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This article presents the findings of a study on the use of reactive nasogastric tube (NGT) feeding in patients with head and neck cancer (HNC) undergoing radiotherapy. The study found that most patients admitted for NGT feeding were receiving curative radiotherapy. The timing of NGT insertion varied, and the study suggests that streamlining access to NGT feeding could reduce hospital stays. The article also discusses the cost implications of NGT feeding and suggests that an outpatient NGT feeding service could be beneficial in initiating earlier enteral feeding and avoiding hospital admissions. [Extracted from the article]

The introduction of immunotherapy into the radical management of head and neck cancer (HNC) is a fast moving phenomenon, which is constantly developing. Although now established in the management of recurrent and metastatic disease in HNC, its use in radical treatment is being investigated in a whole spectrum of clinical trials looking at which immune altering agents give the best results, which can be added safely to radiotherapy, chemotherapy, and chemoradiotherapy for greatest efficiency and when the most appropriate time to add these agents is in the neoadjuvant, concurrent on adjuvant settings. These multiple questions produce a complex matrix for HNC investigators and this article brings together the existing evidence and contemporary trials going on with immunotherapy in HNC, giving an up to date snapshot of present investigations and near future directions for further research. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the oncological outcomes following primary Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). Design: Observational case series. Setting: Tertiary centre; first TORS practice to commence in the UK. Participants: All consecutive patients undergoing primary TORS with curative intent, with or without adjuvant treatment. Main outcome measures: Descriptive analysis of patient and tumour pathology variables. Survival outcomes: Overall, Disease‐Specific, Progression‐Free and Locoregional control. Results: The cohort comprised of 120 patients undergoing TORS with minimum 12‐month follow‐up data and the following characteristics: mean age 58 years, 91 males (76%), 78 tonsil (65%) and 34 base of tongue primaries (28%), 89% HPV‐related OPSCC. The surgical pathology revealed 14 (12%) with positive margins, 19 (16%) had close margins <2mm and 31% with extranodal extension. The treatment was as follows: 39 (33%) treated with TORS alone, 50 (42%) received adjuvant radiotherapy and 31 (26%) received adjuvant radiotherapy with chemotherapy. There were 15 recurrences. Estimated survival for all patients at 3 years (95% CI): overall 85% (78‐92), disease‐specific 90% (85‐96), progression‐free 86% (79‐92) and locoregional control 90% (84‐96). The equivalent survival figures for the HPV‐related cases alone were as follows: overall 88% (82‐94), disease‐specific 93% (87‐98), progression‐free 88% (81‐95) and locoregional control 92% (87‐98). Conclusions: Whilst TORS has become a common practice in the management of OPSCC in the UK, these are the first reported oncological outcomes. For selected patients, TORS with or without adjuvant therapy is an appropriate treatment modality. [ABSTRACT FROM AUTHOR]

The purpose of this observational study was to assess the impact of COVID-19 on the presentation, stage and management pattern on newly presented HNC patients during the pandemic era. The data on all newly diagnosed HNC patients at our centre during April-December 2020 (COVID-19 cohort) were collected, and it was compared against the baseline pre-COVID-19 cohort (all new HNC patients diagnosed between April and December 2019). During the COVID-19 pandemic, it was postulated that there might be a delay in cancer patients' presentation, stage migration and changes in management leading to excess cancer mortality.1 However, there is a paucity of real-time objective data to support this, particularly in HNC. [Extracted from the article]

Long-term swallowing outcomes following transoral surgery and adjuvant radiotherapy vs adjuvant chemoradiotherapy for oropharyngeal carcinoma: Our experience in 37 patients Approximately 75% of patients are recommended adjuvant oncological treatment after transoral surgery (TOS) for oropharyngeal squamous cell carcinoma. Pre-treatment MDADI scores were high in both adjuvant RT and CRT groups at 93.3 (9.7) and 94.6(9.8), respectively, and both declined at long-term follow-up with a greater decline of 19.9 in the CRT group compared to RT group (10.7). There were also variations in radiotherapy treatment with some patients receiving conformal 3D radiotherapy and others intensity modulated RT. [Extracted from the article]

Background: The long‐term effect of concurrent chemoradiation on voice outcomes in the context of non‐laryngeal head and neck cancer is not established. Methods: A prospective, observational study to evaluate the voice quality in disease‐free patients receiving concurrent chemoradiation for advanced non‐laryngeal squamous cell carcinoma of the upper aerodigestive tract. Voice assessment occurred at four distinct time‐points: pretreatment, 3, 12 and 92.6 months (mean) post‐treatment in 34, 21 and nine patients, respectively. The authors used a combination of subjective (VoiSS questionnaire), expert rater‐assessed (GRBAS scale) and acoustic analysis of the fundamental frequency to assess voice outcomes. Ethical approval was obtained from the United Kingdom National Research Ethics Service. Results: Both the VoiSS impairment and GRBAS domains continued to deteriorate over time from pre‐treatment to 92.6 months post‐treatment (P = 0.03). There was a strong correlation between increase in total VoiSS and GRBAS scores (r = 0.93). Acoustic analysis demonstrated no statistically significant variation in fundamental frequency. Conclusion: Radiation therapy for advanced non‐laryngeal head and neck has a significant, deleterious effect on voice, which is apparent up to eight years post‐treatment. [ABSTRACT FROM AUTHOR]

Background Local and/or regional recurrence and metachronous primary tumor arising in a previously irradiated area are rather frequent events in patients with head and neck squamous cell carcinoma (HNSCC). Re-treatment is associated with an increased risk of serious toxicity and impaired quality of life (QOL) with an uncertain survival advantage. Methods We analyzed the literature on the efficacy and toxicity of photon/electron-based external beam reirradiation for previously irradiated patients with HNSCC of non-nasopharyngeal origin. Studies were grouped according to the radiotherapy technique used for reirradiation. Patient selection criteria, target volume identification method, tumor dose, fractionation schedule, systemic therapy administration, and toxicities were reviewed. Results In addition to disease-related factors, current comorbidities and preexisting organ dysfunction must be considered when selecting patients for reirradiation. As morbidity from re-treatment may be considerable and differ depending on which mode of re-treatment is used, it is important to give patients information on potential morbidity outcomes so that an informed choice can be made within a shared decision-making context. With improved dose distribution and adequate imaging support, including positron emission tomography-CT, modern radiotherapy techniques may improve local control and reduce toxicity of reirradiation. A reirradiation dose of ≥60 Gy and a volume encompassing the gross tumor with up to a 5-mm margin are recommended. Concomitant administration of systemic therapeutics and reirradiation is likely to be of similar benefit as observed in large randomized studies of upfront therapy. Conclusion Reirradiation, administered either with or without concurrent systemic therapy, is feasible and tolerable in properly selected patients with recurrent or a new primary tumor in a previously irradiated area of the head and neck, offering a meaningful survival (in the range of 10% to 30% at 2 years). Whenever feasible, salvage surgery is the method of choice for curative intent; patients at high-risk for local recurrence should be advised that postoperative reirradiation is expected to increase locoregional control at the expense of higher toxicity and without survival advantage compared to salvage surgery without reirradiation. © 2014 Wiley Periodicals, Inc. Head Neck 37: 134-150, 2015 [ABSTRACT FROM AUTHOR]

Background This prospective study evaluated swallowing outcomes prechemoradiotherapy (pre-CRT) up to 1 year post-CRT, in a substantial cohort of patients with head and neck cancer and explored factors predicting outcome. Methods One hundred twelve patients were assessed pretreatment and at 3, 6, and 12 months posttreatment using a questionnaire, endoscopic assessment, water swallow test, and diet score. Results Seventy-one patients were retained, the majority had oropharyngeal (53%) or hypopharyngeal cancer (20%). A marked deterioration occurred between pretreatment and 3 months posttreatment ( p ≤ .01). Significant improvement between 3 and 12 months was found on 2 swallowing measures, but not self reported. Three of the 4 pretreatment assessments predicted outcomes at 1 year. Conclusion CRT results in a marked deterioration on different paradigms of swallowing measurements. Improvement occurs on some clinical measures, but limited change is observed in patients' perceptions. Pretreatment measures are important indicators of long-term dysphagia. Swallowing recovery is complex, taking different courses between clinical tests and perspectives. © 2013 Wiley Periodicals, Inc. Head Neck 36: 352-358, 2014 [ABSTRACT FROM AUTHOR]

see page 1382. [ABSTRACT FROM AUTHOR]

Background The voice impact of treatment for nonlaryngeal head and neck primary sites remains unknown. Methods We conducted a prospective study of a consecutive sample of patients undergoing chemoradiation for nonlaryngeal head and neck cancer. The Voice Symptom Scale (VoiSS) was completed, and voice recordings were made at 3 time-points. Results Of 42 recruited patients, 34 completed the measures before and in the early posttreatment phase (mean 16.5 weeks), while 21 patients were assessed at the final time-point (mean, 20.4 months). VoiSS scores showed statistically significant progressive deterioration in the total score ( p = .02) and impairment subscale ( p < .0001) through to the final assessment. Acoustic measures and perceptual ratings deteriorated significantly ( p < .001) in the early posttreatment weeks and improved at the final assessment, but not to the baseline. Interrater agreement was excellent for expert measures. Conclusion To the best of our knowledge, this is the first prospective study to show that chemoradiation therapy for nonlaryngeal head and neck cancer has a significant effect on the patients' self-reported voice quality, even in the long term. © 2012 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

This study is based on the evidence that immunization of macaques with human CD4+ T cells elicits prevention of simian immunodeficiency virus (SIV) infection. We hypothesized that heat-shock protein 70 (HSP70) isolated from CD4+ T cells may act as a chaperone and carry the protective host proteins. Two moieties of HSP70 were affinity-purified from human CD4+ T cells; an ADP preparation with HSP70-bound proteins (ADP-HSP) and an ATP control preparation. Immunization of rhesus macaques with these preparations showed significant inhibition of SIVmac251 infectivity ex vivo in CD4+ T cells only with the ADP-HSP ( P = 0·01). Proteomic analysis identified three cytoskeletal elements, cofilin, profilin and γ-actin, exclusively in the ADP-HSP preparation. Investigation of the mechanism of prevention of SIV replication suggests that antibodies to the cytoskeletal proteins may inhibit actin depolymerization and facilitate viral degradation by the innate antiviral APOBEC3G. As cytoskeletal proteins are critical in the formation of virological and immunological synapses, finding specific antibodies and anti-SIV/human immunodeficiency virus (HIV) factors suggests a novel insight into HIV-1 immunopathogenesis. [ABSTRACT FROM AUTHOR]

Objective: To identify the impact of comorbidity on quality of life during radiotherapy in head and neck cancer patients. Study Design: Prospective assessment of quality of life and retrospective assessment of comorbidity. Subjects and Methods: Patients'' quality of life was assessed at the start and twice during radiation treatment with the University of Washington Quality of Life questionnaire. Comorbidity was assessed from the case notes of 91 patients with the Adult Comorbidity Evaluation-27 index. Results: A mean comorbidity burden of 1.07 was found. Comorbid illnesses afflicted a little more than 60 percent of our cohort. Patients with moderate to severe comorbidity had statistically significantly worse quality of life at the start (P = 0.044) and midpoint of treatment (P = 0.005), but not at the end of treatment (P = 0.114). The magnitude of change of these scores after treatment was not influenced by comorbidity. Conclusion: On the basis of severity of decompensation, radiotherapy does not produce a differential impact on the quality of life. [Copyright &y& Elsevier]

Objective: The aim of this study was to assess the quality of life and psychologic profile during radiation therapy for head and neck cancer. Study design and setting: The University of Washington QoL instrument and the Hospital Anxiety and Depression Scale were administered to 202 patients at two or three time points during radiation therapy. Results: A total of 118 (54.6%) patients completed the questionnaires at the beginning and at the end of the study. A mid-treatment dataset was also available for 67 (31.0%) patients. There was a statistically significant deterioration in composite QoL scores (P < 0.000) and a statistically significant increase in depression (P < 0.000). There was no difference in anxiety levels (P = 0.276). Conclusion: Patients undergoing radiation are increasingly depressed as treatment progresses, with worsening QoL during the treatment. Significance: This study underlines the need for good psychologic support during radiation therapy in head and neck cancer. [Copyright &y& Elsevier]

Evidence is presented that the microbial 70-kD heat shock protein (HSP70) binds to CCR5 chemokine receptors in CCR5-transfected cell lines and in primary human cells. Significant CCR5-mediated calcium mobilization was stimulated by HSP70 and inhibited with TAK 779, which is a specific CCR5 antagonist. HSP70-mediated activation of the p38 MAPK phosphorylation signaling pathway was also demonstrated in CCR5-transfected HEK 293 cells. Direct binding of three extracellular peptides of CCR5 to HSP70 was demonstrated by surface plasmon resonance. Functional evidence of an interaction between HSP70, CCR5 and CD40 was shown by enhanced production of CCL5 by HEK 293 cells transfected with both CD40 and CCR5. Primary monocyte-derived immature DC stimulated with HSP70 produced IL-12 p40, which showed dose-dependent inhibition of >90% on treatment with both TAK 779 and anti-CD40 mAb. Stimulation of IL-12 p40 or TNF-α by HSP70 was related to the differential cell surface expression of CCR5 in primary human immature and mature DC, and those with the homozygous ▵▵32 CCR5 mutation. These findings may be of significance in the interaction between HSP70 and immune responses of CCR5 T cells in HIV-1 infection, as well as in inflammatory bowel disease. See accompanying commentary: [ABSTRACT FROM AUTHOR]

Background. Head and neck sarcomas are extremely rare. This article reviews the management and outcomes in a multidisciplinary clinic. Methods. The records of 41 male and 19 female patients (mean age, 50 years) were reviewed. Forty percent underwent surgical resection only, 35% underwent surgery and adjuvant therapy, and 25% underwent radiotherapy and/or chemotherapy without surgery. Seventy-one percent had complete histologic clearance. Results. The mean follow-up was 3 years and 10 months, with an overall 5-year survival rate of 60%. Completeness of surgical excision was highly significant in determining 5-year local control (p < .025), and the addition of adjuvant radiotherapy had a major effect on local control, but only if complete surgical clearance had been achieved (p < .025). As expected, patients with more aggressive tumors had a significantly poorer overall prognosis, and achieving local control led to an enhanced 5-year survival (p < .025). Conclusion. These tumors are best managed in multidisciplinary clinics, and the mainstay of treatment is wide local excision and planned postoperative adjuvant radiotherapy. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX–XXX, 2005 [ABSTRACT FROM AUTHOR]

The antigen I/II (AgI/II) family polypeptides, ranging from 1310 to 1653 amino acid (aa) residues, are cell wall anchored adhesins expressed by most indigenous species of oral streptococci. The polypeptides interact with a wide range of host molecules, in particular salivary agglutinin glycoprotein (SAG or gp340), and with ligands on other oral bacteria. To determine the receptor recognition properties of six different AgI/II family polypeptides from strains ofStreptococcus gordonii,Streptococcus intermediusandStreptococcus mutans, the genes were cloned and expressed on the surface of the surrogate hostLactococcus lactis. TheS. gordoniiSspA and SspB polypeptides mediated higher binding levels ofL. lactiscells to surface immobilized gp340 than didS. intermediusPas protein, orS. mutansSpaP or PAc proteins. However, the AgI/II proteins were all similar in their abilities to mediate aggregation of lactococci by fluid phase gp340. The SpaPI polypeptide fromS. mutansIngbritt, which was C-terminally truncated by approximately 400 aa residues, did not bind gp340. Lactococci expressing AgI/II proteins, including SpaPI, were aggregated by a synthetic 16 aa residue peptide SRCRP2 derived from the aa repeat block sequences within gp340. In coaggregation assays, SspB fromS. gordoniiwas unique in mediating coaggregation with only group A and group E strains ofActinomyces naeslundii. All the other AgI/II polypeptides mediated coaggregation with group C and group D strains ofA. naeslundii. Analysis of chimeric protein constructs revealed that coaggregation specificity was determined by sequences within the N-terminal half of AgI/II protein. A synthetic peptide (20 aa residues), which defines a putative adhesion epitope within the C-terminal region of polypeptide, inhibited AgI/II-mediated aggregation by gp340 but did not affect coaggregation withA. naeslundii. These results suggest that different mechanisms operate in interactions of AgI/II family polypeptides with native gp340, gp340 SRCR domain peptide, andA. naeslundii. Specificity of these interactions appears to be determined by discontinuous but interacting regions of the polypeptides, thus providing flexibility in receptor recognition for streptococcal colonization of the human host. [ABSTRACT FROM AUTHOR]