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Head and neck cancer remains a leading cause of death worldwide. Most common available treatment methods which include surgery, radiotherapy, and chemotherapy are associated with numerous side effects. MicroRNA therapeutics is an emerging form of gene therapy with potential for use in treatment of head and neck cancer. MicroRNAs are short nucleotide RNAs that target mRNAs (messenger RNA) to regulate gene expression at the post-transcription level. They may act as either tumor suppressor or oncogene in cancer. In the past, their potential use in cancer management (diagnosis, treatment, prognosis prediction), based on their deregulation have been demonstrated and written about but summaries on their application for targeted therapy are limited. This article aims at discussing the potential of some known tumor suppressor microRNAs for treatment of head and neck cancer, either alone or in combination with other treatment forms. It also aims at highlighting some obstacles against their use. The search for literature was done on PubMed using the search term: "MicroRNA based head and neck cancer treatment". Only free full text original articles on specific microRNAs and their tumor suppressive abilities in head and neck cancer, written in English language were used. Most of the studies demonstrated the ability of microRNAs to inhibit tumor growth by targeting specific oncogenes in cancer cells. Tumor suppressor microRNAs show promise for the treatment of head and neck cancer but more researches are needed to further clear areas of concern. [ABSTRACT FROM AUTHOR]

Oral cancer is a global disease. Despite a well elucidated tumour progression model, these cancers present late. Attempts at early detection by way of adjunctive diagnostic technologies and screening have not lived up to expectations in spite initial promise. Surgery is the mainstay of treatment. Treatment intensification by way of adjuvant radiation/chemo radiation is warranted for those with high risk features. Recent studies have explored intensification in those with intermediate risk factors in an attempt to improve outcomes. There has been generation of recent robust evidence that has influenced the need and extent of neck dissection. Neoadjuvant chemotherapy (NACT) may have a potential role in organ preservation and borderline resectable oral cancers. Recurrent tumours should be offered surgery whenever feasible while the addition of biological agents to chemotherapy gives best results in the palliative settings. [ABSTRACT FROM AUTHOR]

Introduction: Hyperbaric oxygen therapy (HBOT) is widely used for the treatment of the late effects of radiation therapy. We report a prospective observational cohort study of 51 patients designed to examine the effectiveness of hyperbaric oxygen treatment (HBOT) for xerostomia following radiotherapy.Methods: Objective (saliva volume) and subjective (quality of life scoring and visual analogue scale (VAS) of discomfort) measurements associated with xerostomia were compared prior to commencement of HBOT, after 30 sessions (over 6 weeks) of HBOT at 243 kPa for 90 minutes daily for five days per week and at 6-week review (12 weeks from commencement).Results: One hundred and one courses of treatment in 99 patients were examined. For 53 (53%) courses in 51 patients, data were recorded before and after HBOT and so could be included in the analysis. Thirty-four (34%) of these patients had complete data for all three time points. The unit of study was per treatment course, not per person. There were no major complications to HBOT. There was a statistically significant difference in saliva volume following HBOT (P = 0.016). The mean saliva volume increase was 0.9 mL over a 5-min collection period (95% CI 0.2-1.5). There was also a statistically significant improvement in discomfort after HBOT (P < 0.001) and QOL (P < 0.001). The mean visual analogue scale for discomfort (VAS on a 0-10 scale) score decreased by 1.4 units (95% CI 0.7-2.1), whilst the mean QOL score was 10 points lower after treatment (95% CI 5.9-14.4).Conclusion: Hyperbaric oxygen therapy may be a safe and effective treatment for symptoms of xerostomia after radiation therapy and should be considered when available. [ABSTRACT FROM AUTHOR]

Background: The evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumor sites with similar outcomes to those of conventional fractionated radiotherapy. The use of hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few countries. The aim of this trial was to evaluate the safety and feasibility of moderate hypofractionated radiotherapy (HYP-RT) with concomitant cisplatin (CDDP).Methods: This single-arm trial was designed to evaluate the safety and feasibility of HYP-RT with concomitant CDDP in LAHNC. Stage III and IV patients withnonmetastatic disease were enrolled. Patients were submitted to intensity modulatedradiation therapy, which comprised 55 Gy/20 fractions to the gross tumor and44-48 Gy/20 fractions to the areas of subclinical disease. Concomitant CDDPconsisted of 4 weekly cycles of 35 mg/m2. The primary endpoints were the treatment completion rate and acute toxicity.Results: Twenty patients were enrolled from January 2015 to September 2016, and 12 (60%) were classified as unresectable. All patients completed the total dose of radiotherapy, and 19 patients (95%) received at least 3 of 4 cycles of chemotherapy. The median overall treatment time was 29 days (27-34). Grade 4 toxicity was reported twice (1 fatigue and 1 lymphopenia). The rates of grade 3 dermatitis and mucositis were 30% and 40%, respectively, with spontaneous resolution. Nasogastric tubes were offered to 15 patients (75%) during treatment; 4 patients (20%) needed feeding tubes after 2 months, and only 1 patient needed a feeding tube after 12 months.Conclusion: HYP-RT with concomitant CDDP was considered feasible for LAHNC, and the rate of acute toxicity was comparable to that of standard concomitant chemoradiation. A feeding tube was necessary for most patients during treatment. Further investigation of this strategy is warranted.Trial Registration: ClinicalTrials, NCT03194061 . Registered 21 Jun 2017 - Retrospectively registered. [ABSTRACT FROM AUTHOR]

Objectives Aggressive cancer therapy places patients at a greater risk for oral complications. Cancer patients suffer from oral toxic effects secondary to antineoplastic therapy (radiotherapy and chemotherapy). The aim of this review is management of the head and neck cancer patients that specifically emphasizes the prevention and treatment of oral and dental complications associated with cancer therapy. Methods In this narrative review article, the specialized databases such as PubMed, PubMed Central, MEDLINE, EBSCO, Science Direct, Scopus from 2008 to 2018 were used to find relevant documents by using Mesh terms: Chemotherapy, Radiotherapy, oral consideration, head and neck. Results The data were categorized in: Complications of head and neck radiotherapy and its management (Xerostomia, Oral Infection, Oral Mucositis, Osteoradionecrosis), Complications of head and neck chemotherapy and its management (Mucosal toxicity, Dental alterations, Neurological disorders, Salivary alterations, Dysgeusia, Infections, Bleeding tendency, Osteonecrosis of the jaws due to bisphosphonates). Conclusion In order to minimize morbidity in the head and neck cancer patients, it is recommended for consulting to dental health care providers before, during and after cancer therapy. [ABSTRACT FROM AUTHOR]

Background: Supraclavicular flap (SCF) repair is widely reported in head and neck surgery in select patients and defects. The authors’ objective is to present our series of 30 patients who underwent SCF repair for varying defects and to review the scope and outcome of SCF repair in the literature. Methods: The authors contributed primary evidence of 30 cases of SCF repair. Our outcomes are compared with those reported in the last 5 years’ literature; 33 articles published between January 2012 and January 2017 that present original clinical experience of 528 SCFs. Results: SCF is suitable for a wide variety of oral cavity, pharyngeal, skull base and cutaneous defects. Consistent with our experience, SCF is highly reliable even in previously irradiated or dissected necks, so long as the supraclavicular artery is intact. Our case series shows minor complications in 3/30 (10%) and flap loss in 1/30 (3.3%) cases. The literature reports a similar rate of complete flap failure of 3.4% and a slightly higher average minor complication rate of 24.6%. Conclusion: We add our experience of 30 cases of SCF repair to the international literature. We experienced a complication rate lower than the reported average, and maintain that the SCF is an excellent reconstructive option in patients with previously irradiated necks or comorbidities that affect microvasculature and anaesthetic resilience. [ABSTRACT FROM AUTHOR]

Aim: To examine deprivation measured by the Scottish index of multiple deprivation (SIMD) and its relation to urgent suspicion of head and neck cancer referrals. A secondary aim was to examine the symptomatology generating urgent suspicion of cancer (USOC) referrals by SIMD category. Methods: All “urgent suspicion of cancer” referrals to the GGC ENT department over a one‐year period, between 2015 and 2016, were reviewed. Information was recorded anonymously and included demographics and red flag referral symptoms. Results: A total of 1998 patients were assessed, 43.4% (n = 867) were male. A total of 171 (8.6%) patients had primary head and neck cancer. A total of 61 patients had other types of cancer, giving an all cause cancer rate of 11.6%. About 71.3% of primary patients with head and neck cancer (HNC) were male. The most common SIMD category observed was SIMD1, the most common SIMD category yielding a primary head and neck cancer diagnosis was SIMD1. Neck lump was the commonest symptom amongst all SIMD categories. Conclusion: A link between deprivation and USOC referrals has been established. A difference in gender distribution between referrals and HNC was observed, more females are referred but a significantly higher number of patients with HNC are males. Neck lump is a very strong referral indicator for HNC and intermittent hoarseness is not. The findings from this analysis could be used to refine local referral patterns and priority of referral. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to identify demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity (PA) intention and behavior in head and neck cancer (HNC) survivors using the theory of planned behavior (TPB).Methods: Data from two cross-sectional studies on correlates of PA in HNC survivors were pooled. Both studies used self-reports to assess PA and social-cognitive correlates. Potential correlates were collected via self-report or medical records. Univariable and multivariable multilevel linear mixed-effects models were built to identify correlates of PA intention and PA behavior (Z scores). Structural equation model analyses were conducted to study the full TPB model in one analysis, taking into account relevant covariates.Results: In total, 416 HNC survivors were surveyed. Their mean (SD) age was 66.6 (9.4) years; 64% were men, and 78% were diagnosed with laryngeal cancer. The structural equation model showed that PA intention was significantly higher in HNC survivors with a history of exercising, who had a more positive attitude, subjective norm, and perceived behavioral control. Patients with higher PA intention, higher PBC, a lower age, and without unintentional weight loss or comorbidities had higher PA behavior. The model explained 22.9% of the variance in PA intention and 16.1% of the variance in PA behavior.Conclusions: Despite significant pathways of the TPB model, the large proportion variance in PA intention and behavior remaining unexplained suggests the need for better PA behavior (change) models to guide the development of PA promotion programs, particularly for the elderly. Such programs should be tailored to comorbidities and nutritional status. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess patient-reported levels of physical activity (PA) and its associations with health-related quality of life (HRQoL) adjusted for important demographic, lifestyle-related, and clinical factors, among head and neck (HNC) survivors.Methods: This cross-sectional study included 116 HNC survivors. PA was assessed with the Physical Activity Scale for the Elderly (PASE) and HRQoL with the EORTC-QLQ-C30 and EORTC-HN35. Associations were studied using univariable and multivariable regression analyses.Results: Median PASE score was 100.3 (interquartile range 65.1;170.8) of which 54% were household, 34% leisure-time, and 12% occupational activities. Younger HNC survivors had higher levels of PA. Higher PA was significantly associated with higher global QoL (p < 0.05). Findings for physical function, role function, social function, fatigue, and pain were in line, but not statistically significant (0.05 ≤ p < 0.10).Conclusions: Among HNC survivors, a large proportion of PA consists of household activities. Younger HNC survivors had higher PA levels, and higher PA levels were associated with higher HRQoL. [ABSTRACT FROM AUTHOR]

• We present results of prospective mid-treatment FDG-PET imaging biomarker study for xerostomia prediction. • 56 mucosal head and neck patients treated with definitive radiotherapy were evaluated with FDG-PET imaging at baseline and week 3 mid-radiotherapy. • We found early metabolic changes in the parotid gland improved prediction of subsequent risk of xerostomia. • There is a potential for FDG-PET changes in parotid gland to be utilised in future adaptive radiotherapy trials for toxicity minimisation. The aim of this study was to measure functional changes in parotid glands using mid-treatment FDG-PET/CT and correlate early imaging changes to subsequent xerostomia in mucosal head and neck squamous cell carcinoma patients undergoing radiotherapy. 56 patients from two prospective imaging biomarker studies underwent FDG-PET/CT at baseline and during radiotherapy (week 3). Both parotid glands were volumetrically delineated at each time point. PET parameter SUV median were calculated for ipsilateral and contralateral parotid glands. Absolute and relative change (Δ) in SUV median were correlated to moderate-severe xerostomia (CTCAE grade ≥ 2) at 6 months. Four predictive models were subsequently created using multivariate logistic regression using clinical and radiotherapy planning parameters. Model performance was calculated using ROC analysis and compared using Akaike information criterion (AIC) 29 patients (51.8%) developed grade ≥ 2 xerostomia. Compared to baseline, there was an increase in SUV median at week 3 in ipsilateral (8.4%) and contralateral (5.5%) parotid glands. Increase in ipsilateral parotid Δ SUV median (p = 0.04) and contralateral mean parotid dose (p = 0.04) were correlated to xerostomia. The reference 'clinical' model correlated to xerostomia (AUC 0.667, AIC 70.9). Addition of ipsilateral parotid Δ SUV median to the clinical model resulted in the highest correlation to xerostomia (AUC 0.777, AIC 65.4). Our study shows functional changes occurring in the parotid gland early during radiotherapy. We demonstrate that integration of baseline and mid-treatment FDG-PET/CT changes in the parotid gland with clinical factors has the potential to improve xerostomia risk prediction which could be utilised for personalised head and neck radiotherapy. [ABSTRACT FROM AUTHOR]

Background Venous thromboembolism (VTE) is a preventable complication in which early ambulation is expected after head and neck surgery. Thus, the role of VTE prophylaxis is questionable and needs further assessment. The purpose of this study was to specify the relative contributing risk factors for patients who underwent head and neck cancer ablation with immediate reconstruction. Methods A retrospective analysis was conducted of consecutive head and neck cancer ablations with immediate reconstructions between 2008 and 2013. Dextran and prostaglandin E2 (PGE2) were routinely given as flap thromboprophylaxis. Logistic regression was applied to analyze the potentially significant risk factors. Results Of 1953 subjects, the incidence of symptomatic VTE was 2.2% with 0.1% mortality rate. Prolonged surgery (>592.5 minutes; P = .048), immobilization (>4 days; P = .019), and subjects without postoperative flap thromboprophylaxis ( P = .002) are significant risk factors for VTE development. Conclusion Our flap thromboprophylaxis regime might have played a crucial role in keeping the incidence of VTE low. Despite prolonged immobilization in fibula flap reconstruction, the incidence of VTE remained low when flap thromboprophylaxis was given. [ABSTRACT FROM AUTHOR]

Objectives: To assess the expression of endoglin in head and neck paragangliomas and the soluble endoglin level in serum of paraganglioma patients. Methods: Seven tumor samples of patients operated for cervical paraganglioma were assessed, as well as serum samples collected preoperatively, on days 4 and 28 postoperation. Serum level of endoglin in healthy controls was also determined. Tumor samples were subjected to immunofluorescent staining and examined with confocal microscope. The level of soluble endoglin in serum samples was examined using the immunoenzymatic assay (ELISA). Results: Endoglin was highly expressed in all tumor samples. The level of soluble endoglin was significantly higher in paraganglioma patients compared to healthy controls and correlated with the tumor size. The serum level of s-endoglin was reduced after surgical excision of the tumor and remained stable after 4 weeks in all patients with complete resection of the tumor. Conclusion: Endoglin is an important factor in the pathophysiology of head and neck paragangliomas and may be a potential diagnostic and prognostic marker in these types of tumors. [ABSTRACT FROM AUTHOR]

Purpose To investigate the relationship between the Diffusion Kurtosis Imaging (DKI) parameters and conventional metrics provided by Diffusion-weighted imaging (DWI) in patients affected by Brain or Head and Neck (HN) cancer. Methods Ten patients affected by brain tumor and nine patients with HN tumor underwent a pre-treatment MR examination at 3 T. The largest tumor section was manually contoured by two expert neuroradiologists. The apparent diffusion coefficient (D app ) and apparent diffusional kurtosis (K app ) parameters were determined at the voxel level by using the DKI model, and compared to the apparent diffusion coefficient (ADC) and the tissue diffusion coefficient (D mono ) obtained from mono-exponential fitting methods. The Akaike Information Criteria (AIC) was calculated to assess the quality of the fitting methods. Cross-correlations between all the variables were assessed using the Spearman rank test. Results Increased K app values were found in each lesion. All parameters were strongly related, in particular an inverse relationship emerged between median values of K app and D app /D mono /ADC in both patient groups, while D app showed positive correlations with D mono and ADC. From the analysis at the voxel level, significant inverse associations were found between K app and D mono within the lesions, while a weak or moderate association emerged between K app and ADC or D app . Conclusions A significant association between the apparent diffusional kurtosis K app and the tissue diffusion coefficient D mono emerged for both brain and HN tumors at 3 T, suggesting that both variables may consistently reflect deeper insight into the microstructural characteristics of tumors. [ABSTRACT FROM AUTHOR]

Background: With conformal radiotherapy techniques, acute and late toxicities can be reduced because of better dose conformity and reduced doses to normal tissue. With Intensity Modulated Radiation Therapy (IMRT) further dose escalation is possible and one of the methods is IMRT with simultaneous integrated boost (IMRT-SIB).Aim: To evaluate feasibility, toxicity patterns and loco-regional control rates of IMRT-SIB technique in head and neck cancer patients who are not suitable candidates for concurrent chemoradiation.Study Design: Prospective study of 30 patients treated with IMRT-SIB technique and evaluation of clinical results.Method and Materials: 30 patients received definitive treatment using IMRT-SIB without concurrent chemotherapy. Patients were monitored during and after treatment for toxicity using the Radiation Therapy Oncology group (RTOG) criteria. Analysis of acute and late toxicity and early efficacy is presented.Results: The median treatment duration was 42days (range 41-43days). Overall, maximum acute Grade 3 toxicity of mucositis, skin, pharynx/esophageal toxicity and laryngeal were 56.66%, 30%, 26.67%, and 6.67% respectively at treatment completion. None of the patients had Grade 4 acute toxicity. No haematological toxicity was seen. Overall, grade 2 late toxicities were 7% (subcutaneous toxicity) and 13.3% (Xerostomia). Loco regional control rate at a median follow up of 13months was 86%.Conclusion: IMRT-SIB is a safe and acceptable treatment option for patients of head and neck squamous cell carcinoma unsuitable for definitive chemo-radiotherapy. [ABSTRACT FROM AUTHOR]

Background Reduced field of view (rFOV) imaging may be used to improve the quality of diffusion-weighted imaging (DWI) in the head and neck (HN) region. Purpose To evaluate the feasibility of rFOV-DWI in patients affected by HN tumors, through a comparison with conventional full FOV (fFOV) DWI. Material and Methods Twenty-two patients with histologically-proven malignant or benign tumors of the head and neck were included in a retrospective study. All patients underwent pre-treatment magnetic resonance imaging (MRI) studies including rFOV-DWI and fFOV-DWI. The apparent diffusion coefficient (ADC) value distributions inside tumor and muscle were derived and the mean, standard deviation (SD), and kurtosis were calculated. Image distortion was quantitatively and qualitatively evaluated, as well as the capability of lesion identification. The Wilcoxon test was used to compare all variables. Agreements between the ADC estimations were assessed by Bland-Altman plots. Results Image distortion and lesion identification scores were both higher for rFOV-DWI compared to fFOV-DWI. A reduction in ADC values with rFOV-DWI emerged for both lesion and muscle, with a mean percentage difference in ADC of 6.2% in the lesions and 24.9% in the muscle. The difference in SD of ADC was statistically significant in the lesions, indicating a higher ADC homogeneity for rFOV DWI ( P = 0.005). Conclusion The application of rFOV DWI in patients affected by HN tumors is feasible and promising, based on both qualitative and quantitative analyses. This technique has potential for improving the diagnostic accuracy of fFOV-DWI for the study of specific tumoral areas. [ABSTRACT FROM AUTHOR]

Lymphoma diffuse large cell is the most common non-Hodgkin lymphoma also in extranodal presentation, its appearance in oral mucosa is rare. It’s of phenotype B and highly aggressive, has a poor prognosis. We report a case with limited clinical manifestations and casual diagnosis in an 88-year-old female patient, who presented an ulcer in the oral mucosa. We review the characteristics of these lesions and current diagnosis and treatment options. [ABSTRACT FROM AUTHOR]

Background Sentinel lymph node biopsy (SLNB) has become an alternative option to elective neck dissection (END) for early oral cavity squamous cell carcinoma (OCSCC) outside of Australia. We sought to assess the technical feasibility of SLNB and validate its accuracy against that of END in an Australian setting. Methods We performed a prospective cohort study consisting of 30 consecutive patients with cT1 - 2N0 OCSCC referred to the Head and Neck Cancer Service, Westmead Hospital, Sydney, between 2011 and 2014. All patients underwent SLNB followed by immediate selective neck dissection (levels I-III). Results A total of 30 patients were diagnosed with an early clinically node-negative OCSCC (seven cT1 and 23 cT2), with the majority located on the oral tongue. A median of three (range: 1-14) sentinel nodes were identified on lymphoscintigraphy, and all sentinel nodes were successfully retrieved, with 50% having a pathologically positive sentinel node. No false-negative sentinel nodes were identified using selective neck dissection as the gold standard. The negative predictive value (NPV) of SLNB was 100%, with 40% having a sentinel node identified outside the field of planned neck dissection on lymphoscintigraphy. Of these, one patient had a positive sentinel node outside of the ipsilateral supraomohyoid neck dissection template. Conclusion SLNB for early OCSCC is technically feasible in an Australian setting. It has a high NPV and can potentially identify at-risk lymphatic basins outside the traditional selective neck dissection levels even in well-lateralized lesions. [ABSTRACT FROM AUTHOR]

• Inadequate reconstruction of the tongue may lead to possible severe disability. • Total glossectomy with larynx-sparing may guarantee good functional results. • Both patient-related and treatment-related factors may affect the functional outcomes. To analyze the functional outcomes and complications of total glossectomy with laryngeal preservation and reconstruction with free or pedicled flaps. A search was conducted using Pubmed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases. A single arm meta-analysis was performed for feeding tube dependence (FTD), tracheostomy dependence (TD), and speech intelligibility (SI) rates. Peri-operative sequels and complications were evaluated as secondary outcomes. A total number of 642 patients (median age: 54.2 years; 95% CI 52.1–58) were included. Functional assessment was performed after a median of 12 months (n = 623/642; 95% CI 10.6–12). Overall, the cumulative FTD rate was 22.9% (n = 188/627; 95% CI 10.2–38.7), the TD rate was 7.3% (n = 95/549; 95% CI 1.9–15.8), and the SI was 91.1% (n = 314/409; 95% CI 80.7%−97.8). The cumulative complication rate was 33.1% (n = 592/642). Eighteen patients (n = 18/592; 3.0%) experienced a major fistula, while aspiration pneumonia occurred in 17 cases (n = 17/592; 2.8%). Total glossectomy with laryngeal preservation and pedicled/free flaps reconstruction may guarantee good functional results and an acceptable quality of life. Further prospective studies are advised to define clinical guidelines about proper patients' and flaps' selection. [ABSTRACT FROM AUTHOR]

The aim in this review was to evaluate recent advances in telerehabilitation for the management of patients with head and neck cancer (HNC) during and after their oncological treatment. A systematic review was carried out in three databases (Medline, Web of Science and Scopus) in July 2022. The methodological quality of randomised clinical trials and quasi-experimental ones was assessed using the Cochrane tool (RoB 2.0) and the Critical Appraisal Checklists of the Joanna Briggs Institute, respectively. 14 out of 819 studies met the inclusion criteria: 6 studies were randomised clinical trials, 1 was a single-arm study with historical controls and 7 were feasibility studies. Most studies reported high participant satisfaction and efficacy of telerehabilitation used, in addition, no adverse effects were reported. None of the randomised clinical trials achieved a low overall risk of bias, whereas the methodological risk of bias of the quasi-experimental studies was low. This systematic review demonstrates that telerehabilitation offers feasible and effective interventions for the patients with HNC follow-up, during and after their oncological treatment. It was observed that telerehabilitation interventions should be personalised according to the patient's characteristics and the stage of the disease. Further research on telerehabilitation to support caregivers as well as to carry out studies with a long-term follow-up of these patients are imperative. • Most telerehabilitation interventions have been effective for different clinical variables. • Disease stage may influence in how well telerehabilitation works. • Mobile applications do not seem to be the best digitized health care. • Health care professionals, caregivers and patients can benefit from telerehabilitation. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

O presente estudo tem por objetivo relatar as características, fatores prognósticos e desfecho de tratamento de 18 casos de melanoma da mucosa nasossinusal e conduzir uma revisão da literatura. MÉTODO: Entre 1995 e 2005, 18 pacientes consecutivos diagnosticados com melanoma da mucosa do trato nasossinusal e tratados em nossa instituição. Para encontrar as principais casuísticas de estudos relacionados, conduzimos uma revisão da literatura em PubMed e Scopus. No total, encontramos 35 casuísticas, incluindo 1.077 pacientes com melanoma da mucosa nasossinusal. RESULTADOS: Encontramos 16 homens e 2 mulheres. A idade de apresentação foi 51-80 anos (mediana de 58 anos). Todos os pacientes sofreram excisão cirúrgica seguida de radioterapia com ou sem quimioterapia. A mediana de sobrevida foi de 15 meses e a sobrevida geral de 5 anos foi de 23%. Sob análise univariada, estadiamento e remissão completa após tratamento inicial foram importantes fatores prognósticos. Entretanto, sob análise multivariada, somente estágio da doença teve significância estatística. CONCLUSÃO: Melanoma nasossinusal é um tumor raro e agressivo com alto fracasso locorregional e distante e pobre desfecho de tratamento. Entretanto, em uma revisão da literatura, encontramos significativa melhora em termos de sobrevida de 5 anos para casuísticas recentes comparadas com casuísticas previamente relatadas.The present study aimed at reporting on the characteristics, prognostic factors and treatment outcomes of 18 cases of nasosinusal mucosa melanoma, and do a literature review on the subject. METHODS: between 1995 and 2005, 18 patients consecutively diagnosed with nasosinusal mucosa melanoma were managed in our institution. We reviewed the literature in PubMed and Scopus in order to find the main series from studies associated with this topic. We found a total of 35 series, involving 1,077 patients with nasosinusal mucosa melanoma. RESULTS: we found 16 men and 2 women, with age at presentation between 51 and 80 years (median of 58 years). All these patients were submitted to surgical excision followed by radiotherapy with or without chemotherapy. The survival median was 15 months, and the 5-year general survival had a percentage value of 23%. Considering our univariate analysis: tumor staging and complete remission after initial treatment were deemed relevant prognostic factors. Nonetheless, considering the multivariate analysis, only disease stage was statistically significant. CONCLUSION: nasosinusal melanoma is a rare and aggressive tumor, with high loco-regional and distant failure rates, and poor treatment outcomes. Notwithstanding, in a literature review we found significant improvements considering the 5-year survival for recent series when compared to previously reported ones.

Although esophageal liposarcoma is an extremely rare tumor, liposarcoma is the most common soft tissue sarcoma in adults. Liposarcoma is currently classified into the types of well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated liposarcoma. Up to now only a few cases of esophagus liposarcoma have been described in the world literature. We describe a myxoid type liposarcoma of the esophagus in a 68 year old man presented with hoarseness and intermittent dysphagea to solid food. He had a huge mass in his mouth which was mobile with gag reflex. A barium swallow, esophageal manometery and CT scan of the esophagus have not clearly revealed the mass. After endoscopic surgical resection of the tumor the histological examination revealed a myxoid liposarcoma. Both the presenting signs and symptoms and the histology type are rare for such tumor. This case demonstrate a rare differential diagnosis of intermittent dysphagia as early diagnosis is so important in those tumors and should kept in mind them, although they are quite rare.

Objective: To evaluate the influence of lymph node reactivity on recurrence and survival rates in a population of pT3 or pT4 pN0 patients with laryngeal squamous cell carcinoma. Methods: Between 2002 and 2005, 105 patients with LSSC underwent total laryngectomy with bilateral selective neck dissection including levels II, III and IV. Most (69) received PO radiotherapy. All pathological specimens were either pT3 or pT4, and all necks were pN0. All lymph nodes were analyzed and their reactivity status were classified as the following four patterns: follicular hyperplasia associated with humoral response, paracortical hyperplasia associated with cellular response, sinus histiocytosis with no association with specific immune response, or normal lymph node. Only the first two patterns were considered stimulated, whereas the last two were considered non-stimulated. The most prevalent pattern in a particular neck specimen was considered for the analysis of recurrence and survival. Results: The total number of lymph nodes studied was 3,648, with an average of 34.7 lymph nodes/neck specimens. The most frequent lymph node reactivity patterns were sinusal histiocytosis (50 cases), paracortical hyperplasia (35 cases), and follicular hyperplasia (20 cases). There was no statistical association of these individual patterns with recurrence rate (p = 0.98) or mortality (p = 0.49). However, there was a statistically significant association between paracortical hyperplasia pattern (related to cellular lymph node immunity) and improved five-year survival (76 versus 60%; log-rank = 0.05). Conclusions: There was a positive correlation between stimulated cellular lymph node pattern and improved 5-year survival rate in patients with pN0 laryngeal squamous cell carcinoma, suggesting the indication of adjuvant treatment for those individuals with decreased immune response, even in the absence of pathologic metastases detected by the usual methods.

Objetivo: Conocer las características y la evolución de los pacientes diagnosticados de neoplasia de cabeza y cuello (NCC) que precisaron recibir tratamiento de radioterapia y que fueron atendidos en un programa de nutrición enteral por sonda a domicilio (NESD). Análisis del peso en función de administrar la nutrición enteral antes o después del inicio de la radioterapia. Material y métodos: Estudio observacional de pacientes con NCC incluidos en el programa de NESD de nuestro hospital durante 2 años. Variables analizadas: sexo, edad, índice de masa corporal (IMC), índice de Karnofsky (IK), motivo del inicio de soporte nutricional, tipo de sonda para la administración de la nutrición, tipo de fórmula nutricional y aporte calórico prescrito, necesidad de cambio de vía y días de NESD. Resultados: Se incluyeron 62 pacientes (77,4% varones y 22,6% hembras) con una edad media de 64 años ± 10,1 (rango entre 39 y 90). La disfagia fue el motivo principal de colocación de sonda en estos pacientes. Predominio de sonda nasogástrica (67,7%). La fórmula más utilizada fue la polimérica hipercalórica con un aporte calórico de 1.629 ± 267,09 kcal/día. Globalmente, se observó una pérdida de peso en todos los pacientes durante el período de estudio. Sin embargo, aquellos en los que se inició la NESD antes de la radioterapia el IMC no disminuyó. Conclusión: Los pacientes que iniciaron nutrición por sonda con anterioridad al tratamiento oncológico no perdieron peso durante el periodo de estudio.Objective: To know characteristics and the patients' evolution with head and neck cancer who received radiotherapy treatment and they were included at a home enteral nutrition (HEN) by feeding tube programme. To analyse the weight evolution according to the start of HEN before or after radiotherapy. Methods: Observational study of tube feeding patients with head and neck cancer who were included in HEN programme in our hospital for two years. Variables analysed: gender, age, Body Mass Index (BMI), Karnofsky Index (KI), reason for nutritional support, type of feeding tube, formula used and prescribed caloric contribution, necessity to change access device and HEN days. Results: 62 patients were studied (77.4% men; 22.6% women). Age 64 ± 10.1 years (rang: 39-90). The dysphagia was the main cause to begin enteral nutrition by feeding tube in these patients. Naso-gastric tube was prevalence (67.7%). The most used formula was polymeric hypercaloric diet with a mean of caloric contribution of 1,629 ± 267.09 kcal/day. Overall, there was a weight loss in all patients during the study period time. However, patients who began the HEN by feeding tube before the radiotherapy treatment, the BMI did not decrease. Conclusion: All patients who began feeding tube before oncological treatment didn't lose weight for the period of study.

Background: Locally advanced head and neck cancer (LAHNC) can significantly impact the quality of life of patients in various ways. However, several factors can contribute to the decrease in quality of life. In Thailand, there is limited knowledge about the factors that affect the quality of life of patients with LAHNC before they receive treatment., Objective: This study aimed to examine the correlations between Palliative Performance Scale (PPS), family income, body mass index (BMI), age, comorbidity index, and the quality of life of patients with LAHNC before they undergo treatment., Methods: A correlational cross-sectional study was conducted, and data were collected from 94 pretreatment patients with LAHNC who were admitted to a cancer center in central Thailand using purposive sampling. The data collection instruments included a demographic data form, a medical record form, the Charlson Comorbidity Index (CCI), the Palliative Performance Scale (PPS), and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4. Descriptive statistics, Pearson's correlation, and Spearman's rank correlation were used to analyze the data., Results: All study participants completed the questionnaire. The results showed that the overall quality of life of the patients was moderate. PPS, family income, and body mass index were moderately positively correlated with quality of life ( r = 0.494, p <0.01; r = 0.420, p <0.01; r = 0.339, p <0.01, respectively). Age had a moderate negative correlation with quality of life ( r = -0.596, p <0.01), while comorbidity was not significantly associated with quality of life., Conclusion: The quality of life of patients with LAHNC before treatment was associated with various factors, including PPS, family income, body mass index, and age. These findings highlight the importance of nutritional support before treatment and the need for social support, especially for older adult patients, to improve their quality of life. The results of this study can be valuable for nurses in developing care programs that enhance the quality of life for patients with LAHNC during the pretreatment phase., Competing Interests: The authors declared no conflict of interest in this study., (© The Author(s) 2023.)

Objective: The outbreak of the COVID-19 pandemic had a considerable impact on the healthcare access, treatment, and follow-up of oncologic patients. The aim of this study was to evaluate how the COVID-19 pandemic has affected consultation and follow-up demand as well as treatment volume at Brazilian Head and Neck Surgery centers., Methods: An anonymous online questionnaire was used for collection of data across all Brazilian Head and Neck Surgery Centers across a 3-month period (April‒June 2021). This information included the characteristics of each center, and the perceived self-reported impact of the COVID-19 pandemic on academic activities, residency training, and the diagnosis, treatment, and follow-up of patients with Head and Neck diseases between 2019 and 2020., Results: The response rate across the 40 registered Brazilian Head and Neck Surgery Centers was 47.5% (n=19). The data showed a significant reduction in the total number of consultations (24.8%) and number of attending patients (20.2%) between 2019 and 2020. The total number of diagnostic exams (31.6%) and surgical procedures (13.0%) conducted over this period also decreased significantly., Conclusions: The COVID-19 pandemic had a significant national impact on Brazilian Head and Neck Surgery Centers. Future studies should examine the long-term effects of the pandemic on cancer treatment., Level of Evidence: Evidence from a single descriptive study., (Copyright © 2023 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: Head and neck cancer (HNC) is one of the fastest increasing cancer-types, where both disease and oncologic treatment have severe impact on health-related quality of life (HRQL). This study aimed to report HRQL prospectively up to 5-years following radiotherapy-treatment in HNC and to, if possible, identify trends in HRQL over time., Methods: This prospective study followed 211 patients receiving curatively intended radiotherapy pre-diagnosis, 3-, 6-, 12- and 60-months post-radiotherapy completion. HRQL was measured using EORTC QLQ-C30 and EORTC QLQ-HN35., Results: A deterioration three months post-radiotherapy was reported in 14/15 domains of EORTC QLQ-C30. Eight out of 12 domains had recovered to baseline-values at 12 months post-radiotherapy and remained unchanged up to study endpoint. Corresponding figures for EORTC QLQ-HN35 were deteriorations in 15/16 domains at three months post-radiotherapy, with recovery of 5 domain at 12-months, whereas the other 11 domains remained significantly worse at 5-years post-RT compared to baseline., Conclusion: Following the deterioration in HRQL seen immediately following radiotherapy, the continued course of HRQL can be divided into three trends: short-term deterioration, long-term deterioration and long-term improvements. The combination of disease- and diagnosis-specific questionnaires is crucial when assessing HRQL in the HNC population., (© 2023. The Author(s).)

Background: Previous studies have highlighted the unmet nutritional and supportive care needs of patients with head and neck cancer (HNC) and their carers from diagnosis and throughout the treatment and survivorship period. The aim of this study was to bring patients, carers and healthcare professionals together to co-design a framework to improve access to nutrition information and support for patients and carers with HNC from diagnosis and throughout the treatment and survivorship period., Methods: Using experience-based co-design (EBCD), semistructured individual interviews were conducted with patients, carers and healthcare professionals to understand their experiences in accessing information and support outside of the hospital environment. Feedback events and co-design workshops were held to prioritise areas for service improvement., Results: Participants (10 patients, 7 carers and 15 healthcare professionals) highlighted the importance of having consistent information and support recommendations from the multidisciplinary team. The two key areas for improvement identified through group and workshop events were linking reputable HNC resources to a HNC portal on the hospital website and the development of a series of short podcasts and video blogs with fact sheets attached presented by members of the multidisciplinary team, patients and carers at four time points spanning pretreatment and throughout the survivorship period., Conclusions: Using EBCD has enabled the co-design of a framework for resource development with patients, carers and healthcare professionals to improve access to information and resources to support nutrition intake and supportive care needs for patients with HNC with their carers. Development and implementation of resources and evaluation of outcomes is ongoing., (© 2022 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Aneurysmal bone cysts are benign bone tumors that most commonly occur in people younger than 30 years. The cysts are most often found in the metaphyses of long bones and rarely affect the skull. We present a 54-year-old woman with a rapidly enlarging mass in the left occipital region that caused tenderness for 2 weeks. Computed tomography (CT) revealed an expansile, osteolytic lesion with characteristic soap-bubble appearance and fluid-fluid levels. Magnetic resonance images showed a dark rim surrounding the lesion, as well as multilocular spaces with fluid-fluid levels. The tumor was soft, fragile, and pulsatile during surgery. The patient was treated with en bloc resection of the tumor with cranioplasty. Follow-up CT 5 months later showed no evidence of recurrence. [J Formos Med Assoc 2007;106(3):255-259]

Malignant Melanoma of nasal cavity is an extremely rare tumour and is more aggressive than its cutaneous counterpart. Primary malignant melanoma of nasal cavity arise from melanocytes located in the mucous membrane. Only 0.5% of malignant melanoma arises in nasal cavity. We report a case of malignant melanoma of the nasal cavity in a 51-year-old male who presented with swelling of nose, nasal block and epistaxis. By brush cytology and CT scan imaging, the pre operative diagnosis of malignant melanoma was made which was later confirmed by histopathology examination along with immunohistochemistry by using S100 and HMB 45. Malignant melanoma of nose is rare tumour, with aggressive behavior and poor prognosis. Rarity of this lesion warrants its mention and emphasizes the importance of considering malignant melanoma among the differential diagnosis of tumours of nose and paranasal sinuses.

Skin cancer is the most common form of malignancy in the world, the incidence of cutaneous malignancies has increased dramatically over the past several decades. More than 80% of cases involve the head and neck region, resection and latter reconstruction of advanced cutaneous malignancies constitute significant problems due to aesthetic and functional concerns. Aim of this study is to discuss the therapeutic options and challenges usually seen in the treatment course. From 2006 to 2016, 50 patients with advanced stage (TNM stage of 3 or greater) cutaneous head and neck cancers were included in the study. Patients were evaluated according to demographic data and treatment options. The mean age of patients was 61.4 (26-87), 32 were male and 18 were female. Most common tumor type was squamous cell carcinoma (36 patients), most common localizations were mandible (7 patients) and orbita (6 patients). After tumor ablation, most commonly performed reconstruction was free tissue transfer (31 patients). 38 patients received adjuvant therapy (chemotherapy, radiotherapy or interferon) at the postoperative period. Six patients were lost at following one year period. Head and neck region are more exposed to direct sunlight than any other body part. Especially advanced stage cutaneous malignancies can be seen in these region due to patient negligence and previous failed treatment attempts. Surgical therapy is long standing option, usually necessitates 3D reconstruction with free flaps and multidisciplinary approach is crucial in the treatment course. Postoperative rehabilitation is complex and demanding process which requires extra patient and family motivation, also must be individualized for each patient. [ABSTRACT FROM AUTHOR]

Objectives: To assess the independent prognostic value of standardized uptake value (SUV) and apparent diffusion coefficient (ADC), separately and combined, in order to evaluate if the combination of these two variables allows further prognostic stratification of patients with head and neck squamous cell carcinomas (HNSCC).Methods: Pretreatment SUV and ADC were calculated in 57 patients with HNSCC. Mean follow-up was 21.3 months. Semiquantitative analysis of primary tumours was performed using SUVmaxT/B, ADCmean, ADCmin and ADCmax. The prognostic value of SUVmaxT/B, ADCmean, ADCmin and ADCmax in predicting disease-free survival (DFS) was evaluated with log-rank test and Cox regression models.Results: Patients with SUVmaxT/B ≥5.75 had an overall worse prognosis (p = 0.003). After adjusting for lymph node status and diameter, SUVmaxT/B and ADCmin were both significant predictors of DFS with hazard ratio (HR) = 10.37 (95 % CI 1.22-87.95) and 3.26 (95 % CI 1.20-8.85) for SUVmaxT/B ≥5.75 and ADCmin ≥0.58 × 10-3 mm2/s, respectively. When the analysis was restricted to subjects with SUVmaxT/B ≥5.75, high ADCmin significantly predicted a worse prognosis, with adjusted HR = 3.11 (95 % CI 1.13-8.55).Conclusions: The combination of SUVmaxT/B and ADCmin improves the prognostic role of the two separate parameters; patients with high SUVmaxT/B and high ADCmin are associated with a poor prognosis.Key Points: • High SUV maxT/B is a poor prognostic factor in HNSCC • High ADC min is a poor prognostic factor in HNSCC • In patients with high SUV maxT/B , high ADC min identified those with worse prognosis. [ABSTRACT FROM AUTHOR]

Background: The majority of chemoradiation (CRT) trials for locally advanced head and neck squamous cell carcinoma (HNSCC) have relied on platinum-based chemotherapy regimens administered every-3-weeks. However, given the increased utilization of weekly platinum regimens, it remains unclear how different chemotherapy schedules compare regarding efficacy and toxicity. Methods: We retrospectively identified 212 patients with HNSCC who were treated at a single academic medical center with concurrent platinum-based CRT given weekly (N = 68) or every-three-weeks (N = 144). JMP version 10 (SAS Institute) was used for statistical analysis. Discrete variables were compared with the chi-square test and differences in the medians were assessed using the Wilcoxon test. Survival curves were constructed using the Kaplan-Meier method and significance was assessed using the log rank test. For univariate analysis and multivariate analysis, we used Cox proportional hazard or logistic regression models to compare differences in survival or differences in categorical variables, respectively. Results: Patients receiving weekly platinum regimens were more likely to be older (median age 61.4 vs. 55.5 y; P < .001), have high or very high Charlson comorbidity index (45.6% vs. 27.8%; P = .01), and receive carboplatin-based chemotherapy (6.3% vs. 76.5%; P < .001). Weekly and every-3-week platinum regimens had similar locoregional control (HR 1.10; 95% CI 0.63-1.88; P = .72), progression-free survival (HR 1.13; 95% CI 0.75-1.69; P = .55), and overall survival (HR 1.11; 95% CI 0.64-1.86; P = .71). Every-3-weeks platinum regimens were associated with increased days of hospitalization (median: 3 days vs. 0 days; P = .03) and acute kidney injury (AKI) during radiotherapy (50.0% vs. 22.1%; P < .001). On multivariate analysis, AKI was significantly associated with every-3-weeks regimens (OR: 24.38; 95% CI 3.00-198.03; P = .003) and high comorbidity scores (OR: 2.74; 95% CI 2.15-5.99; P =. 0 1 ) . Conclusions: Our results suggest that every-3-weeks and weekly platinum-containing CRT regimens have similar disease control but weekly platinum regimens are associated with less acute toxicity. [ABSTRACT FROM AUTHOR]

Docetaxel is a semi-synthetic taxoid anti-cancer drug, which can basically freeze intracellular skeleton that is composed of microtubules, so as to inhibit cell division. Under normal condition, Docetaxel can make microtubule in a cell cycle follow the rule of first polymerization and then depolymerization. Moreover, docetaxel can further promote the microtubule polymerization while inhibiting cell depolymerization, so as to prevent cells division, lead to cancer cells death, and improve the therapeutic efficiency of tumor and cancer. However, as a newly developed drug, docetaxel's specific clinical effect has not been fully verified yet. Therefore, in this research, 2000 patients of advanced head and neck neoplasm were selected as research objects, which were treated with docetaxel combined with DDP and fluorouracil. By observing indexes such as patient's condition, complication condition, and life quality, the clinical effect of docetaxel combined therapy scheme in treating head and neck neoplasm was analyzed. Results show that such therapy scheme is of sound therapeutic effect and high application value. [ABSTRACT FROM AUTHOR]