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Cureus Apr 2023To compare the objective and patient-reported toxicities of concomitant boost radiotherapy (CBRT) and concurrent chemoradiation (CRT) in patients with locally advanced...
PURPOSE
To compare the objective and patient-reported toxicities of concomitant boost radiotherapy (CBRT) and concurrent chemoradiation (CRT) in patients with locally advanced head and neck cancers.
METHODS AND MATERIAL
In this prospective study, 46 patients with histologically proven stage III-IVA head and neck cancer were randomly assigned to receive either concurrent chemoradiation to a dose of 66 Gy in 33 fractions over 6.5 weeks with concurrent cisplatin (40 mg/m2 IV weekly; control arm) or accelerated radiotherapy with concomitant boost radiotherapy (study arm) to a dose of 67.5 Gy in 40 fractions in five weeks. Acute toxicity was evaluated using RTOG toxicity criteria. The assessment was done weekly after initiation of treatment, at the first follow-up (six weeks), and at three months. The four main patient-reported symptoms of pain, hoarseness of voice, dryness of mouth, and loss of taste were also compared between the two groups to assess patient quality of life during treatment.
RESULTS
The mean treatment duration was 37 days in the CBRT arm and 49 days in the CRT arm. Treatment-related interruptions were less in the study group,17.3% in the study, and 27.2% in the control with insignificant P-value. Grade III laryngeal toxicity was significantly higher in the study group (P=0.029). Other acute grade I-III toxicities (pharyngeal, skin, mucositis, and salivary) were comparable in both CRT and CBRT arms. Grade IV toxicities were seen only in the CBRT arm but were resolved at the first follow-up. Haematological toxicities and renal toxicities were significantly higher in the CRT arm, with significant P-values of 0.0004 and 0.018, respectively.
CONCLUSION
In patients with locally advanced head and neck cancer, concomitant boost radiotherapy is well tolerated with acceptable local toxicity and minimal systemic toxicity as compared to conventional chemoradiation. It is a feasible option for patients with locally advanced head and neck cancer not fit for concurrent chemoradiation.
PubMed: 37266055
DOI: 10.7759/cureus.38362 -
Viruses May 2023The main objectives were to describe the prevalence of HPV, its genotypes and HPV-associated dysplastic lesions in the oropharyngeal mucosa of PLHIV and related factors.
BACKGROUND
The main objectives were to describe the prevalence of HPV, its genotypes and HPV-associated dysplastic lesions in the oropharyngeal mucosa of PLHIV and related factors.
MATERIAL AND METHODS
This cross-sectional prospective study consecutively enrolled PLHIV attending our specialist outpatient units. At visit, HIV-related clinical and analytical variables were gathered, and oropharyngeal mucosa exudates were taken to detect HPV and other STIs by polymerase chain reaction. Samples were also taken from the anal canal of all participants and from the genital mucosa of the women for HPV detection/genotyping and cytological study.
RESULTS
The 300 participants had a mean age of 45.1 years; 78.7% were MSM and 21.3% women; 25.3% had a history of AIDS; 99.7% were taking ART; and 27.3% had received an HPV vaccine. HPV infection prevalence in the oropharynx was 13%, with genotype 16 being the most frequent (2.3%), and none had dysplasia. Simultaneous infection with (HR: 4.02 (95% CI: 1.06-15.24)) and a history of anal HSIL or SCCA (HR: 21.52 (95% CI: 1.59-291.6)) were risk factors for oropharyngeal HPV infection, whereas ART duration (8.8 vs. 7.4 years) was a protective factor (HR: 0.989 (95% CI: 0.98-0.99)).
CONCLUSIONS
The prevalence of HPV infection and dysplasia was low in the oropharyngeal mucosae. A higher exposure to ART was protective against oral HPV infection.
Topics: Male; Humans; Female; Middle Aged; Anal Canal; Papillomavirus Infections; HIV Infections; Homosexuality, Male; Cross-Sectional Studies; Prospective Studies; Papillomaviridae; Risk Factors; Mucous Membrane; Genotype; Hyperplasia; Oropharynx; Genitalia; Prevalence
PubMed: 37243256
DOI: 10.3390/v15051170 -
Indian Journal of Otolaryngology and... Apr 2023Eustachian tube dysfunction (ETD) is considered a causative factor for middle ear disease as well as treatment failure. The pathogenesis may be a result of chronic...
BACKGROUND
Eustachian tube dysfunction (ETD) is considered a causative factor for middle ear disease as well as treatment failure. The pathogenesis may be a result of chronic infection, allergy, laryngopharyngeal reflux, primary mucosal disease, dysfunction of the dilation mechanism and anatomical obstruction. Hence, it becomes essential to know the structure and anatomical variations of the Eustachian tube(ET), particularly with the advent of novel therapeutic options such as tuboplasty to ensure optimal therapeutic outcome.
AIMS
This cross-sectional study is done to perform multiparametric measurements of the ET and peritubal region using computed tomography and develop a structured protocol for pre-tuboplasty workup.
MATERIALS AND METHODS
This study was done for a period of 20 months, in 100 normal subjects aged between 18 and 60 years, who underwent computed tomography (CT) study of the head and face region, for indications other than nasal/ pharyngeal and sinus disease.
RESULTS
The mean bony, cartilaginous and overall ET lengths were higher in males. In females, the mean ET angles with Reid's plane were higher. Higher mean craniocaudal diameters of the ET lumen were observed in males. Carotid canal dehiscence was seen in equal prevalence on both sides (5%), with no significant gender differences.
CONCLUSION
Therapeutic interventions such as eustachian tuboplasty will benefit from preoperative imaging based planning. This structured protocol provides standardization of pre-operative workup for tuboplasty.
PubMed: 37206748
DOI: 10.1007/s12070-022-03447-w -
Nature Immunology Jul 2023Fibroblastic reticular cells (FRCs) direct the interaction and activation of immune cells in discrete microenvironments of lymphoid organs. Despite their important role...
Fibroblastic reticular cells (FRCs) direct the interaction and activation of immune cells in discrete microenvironments of lymphoid organs. Despite their important role in steering innate and adaptive immunity, the age- and inflammation-associated changes in the molecular identity and functional properties of human FRCs have remained largely unknown. Here, we show that human tonsillar FRCs undergo dynamic reprogramming during life and respond vigorously to inflammatory perturbation in comparison to other stromal cell types. The peptidase inhibitor 16 (PI16)-expressing reticular cell (PI16 RC) subset of adult tonsils exhibited the strongest inflammation-associated structural remodeling. Interactome analysis combined with ex vivo and in vitro validation revealed that T cell activity within subepithelial niches is controlled by distinct molecular pathways during PI16 RC-lymphocyte interaction. In sum, the topological and molecular definition of the human tonsillar stromal cell landscape reveals PI16 RCs as a specialized FRC niche at the core of mucosal immune responses in the oropharynx.
Topics: Humans; T-Lymphocytes; Palatine Tonsil; Fibroblasts; Lymphocytes; Inflammation; Carrier Proteins; Glycoproteins
PubMed: 37202490
DOI: 10.1038/s41590-023-01502-4 -
Journal of Clinical Medicine May 2023Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral... (Review)
Review
Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol drinking coupled with tobacco use, which accounts for 70% to 80% of HNSCCs. Human papilloma virus (HPV) is another independent risk factor for oropharyngeal SCC, but it is only a minor contributor to oral cavity SCC (OSCC). Betel quid chewing is also an established risk factor in southeast Asian countries. However, OSCC, and especially oral tongue cancer, incidence has been reported to be increasing in several countries, suggesting risk factors that have not been identified yet. This review summarizes the established risk factors for oral cavity squamous cell carcinomas and examines other undemonstrated risk factors for HNSCC.
PubMed: 37176704
DOI: 10.3390/jcm12093264 -
BMC Zoology Jul 2022According to our acknowledgment this is the first full anatomical description of the studied laryngeal mound of the Egyptian Cattle Egret (Bubulcus ibis, Linnaeus,...
BACKGROUND
According to our acknowledgment this is the first full anatomical description of the studied laryngeal mound of the Egyptian Cattle Egret (Bubulcus ibis, Linnaeus, 1758). This study was obtained with the aid of scanning electron microscopy (SEM) and histological techniques. Heads of ten healthy adult male Egyptian cattle egrets were used in this study.
RESULTS
The laryngeal mound (Mons laryngealis) was a pear-shaped musculoskeletal elevation. It represented 20.55 and 67.87% of the total length of the oropharyngeal floor and the pharyngeal floor, respectively. By SEM view, the lateral aspect of the caudal third of the laryngeal mound had a serrated mucosal appearance, forming of 6-7 finger-like projections. Furthermore, the terminal part of the laryngeal mound (except the middle part) was bordered a transverse row of pyramidal-shaped papillae, which demarcated from the esophagus. Histologically, laryngeal salivary glands termed (cricoarytenoid salivary glands) of the laryngeal mound were simple tubular type and were arranged in one row within the lamina propria connective tissue close to the lamina epithelialis. Those glands were surrounded by abundant aggregation of lymphocytes, extended overlying the surface lining epithelium. The glottis within the laryngeal mound was supported by hyaline cartilages; dorsally by paired arytenoid cartilages, ventrolaterally by cricoid cartilage, and caudodorsally by procricoid cartilage. Two groups of intrinsic laryngeal skeletal muscles have connected the cartilages. The glandular epithelium of the laryngeal salivary glands and chondrocytes of the laryngeal cartilages showed strongly positive alcian blue reaction.
CONCLUSIONS
The laryngeal mound shows certain features that are unique as an adaptation to lifestyles and bird's habitat.
PubMed: 37170377
DOI: 10.1186/s40850-022-00147-4 -
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 -
The Nigerian Postgraduate Medical... 2023This study assessed the eustachian tube (ET) function in adult patients with chronic rhinosinusitis (CRS) using tympanometry and nasal endoscope.
BACKGROUND
This study assessed the eustachian tube (ET) function in adult patients with chronic rhinosinusitis (CRS) using tympanometry and nasal endoscope.
MATERIALS AND METHODS
This was a hospital-based cross-sectional study conducted for 9 months. All participants underwent endoscopic evaluation of the pharyngeal end of their ETs, and the middle ear function was assessed using tympanometry. Endoscopic findings were graded based on a validated mucosal inflammatory endoscopic grading scale. Statistical analysis was carried out using SPSS version 24.
RESULTS
A total of 102 CRS patients and age- and sex-matched controls were recruited. Tympanograms suggestive of eustachian tube dysfunction (ETD) types B and C were found among 7.8% and 12.8% of the right and left ears of the CRS groups, respectively. Mucosal inflammatory endoscopic grade that is diagnostic of ETD Grades 3 and 4 was found among 24.5% and 38.2% of the right and left ET of CRS cases, respectively.
CONCLUSION
CRS predisposes patients to anatomical and functional impairment of ET. The relationship between tympanometry and mucosal inflammatory endoscopic grading scale in detecting ETD among CRS patients showed a strong relationship. However, a combination of the two will improve the diagnosis of ETD by evaluating the ET function directly and indirectly.
Topics: Adult; Humans; Acoustic Impedance Tests; Eustachian Tube; Cross-Sectional Studies; Nigeria; Sinusitis; Ear Diseases; Chronic Disease
PubMed: 37148114
DOI: 10.4103/npmj.npmj_31_23 -
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