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Accurately calculating setup errors is crucial in ensuring quality assurance for patients undergoing radiation therapy treatment. This cross-sectional study aimed to determine the systematic, random, and planning target volume (PTV) margin errors for patients with head and neck cancer (n=48) and breast cancer (n=50). The treatment setup was performed using electronic portal imaging (EPIDs) and irradiated using Elekta linac. The errors were calculated using the van Herk formula. The systematic error for the head and neck was 0.89, 0.43, and 1.49 mm on the x, y, and z-axis, respectively, and 0.39, 0.74, 0.38 for the breast cases. The random error was 0.82, 0.68, 0.94 mm for the head and neck and 0.66, 0.72, 0.79 mm for the breast. The PTV margin shifting error for the head and neck were 2.79, 1.55, and 4.38 mm, while it was 1.43, 2.35, and 1.50 mm for the breast. The setup errors varied according to the tumor location. The study highlights the potential benefits of using EPIDs for reducing uncertainties in setup verification procedures. [ABSTRACT FROM AUTHOR]

Abstract Objective Besides angiotensin converting enzyme 2 (ACE2), an active involvement of proteases (FURIN and/or TMPRSS2) is important for cellular entry of SARS‐CoV‐2. Therefore, a simultaneous expression profiling of entry proteins in a tissue might provide a better risk assessment of SARS‐CoV‐2 infection as compared to individual proteins. In an attempt to understand the relative susceptibility of oral squamous cell carcinoma (OSCC) lesions as compared to the normal oral mucosa (NOM) for SARS‐CoV‐2 attachment/entry, this study examined the mRNA and protein expression profiles of ACE2, FURIN, and TMPRSS2 in the corresponding tissues using public transcriptomic and proteomics datasets. Methods and methods Public transcriptomic and proteomics datasets (the Cancer Genome Atlas (TCGA)/the Genotype‐Tissue Expression (GTEx), the Human Protein Atlas (HPA), and two independent microarray datasets) were used to examine the expression profiles of ACE2, TMPRSS2 and FURIN in NOM and OSCC. Results ACE2, TMPRSS2, and FURIN mRNAs were detected in NOM, however, at lower levels as compared to other body tissues. Except for moderate up‐regulation of FURIN, expression levels of ACE2 and TMPRSS2 mRNA were unchanged/down‐regulated in OSCC as compared to the NOM. Conclusions These results indicate that NOM may serve as a possible site for SARS‐CoV‐2 attachment, however, to a lesser extent as compared to organs with higher expression levels of the SARS‐CoV‐2 entry proteins. However, the evidence is lacking to suggest that expression status of entry proteins predisposes OSCC lesions to additional risk for SARS‐CoV‐2 attachment/entry as compared to NOM.

Background: Advanced head and neck squamous cell carcinoma (HNSCC) is associated with a poor prognosis, and biomarkers that predict response to treatment are highly desirable. The primary aim was to predict progression-free survival (PFS) with a multivariate risk prediction model. Methods: Experimental covariates were derived from blood samples of 56 HNSCC patients which were prospectively obtained within a Phase 2 clinical trial (NCT02633800) at baseline and after the first treatment cycle of combined platinum-based chemotherapy with cetuximab treatment. Clinical and experimental covariates were selected by Bayesian multivariate regression to form risk scores to predict PFS. Results: A ‘baseline’ and a ‘combined’ risk prediction model were generated, each of which featuring clinical and experimental covariates. The baseline risk signature has three covariates and was strongly driven by baseline percentage of CD33+CD14+HLADRhigh monocytes. The combined signature has six covariates, also featuring baseline CD33+CD14+HLADRhigh monocytes but is strongly driven by on-treatment relative change of CD8+ central memory T cells percentages. The combined model has a higher predictive power than the baseline model and was successfully validated to predict therapeutic response in an independent cohort of nine patients from an additional Phase 2 trial (NCT03494322) assessing the addition of avelumab to cetuximab treatment in HNSCC. We identified tissue counterparts for the immune cells driving the models, using imaging mass cytometry, that specifically colocalized at the tissue level and correlated with outcome. Conclusions: This immune-based combined multimodality signature, obtained through longitudinal peripheral blood monitoring and validated in an independent cohort, presents a novel means of predicting response early on during the treatment course. Funding: Daiichi Sankyo Inc, Cancer Research UK, EU IMI2 IMMUCAN, UK Medical Research Council, European Research Council (335326), Merck Serono. Cancer Research Institute, National Institute for Health Research, Guy’s and St Thomas’ NHS Foundation Trust and The Institute of Cancer Research. Clinical trial number: NCT02633800.

Background: Neck mass is one of the most common clinical findings in all age groups. Differential diagnosis of masses includes a range of pathologies from congenital to infectious or neoplasm. Understanding the risk factors of neck masses can help us to assess them properly. The purpose of this study is to obtain the epidemiological and clinical features of different neck masses in Kerman, Iran. Methods: This research was a descriptive, retrospective and cross-sectional study. 120 Patients that have been biopsied from neck masses during March 2014 to March 2018 in the otorhinolaryngology department of Shafa hospital of Kerman (referral center of otorhinolaryngology disease of southeastern Iran), were the participants of the study. Data regarding age, sex, history of addiction, smoking and definite pathologic diagnosis were collected and analyzed with SPSS 20th version. Results: Of 120 cases, 57.5 % were male and 42.5% were female. In the malignant masses group, the male to female ratio was 4.1 to 1. The average age of patients was 39.44 years old. From them, 20.83 percent had a history of smoking but 79.17 percent had never experienced smoking. In addition, 77.5% of the patients have not experienced opium consumption and 22.5% were addicted to opium regularly. There was a significant relationship between smoking and opium consumption and the incidence of malignant cervical masses (P

Considering that India's middle class is not far above the International Poverty line and illness makes our population vulnerable to fall back into poverty. There is a pressing need to identify cost effective palliative chemotherapy medicines for the common man in India and apply the principles of pharmacoeconomics as an important priority in deciding the palliative chemotherapy medicines for the cancer patients. Pharmacoeconomics identifies and compares the costs and consequences of drug therapy to healthcare systems and society. This review article aims at compiling the current data available on the pharmacoeconomically cost effective palliative chemotherapy available for head and neck cancers and is meant to highlight important palliative chemotherapy medicines in head and neck cancers, comparing its cost and improvement in Quality of Life (QOL), TWIST (Time Without Symptoms or Toxicities) score/symptom control, Response Rate, survival advantage to overall guide the decisions of patient and their families in a ethically justified manner. [ABSTRACT FROM AUTHOR]

Background: No clear chemotherapy regimen for recurrent or metastatic parotid cancer exists. We describe our experience with pembrolizumab to treat recurrent or metastatic parotid cancer. Case Report: A 73-year-old woman with swelling in the lower part of the right ear for 10 years before surgery was diagnosed with right parotid cancer, underwent total right parotidectomy, and reported recurrence. She requested treatment due to diminished quality of life caused by neurological symptoms. Tissue was collected from the recurrent lesion and its combined positive score was >20; pembrolizumab was started 9 years postoperatively. Results: To date, the patient has received 14 cycles of pembrolizumab. Evaluation by computed tomography showed a partial response to treatment. The only immune-related adverse event was grade 1 pneumonia in both lungs. Conclusion: Significant response to pembrolizumab in recurrent or metastatic parotid cancer is rarely reported, making this a remarkable case. We plan to continue pembrolizumab administration. [ABSTRACT FROM AUTHOR]

Objective: Besides angiotensin converting enzyme 2 (ACE2), an active involvement of proteases (FURIN and/or TMPRSS2) is important for cellular entry of SARS‐CoV‐2. Therefore, a simultaneous expression profiling of entry proteins in a tissue might provide a better risk assessment of SARS‐CoV‐2 infection as compared to individual proteins. In an attempt to understand the relative susceptibility of oral squamous cell carcinoma (OSCC) lesions as compared to the normal oral mucosa (NOM) for SARS‐CoV‐2 attachment/entry, this study examined the mRNA and protein expression profiles of ACE2, FURIN, and TMPRSS2 in the corresponding tissues using public transcriptomic and proteomics datasets. Methods and methods: Public transcriptomic and proteomics datasets (the Cancer Genome Atlas (TCGA)/the Genotype‐Tissue Expression (GTEx), the Human Protein Atlas (HPA), and two independent microarray datasets) were used to examine the expression profiles of ACE2, TMPRSS2 and FURIN in NOM and OSCC. Results: ACE2, TMPRSS2, and FURIN mRNAs were detected in NOM, however, at lower levels as compared to other body tissues. Except for moderate up‐regulation of FURIN, expression levels of ACE2 and TMPRSS2 mRNA were unchanged/down‐regulated in OSCC as compared to the NOM. Conclusions: These results indicate that NOM may serve as a possible site for SARS‐CoV‐2 attachment, however, to a lesser extent as compared to organs with higher expression levels of the SARS‐CoV‐2 entry proteins. However, the evidence is lacking to suggest that expression status of entry proteins predisposes OSCC lesions to additional risk for SARS‐CoV‐2 attachment/entry as compared to NOM. [ABSTRACT FROM AUTHOR]

Carotid sinus syncope due to head and neck cancer is uncommon and the management is challenging. Permanent pacemaker implantation is generally considered but malnutrition with subsequent chemo-radiation increases the risk of device infection. This is a first case report of the sequential use of aminophylline and theophylline for pharmacological temporization. (Level of Difficulty: Advanced.)

Background: Neck mass is one of the most common clinical findings in all age groups. Differential diagnosis of masses includes a range of pathologies from congenital to infectious or neoplasm. Understanding the risk factors of neck masses can help us to assess them properly. The purpose of this study is to obtain the epidemiological and clinical features of different neck masses in Kerman, Iran. Methods: This research was a descriptive, retrospective and cross-sectional study. 120 Patients that have been biopsied from neck masses during March 2014 to March 2018 in the otorhinolaryngology department of Shafa hospital of Kerman (referral center of otorhinolaryngology disease of southeastern Iran), were the participants of the study. Data regarding age, sex, history of addiction, smoking and definite pathologic diagnosis were collected and analyzed with SPSS 20th version. Results: Of 120 cases, 57.5 % were male and 42.5% were female. In the malignant masses group, the male to female ratio was 4.1 to 1. The average age of patients was 39.44 years old. From them, 20.83 percent had a history of smoking but 79.17 percent had never experienced smoking. In addition, 77.5% of the patients have not experienced opium consumption and 22.5% were addicted to opium regularly. There was a significant relationship between smoking and opium consumption and the incidence of malignant cervical masses (P<0.05). In the pathological study, inflammatory and infectious masses with 48.33 percent were in the head of pathology; malignant neoplasm with 25 percent, benign neoplasms with a prevalence of 12.5 percent and congenital masses with a prevalence of 9.7 percent were in the next ranks. Conclusion: In this study, we investigated the epidemiological and clinical features of neck masses in Kerman. It is obvious that smoking is an important risk factor for neck mass malignancies. Also, the present study revealed that the incidence of malignant tumors increased with age. [ABSTRACT FROM AUTHOR]

Head and neck tumors can affect afferent baroreceptor neurons and either interrupt or intermittently increase their signaling, causing blood pressure to become erratic. When the afferent fibers of the baroreflex are injured by surgery or radiotherapy or fail to develop as in familial dysautonomia, their sensory information is no longer present to regulate arterial blood pressure, resulting in afferent baroreflex failure. When the baroreflex afferents are abnormally activated, such as by paragangliomas in the neck, presumably by direct compression, they trigger acute hypotension and bradycardia and frequently syncope, by a mechanism similar to the carotid sinus syndrome. We describe our observations in a large series of 23 patients with afferent baroreflex dysfunction and the cardiovascular autonomic features that arise when the sensory baroreceptor neurons are injured or compressed. The management of afferent baroreceptor dysfunction is limited, but pharmacological strategies can mitigate blood pressure swings, improve symptoms, and may reduce hypertensive organ damage. Although rare, the prevalence of afferent baroreflex dysfunction appears to be increasing in middle-aged men due to human papillomavirus related oropharyngeal cancer. [ABSTRACT FROM AUTHOR]

Head and neck cancers are the most common cancers in the body. Treatments are determined on the basis of the location and stage of the primary tumor. The goal of treatment is to eliminate the tumor, prevent recurrence or metastasis, and maintain the quality of life. There are several treatments available for the management of head and neck cancers, including surgery, radiation therapy, chemotherapy, new molecular agents, and a combination of them. Transoral robotic technique is a short-time operation using a type of robotic machine in which the patient undergoes anesthesia for a shorter time and the side effects of this operation and the time of hospitalization are less than open surgery. Due to the importance of speed and accuracy in head and neck cancer surgery and the importance of application of robotics in surgery, the present study was designed and implemented to review the application of robotics in the management of head and neck cancers. In this review study, the keywords: application, robotic, surgical, head cancer, transoral robotic surgery (TORS), and neck cancer, were searched in ISI, PubMed, Scopus, Google scholar databases. Related articles written domestically or abroad that have covered areas such as the background of transoral robotic surgery, maintaining organ function and approaches, the advantages and disadvantages of TORS, the affordability of TORS, the combination of TORS with other therapeutic approaches published from 2003 to 2019 were reviewed. The use of robotic surgery for precise operations such as head and neck cancers seems to be essential. More advanced robotic devices are expected to expand the surgery treatment for head and neck cancers as well as the results of using TORS for oncologic optimization and acceptability of results while maintaining organ function and patient's quality of life.

State-of-art normal tissue complication probability (NTCP) models do not take into account more complex individual anatomical variations, which can be objectively quantitated and compared in radiomic analysis. The goal of this project was development of radiomic NTCP model for radiation-induced hypothyroidism (RIHT) using imaging biomarkers (radiomics). We gathered CT images and clinical data from 98 patients, who underwent intensity-modulated radiation therapy (IMRT) for head and neck cancers with a planned total dose of 70.0 Gy (33–35 fractions). During the 28-month (median) follow-up 27 patients (28%) developed RIHT. For each patient, we extracted 1316 radiomic features from original and transformed images using manually contoured thyroid masks. Creating models based on clinical, radiomic features or a combination thereof, we considered 3 variants of data preprocessing. Based on their performance metrics (sensitivity, specificity), we picked best models for each variant ((0.8, 0.96), (0.9, 0.93), (0.9, 0.89) variant-wise) and compared them with external NTCP models ((0.82, 0.88), (0.82, 0.88), (0.76, 0.91)). We showed that radiomic-based models did not outperform state-of-art NTCP models (p > 0.05). The potential benefit of radiomic-based approach is that it is dose-independent, and models can be used prior to treatment planning allowing faster selection of susceptible population.

Awake fiberoptic intubation (AFOI) is mandatory to manage difficult airways. Superior laryngeal nerve block (SLNB) could reduce risks and improve patient comfort. The aim of this study is to assess the procedural comfort of SLNB during AFOI in a population of patients undergoing upper airway oncological surgery. Forty patients were randomized into two groups and were treated with continuous infusion of remifentanil, topic anesthesia and intercricoid block. In the study group (=20), SLNB was performed with lidocaine (L-SLNB); in the control group (n=20) SLNB was performed using saline (S-SLNB). AFOI was more comfortable in the L-SLNB group compared to S-SLNB patients [FOICS ≤ 1 in 18 patients (90%) L-SLNB; 2 (10%) S-SLNB (P<0.001)]. Intubation was faster in L-SLNB (47.45 ±15.38 sec) than S-SLNB (80.15 ±37.91 sec) (p<0.001). The SLNB procedure during AFOI is a safe and comfortable procedure in a population of patients undergoing upper airways surgery. Time to intubation was shorter in L-SLNB than in S-SLNB. [ABSTRACT FROM AUTHOR]

Head and neck cancers are the most common cancers in the body. Treatments are determined on the basis of the location and stage of the primary tumor. The goal of treatment is to eliminate the tumor, prevent recurrence or metastasis, and maintain the quality of life. There are several treatments available for the management of head and neck cancers, including surgery, radiation therapy, chemotherapy, new molecular agents, and a combination of them. Transoral robotic technique is a short-time operation using a type of robotic machine in which the patient undergoes anesthesia for a shorter time and the side effects of this operation and the time of hospitalization are less than open surgery. Due to the importance of speed and accuracy in head and neck cancer surgery and the importance of application of robotics in surgery, the present study was designed and implemented to review the application of robotics in the management of head and neck cancers. In this review study, the keywords: application, robotic, surgical, head cancer, transoral robotic surgery (TORS), and neck cancer, were searched in ISI, PubMed, Scopus, Google scholar databases. Related articles written domestically or abroad that have covered areas such as the background of transoral robotic surgery, maintaining organ function and approaches, the advantages and disadvantages of TORS, the affordability of TORS, the combination of TORS with other therapeutic approaches published from 2003 to 2019 were reviewed. The use of robotic surgery for precise operations such as head and neck cancers seems to be essential. More advanced robotic devices are expected to expand the surgery treatment for head and neck cancers as well as the results of using TORS for oncologic optimization and acceptability of results while maintaining organ function and patient's quality of life. [ABSTRACT FROM AUTHOR]

Context: A significant number of patients with head-and-neck cancers have an incurable disease with limited life expectancy. The objective of the present study was to compare two different short courses of hypofractionated palliative radiotherapy regimens to evaluate symptoms, disease response, and acute toxicity. Materials and Methods: Previously untreated 50 patients of Stage IV B and IV C head and neck cancers were randomized to receive conventional hypofractionated palliative radiotherapy 30 Gy/10 fractions/2 weeks (control group) or Quad Shot regimen (study group) 14 Gy in 4 fractions given twice a day at least 6 h apart for 2 consecutive days. This regimen was repeated at 4 weekly intervals for a further two courses if there was no tumor progression. Results: Symptom relief was similar among the two schedules for pain (60.86 vs. 57.17), dysphagia (60.86 vs. 52.17%), and hoarseness (43.85 vs. 38.09%). Overall response (that is partial response and stable disease) was seen in majority (>70%) of the patients in both the groups. Treatment was very well tolerated with no patient experiencing more than Grade 3 toxicity in the control group and Grade 2 toxicity in the study group. Conclusions: Quad Shot regimen is an effective hypofractionated palliative radiotherapy schedule with minimal toxicity, good symptom relief, and response rate as compared to conventionally used regimen (30 Gy/10 fractions/2 weeks). [ABSTRACT FROM AUTHOR]