Search

The aim of the study was to evaluate survival in patients with advanced glottic laryngeal squamous cell carcinoma treated by bioradiotherapy (BioRT) with cetuximab and eventual salvage surgery (group A, n = 66) or upfront surgery (total laryngectomy or near-total laryngectomy) with or without postoperative radiotherapy (PORT) (group B, n = 66). The predictive role of HER1 expression in the bioselection of tumors was evaluated. Relapse-free (RFS), metastasis-free (MFS), overall (OS) survivals, salvageability, and rates of larynx preservation were analyzed. The two groups were balanced by propensity score method on their baseline characteristics. No significant differences in RFS and OS were found, while MFS results were significantly higher in group A (p = 0.04). Group A showed a 22% reduction in the probability of nodal metastasis (p = 0.0023), mostly in tumors with higher HER1 expression. The salvageability with TL at 3 years was 54% after prior BioRT and 18% after prior upfront NTL (p < 0.05). BioRT with cetuximab showed a reduction in the risk of lymph node relapse, particularly in the case of HER1 positive tumors, and it allowed to achieve a higher rate of functional larynx preservation and a higher salvageability compared with upfront surgery. HER1 analysis could be clinically useful in the bioselection of tumors that may benefit from BioRT with cetuximab, particularly in those with neck node metastatic propensity.

Irreversible bilateral sensorineural hearing loss is a common side effect of platinum compounds. Because of the extended overall survival, a prolonged hearing surveillance and management of hearing impairments are emerging concerns for pediatric oncology.In this retrospective observational study, we enrolled 38 children out of 116 treated at our institution by chemotherapy (cisplatin and/or carboplatin) with or without irradiation between 2007 and 2014, submitted to hearing monitoring before every cycle of chemotherapy, and who completed a 5-year long-term audiological follow-up. Chemotherapy regimens, demographic findings, cumulative doses, and cranial irradiation were compared.At the end of 5-year follow-up, ototoxicity was significantly increased compared to that observed at the end of chemotherapy (52.5% vs 39.5%, p 0.001). A late onset of hearing loss was experienced in 13.1% of children, while in 26.3% progressive hearing loss was measured. Deafness at the end of chemotherapy and irradiation were significant prognostic factors for late ototoxicity outcomes (Odds Ratio 7.2-CI 1.67-31.1-p 0.01 and 5.25-CI 1.26-21.86-p 0.01 respectively). No significant differences were found between cisplatin and combined treatment (i.e., cisplatin shifted to carboplatin during monitoring for the onset of ototoxicity) and ototoxicity was not associated with platinum compounds cumulative dose (p 0.05). 13.1% of children needed hearing aids at the end of follow-up.Long-term monitoring of at least 5 years prevents the harmful effects of hearing deprivation identifying late onset/progressive hearing loss after platinum compound chemotherapy in children thanks to early hearing rehabilitation, especially in those who underwent multimodal therapy or subjected to irradiation.

Introduction: Tinnitus is a common and disabling symptom often associated with hearing loss. While clinical practice frequently shows that a certain degree of psychological discomfort often characterizes tinnitus suffers, it has been recently suggested in adults as a determining factor for cognitive decline affecting attention and memory domains. The aim of our systematic review was to provide evidence for a link between tinnitus, psychological distress, and cognitive dysfunction in older patients and to focus on putative mechanisms of this relationship. Methods: We performed a systematic review, finally including 192 articles that were screened. This resulted in 12 manuscripts of which the full texts were included in a qualitative analysis. Results: The association between tinnitus and psychological distress, mainly depression, has been demonstrated in older patients, although only few studies addressed the aged population. Limited studies on cognitive dysfunction in aged patients affected by chronic tinnitus are hardly comparable, as they use different methods to validate cognitive impairment. Actual evidence does not allow us with certainty to establish if tinnitus matters as an independent risk factor for cognitive impairment or evolution to dementia. Conclusion: Tinnitus, which is usually associated with age-related hearing loss, might negatively affect emotional wellbeing and cognitive capacities in older people, but further studies are required to improve the evidence.

Quando è indicato un approccio chirurgico multidisciplinare nel management dei tumori primitivi cutanei non melanocitari della testa e del collo e dei tumori localmente avanzati del distretto testa-collo con interessamento della cute?I tumori della pelle non melanocitari, che comprendono soprattutto il carcinoma squamocellulare e il carcinoma basocellulare, sono i tumori maligni più frequenti nella popolazione caucasica, e la cute della testa e del collo rappresenta la sede più coinvolta. Tali tumori non dovrebbero essere sottovalutati, in particolare le cosiddette lesioni ad alto rischio e i tumori cutanei avanzati richiedono un iter diagnostico più accurato e un trattamento chirurgico più aggressivo, che dovrebbe essere gestito coinvolgendo il chirurgo testa-collo, il dermatologo e il chirurgo plastico. Le neoplasie primitive cutanee del distretto testa-collo sono spesso trascurate e non sono routinariamente discusse in seno a teams chirurgici multidisciplinari. Allo stesso modo, per i tumori primari della testa e del collo con infiltrazione cutanea, il coinvolgimento del dermatologo e del chirurgo plastico può più efficacemente definire la diagnosi e pianificare il trattamento. La gestione di questi pazienti pone problemi sia terapeutici che etici, perché la prognosi infausta è gravata da importanti inestetismi facciali, ferite aperte maleodoranti e dolore intrattabile. Pertanto, anche nei pazienti con malattia avanzata non suscettibile di chirurgia radicale, la chirurgia potrebbe ugualmente trovare spazio, ma con finalità palliativa, al fine di migliorare la qualità di vita.Non-melanoma Skin cancer, including cutaneous squamous cell carcinoma and basal cell carcinoma, is the most common form of malignancy in the Caucasian population, and the skin of the head and neck is the site most involved. They should not be underestimated; in particular, high-risk lesions and advanced skin cancers require accurate diagnostic work up, aggressive surgical treatment and should be managed by the head and neck surgeon, the dermatologist and the plastic surgeon. Cutaneous head-neck malignancies are often overlooked or not routinely treated with a multidisciplinary surgical approach. Similarly, for primary head and neck cancers with involvement of surrounding skin, the involvement of the dermatologist and the plastic surgeon could better define an adequate diagnosis and treatment planning. The management of these patients presents both therapeutic and ethical problems, because the poor prognosis is burdened by facial disfigurement, open malodorous wounds and intractable pain. Therefore, in patients with advanced disease that is not candidate to radical surgery, palliative surgery with flap reconstruction could take place and could be proposed to improve quality of life.

Background. Irreversible bilateral sensorineural hearing loss is a common side effect of platinum compounds. Because of extended overall survival period of children, a prolonged hearing surveillance and management of hearing impairments are emerging concerns for pediatric oncology. Methods. In this retrospective observational study we enrolled 38 children out of 116 treated at our institution by chemotherapy (cisplatin and/or carboplatin) with or without irradiation between 2007–2014, and submitted to hearing monitoring before every cycle of chemotherapy and that completed a 5 years long-term follow-up. Chemotherapy regimens, demographic findings, cumulative doses and cranial irradiation were compared. Results. At the end of 5-years follow-up ototoxicity was significantly increased compared to that at observed the end of chemotherapy (52.5% vs 39.5%, p 0.05). 13.1% of children needed hearing aids at the end of follow-up. Conclusions. Our study confirms the effectiveness of long-term follow-up in identifying late onset/progressive hearing loss after platinum compound chemotherapy and allows us to avoid the harmful effects of hearing deprivation with hearing aid intervention.