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Radiation may cause long-term splenic dysfunction, risking potentially fatal late sepsis. We aimed to review this complication's magnitude in paediatric radiotherapy and gauge the level of awareness of the spleen as an organ at risk. Clinical trial protocols and radiotherapy guidelines, patient/parent information sheets, and professional guidance documents were reviewed to assess the perceived risk of radiotherapy-related splenic dysfunction. Paediatric oncologists and paediatric radiation oncologists across Europe were surveyed to estimate the level of understanding of this risk and to ascertain current practice. Spleen doses received in practice were examined. A systematic review of relevant publications was undertaken. The risk is not mentioned in most clinical trials, patient information leaflets, or professional guidance documents. When mentioned, a threshold dose of 40 Gy is cited. The survey showed only limited awareness. More than half of patients assessed received spleen doses in excess of 10 Gy. The systematic review identified one paper reporting a relative mortality risk of 5.5 with spleen doses in the 10–20 Gy range. The risk of mortality from overwhelming infection is poorly recognised. We therefore recommend routine delineation of the spleen. Protocols and guidelines should give a spleen dose objective as low as reasonably achievable, ideally mean <10 Gy without compromise to target volumes. Revised evidence-based guidelines and continuing professional development activities should inform oncologists. Patient/parent information should mention the risk and the dose received be communicated to colleagues. Antibiotic prophylaxis and/or (re)vaccination should be considered if the mean spleen dose is ≥10 Gy. • Incidental irradiation may impair splenic function in children. • This may be associated with a late risk of death due to overwhelming sepsis. • We demonstrate that this risk is not always recognised. • We make recommendations to increase awareness of the risk. • We recommend ways to mitigate this risk. [ABSTRACT FROM AUTHOR]

Despite substantial improvements following the introduction of novel agents and antibodies, amyloid light‐chain (AL)‐amyloidosis still carries a grim prognosis. Here, we report on the case of a severely frail 86‐year‐old patient suffering from monoclonal gammopathy of renal significance (MGRS)‐associated AL‐amyloidosis with a diuretic‐refractory nephrotic syndrome. In this patient, treatment with bortezomib–dexamethasone effectively induced a serological response, but was unfortunately poorly tolerated and failed to promote renal recovery fast enough to prevent secondary complications. Facing ongoing nephrotic syndrome, we performed unilateral kidney embolization and observed a substantial improvement of hypoalbuminemia accompanied by a significant gain in overall quality of life despite the necessity for thrice weekly dialysis. It can be concluded that systemic drugs in MGRS typically do not lead to instantaneous organ recovery but may initially rather be associated with substantial treatment‐related morbidity. In this setting, unilateral renal artery embolization is effective to treat nephrotic syndrome and its secondary complications. The risk of potentially adverse effects, including post‐embolization syndrome, can be minimized by unilateral embolization, still noting that also one‐sided renal ablation has to be balanced against the requirement for life‐long renal replacement therapy. Prospective controlled trials in a more comprehensive cohort will be needed to estimate the overall benefit of kidney embolization relative to novel agent therapies in frail patients with MGRS‐related AL‐amyloidosis. [ABSTRACT FROM AUTHOR]

Background Transoral robotic surgery (TORS) has become an accepted first-line treatment for T1 and T2 head and neck squamous cell carcinoma (HNSCC). The growing popularity of this procedure is the result of mounting skepticism as to the survival and quality of life (QOL) benefits of primary chemoradiation over definitive surgery, the rising incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) in progressively younger patients, and the advantages of TORS over transoral laser microsurgery (TOLM) and open surgery. Methods The authors use their experience and data gained from the TORS-based management of >100 patients to establish a systematic approach to the use of TORS in HNSCC. Results This approach is constructed on a framework which goal is to select the primary treatment option that is most likely to reduce morbidity while preserving function and maintaining oncologic safety. Conclusion A consensus regarding the indications of TORS and its role in the multidisciplinary management of HNSCC is to be established. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2190-E2196, 2016 [ABSTRACT FROM AUTHOR]

Background This is a single-institution prospective study in a tertiary care center to evaluate feasibility, completeness of resection, and functional outcomes for oropharyngeal squamous cell carcinoma (SCC) treated primarily with transoral robotic-assisted resection. Methods Thirty-five patients with T1 and T2 squamous cell carcinoma of the oropharynx were included. They underwent transoral robotic surgery (TORS) between September 2011 and April 2013, with a median follow-up time of 13 months. Results Main outcome measures were completeness of resection, disease-free survival, and cancer recurrence for the preliminary oncologic outcome; postoperative bleeding, number of days intubated, rate of elective tracheotomy, duration of intensive care and/or intermediate care, speech and swallowing function, and length of nasogastric and/or gastrostomy tube dependency for the functional results. Conclusion Our 1-year (median) functional and early oncologic results of 35 patients with oropharyngeal cancer treated primarily with TORS are encouraging to continue gaining further experiences with this surgical modality on a select subgroup of patients. © 2014 Wiley Periodicals, Inc. Head Neck, 2014 © 2014 Wiley Periodicals, Inc. Head Neck 37: 1618-1624, 2015 [ABSTRACT FROM AUTHOR]

Over the past 5 years, transoral robotic surgery (TORS) has become well established as one of the standard treatment options for T1 and T2 oropharyngeal squamous cell carcinoma. Besides this main indication, TORS can provide with improved access to other subsites of the upper aerodigestive tract as well, such as the supraglottic larynx and the hypopharynx, with superior visibility and maneuverability to that of transoral laser microsurgery (TOLM). Since September 2011, over one hundred TORS procedures have been performed at our institution, predominantly for oropharyngeal cancer. As part of our first 50 transoral robotic cases making up our initial TORS-trial, five patients underwent TORS for early hypopharyngeal carcinoma. The present case series evaluates its feasibility, safety and the completeness of resection in this well-defined subgroup of patients. Main outcome measures were completeness of resection, the presence or lack of postoperative bleeding, number of days intubated, rate of elective tracheotomy, duration of intensive care and/or intermediate care, speech and swallowing function, and duration of nasogastric and/or gastrostomy tube dependency. All patients have been free of recurrence to date. One patient died of other disease. Four patients are alive and free of tumour, three of them did not need adjuvant therapy. Transoral robotic surgery with appropriate neck dissection is a valid primary treatment option for select early hypopharyngeal carcinoma, especially in cases that did not require adjuvant treatment. In contrast to TOLM, TORS allows a multi-planar en bloc resection in the hypopharynx which makes histopathological evaluation more reliable. In addition to this, its faster learning curve makes the results less dependent on the individual surgeons' capabilities. [ABSTRACT FROM AUTHOR]

In recent decades, the prognosis of Hodgkin lymphoma has been substantially improved, but these successes have been restricted to younger patients and could not be translated into a major benefit for older patients, especially those with advanced-stage disease. Major problems in treating older patients include a different biology, frailty, comorbidities, and poorer tolerance of therapy. Additionally, these patients are often excluded from randomized trials, so an evidence-based standard of care is lacking. Importantly, the proportion of older patients with HL will increase over the next 50 years. Currently, ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, and dacarbazine) is considered to be the gold standard, even though it has some toxicity in older patients and prospective data are not available. Thus, further studies are required, including the assessment of comorbidities and the incorporation of new drugs such as immunomodulatory agents, antibody-drug conjugates, mTOR inhibitors, or histone deacetylase (HDAC) inhibitors. [ABSTRACT FROM AUTHOR]

Background. Sentinel node biopsy (SNB) has been proposed for staging of N0 neck in oral/oropharyngeal carcinomas. It is claimed that SNB may be superior to selective neck dissection (SND) with respect to quality of life (QOL) and postoperative morbidity. Methods. Twenty-four patients after SNB and 25 patients after SND (levels I–III) were enrolled. QOL and psychosocial variables were assessed by the health-related EORTC QLQ-C30 questionnaire, the disease-specific EORTC QLQ-H&N35 module, the Hospital Anxiety and Depression Scale, and a fear of progression questionnaire. The functional status was evaluated by scores for cervical scar, extent of lymphedema (Miller score), sensory function, function of facial and hypoglossal nerve, cervical spine, and shoulder (Constant score). Results. Health-related QOL measurement revealed no differences between the 2 groups. Disease-specific QOL scores showed fewer swallowing problems in SNB patients (p = .043). SNB patients felt less fear of progression, experienced significantly less impairment from cervical scars, and had less sensory dysfunction and better shoulder function. Conclusion. Functional outcome after SNB is significantly better than after SND; however, this is not reflected in the scores of QOL questionnaires. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [ABSTRACT FROM AUTHOR]

Objective: Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients., Methods: We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients : age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups : Group A (surgical clipping), Group B (coil embolization), and Group C (observation only)., Results: Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate., Conclusion: Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients. In the treatment of patients more than 65 years old, age is not the limiting factor.