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Recurrent respiratory papillomatosis (RRP) is a currently incurable benign neoplasm caused by human papilloma virus (HPV) infection. It usually reduces voice, respiratory, and general quality of life, and is sometimes life-threatening. Patients usually need repeated operations. The use of adjuvant bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A, has been described in several case reports, with a good efficacy and safety profile. We report the cases of five patients with aggressive RRP who were treated with adjuvant systemic bevacizumab in a single Belgian tertiary center. A complete response was achieved in four patients after a median of 4.5 months, and a partial response in one. In all cases, the number of surgeries was drastically reduced, and quality of life improved. Toxicity was easily managed. Systemic bevacizumab seems to be an effective and safe adjuvant treatment for aggressive RRP.

Spasmodic dysphonia (SD) or laryngeal dystonia is as a rare vocal disorder characterized by involuntary action-induced endolaryngeal contraction. In the last decade, botulin toxin injection has become the standard treatment in adductor spasmodic dysphonia necessitating repetitive injections. The purpose of this study is to analyze retrospectively data from patients treated with the minimal-invasive transoral radiofrequency-induced thermotherapy (RFITT) of the terminal branches of the recurrent nerve. Between 2009 and 2015, 11 patients (six females and five males aged from 32 to 91 years) with adductor SD were treated with RFITT. Pre-operative and post-operative vocal assessments (VHI-30, GRBASI, and acoustic-aerodynamics measurements), number of surgical revisions, delay between procedures, and post-operative complications were recorded. Statistical analyses were carried out on the first vocal assessment performed 2-8 weeks after the first procedure. Based on available data from ten patients, voice handicap index (VHI) showed improvement with a mean value of -17.7 points (p-value (pval) = 0.014, adjusted p-value (adj pval) = 0.21); instability has also revealed improvement in six patients (pval = 0.05, adj pval = 0.31). Four patients underwent only one procedure including one patient showing still long-term beneficial results after 5 years of follow-up. Other patients required one to three new procedures with an average time between procedures of 15.3 months. Over 24 surgeries performed on a total of 11 patients, one definitive treatment-related severe adverse event was reported. Thanks to long-lasting effect, repetitive treatments are less frequent compared to botulin toxin therapy. In our opinion, RFITT is a promising alternative to botulin toxin as a second-step procedure in case of toxin resistance or patient's lack of compliance.

Transoral Robotic Surgery (TORS) is an emerging technique for the treatment of head and neck tumors. The aim of this paper is to describe our experience of perioperative considerations. Indeed, TORS is feasible, safe, and both oncologically and functionally effective. However, this technology has certain perioperative implications. We present the experience of anesthesiologists and surgeons over the past ten years with the Da Vinci Surgical System, and strongly recommend assigning a specific medical and paramedical team to shorten the learning curve and manage this innovative surgical technique with confidence and expertise.

Objective: Medialization thyroplasty using the Montgomery® Implant System (MTIS) is a surgical procedure for the treatment of persistent glottal gaps. In this study, we aimed to analyze postoperative vocal outcomes in patients suffering from unilateral vocal fold paralysis. Methods: A retrospective study was conducted on 30 patients undergoing MTIS medialization thyroplasty for unilateral vocal fold immobility. This series was selected from 68 patients operated on by the same technique between 2009 and 2018. Patients with missing data were excluded. The surgical procedure was performed under local anesthesia and sedation with peroperative fiberoptic examination. A complete vocal assessment was undertaken pre- and postoperatively, including perceptual, aerodynamic, and acoustic parameters and a questionnaire. Shortterm outcomes were analyzed. Results: Postoperative assessment was performed at a median of 33 days (range eight to 216). Absolute median maximum phonation time showed an increase of 4.10 seconds (p < 0.05), whereas the voice handicap index decreased by 36 points (p < 0.05). No significant differences were found between sexes. Conclusion: This retrospective study confirms the excellent immediate vocal results after medialization thyroplasty using MTIS. Further studies with prospective data are needed to evaluate the results according to sex of the patient.

In this study, we report a rare case of herpetic infection of the larynx with vagus nerve palsy. Herpes simplex virus (HSV) and varicella zoster virus (VZV) are among the most common viral causes of vagus nerve (VN) dysfunction. The clinical presentation of herpetic laryngitis is variable. The diagnosis is clinical and can be confirmed by serological test or better yet by a PCR. When HSV or VZV infection is suspected, it is mandatory to start the antiviral treatment rapidly, within 72 hours. The use of corticosteroids remains a controversial subject. The consequences of vagus nerve damage are not negligible in terms of quality of life and may cause multiple symptoms due to the anatomical distribution of the nerve. Once the diagnosis is confirmed, intensive voice and swallowing rehabilitation must be undertaken to limit the functional impact and quality of life degradation.

Background: Insufficient exposure may require termination of procedure in transoral robotic surgery (TORS). The aim of study was to develop a "Pharyngoscore" to quantify the risk of difficult oropharyngeal exposure (DOE) before TORS. Methods: Three-hundred six patients undergoing any surgical procedure at one Academic Hospital were prospectively enrolled. Oropharynx was exposed with Feyh-Kastenbauer retractor. Exposure was evaluated by direct and endoscopic visualization of the four oropharyngeal subsites. Preoperative clinical/anthropometric parameters were studied in good oropharyngeal exposure and DOE groups. Logistic regression was performed to explore association between clinical/anthropometric parameters and DOE. Statistically significant parameters at multivariate analysis were incorporated into a nomogram. Results: Sixty-five (21.2%) subjects were characterized by DOE. Variables associated with DOE at univariate analysis were male (p = 0.031), modified Mallampati Class (MMC) ≥ III (p < 0.001), smaller interincisor gap (p < 0.001), and larger neck circumference (p = 0.006). MMC, interincisor gap, and neck circumference were significant at multivariate analysis and were presented with a nomogram for creating the Pharyngoscore. Conclusions: The Pharyngoscore is a promising tool for calculating DOE probability before TORS.

Laryngeal transoral surgery classically requires a neuromuscular block (NMB) to facilitate tracheal intubation and to improve surgical conditions. However, the short duration of most procedures and the potential complications of residual NMB lead to consider a no block approach. The hypothesis that intravenous anesthesia (remifentanil and propofol infusions) without NMB but including glottis topical lidocaine anesthesia would allow clinically acceptable laryngeal exposure and good surgical conditions was tested in the specific context of procedures undergone with High Frequency Jet Ventilation (HFJV). A prospective randomized clinical comparison. 66 consenting patients were planned to receive 0.6 mg·kg rocuronium or saline at random. The outcome measurements included the time and conditions to complete suspended laryngoscopy, and the surgical conditions rated by the surgeon. Any vocal cord movement or coughing was recorded. Data were compared using a Wilcoxon rank-sum test for numerical variables and chi-square test for categorical ones. Treatment failure was defined as an impossible laryngoscopy or a grade 4 surgical field occurring at any time during surgery and was compared to its null theoretical value by a general z-test. An interim analysis after completion of 50% patients was performed using Pocock boundaries at 0.0294 significance levels. A significant failure rate occurred in the non paralysed group (27%, p < 0.001). No coughing and no vocal cords movement occurred in the NMB group. Poorer surgical conditions were obtained without NMB (p = 0.011). Inducing a deep NMB ensured improved conditions during direct laryngeal microsurgery with HFJV.

1.1. Purpose: As a result of increased life expectancy, the proportion of elderly patients with head and neck cancer is constantly rising. Transoral robotic surgery has been developed over the last ten years as a minimal invasive surgical procedure. The purpose of this study is to evaluate the place of this technique for elderly patients. 1.2. Methods & material: Study data related to elderly (age over 75 years) patients who underwent TORS between March 2008 and March 2018 were analyzed. 28 elderly patients were included; the different locations were 18 laryngeal (10 glottic and 8 supraglottic), 3 hypopharyngeal, 2 oral cavities and 5 oropharyngeal carcinoma respectively. 1.3. Results: 28 patients, 23 men and 5 women, with an average of 79 years old were successfully operated without external conversion. The 3-year Disease-Specific Survival (DSS) rate is 87.3% and the 3-year overall survival (OS) rate is 65,6%. Surgery was completed in a mean of 131 minutes (including exposure). All patients were extubated the same day (56%) or the day after the surgery (44%). Except for total laryngectomies, three patients (10.7%) received transient tracheostomies. Oral feeding was started after an average of 11 days after surgery. The hospitalization stay was 27 days on average. 1.4. Conclusions: Trans-oral Robotic surgery is a valuable technical option to address selected head and neck carcinoma in the elderly population. Early postoperative rehabilitation limits swallowing disorders and pulmonary complications. The surgical time is reduced compared to conventional open surgery which is a great advantage for this fragile population.

BACKGROUND: When a patient is seen with a newly diagnosed oropharyngeal squamous cell carcinoma, it remains unclear to the treating physicians how fast the tumor growth rate is. METHODS: From patients with oropharynx squamous cell carcinoma treated by radiotherapy, the investigators selected comparable diagnostic CT-scan (DiCT) and radiotherapy planning CT-scan (RtCT). Tumor and pathological lymph node volumes were measured in order to calculate tumor progression. RESULTS: From the selection of 19 patients, the mean absolute tumor progression rate was 0.23 ± 0.2 cm3 /d and mean relative progression rate was 1.84 ± 1.64%/d. Mean tumor doubling time is 286 days (range 7-1282 days), demonstrating a wide range of tumor growth pattern. Significant tumor progression (>20%) between DiCT and RtCT was shown in 73% of patients, and 53% of the patients were seen a tumor progression of >50% within a mean waiting time of 42.1 days. Kaplan-Meier curves showed a non-significative link between fast progression tumors (>1%/d) and higher risk of recurrence (HR: 2.2; P = .23). CONCLUSIONS: Tumor progression can be assessed based on DiCT and RtCT. Treatment delay should be avoided at all cost. Different growth patterns were evidenced. For the fast-growing tumors subgroup, pejorative clinical outcomes were suggested. Prospective studies are needed to confirm a link between fast-growing tumors and higher risk for recurrence.

The incidence of thyroid cancer has increased markedly in recent decades, but has been stable in terms of mortality rates. For the most part, these cancers are treated with surgery, which may or may not be followed by radioactive iodine depending on the tumor subtype. Still, many of these cancers will recur and may be treated with radioactive iodine or another surgery. It is unclear what treatment is best for cases of locally advanced or metastatic thyroid cancer that are refractory to radioactive iodine. Chemotherapy has a very low response rate. However, in the past few years, several systemic therapies, primarily targeted, have emerged to improve the overall survival of these patients. Alternative treatments are also of interest, namely peptide receptor radionuclide therapy or immunotherapy.

OBJECTIVE: The aim of this multicentric cross-sectional study was to examine the permanency of Montgomery thyroplasty (MTIS) results from a patient's perspective. DESIGN: The study consisted of collecting Voice Handicap Index (VHI-30) questionnaires from patients who had previously been operated with MTIS between 2 and 12 years before. Very long-term (>2 years) postoperative data were compared with the previously acquired preoperative and early postoperative VHI results. Influence of factors such as age, gender, size/side of the prosthesis and length of the follow-up were also analysed. SETTING: Multicentric study involving three tertiary European voice centres. PARTICIPANTS: Forty-nine unilateral vocal fold paralysis (UVFP) patients, treated by MTIS, were included in the study. MAIN OUTCOME MEASURES: The Voice Handicap Index-30 score. RESULTS & CONCLUSIONS: The median VHI was significantly different over time-points (Friedman's test P < .001), with a significant difference between preoperative and early postoperative time-points (median VHI: 70 vs 21, respectively; P < .001) and between preoperative and very long-term postoperative time-points (median VHI: 70 vs 16, respectively; P < .001). The median VHI did not differ for the early and very long-term postoperative time-points (median VHI: 21 vs 16; P = .470). Age differences, gender differences and size/side differences of the prostheses, centres where surgery took place and length of the follow-up showed no significant influence. Medialisation thyroplasty (MT) overall and MTIS, in particular, should be considered as a possible standard of care for UVFP when permanency of voice results is sought.

Transoral robotic surgery (TORS) in Head and Neck oncology is a recent technical option with continued refinements. The management of head and neck cancer is currently based on organ preservation strategy. Surgery when required can be a first-line or as part of a salvage surgery. It is performed by open neck approach or transorally. In the case of a transoral surgery, the contribution of the robot is outlined. In this article, we have reviewed the existing published data and based on our expertise provided to the reader the evidence about the role of TORS for head and neck cancer, current indications for this procedure, advantages, disadvantages future developments as well as the user’s expectations.

Head and neck surgery can be fraught with difficulties in accessing the pharynx and larynx. Minimally invasive surgery has developed with the recent advances in technology. Currently, we have a variety of high-definition multichannel videoendoscopes and robots in our armamentarium. We present our experience in a new robotic surgical system-'The Medrobotics Flex™ System' at our tertiary referral unit. We aimed to assess the safety, functionality and ease of use of this new device in this prospective study. Thus far, this is the first study in live human subjects who have undergone surgery for the following conditions: (1) obstructive sleep apnoea involving the base of tongue, the tonsil and the velum; (2) vocal fold polyp; (3) carcinoma of the lateral edge of the tongue. There were no complications in our series and the system provided good visualisation and access to these subsites without compromising safety or success. In summary, we found the Medrobotics Flex™ System to have certain other advantages including ease of set up and use besides being reliable and safe.

Over the past decade, the development of transoral robotic surgery (TORS) brought a new opportunity in the treatment of early T-stage oropharyngeal squamous cell carcinoma (OPSCC). The objective of this study is to review the functional outcomes after TORS. Indeed, dysphagia is among the most commonly cited functional impairments in OPSCC survivors treated by surgeries with an open approach or conventional radiotherapy. We performed a review of the literature and analysed functional outcomes after TORS. Althought the technique is very recent, early functional and oncologic outcome data are promising and the major studies analysing these parameters support that TORS is feasible and safe as well as oncologically and functionally efficacious.

Intuitive Surgical Inc. (Sunnyvale, Ca, USA) extended the use of the da Vinci robot to head and neck surgery in 2005 following the previous use in urological, gynecological and cardiothoracic surgery. It then gained wide popularity throughout the globe. Our aim is to describe the da Vinci Robot System and discuss its applications in head and neck surgery. Continued refinements and applications in robotic surgery for otolaryngology will in time be possible as new robotic procedures are developed for endolaryngeal work.

Recurrent respiratory papillomatosis is a viral-induced disease, associated with exophytic epithelial lesions affecting the upper airways. Problem of treatment is the high recurrence of papilloma growth after surgical removal; therefore, adjuvant therapy schemes have been established. We used cidofovir, 7.5 mg/ml, in adjuvant therapy in the past years. Out of 31 adult patients treated with the drug, 26 (83.9 %) are at the moment in complete response. 19 (73 % of pts with CR) of those 26 patients were cured with a number of injections between 1 and 4 (mean 2.5). We did not see any clinical manifestation of renal toxicity or neutropenia (superinfection) necessitating a blood test. Six patients presented dysplasia during the treatment with the drug, while six patients had dysplasia prior to cidofovir injection. Due to recurrent nature of the disease and the high number of mechanical and laser surgeries required we treated one tracheal stenosis, two scarred larynx, and two glottic synechiaes. There is still an ongoing discussion within the European Laryngological Society about the effectiveness and possible side effects of this drug. Results show promising long-term effects of adjuvant use of cidofovir, without any relevant side effects.

OBJECTIVES/HYPOTHESIS: To describe a single center outcomes following transoral robotic surgery for supraglottic laryngectomy (TORS-SL). STUDY DESIGN: Prospective data collection. METHODS: Patient records receiving TORS-SL for squamous cell carcinoma (SCCA) with at least 12 months follow-up fit inclusion for this study. Two patients with previous SCCA were excluded. RESULTS: 18 patients (14 male, 4 female) were included in the study, having a mean follow-up time of 28.1 months (SD = 12.1). All patients had negative margins confirmed on final pathology. Nine (50%) patients received postoperative chemoradiation therapy for advanced neck disease. No (0%) patients received tracheostomy or gastrostomy tubes. There were no (0%) local recurrences, and three (16.7%) regional recurrences. Five (27.8%) patients experienced temporary postoperative complications. Overall 2-year outcomes reached 83%, 100%, and 89% for locoregional control, disease-specific survival, and overall survival respectively. CONCLUSIONS: Initial outcomes for TORS-SL are encouraging and are comparable to previously described treatment modalities. Larger studies are encouraged.

Fourteen dysphonic patients who had previously undergone total or extended cordectomy underwent medialization thyroplasty. A minimum delay of 6 months was respected to allow the spontaneous "neocord" formation, to evaluate the voice recovery achieved by speech therapy alone and to avoid an undiagnosed early recurrence. Surgery was performed under general anaesthesia, using a laryngeal mask, because undermining the fibrous tissue at the inner side of the thyroid ala is a prolonged and difficult procedure. This step was essential to ensure an easy placement of the implant and to avoid tearing the fibrous tissue, with subsequent risk of implant extrusion. Visual control of the implant implementation was obtained by flexible videoendoscopy. The Montgomery(®) implant system (Boston, Westborough, MA) was used for the majority of the cases. Hand-made modified Montgomery implants or Gore-tex(®) were used in case of extended scarring or peculiar anatomic defect. The voice assessment showed a decrease of the VHI score from 50.5 to 39.4; a decrease of G from 2.4 to 2; an increase of maximum phonation time (MPT) from 6.2 to 7.3 s; a decrease of the maximum fundamental frequency (Fo-high) from 338.7 to 242.4 Hz and a decrease of the phonation quotient from 1,144.9 to 544.9 ml/s. The lower intensity (I-low) remained unchanged, from 60 to 58 dB. Statistically significant improvement was noted only for VHI and G grading. A decrease of the voice efforts and fatigue were noticed by all the patients.

Dysphagia is a common problem encountered among old persons, especially in nursing homes or during hospitalizations. Swallowing disorders have a potential negative clinical impact on the health status and quality of life of this population. However, dysphagia often remains under-diagnosed leading to a delay in implementing preventive measures. The aim of this article is to provide geriatric caregivers with information to better recognize this clinical sign, and to improve their knowledge about age-related physiological changes of swallowing, and required preventive measures. This article is a summary of a meeting organized at the teaching hospital CHU Mont-Godinne-Dinant, UCL, Belgium, the 15th May 2012 on swallowing disorders among old persons.

BACKGROUND: The purpose of this study was to investigate the value of p53 functional analysis of separated alleles in yeast (FASAY) as a witness of p53/p21 pathway alteration in head and neck squamous cell carcinoma (HNSCC). METHODS: The p53 transcriptional activity was prospectively analyzed in 82 newly diagnosed patients with HNSCC. FASAY and p53 immunostaining were carried out on paired tumoral and histologically normal tissues. The predictive value of FASAY for locoregional recurrence was assessed by Cox survival analysis. RESULTS: Loss of p53/p21 transcriptional activity was encountered in 88% tumoral and 18% histologically normal samples, associated with mutations (79%) and insertions/deletions (21%). The p53 overexpression underestimated p53 transcriptional abnormalities. FASAY-positive histologically normal mucosa was significantly associated with locoregional recurrence. CONCLUSION: FASAY positivity indicates field cancerization in a subgroup of patients with HNSCC, in which nonfunctional p53 was significantly associated with locoregional recurrence. This prompted us to pursue the study on the p53 functional status of normal mucosa in patients with HNSCC. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.

Head and Neck Squamous Cell Carcinoma (HNSCC) is a complex disease arising in various localisations of the upper aerodigestive tract, caused by tobacco and alcohol consumption or by high-risk types of human papillomavirus. These tumors often develop within pre-neoplastic fields of genetically altered cells that often extend out of the clinically and macroscopically involved area where the focus of treatment is. This phenomenon is a major cause of locoregional recurrences or second primary tumors and subsequently of poor survival improvement in HNSCC patients. Among the numerous genetic alterations found in HNSCC carcinogenesis, mutations of TP53 tumor suppressor gene were found to be one of the earliest and the most significant events of invasive cancer development. TP53 gene encodes the p53 protein that plays a crucial role in apoptosis and cell cycle control, making it a plausible predictive biomarker for HNSCC survival. The purpose of the study was to investigate the field cancerization through the analysis of p53 functionality on both tumoral and histologically normal tissue distant from the tumor. As expected, alteration of p53 functionality was encountered in 88% of tumoral samples. More interestingly, the loss of p53 transcriptional activity was detected in 18% of distant histologically normal samples and was significantly associated with loco-regional recurrences. We demonstrated that FASAY positivity indicates field cancerization in a subgroup of patients with HNSCC. These findings prompted us to pursue the study on p53 functional status of normal mucosa in patients with HNSCC in a homogeneous cohort of patients with oropharyngeal squamous cell carcinoma, stratified for HPV status, obtained by multicentric study. In order to avoid underestimation of the FASAY positive rate in histologically normal surrounding mucosa, we developed a non-invasive collection method allowing the study of a wider mucosal surface. While this sample collection method deals with sc, (MED 3) -- UCL, 2012

Anterior glottic webs are most frequently acquired and result in a major vocal handicap. Many treatment modalities have been reported in the literature. None of them achieves perfect morphological or functional results. We present our series treated by an endoscopic technique based on CO 2 laser section of the web, mitomycin application and placement of a temporary silastic stent. We retrospectively reviewed the charts of 18 consecutive patients with anterior webs treated at our university hospital between 2003 and 2010. The endoscopic technique consisted of the section of the web with the CO 2 Acublade system, immediate application of mitomycin C and placement of a silastic stent. No tracheostomy was required. The stent was removed 3 weeks later. Patients had a vocal evaluation pre and postoperatively. It consisted of a video-stroboscopic examination, the global score of the Voice Handicap Index, the global and roughness scores of the perceptive voice evaluation according to Hirano, acoustic and aerodynamic parameters. Eighteen patients were included in the study with a mean age of 46 years (min. = 5, max. = 76). Twenty-two percent were women. All patients had postoperative speech therapy. The mean follow-up is 48.4 months (3-87 months). At the last follow-up, none of the patients had recurrence of the laryngeal web. The grade G of dysphonia signiWcantly decreased from 2 to 1 (p = 0.035). CO 2 laser resection of anterior webs with mitomycin C application and placement of a silastic stent for 3 weeks induces a good morphological result with absence of web reformation but without substantial voice improvement observed in our series. © Springer-Verlag 2012.

Hereditary angioedema (HAE) is a rare genetic disorder causing a deficiency in C1 esterase inhibitor (C1-INH) that is manifested through unpredictable oedema. We describe a case of a patient with HAE who had previously been refused surgery for tonsillitis due to the potential for oedema, in whom regular monitoring of C1-INH levels combined with intensified therapy with danazol, tranexamic acid and C1-INH concentrate enabled an uncomplicated procedure with no oedema crisis. However, clinicians should be alerted that higher overall dosages of C1-INH concentrate for perioperative prophylaxis may be required than those typically used to treat acute HAE attacks.

BACKGROUND: This study compared automated vs. manual tissue grinding in terms of RNA yield obtained from oral mucosa biopsies. METHODS: A total of 20 patients undergoing uvulectomy for sleep-related disorders and 10 patients undergoing biopsy for head and neck squamous cell carcinoma were enrolled in the study. Samples were collected, snap-frozen in liquid nitrogen, and divided into two parts of similar weight. Sample grinding was performed on one sample from each pair, either manually or using an automated cell disruptor. The performance and efficacy of each homogenization approach was compared in terms of total RNA yield (spectrophotometry, fluorometry), mRNA quantity [densitometry of specific TP53 amplicons and TP53 quantitative reverse-transcribed real-time PCR (qRT-PCR)], and mRNA quality (functional analysis of separated alleles in yeast). RESULTS: Although spectrophotometry and fluorometry results were comparable for both homogenization methods, TP53 expression values obtained by amplicon densitometry and qRT-PCR were significantly and consistently better after automated homogenization (p<0.005) for both uvula and tumor samples. Functional analysis of separated alleles in yeast results was better with the automated technique for tumor samples. CONCLUSIONS: Automated tissue homogenization appears to be a versatile, quick, and reliable method of cell disruption and is especially useful in the case of small malignant samples, which show unreliable results when processed by manual homogenization.

Purpose: Head and neck squamous cell carcinoma (HNSCC) account for 8% of newly diagnosed cancers in adults worldwide. Despite advances in therapeutic approach, locoregional recurrences and 5-years survival of patients with locally advanced HNSCC is still about 60%. To substantially improve the response and survival rates, combined radiotherapy and adjuvant chemotherapy, among which the association docetaxel, cisplatin and fluorouracil, is increasingly used. While improved survival is observed in cases of unresectable HNSCC, contradictory data regarding the combination taxane-radiotherapy has been reported. Accordingly, the cellular and molecular mechanisms induced by the combination taxane-radiotherapy versus taxane alone or radiotherapy alone were assessed in vitro and compared according to the functional p53 status. Methods: Human papillomavirus-free HNSCC cell lines expressing nonfunctional mutated (SC179, SCC61) and functional wild-type p53 (HN30) were grown either in presence of increasing concentration of docetaxel, exposed to graded doses of radiation up to 10 Gy, or to both treatment modalities. Cell death was monitored by using an apoptotic assay (caspase-3 activation) and clonogenic assay (cell-surviving fraction assessed after 15 days incubation). Modulation of gene expression was evaluated by microarray analysis on low density arrays (DualChip Human General; Eppendorf Array Technologies). These low-density chips are indeed designed to specifically investigate some of the most common gene pathways involved in the regulation of cell cycle, apoptosis, and cell proliferation. Results: Regarding the radiosensitivity, the surviving fraction at 2 Gy (SF2) was calculated as the ratio of the plating efficiencies in treated to untreated cells. As expected, radiosensitivity was higher in HN30 (SF2: 3%) compared to the other p53-mutated cell lines (SF2: 16 and 36% for SCC61 and SC179, respectively). Conversely, the p53 status did not influence the sensitivity to doc

BACKGROUND: The aim of the present study was to compare RNALater with the usual method of liquid nitrogen snap freezing as a surrogate mRNA preservation method for functional analysis of separated alleles in yeast (FASAY). METHODS: A total of 81 patients with transitional cell carcinoma of the bladder underwent fresh tissue biopsies directly transferred into RNALater and stored at room temperature or at 4 degrees C for increasing time intervals until RNA processing. From this cohort of patients, 53 paired snap-frozen and RNALater preservative-suspended tissues were obtained. Samples immediately frozen in liquid nitrogen were further stored at -80 degrees C. RESULTS: Of the 81 RNALater samples, 14 were not processed for FASAY because of RNA degradation. Of the remaining 67 samples, 15 (22%) were FASAY-positive. Identical FASAY results were found for 50 of 53 (94.4%) paired samples and the percentage of red yeast colonies was highly correlated (Cohen's kappa<0.82; p<0.00001). A single p53 missense mutation was found in each of the three discordant positive FASAY and was identical in each concordant positive sample (10/53). Storing samples in RNALater at room temperature for 3 days and at 4 degrees C for less than 1 month provided high-quality mRNA suitable for FASAY. CONCLUSIONS: Our results demonstrate that RNALater is a suitable and flexible alternative to snap freezing for FASAY analysis.

Soft tissue has been recently recognized as a primary site for myoepithelial tumour and only a small number has been reported to occur in the head and neck. Although the majority of myoepithelial tumours of the soft tissue are benign, some can be aggressive and develop distant metastases. We describe a patient with malignant myoepithelial tumour occurring in the soft tissue of the head and neck and rapid metastatic progression. In contrast to previous publications warning for overtreatment of patients with myoepithelial tumours, our report suggests that early and correct diagnosis followed by a radical therapeutic approach is required when there is evidence of malignancy.