Search

Introduction: There is a lack of comprehensive and uniform data on head and neck paragangliomas (HNPGLs), and research is challenging due to its rarity and the involvement of multiple medical specialties. To improve current research data collection, we initiated the Head and Neck Paraganglioma Registry (HNPGL Registry). The aim of the HNPGL Registry is to a) collect extensive data on all HNPGL patients through a predefined protocol, b) give insight in the long term outcomes using patient reported outcome measures (PROMs), c) create uniformity in the diagnostic and clinical management of these conditions, and thereby d) help provide content for future (randomized) research. Methods and analysis: The HNPGL Registry is designed as a prospective longitudinal observational registry for data collection on HNPGL patients and carriers of (likely) pathogenic variants causative of HNPGLs. All patients, regardless of the received treatment modality, can be included in the registry after informed consent is obtained. All relevant data regarding the initial presentation, diagnostics, treatment, and follow-up will be collected prospectively in an electronic case report form. In addition a survey containing the EuroQol 5D-5L (EQ-5D-5L), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Modified Fatigue Impact Scale (MFIS), Short QUestionnaire to Assess Health-enhancing physical activity (SQUASH), Cancer Worry Scale (CWS) and Hospital Anxiety and Depression Scale (HADS) will be sent periodically. The registry protocol was approved by the Medical Ethical Review Board of the University Medical Center Utrecht. Conclusion: The HNPGL Registry data will be used to further establish the optimal management for HNPGL patients and lay the foundation for guideline recommendations and the outline of future research. [ABSTRACT FROM AUTHOR]

Background: Squamous cell carcinoma of the nasal vestibule (SCCNV) is a rare disease, distinctly different in presentation, treatment, and outcome from squamous cell carcinoma (SCC) of the nasal cavity and paranasal sinuses. However, these are often not analyzed separately. Methods: The Netherlands Cancer Registry (NCR) and pathology reports from the Dutch Nationwide Pathology Databank (PALGA) were used to identify all newly diagnosed SCCNV cases in the Netherlands between 2008 and 2021. Results: A total of 763 patients were included. The yearly incidence rate displayed a significant downward trend with an annual percentage change (APC) of −3.9%. The 5‐year overall survival (OS) and disease‐free survival were 69.0% and 77.2%, respectively. The 5‐year relative survival was 77.9% and improved slightly over the inclusion period. OS for patients who were staged cT3 appeared to be worse than those staged cT4a, calling the applicability of the TNM‐classification into question. Conclusion: SCC of the nasal vestibule is rare, with declining incidence rates. Introducing a specific topography code for SCCNV is recommended to enhance registration accuracy. The TNM classification seems poorly applicable to SCCNV, suggesting the need to explore alternative staging methods. [ABSTRACT FROM AUTHOR]

The treatment of head and neck cancers (HNCs) encompasses a complex paradigm involving a combination of surgery, radiotherapy, and systemic treatment. Locoregional recurrence is a common cause of treatment failure, and few patients are suitable for salvage surgery. Reirradiation with conventional radiation techniques is challenging due to normal tissue tolerance limits and the risk of significant toxicities. Stereotactic body radiotherapy (SBRT) has emerged as a highly conformal modality that offers the potential for cure while limiting the dose to surrounding tissue. There is also growing research that shows that those with oligometastatic disease can benefit from curative intent local ablative therapies such as SBRT. This review will look at published evidence regarding the use of SBRT in locoregional recurrent and oligometastatic HNCs. [ABSTRACT FROM AUTHOR]

Simple Summary: Stereotactic body radiotherapy (SBRT) is a highly precise, non-invasive, and image-guided form of hypofractionated radiotherapy aimed at well-defined small targets. It is characterized by superior conformity of dose distribution, steep dose drop-off gradients, and short overall treatment time, which allow effective protection of surrounding normal tissue from high radiation doses, potentially resulting in lower toxicity and a more potent biological effect. Currently, SBRT is an established curative therapy for certain cancers and some benign tumors, as well as a valuable palliative option. There is limited experience with SBRT for de novo mucosal carcinoma of the head and neck. A systematic review of the literature and subsequent analysis of 124 patients from five studies treated between 2012 and 2020 confirmed that SBRT is an effective and relatively safe treatment for small tumor targets in de novo mucosal carcinoma of the head and neck. Standardization of SBRT practice and well-designed prospective clinical trials are highly needed. Stereotactic body radiotherapy (SBRT) is characterized by a high dose per fraction, well-defined small targets, superior dose conformity, and a steep off-target dose gradient. A literature search was conducted to examine the experience with SBRT as a curative treatment for newly diagnosed mucosal carcinoma of the head and neck (MCHN). Four retrospective case series and one prospective phase I clinical trial published between 2012 and 2020 described 124 patients. SBRT was mainly performed in older patients with different tumor sites. The median size of the planning target volumes ranged from 5.3 to 41 cm3. Different approaches were used to create margins. In two studies, limited elective nodal irradiation was performed. The equivalent doses used were 60–83.33 Gy delivered in five fractions. Considerable heterogeneity was observed in the radiation dose specification. The incidence of grade ≥3 late toxicity was 0–8.3%, with local and regional control ranging from 73% to 100%. Improved or stable quality of life after SBRT was reported in two studies. Curative-intent SBRT for de novo MCHN appears to be an effective and relatively safe treatment for small tumor targets, preferably without concomitant elective tissue irradiation. Standardization of SBRT practice and well-designed prospective clinical trials are needed to better define the role of SBRT in this setting. [ABSTRACT FROM AUTHOR]

Simple Summary: All patients suspected of having head and neck paragangliomas (HNPGLs) undergo magnetic resonance imaging (MRI) or computed tomography (CT) of the head and neck area as the standard imaging according to the Dutch guidelines. However, a relatively new imaging modality, [68Ga]Ga-DOTATOC PET/CT, has shown promising results in the detection of HNPGLs. In this pilot study, we aimed to compare the results of this new modality with the standard imaging. We compared both techniques in 25 patients at the University Medical Center Utrecht, The Netherlands. Twenty-eight percent of the patients had different outcomes between both modalities. In all cases, additional HNPGLs were identified using the [68Ga]Ga-DOTATOC PET/CT, suggesting the need for further prospective research to validate this finding. If confirmed, this modality could potentially be implemented as the standard of care for HNPGL detection in germline variant carriers. The Dutch guideline for patients suspected of head and neck paragangliomas (HNPGLs) recommends magnetic resonance imaging (MRI) and/or computed tomography (CT) of the head and neck area. Additionally, it suggests considering additional nuclear imaging. The aim of this study was to evaluate the outcomes of [68Ga]Ga-DOTATOC PET/CT compared to MRI in patients with suspected HNPGLs and carriers of genetic variations. Methods: In this single-center pilot study, retrospective data were obtained from consecutive patients between 2016 and 2023. Both MRI and [68Ga]Ga-DOTATOC PET/CT were performed within 12 months. The primary outcome was the location of HNPGLs. Results: A total of 25 consecutive patients were included, and 7 patients (28.0%, p = 0.5) showed differences between the imaging modalities, of whom 5 patients had unexpected localizations with additional uptake by somatostatin receptors (SSTR) on the [68Ga]Ga-DOTATOC PET/CT. Conclusions: The authors recommend performing baseline imaging with [68Ga]Ga-DOTATOC PET/CT (if available) in variant carriers and using MRI/CT for follow-up according to the regional protocol, thereby shifting the gold standard for baseline imaging from MRI/CT to [68Ga]Ga-DOTATOC PET/CT. [ABSTRACT FROM AUTHOR]

Simple Summary: Nasal vestibule cancer is considered to be a rare form of cancer. There are several different staging systems in place for categorizing these tumors, which can result in inconsistencies and unreliable data due to variations in registration. The "Rome" classification is the most recent addition. This study aimed to assess the effectiveness of this new staging system and to compare it to the UICC/AJCC system. One hundred and forty-nine patients with a squamous cell carcinoma of the nasal vestibule were included. There was a significant association between an increased disease stage as staged per the Rome classification and decreased survival. This association persisted when correcting for various covariates (i.e., age at the time of diagnosis, sex, the presence of lymph node metastases, and treatment modality) in multivariable analysis. The Rome classification appears to be capable of adequately categorizing and stratifying patients for different outcome measures. Nevertheless, additional research with a larger number of patients is required before any definitive conclusions can be drawn. Squamous cell carcinoma of the nasal vestibule is considered a rare malignancy that differs from other sinonasal malignancies in many respects. Four staging systems currently exist for this disease, the most recent addition being the "Rome" classification. This study assesses the use of this new classification and its prognostic value regarding various outcome measures. A retrospective multicenter cohort study of patients with a primary squamous cell carcinoma of the nasal vestibule who were treated in three tertiary head and neck oncology referral centers was conducted. A total of 149 patients were included. The median follow-up duration was 27 months. Five-year locoregional control (LRC), disease-specific survival (DSS), and overall survival (OS) were 81.6%, 90.1, and 62.5% respectively. A statistically significant association was observed between the Rome classification and all survival outcomes in both univariable and multivariable analyses. Moreover, it appeared to perform better than the Union for International Cancer Control TNM classification for tumors of the nasal cavity and paranasal sinuses. The new Rome classification can be used effectively and is associated with LRC, DSS, and OS. However, it requires further validation in a larger (prospective) study population. [ABSTRACT FROM AUTHOR]

Objective: To investigate utilization of mental healthcare among head and neck cancer (HNC) patients from diagnosis to 2 years after treatment, in relation to psychological symptoms, mental disorders, need for mental healthcare, and sociodemographic, clinical and personal factors. Methods: Netherlands Quality of life and Biomedical Cohort study data as measured before treatment, at 3 and 6 months, and at 1 and 2 years after treatment was used (n = 610). Data on mental healthcare utilization (iMCQ), psychological symptoms (Hospital Anxiety and Depression Scale, Cancer Worry Scale), mental disorders (CIDI interview), need for mental healthcare (Supportive Care Needs Survey Short‐Form 34, either as continuous outcome indicating the level of need or dichotomized into unmet need (yes/no)) and several sociodemographic, clinical and personal factors were collected. Factors associated with mental healthcare utilization were investigated using generalized estimating equations (p < 0.05). Results: Of all HNC patients, 5%–9% used mental healthcare per timepoint. This was 4%–14% in patients with mild‐severe psychological symptoms, 4%–17% in patients with severe psychological symptoms, 15%–35% in patients with a mental disorder and 5%–16% in patients with an unmet need for mental healthcare. Among all patients, higher symptoms of anxiety, a higher need for mental healthcare, lower age, higher disease stage, lower self‐efficacy and higher social support seeking were significantly associated with mental healthcare utilization. Conclusion: Mental health care utilization among HNC patients is limited, and is related to psychological symptoms, need for mental healthcare, and sociodemographic, clinical and personal factors. [ABSTRACT FROM AUTHOR]

The preferred treatment for oral squamous cell carcinoma is complete surgical tumour resection to achieve local-regional control. [1] Complete surgical removal requires an adequate resection margin of at least 5 mm of healthy tissue around the tumour. Unfortunately, international literature reports 30% to 85% inadequate resection margins (i.e., positive and close margins). [2] This study aims to investigate whether adequate tongue cancer resection margins can accurately be determined using ex-vivo high-field magnetic resonance imaging (MRI). This proposed technique could help improve the localisation of inadequate margins during surgery. Nine fresh resection specimens of tongue cancer patients were scanned with a small-bore 7 Tesla (7T) MRI scanner (Biospec 70/20, Bruker, Ettlingen, Germany) interfaced with a Philips console. For each resection specimen, four MRI scans were obtained: a 3D T2-weighted (T2W) Turbo Spin Echo (TSE) scan with an isotropic voxel size of 0.3 mm3 and three orthogonal multi-slice T2W TSE scans with an in-plane resolution of 0.125 mm2 and a slice thickness of 1 mm. After completion of the MR protocol, the resection specimens were processed according to routine clinical histopathological workup. The tumour was delineated by a histopathologist (HP) on the hematoxylin and eosin (HE) stained histopathological slices and by two independent radiologists (R1 and R2) on the coronal multi-slice MR scan. For each patient, a 3D representation of the resection specimen was created using the following three steps: 1) For each HE-slice, the MR-slice with the highest resemblance was found by visual inspection (Fig. 1A, 1B). 2) These corresponding slices were registered using point-based registration based on visual corresponding anatomical points (e.g., specimen contour, tumour-protrusions, mucosa) (Fig. 1C). 3) The registered HE-slices were digitally stacked to create a 3D-specimen of all HE-slices (Fig. 1D). This method to create the 3D-specimen was previously discussed and used in the work by Caldas-Magalhaes et al. [3] The delineated tumour created by the radiologists (tR1 and tR2) and histopathologist (tHP) were interpolated and mapped to the other MRI-scans (i.e., sagittal, axial, and 3D TSE scan) (Fig. 1D). The accuracy of the inadequate margin detection by R1 and R2 was determined using two different methods. First, the minimal resection margins in all five directions (anterior, posterior, craniomedial, caudolateral and central) were measured based on tR1 and tR2 and compared to the measurements reported by the HP. Second, the 95th percentile Hausdorff distance (HD95) of the overestimation (O-HD 95) and underestimation (U-HD 95) of tR1 and tR2 was calculated with respect to the ground truth (tHP) in all five directions. The relationship between the measured resection margins based on tR1, tR2 and tHP was evaluated using Pearson's correlation coefficient (PCC). Only the craniomedial, caudolateral, and central resection margins were included in the PCC analysis. [Display omitted] According to the histological report, one of the nine resection specimens was adequately resected. Based on the in-plane measurements, R1 and R2 were able to accurately determine which tumours were (in)adequately removed in 7/9 and 8/9 cases. Two of these cases were inadequate but considered adequate by the radiologists, and the other case was determined inadequate by R1 but adequate according to the HP. All these three incorrect cases had a T-stage of 1. Based on the tumour segmentation, the sensitivity and specificity of the detection of inadequate margins with respect to the final histopathological report were 77% and 50% for R1 and 65% and 57% for R2, respectively. The median U-HD95 and O-HD95 for R1 were 0.9 mm (range: 0.0-1.7 mm) and 2.5 mm (range: 0.6-11.8 mm). For R2, the median U-HD95 and O-HD95 were 0.5 mm (range: 0.3-5.3 mm) and 2.5 mm (range: 1.2-6.6 mm). [Display omitted] The PCC of the measured margins between the HP and two radiologists was 0.67 and 0.71 for R1 and R2, respectively. Between both radiologists, the PCC of the measured margins was 0.75. Figure 2 shows an example of a 3D-specimen and the corresponding MRI-slices. Ex-vivo 7T MRI enables accurate margin predictions for tongue cancer resection specimens. The radiologists' assessment of in- and adequate resections based on ex-vivo 7T MRI generally aligns with the histopathology reports. The sensitivity of both radiologists for adequate margin detection is reasonable. However, the specificity is low, which might be caused by the radiologists' overestimation of the tumour on ex-vivo 7T MRI. This study offers a proof of principle for future studies to validate and further improve the detection of inadequate margins for oral cavity resection specimens using ex-vivo 7T MRI. This technique could provide guidance for surgeons to localise inadequate margins and enable them to perform accurate re-resections during surgery. [ABSTRACT FROM AUTHOR]

Introduction: Patients with head and neck squamous cell carcinoma (HNSCC) treated with cisplatin-based chemoradiotherapy (CRT) frequently experience irreversible sensorineural hearing loss (SNHL). Patients with low lumbar skeletal muscle index (LSMI) may experience higher serum peak dosages of cisplatin. This study investigated whether pre-treatment low LSMI is associated with increased SNHL upon cisplatin-based CRT., Materials and Methods: LSMI was assessed using routine pre-treatment CT scans. Pure tone audiometry was performed at baseline and at follow-up to assess treatment-related SNHL. Linear mixed models were used to reveal a potential association between the continuous variable LSMI and SNHL., Results: This retrospective cohort study included 81 patients and found a significant association between low LSMI and increased treatment-related SNHL at pure tone frequencies vital for the perception of speech (averaged of 1, 2, and 4 kHz) (p = 0.048)., Conclusions: HNSCC patients with low LSMI suffer increased treatment-related SNHL upon cisplatin-based CRT., (© 2024 The Author(s). Head & Neck published by Wiley Periodicals LLC.)