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Background and Objectives: The role of occult nodal metastases in patients with parotid gland cancers remains unclear; such metastases are histologically diverse and exhibit unpredictable clinical courses. Here, we evaluated the prognostic utilities of such metastases, including metastases in the intraparenchymal lymph nodes (PARs). Materials and Methods: We retrospectively reviewed the medical charts of patients who underwent surgery to treat clinically N0 primary parotid gland cancers from 2000 to 2022. The primary outcome variables were 5-year overall survival (OS) and 5-year disease-free survival (DFS). We explored the effects of occult nodal metastases, including metastases in the PARs, especially in terms of the pathological T (pT) classification. Results: Among 74 patients, 48 (64.8%) were pT1/2 cases, and 26 (35.2%) were pT3/4 cases. Both perineural and lymphatic invasion were negatively associated with the 5-year DFS (hazard ratio [HR] = 3.533, 95% confidence interval [CI] = 1.325–9.421, p = 0.012; HR = 4.028, 95% CI = 1.497–10.839, p = 0.006, respectively). During pathological review, PAR metastases were observed in 12 patients (16.2%), and other occult metastases were present in 8 patients (10.8%). PAR metastases reduced the 5-year DFS in pT1/2 cases (87.2% vs. 22.2%, p = 0.001) but not in pT3/4 cases. Conclusions: PAR metastases significantly reduced the 5-year DFS in patients with clinically N0 primary parotid gland cancer. On subgroup analysis according to pT classification, this effect was significant among patients with early pT1/2 status but not patients with advanced pT3/4 status. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis investigated the impact of salvage surgery on 5‐year overall survival (OS) and prognostic factors in recurrent oral cavity cancer (rOCC) patients. Relevant literature before May 2022 was reviewed, including retrospective cohort studies and observational studies comparing salvage surgery to other treatments. Risk‐of‐bias assessments were conducted using the Newcastle–Ottawa scale. Statistical and subgroup analyses assessed the impact of salvage surgery on 5‐year OS and prognostic factors. 3036 documents were initially retrieved, with 14 retrospective cohort studies (2069 participants) included. Meta‐analysis of 5‐year OS in salvage surgery patients yielded a rate of 43.0%. Subgroup analysis showed higher OS in Asians (49.9% vs. 36.9%, p = 0.003) and late‐relapse (63.8% vs. 30.0%, p = 0.004) groups. Prognostic factors revealed hazards associated with nodal recurrence, extranodal extension, and perineural invasion. Salvage surgery is a viable option for rOCC patients, showing favorable 5‐year OS outcomes. Low publication bias enhances study reliability, but its single‐arm design limits conclusions on salvage surgery superiority over other treatments. [ABSTRACT FROM AUTHOR]

Simple Summary: The need to predict failure of locoregional or systemic control in tonsillar cancer is increasing. Therefore, we explored whether several 18F-fluorodeoxyglucose (FDG)-related parameters can predict metastasis. We retrospectively reviewed the medical records of 55 patients with tonsil squamous cell carcinoma who underwent pretreatment 18F-FDG positron-emission tomography/computed tomography (PET/CT) followed by primary surgery. In our cohort, the metabolic tumor volume (MTV2.5), total lesion glycolysis, and tumor-to-liver uptake ratio were higher than those of the patients without systemic metastasis. The MTV2.5 value was significantly different between the groups even when the values for the primary tumor and metastatic lymph nodes were summed. Our results will aid prognostic predictions and individualized post-treatment surveillance; additional systemic therapy should be considered for patients at high risk of disease control failure. Although the prognosis of tonsillar cancer (human papillomavirus-positive oropharyngeal squamous cell carcinoma) is improving, disease control failure (distant metastasis) still occurs in some cases. We explored whether several 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) parameters can predict metastasis. We retrospectively reviewed the medical records of 55 patients with tonsil squamous cell carcinoma who underwent pretreatment 18F-FDG positron-emission tomography/computed tomography (PET/CT) followed by primary surgery. During the follow-up period, systemic metastases were found in 7 of the 55 patients. The most common sites were the lungs (33%), bone (22%), brain/skull base (22%), small bowel (11%), and liver (11%). Pathologically, P53 mutation was less common in patients with systemic metastasis (41.7% vs. 14.3%, p = 0.054) than without systemic metastasis. In terms of PET parameters, the metabolic tumor volume (MTV2.5) and total lesion glycolysis (TLG2.5) values were lower in the primary tumor, and higher in the metastatic lymph nodes, of human papillomavirus (HPV)-positive compared to HPV-negative patients (all p < 0.05). The MTV2.5, TLG2.5, and tumor–to–liver uptake ratio were 36.07 ± 54.24 cm3, 183.46 ± 298.62, and 4.90 ± 2.77, respectively, in the systemic metastasis group, respectively; all of these values were higher than those of the patients without systemic metastasis (all p < 0.05). The MTV2.5 value was significantly different between the groups even when the values for the primary tumor and metastatic lymph nodes were summed (53.53 ± 57.78 cm3, p = 0.036). The cut-off value, area under the curve (95% confidence interval), sensitivity, and specificity of MTV2.5 for predicting systemic metastasis were 11.250 cm3, 0.584 (0.036–0.832), 0.571, and 0.565, respectively. The MTV2.5 of metastatic lymph nodes and summed MTV2.5 values of the primary tumor and metastatic lymph nodes were significantly higher in tonsillar cancer patients with than without systemic metastases. We suggest PET/CT scanning for pre-treatment cancer work-up and post-treatment surveillance to consider additional systemic therapy in patients with a high risk of disease control failure. [ABSTRACT FROM AUTHOR]

Robotic neck dissection is emerging as an alternative to conventional open neck dissection. However, the oncologic safety of robotic elective neck dissection (END) and its indications in early-stage tongue cancer are unclear. We retrospectively reviewed the data of 78 patients who underwent transoral excision for T1, T2 squamous cell carcinoma of tongue with simultaneous ipsilateral END. Patients were assigned to two groups: the robotic group (n = 32)—postauricular face-lift —and the conventional group (n = 46)— transcervical incision. We compared the survival, clinical, pathologic and cosmetic outcomes of the two groups, and evaluated the number of retrieved lymph nodes and robot console time in the robotic group. The mean age was lower in the robotic group (43.6 ± 12.8 vs. 55.8 ± 14.0, p < 0.001) and the conventional group had more T2 patients (p = 0.01). The mean operation time was significantly longer in the robotic group than the conventional group (178.81 ± 33.9 vs. 92.28 ± 16.7, p < 0.001). The mean number of retrieved lymph nodes was not significantly different between the two groups (19.22 ± 8.51 vs. 20.7 ± 11.4, p = 0.41). The 5-year disease-free survival rate was not significantly different between the two groups (93.6 % vs. 82.9 %, p = 0.59). Overall scar satisfaction assessed by VAS score, the robotic group showed significantly better results compared to the conventional group (8.38 vs. 5.86, p = 0.033). Robotic END by a postauricular facelift approach is a feasible and safe approach for early-stage tongue cancer. • Robotic neck dissection is emerging as an alternative to conventional open neck dissection • The mean number of retrieved lymph nodes and disease-free survival of robotic neck dissection were comparable to those of conventional open neck dissection • Robotic elective neck dissection by a postauricular facelift approach is a feasible and safe alternative to conventional neck dissection for early-stage tongue cancer with cN0. [ABSTRACT FROM AUTHOR]

The purpose of this study was to present our evaluation of the outcome of tonsillar cancer managed with neoadjuvant chemotherapy followed by surgery as definitive treatment. Thirty-eight patients with human papilloma virus (HPV)-associated tonsillar cancer were treated with neoadjuvant chemotherapy followed by surgery. The volume reduction response of the tumor to neoadjuvant chemotherapy was evaluated and verified by histopathology. The complete pathologic response (pCR) rates at primary and nodal sites were 60 % and 45 %. Tumor volume reduction ≥78.8 % following neoadjuvant chemotherapy predicted pCR of the cervical node. In addition, the optimal cut-off value to predict pCR at the primary tumor site was 83.4 % volume reduction but was not a significant result. For pCR, neoadjuvant chemotherapy decreased the pathological adverse features, significantly reducing the need for adjuvant therapy. The overall survival of the adjuvant group was 79.2 %, and that of the non-adjuvant group was 87.5 %, with disease-free survival of 65.9 % and 54.2 %. There was no significant difference between the two groups. Neoadjuvant chemotherapy followed by surgery proved to be a good therapeutic option for management of HPV-associated tonsillar cancer. A greater reduction in tumor volume in post-neoadjuvant chemotherapy imaging predicts a complete pathologic response. • Neoadjuvants can reduce the need for adjuvant treatment and prevent resulting long-term sequalae. • Neoadjuvant chemotherapy followed by surgery proved to be a good therapeutic approach for definitive management of HPV-related tonsillar cancer. • A greater reduction in tumor volume in post-neoadjuvant chemotherapy imaging predicts a complete pathologic response. [ABSTRACT FROM AUTHOR]

Background: Contralateral elective neck dissection in human papillomavirus (HPV)- associated tonsil cancer is a matter of debate., Objectives: The aim of this study was to analyze rates of contralateral lymph node (LN) metastasis and their prognostic effects on HPV-associated tonsil cancer. We also assessed the necessity of elective contralateral neck dissection., Methods: To investigate the pathologic incidence of and risk factors for contralateral nodal disease in HPV-associated tonsil cancer treated with upfront primary surgery and bilateral neck dissection, the records of 68 patients were reviewed., Results: Six (8.8%) patients displayed pathologic contralateral nodal disease; four of the patients had LN metastasis confirmed in contralateral level II, one patient had LN metastasis in level III, and one patient had multi-level metastasis in contralateral levels II and III. Contralateral LN metastasis showed a significant association with greater depth of invasion (DOI) in primary tumor (p = 0.032), count of positive LN (p = 0.008), and positive LN ratio of the ipsilateral neck (p = 0.01). Patients with contralateral LN metastasis showed a significantly worse five-year overall survival but no significant difference in disease-free survival., Conclusion: HPV-associated tonsil cancer has exceedingly low rates of occult contralateral LN metastasis. However, in cases of ipsilateral multiple node metastases and higher DOI, it may be worth considering elective contralateral neck dissection based on the risk of occult metastasis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Recently, a new cryotherapy device that precisely controls skin temperature was developed. Precision cryotherapy (PC) can be a safe and alternative treatment modality for immune-related skin diseases that are difficult to treat by conventional cryotherapy because of serious adverse events., Objective: To evaluate the efficacy and safety of PC in scalp seborrheic dermatitis (SD)., Methods: A single-arm, prospective trial was designed. Twenty-four patients with SD underwent 3 PC interventions 2 weeks apart. At the baseline, Week 6, and Week 8, overall improvements in Physician Global Assessment (PGA) and clinical severity scores were assessed. At each visit, the erythema index (EI) and transepidermal water loss were evaluated. The patients scored 9 subjective symptoms using a visual analog scale (VAS)., Results: The itch VAS score decreased by 50.4% at Week 8. Blinded investigators reported improvement of PGA scores from 2.86 ± 0.62 to 1.66 ± 0.61 and clinical severity scores from 4.55 ± 1.30 to 2.45 ± 1.37. The average EI decreased by 19.6% at Week 8 ( p < .05)., Conclusion: This study not only demonstrated the efficacy and safety of PC in scalp SD but it also revealed insights for PC being a promising treatment modality in immune-related skin diseases., (Copyright © 2023 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)