in the parotid gland, posterior ear, and neck. This may be a synchronous dual primary tumor coexisting with NPC and NPL. Pathology consultation confirmed that the biopsy specimen of the nasopharynx was a collision tumor of NPC and MCL. Positron emission tomography computed tomography (PET-CT) revealed thickening of the posterior wall of the nasopharynx, which was considered NPC with lymphoma. The enlargement of the pharyngeal lymph ring and multiple hypermetabolic lymph nodes were evaluated as lymphoma infiltration. The patient received two courses of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by head and neck radiotherapy. At the time of this writing, he had remained alive without recurrence for 61 months since the initial treatment and was still undergoing follow-up.
CONCLUSIONS
It is very important to correctly recognize collision tumors. Magnetic resonance imaging helps identify different components of collision tumors. Pathological examination helps to confirm the diagnosis. Histological examination reveals different components, and PET-CT can help determine the extent of the lesion. Dose-adjusted chemotherapy combined with radiotherapy may have promising herapeutic effects, but additional case studies are needed to confirm.
Topics: Male; Humans; Adult; Middle Aged; Nasopharyngeal Carcinoma; Lymphoma, Mantle-Cell; Positron Emission Tomography Computed Tomography; Nasopharyngeal Neoplasms; Nasopharynx
PubMed: 37718438
DOI: 10.1186/s12903-023-03415-y -
Cureus Aug 2023Gastric metastases from breast cancer are difficult to distinguish from primary gastric cancer. We report two cases of gastric metastasis of breast cancer with a review...
Gastric metastases from breast cancer are difficult to distinguish from primary gastric cancer. We report two cases of gastric metastasis of breast cancer with a review of the literature. In the first case, a 77-year-old woman was diagnosed with adenocarcinoma after upper gastrointestinal endoscopy, which revealed an erosive lesion in the gastric corpus. She was treated with an aromatase inhibitor and a CDK4/6 inhibitor, but five years later, she developed multiple bone metastases and gastric lesions, and she is currently receiving weekly paclitaxel (PTX) and bev. In the second case, a 63-year-old woman underwent total mastectomy and axillary lymphadenectomy [invasive lobular carcinoma (ILC)]. Eleven years after the surgery, the patient complained of pharyngeal tightness, and upper gastrointestinal endoscopy revealed a type 4 gastric tumor in the gastric body and posterior wall. In conclusion, when a patient with ILC or advanced breast cancer presents with gastric symptoms and anemia, it is important to examine and treat the patient based on the possibility of gastric metastasis.
PubMed: 37711950
DOI: 10.7759/cureus.43434