Impact of the COVID-19 Pandemic on Brazilian Head and Neck Surgery Centers

Abstract 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.

“MaRhyThe© and cupping” – A novel multimodal approach for radiation-induced trismus

Head-and-neck cancer is the fifth most frequently occurring cancer in India. Among the various treatment options, side effects such as trismus are mostly caused due to radiation therapy. Physical therapy is known to be beneficial in treating post-cancer treatment side effects. To the best of our knowledge, this is the first study report highlighting the efficacy of MaRhyThe© in treating radiation induced trismus. A multimodal approach (MaRhyThe©, Cupping therapy, Myofascial Release, and exercises) has shown to be beneficial in treating trismus, shoulder disability, pain, muscle spasm, and improving the quality of life in the head-and-neck cancer patient.

Oral complications of head and neck radiotherapy: the importance of the dental surgeon / Complicações orais da radioterapia de cabeça e pescoço: a importância do cirurgião-dentista

ABSTRACT Objective: radiotherapy can lead to different adverse effects in the oral epithelial cells. This article aimed to address the main oral manifestations associated with radiotherapy of head and neck neoplasms, highlighting the importance of the dental practitioners' participation within the skilled multidisciplinary personnel to treatment. Methods: Research was conducted in the PubMed, Lilacs, SciELO, and Google Scholar databases using the keywords "head and neck radiotherapy", "oral manifestations'', and "head and neck neoplasm". Eighteen out of 533 articles published between 2015 and 2022 were selected after duplicates removal and eligibility criteria application. Results: xerostomia, hyposalivation, trismus, dysgeusia, dysphagia, dentin hypersensitivity, fungal and viral infections, radiation caries, osteoradionecrosis, mucositis, periodontal alterations, and tooth development abnormalities were the most frequently reported oral effects of radiotherapy. Conclusions: The participation of dentists in the multidisciplinary team that treats patients with head and neck cancers is fundamental since several oral complications of radiotherapy are observed. Dentists can prevent, reduce and treat some detrimental effects whether the patient is followed-up since the beginning of radiotherapy.

RESUMO Objetivo: A radioterapia pode levar a diferentes efeitos adversos nas células epiteliais orais. Este artigo teve como objetivo abordar as principais manifestações bucais associadas à radioterapia de neoplasias de cabeça e pescoço, destacando a importância da participação do cirurgião-dentista na equipe multidisciplinar apta ao tratamento. Métodos: foi realizada uma busca nas bases de dados PubMed, Lilacs, SciELO e Google Acadêmico utilizando as palavras-chave "radioterapia cabeça e pescoço", "manifestações orais" e "neoplasma de cabeça e pescoço". Dezoito dos 533 artigos publicados entre 2015 e 2022 foram selecionados após a remoção das duplicatas e aplicação dos critérios de elegibilidade. Resultado: xerostomia, hipossalivação, trismo, disgeusia, disfagia, hipersensibilidade dentinária, infecções fúngicas e virais, cárie de radiação, osteorradionecrose, mucosite, alterações periodontais, e anormalidades do desenvolvimento dentário foram os efeitos orais da radioterapia mais relatados. Conclusão: A participação dos dentistas na equipe multidisciplinar que atende pacientes com câncer de cabeça e pescoço é fundamental, pois são observadas diversas complicações bucais da radioterapia. Os dentistas podem prevenir, reduzir e tratar alguns efeitos deletérios se o paciente for acompanhado desde o início da radioterapia.

Análisis de tiroglobulina preablativa y cáncer diferenciado de tiroides preoperatorio / Analysis of pre-ablative and preoperative thyroglobulin in differentiated thyroid cancer

BACKGROUND: The measurement of plasma thyroglobulin (Tg) is widely used in the monitoring of differentiated thyroid cancer (CDT). In recent years, its value as a prognostic marker prior to ablation with radioiodine has increased, demonstrating its high negative predictive value. Recent studies indicate that a wide variety of factors could potentially influence pre-ablative Tg values, including residual tumor burden and stimulation modality. Aim: To relate the value of pre-ablative Tg with the amount of preoperative disease burden, lymph node metastases, treatment, and presence of residual disease. MATERIAL AND METHODS: Retrospective observational study of 70 patients with CDT treated between 2012 and 2018. The amount of disease burden was defined as the sum of largest diameter of individual tumors in each patient, and as the individually largest tumor per patient and number of metastatic lymph nodes. RESULTS: A smaller tumor size and absence of remnant tissue was associated with lower Tg values, although the association was not always significant. Furthermore, no significant difference was found between Tg levels measured within or more than 14 days after the surgical procedure. Thus, an early measurement of pTg after surgery would allow an initial therapeutic decision making. Conclusions: A statistical association between pre-ablative Tg levels and the amount of preoperative tumor tissue burden was found in some subgroups of patients.

Qualidade de vida relacionada à deglutição em pacientes com câncer de cabeça e pescoço / Quality of life related to swallowing in patients with head and neck cancer / Calidad de vida relacionada con la deglución en pacientes con cáncer de cabeza y cuello

Introdução: No câncer de cabeça e pescoço (CCP), as sequelas relacionadas aos tratamentos e à própria localização do tumor podem trazer alterações físicas e funcionais, com impacto na qualidade de vida (QV) destes pacientes. Objetivo: mensurar o impacto do câncer de boca sobre a qualidade de vida relacionada à deglutição e saúde bucal em pacientes com câncer de cabeça e pescoço, após tratamento médico com radioterapia e/ou cirurgia. Métodos: participaram do estudo dez pacientes em pós-tratamento médico para o CCP e que foram submetidos aos questionários de qualidade de vida M.D. Anderson Dysphagia Inventory (MDAD),Oral Health Impact Profile (OHIP-14) e Questionário de Qualidade de Vida da Universidade de Washington(UW-QOL). Resultados: Os resultados dos domínios emocional e funcional do protocolo MDADI demonstraram médias positivas, enquanto o domínio físico apresentou médias que demonstraram baixo funcionamento do dia-a-dia e qualidade de vida. A partir do questionário OHIP-14, verificou-se que 40% dos participantes foram classificados com alto índice de impacto na saúde bucal. As dimensões ''desconforto psicológico'' e ''deficiência'' impactam negativamente na QV dos pacientes. "Atividade'' e "saliva" foram os problemas mais relatados, mostrando que, ''saliva'', ''humor'' e ''mastigação'' foram os três domínios mais importantes na visão dos pacientes, verificado a partir do protocolo UW-QOL. Conclusão: Apesar do número reduzido de pacientes e da heterogeneidade de localização dos tumores, os resultados demonstram que o CCP e as sequelas de seu tratamento podem impactar de maneira significativa a QV dos pacientes em diversos domínios.

Introducción: En el cáncer de cabeza y cuello (CCC), las secuelas relacionadas con el tratamiento y la propia localización del tumor pueden traer cambios físicos y funcionales, con impacto en la calidad de vida (CV) de estos pacientes. Objetivo: medir el impacto del cáncer bucal en la calidad de vida relacionada con la deglución y la salud bucal en pacientes con cáncer de cabeza y cuello después del radioterapia y/o cirurgía. Metodos: participaron del estudio diez pacientes en postratamiento médico por cáncer de cabeza y cuello y fueron sometidos a cuestionarios de calidad de vida M.D. Anderson Dysphagia Inventory (MDADI), Oral Health Impact Profile (OHIP-14) y cuestionario de calidad de vida de la Universidad de Washington (UW-QOL). Resultados: Los resultados de los dominios emocional y funcional del protocolo MDADI mostraron medias positivas, mientras que el dominio físico mostró medias que evidenciaron bajo funcionamiento cotidiano y calidad de vida. Del cuestionario OHIP-14 se encontró que 40% de los participantes fueron clasificados como de alto impacto en la salud bucal. Las dimensiones "malestar psicológico" y "discapacidad" tienen un impacto negativo en la calidad de vida de los pacientes. "Actividad" y "saliva" fueron los problemas más reportados, mostrando que "saliva", "estado de ánimo" y "masticar" eran los tres dominios más importantes en la opinión de los pacientes verificado a partir del protocolo UW-QOL. Conclusión: A pesar del pequeño número de pacientes y la heterogeneidad de la localización del tumor, los resultados demuestran que el CCP y las secuelas de su tratamiento pueden impactar significativamente la calidad de vida de los pacientes en varios dominios.

Introduction: In head and neck cancer (HNC), the sequelae related to the treatment and the location of the tumor itself can bring physical and functional changes, with an impact on the quality of life (QoL) of these patients. Objective: measure the impact of oral cancer on quality of life related to swallowing and oral health in patients with head and neck cancer after radiotherapy and/or surgery. Methods: 10 patients participated on study in medical post-treatment for head and neck cancer and they were submitted the quality of life questions M.D. Anderson Dysphagia Inventory, Oral Health Impact Profile (OHIP-14) and University of Washington quality of life questionnaire (UW-QOL). Results: The results of the emotional and functional domains of the MDADI protocol showed positive means, while the physical domain showed low day-to-day functioning and quality of life means. From the OHIP-14 questionnaire, it was found that 40% of participants were hated with a high index of impact on oral health. The dimensions "psychological discomfort" and "deficiency" negatively impact on patients QOL. "Activity" and "spittle" were the problems most reported, showing that, "spittle", "humor" and "chewing" were the three most important domains on patient's view verified from the UW-QOL protocol. Conclusion: Despite the small number of patients and the heterogeneity of tumor location, the results demonstrate that the CCP and the sequelae of its treatment can significantly impact the QoL of patients in several domains.

Prospective study of apatinib combined with chemoradiotherapy for head and neck squamous cell carcinoma / 中华放射肿瘤学杂志

Objective:To evaluate the efficacy and safety of apatinib in combination with chemoradiotherapy for head and neck squamous cell carcinoma (HNSCC).Methods:37 patients orally received apatinib at 250 mg/d during concurrent chemoradiotherapy until completion of radiotherapy, complete remission assessed by imaging examination, the onset of unacceptable toxicity or death. Baseline characteristics, objective response rates (ORR) and adverse events were assessed in all enrolled patients with complete baseline and safety data. Progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method. Prognostic factors were statistically identified using Cox regression models.Results:The ORR was 85%(95% CI: 72%-98%). The median PFS was 17.9 months and the 2-year OS rate was 62%(95% CI: 48%-80%). Ineffective short-term efficacy ( HR=0.035, 995% CI: 0.02-0.652, P=0.025) was an independent risk factor for poor OS. In addition, ineffective short-term efficacy ( HR=0.104, 95% CI: 0.017-0.633, P=0.014) and lymphocytopenia ( HR=17.539, 95% CI: 2.040-150.779, P=0.009) were independent risk factors for poor PFS. Common adverse events (>60%) included lymphocytopenia (76%), leukopenia (68%) and irradiation-induced mucosal injury (65%). The most common treatment-associated grade 3 adverse event was lymphopenia (49%). Conclusions:Apatinib combined with chemoradiotherapy yield significant anti-tumor activity for HNSCC with controllable toxicity. For patients with advanced HNSCC, short-term efficacy and lymphocytopenia may be potential predictors for clinical efficacy of apatinib combined with chemoradiotherapy.

Clinical implementation of MR-Linac systems in adaptive radiation therapy for head and neck cancer / 中华放射肿瘤学杂志

Adaptive radiation therapy (ART) has been proposed as a method to account for changes in head and neck cancer and normal tissues to enhance the therapeutic ratios. Online magnetic resonance-guided radiotherapy (MRgRT) using hybrid MR-Linac systems is a novel innovative application in ART for head and neck cancer. The concept of MR-Linac systems is the ability to acquire MR images for ART and also online imaging during treatment delivery. Daily ART allows to improve the targeting accuracy while avoiding organs at risk for head and neck cancer. Although an increasing number of studies related to clinical application and technical aspect of MRgRT in head and neck cancer have been published, MRgRT for ART of head and neck cancer remains in its infancy. The purpose of this article is to summarize and discuss the rationale, clinical implementation, and prospect of this promising adaptive radiotherapy modality for treating head and neck cancer.

Dysregulation in the secretion of the stress-related catecholamines in oral cancer patients: predictors and prognostic value / Desregulação da secreção das catecolaminas relacionadas ao estresse em pacientes com câncer de boca: valor preditivo e prognóstico

Introdução: Pacientes com câncer podem apresentar uma hiperativação do Sistema Nervoso Simpático (SNS). Como consequência, uma desregulação na secreção das catecolaminas relacionadas ao estresse norepinefrina (NE) e epinefrina (EPI) têm sido implicadas na progressão de alguns tipos de tumores malignos. No entanto, a associação entre os níveis sistêmicos das catecolaminas e o prognóstico do câncer, bem como seus fatores preditores são pobremente conhecidos. Pacientes e métodos: O presente estudo investigou os níveis plasmáticos de NE e EPI em 168 pacientes com carcinoma espinocelular (CEC) de boca, 70 pacientes com leucoplasia bucal e 54 voluntários saudáveis; bem como sua associação com variáveis demográficas, clínicopatológicas, biocomportamentais e psicológicas nos pacientes oncológicos. Os níveis plasmáticos de NE e EPI foram medidos por cromatografia líquida de alta eficiência com detecção eletroquímica (CLAE-ED) e o estado psicológico de humor foi avaliado pela Escala de Humor de Brunel (BRUMS). Análise de Kaplan-Meier e regressão de Cox foram usadas para investigar as associações entre os níveis de NE e EPI e a sobrevida global e específica após 5 anos de follow-up em 82 pacientes com câncer de boca. Os níveis sistêmicos das catecolaminas também foram avaliados em 32 pacientes após o tratamento da doença e comparados com os níveis pré-tratamento. Resultados: As concentrações plasmáticas de NE e EPI foram significativamente maiores em pacientes com CEC de boca em comparação aos pacientes com leucoplasia bucal (p< 0,0001 e p=0,024, respectivamente). Os pacientes com CEC de boca também apresentaram níveis plasmáticos de NE mais elevados do que os voluntários saudáveis (p= 0,0002). As concentrações plasmáticas de NE nos pacientes com leucoplasia bucal foram menores do que os voluntários saudáveis (p= 0,032). Análises de regressão múltipla mostraram que níveis aumentados de NE foram significativamente associados com uma sensação de "sentir-se sem energia", um descritor medido pelo BRUMS (OR= 2,9; p= 0,023). Baixa escolaridade e ocorrência de comorbidades com maior severidade foram independentemente associados a altos níveis de EPI (OR= 4,0; p= 0,004 e OR= 7,2; p= 0,005; respectivamente). Além disso, a presença de um estado de humor de raiva e "não estar em alerta" foram associados a altos níveis plasmáticos de EPI (OR= 2,6; p= 0,039 e OR= 3,2; p= 0,010, respectivamente). Os resultados mostraram que os pacientes com CEC de boca não casados e que tinham pior renda familiar foram preditivos para menor sobrevida global dos pacientes com CEC de boca (p< 0,05). Estágio clínico avançado foi associado à diminuição da sobrevida global (HR= 5,2; p= 0,000) e específica do câncer (HR= 4,2; p= 0,000). A análise de regressão de Cox também evidenciou que níveis sistêmicos aumentados tanto de NE como de EPI foram associados à menor sobrevida global (HR= 3,4; p= 0,002 e HR= 2,8; p=0,006, respectivamente). Os pacientes com CEC de boca apresentaram níveis plasmático de NE mais baixos após o tratamento do câncer em comparação com a fase pré-tratamento (p= 0,0008). Conclusão: Os resultados do presente estudo mostram que pacientes com câncer de boca podem apresentar níveis sistêmicos elevados das catecolaminas norepinefrina e epinefrina, e que esta desregulação hormonal associada com fatores clinicopatológicos e psicológicos é preditiva para pior sobrevida global(AU)

Introduction: Cancer patients may have a hyperactivation of the Sympathetic Nervous System (SNS). Therefore, dysregulation in the secretion of the stress-related catecholamines norepinephrine (NE) and epinephrine (EPI) have been implicated in the progression of some types of cancer. However, the association between systemic levels of catecholamines and cancer prognosis, as well as its predictors, are poorly understood. Patients and methods: The present study investigated the plasma NE and EPI levels in 168 patients with oral squamous cell carcinoma (OSCC), 70 patients with oral leukoplakia and 54 healthy volunteers; as well as its association with demographic, clinicopathological, biobehavioral and psychological variables in cancer patients. Plasma NE and EPI levels were measured by high performance liquid chromatography with electrochemical detection (HPLC-ED) and psychological mood states was assessed by the Brunel Mood Scale (BRUMS). Kaplan-Meier analysis and Cox regression were used to investigate associations between the systemic levels of catecholamines and overall and specific survival after 5 years of follow-up in 82 patients with oral cancer. Systemic levels of catecholamines were also evaluated in 32 patients after oral cancer treatment and were compared with pre-treatment levels. Results: Plasma NE and EPI concentrations were significantly higher in patients with oral SCC compared to patients with oral leukoplakia (p<. 0001 and p=.024, respectively). Patients with oral SCC also displayed higher plasma NE levels than healthy volunteers (p=.0002). Patients with oral leukoplakia had lower plasma NE levels than healthy volunteers (p=.032). Multiple regression analyzes showed that increased NE levels were associated with a feeling of "no energy", a descriptor measured by BRUMS (OR= 2.9; p= .023). Low education and the occurrence of severe comorbidities were independently associated with high levels of EPI (OR= 4.0; p= .004 and OR= 7.2; p= .005; respectively). Furthermore, the presence of an angry mood state and denial of "being on alert" were associated with high EPI levels (OR= 2.6; p= .039 and OR= 3.2; p= .010, respectively). The results showed that nonmarried oral SCC patients and those who had a lower family income had lower overall survival in patients with oral SCC (p< 0.05). Advanced clinical stage was associated with decreased overall (HR=5.2; p=.000) and cancer-specific (HR=4.2; p=.000) survival. Cox regression analysis also showed that increased levels of both NE and EPI were associated with worse overall survival (HR=3.4; p=.002 and HR=2.8; p=.006, respectively). Patients with oral SCC had lower plasma NE levels after cancer treatment compared to the pre-treatment period (p=.0008). Conclusion: The results of the present study reveal that patients with oral cancer may have high systemic levels of the catecholamines norepinephrine and epinephrine, and that this hormonal dysregulation is associated with clinicopathological and psychological factors and predictive for worse overall survival(AU)

Construction of training system for first aid ability of nurses in Head and Neck Oncology Department / 中国实用护理杂志

Objective:To develop a training system for head and neck oncology nurses to improve the emergency response competency to recognize and response to acute and critical medical conditions.Methods:Based on literature review and semi-structured interviews with 12 nurses, two rounds of consultation with 15 head and neck cancer care specialists from 6 Tertiary hospitals using Delphi method were conducted to establish the training system for head and neck oncology nurses.Results:The authority coefficients of experts were 0.87 and 0.89, respectively. The coefficient of variation of each item ranged from 0 to 0.167. The coefficients of concordance ranged from 0.243 to 0.403 ( P<0.01). There was statistical significance after Chi-square test ( χ2 values were 14.60-436.64, all P<0.01). In the final training system, training aims included 5 first-level indicators and 16 second-level indicators; training contents included 5 first-level indicators, 16 second-level indicators, and 60 third-level indicators. Conclusions:The authority coefficients and the coefficients of concordance of the experts for the training system were both high. The training system can be applied to improve the emergency response competency of head and neck oncology nurses.

Non-ulcerated necrotizing sialometaplasia may mimic a salivary gland tumor

Necrotizing sialometaplasia (NS) is a benign, self-limiting inflammatory entity that mainly affects the minor salivary glands located in the hard palate. Classically, NS is characterized as a nodule that evolves to a central ulcer. The most widely recognized triggering factor is an ischemic event. The diagnosis becomes a challenge in non-ulcerated NS cases which is essential to rule out the possibility of salivary gland tumors, especially the malignant ones. Here, we presented a case of a 32-year-old male patient with a 1-month complaint of a painful, slightly elevated erythematous area on the hard palate. Incisional biopsy was performed, and NS was diagnosed based on histopathological and immunohistochemical analyses. Clinicians should be aware of and consider NS as a differential diagnosis of minor salivary gland tumors, particularly when it presents as a non-ulcerated clinical aspect.

Adenoma Pleomorfo de Parótida, Manejo Quirúrgico: A Propósito de un caso / Pleomorphic adenoma of the parotid gland, surgical management: a case report

INTRODUCCIÓN: El adenoma pleomorfo es el tumor benigno más común de las glándulas salivales y particularmente de la glándula parótida, la característica principal de este tumor benigno es su crecimiento lento, provocando la presencia notoria de una masa a nivel facial o cervical. Su tratamiento es quirúrgico y uno de los principales riesgos, es la posibilidad de parálisis facial posquirúrgica. Presentamos un caso, resuelto de forma quirúrgica mediante parotidectomía parcial, que conlleva la disección del nervio facial. CASO CLÍNICO: Se trató de una paciente de sexo femenino de 34 años de edad que acude para valoración por presentar masa de crecimiento lento en región parotídea derecha, negó asociación con dolor o parálisis facial. Luego de valoración tomográfica y por PAAF, se diagnosticó Adenoma Pleomorfo de parótida y se decidió parotidectomía parcial derecha. EVOLUCIÓN: Para el tratamiento quirúrgico se recurrió a la técnica descrita en la bibliografía con la variante en la incisión, se usó incisión modificada de Blair. Se logró extirpar la totalidad del tumor. Paciente en su postquirúrgico mediato, presentó parálisis facial, tratada con corticoides, fue dada de alta con una puntuación de House Brackmann CONCLUSIÓN: En concordancia con la bibliografía citada, el manejo adecuado de esta patología es netamente quirúrgico, la realización de parotidectomía en casos de tumoración de glándulas salivales es la única manera de evitar que la masa provoque lesiones a nivel de estructuras cercanas, como el nervio facial. Su correcta disección e identificación están dentro de los principales asuntos dentro del procedimiento.(au)

BACKGROUND: Pleomorphic adenoma is the most common benign tumor of the salivary glands, particularly of the parotid gland. The main characteristic of this benign tumor is its slow growth, causing the noticeable presence of facial or cervical mass. The treatment is surgery, with the main risk of postoperative facial paralysis. We present a case report, resolved surgically with a partial parotidectomy, which involves dissection of the facial nerve. CASE REPORTS: A 34 year old female patient, seeking medical attention due to a slow-growing mass in the right parotid region. Patient denied associated symptoms. After CT and Fine needle puncture, the patient was diagnosed of a pleomorphic adenoma of the parotid gland, and treated with right partial parotidectomy. EVOLUTION: The surgical technique used is described on literature, with a variant in the incision type. We used modified Blair incision. The whole tumor was removed. After surgery patient presented with facial paralysis, she was treated with corticoids. Patient was discharged with a House Brackmann 1 score. CONCLUSIONS: Accordingly with literature, the resolution of this pathology is surgical, paratidectomy is the only treatment that avoids the mass causing damage to adjacent structures, like the facial nerve. The proper identification and dissection of this nerve, is one of the main concerns of the procedure.(au)

Clinical diagnosis and treatment of perineural invasion of head and neck malignant tumors / 中华放射肿瘤学杂志

Perineural invasion is a unique biological behavior of tumors via nerve dissemination and metastasis, which is intimately correlated with the recurrence, metastasis and prognosis. With the deepening research, the clinical significance of perineural invasion has been widely recognized. However, due to the low incidence of head and neck neoplasms and the varying incidence of perineural invasion in different anatomical sites and pathological types, high-level evidence-based medical evidence is still lacking. Currently, the pathological mechanism of perineural invasion has not been clearly clarified. No specific treatment has been available for perineural invasion. Therefore, the treatment of perineural invasion of head and neck tumors is an enormous challenge for clinicians. In this article, the current status of clinical diagnosis and treatment of perineural invasion in head and neck malignancies was reviewed.

3D-printing non-coplanar template assisted 125I seed implantation for head and neck tumor: individualized template design and application / 中华放射肿瘤学杂志

Objective@#To compare the dosimetric data between preoperative plans and postoperative verification in computed tomography (CT)-guided and 3D-printing non-coplanar template-assisted 125I seed implantation for head and neck tumor, aiming to explore the safety, feasibility and accuracy of the individualized template design method.@*Methods@#A total of 42 patients with recurrent/metastatic malignant head and neck tumor admitted to Peking University Third Hospital from January to December 2016 were recruited in this study. A prescribed dose of 110-160Gy was adopted.3D-printing non-coplanar templates were designed for 42 cases. The dosimetric parameters including D90, minimum peripheral dose (mPD), V100, V150, V200, conformal index (CI), external index (EI) and homogeneity index (HI) were statistically compared before and after surgery.@*Results@#All templates were properly implanted intraoperatively. Compared with preoperative planning, postoperative D90, V100, CI, EI and HI did not significantly differ (P=0.490, 0.407, 0.893, 0.143 and 0.079), whereas mPD, V150 and V200 significantly differed (P=0.036, 0.007 and 0.000).@*Conclusion@#After postoperative verification, the main dosimetric parameters have high therapeutic accuracy and properly match with preoperative planning, which can meet clinical requirements.

Clinical diagnosis and treatment of perineural invasion of head and neck malignant tumors / 中华放射肿瘤学杂志

Perineural invasion is a unique biological behavior of tumors via nerve dissemination and metastasis,which is intimately correlated with the recurrence,metastasis and prognosis.With the deepening research,the clinical significance of perineural invasion has been widely recognized.However,due to the low incidence of head and neck neoplasms and the varying incidence of perineural invasion in different anatomical sites and pathological types,high-level evidence-based medical evidence is still lacking.Currently,the pathological mechanism of perineural invasion has not been clearly clarified.No specific treatment has been available for perineural invasion.Therefore,the treatment of perineural invasion of head and neck tumors is an enormous challenge for clinicians.In this article,the current status of clinical diagnosis and treatment of perineural invasion in head and neck malignancies was reviewed.

3D-printing non-coplanar template assisted 125I seed implantation for head and neck tumor: individualized template design and application / 中华放射肿瘤学杂志

Objective To compare the dosimetric data between preoperative plans and postoperative verification in computed tomography (CT)-guided and 3D-printing non-coplanar template-assisted 125I seed implantation for head and neck tumor,aiming to explore the safety,feasibility and accuracy of the individualized template design method.Methods A total of 42 patients with recurrent/metastatic malignant head and neck tumor admitted to Peking University Third Hospital from January to December 2016 were recruited in this study.A prescribed dose of l10-160Gy was adopted.3D-printing non-coplanar templates were designed for 42 cases.The dosimetric parameters including D90,minimum peripheral dose (mPD),V100,V150,V200,conformal index (CI),external index (EI) and homogeneity index (HI) were statistically compared before and after surgery.Results All templates were properly implanted intraoperatively.Compared with preoperative planning,postoperative D90,V100,CI,EI and HI did not significantly differ (P=0.490,0.407,0.893,0.143 and 0.079),whereas mPD,V150 and V200 significantly differed (P=0.036,0.007 and 0.000).Conclusion After postoperative verification,the main dosimetric parameters have high therapeutic accuracy and properly match with preoperative planning,which can meet clinical requirements.

Overall and disease-specific survival outcomes following primary surgery for oral squamous cell carcinoma: analysis of consecutive 67 patients

OBJECTIVES: This study evaluated the predictive factors for survival of patients with oral squamous cell carcinoma (OSCC) and investigated the overall and disease-specific survival (DSS) outcomes. MATERIALS AND METHODS: A total of 67 consecutive patients who underwent surgery for OSCC from January 2006 to November 2014 were included in this study. Patients were classified according to age, sex, pTNM stages, primary sites, smoking and alcohol drinking habits, depth of invasion, perineural and lymphovascular invasion, cell differentiation and postoperative radiotherapy. Kaplan-Meier methods were used to estimate the survival categorized by patient groups. Cox regression methods were used to investigate the main independent predictors of survival. RESULTS: Nineteen patients died of OSCC during follow-up periods. Another five patients died of other diseases including lung adenocarcinoma (n=1), cerebral infarction (n=1), general weakness (n=2), and pneumonia (n=1). The tongue (n=16) was the most common site for primary origin, followed by buccal mucosa (n=15), mandibular gingiva (n=15), maxillary gingiva (n=9), floor of mouth (n=9), retromolar trigone (n=2), and palate (n=1). Eleven patients had pTNM stage I disease, followed by stage II (n=22) and stage IV (n=34). No patients had pTNM stage III disease in this study. The overall survival of all patients was 64.2% and the DSS was 71.6%. DSS of patients with stage I and II disease was 100%. Stepwise Cox regression showed the two predictors for DSS were pTNM stage (P<0.0001, odds ratio=19.633) and presence of metastatic lymph nodes (P=0.0004, odds ratio=0.1039). CONCLUSION: OSCC has been associated with poor prognosis; however, there were improved survival outcomes compared with past studies. Advanced-stage disease and presence of metastatic lymph nodes were associated with poorer survival compared with early-stage OSCC and absence of neck node metastasis. Stage I and II OSCC were associated with excellent survival results in this study.

Malakoplakia of Head and Neck Mimicking Malignant Lymphadenopathy: A Case Report / 대한이비인후과학회지

Malakoplakia is usually found in the genitourinary tract; however, it occurs uncommonly as a chronic inflammatory disease and rarely in the head and neck area, having been reported in the literature only few times. Here, we report, with a review of the related literature, a case of malakoplakia on the posterior neck. A 76-year-old male patient visited our institution presenting a rapidly growing neck mass that had invaded the overlying skin for several weeks. The results of imaging studies strongly indicated a malignant tumor, but an accurate diagnosis was not made until after a fine needle aspiration biopsy was undertaken twice. The lesion was completely excised with an extended radical neck dissection including the overlying skin and scalene muscle upon consent of the patient. The pathological diagnosis was made with various immunohistochemical staining methods including Von Kossa, Periodic acid-Schiff-diastase, CD-68 and CD163. During the 24 months follow-up after the surgery, there was no sign of recurrence.

Expert consensus on prevention and control strategy of radiotherapy-induced oral mucositis (2019) / 中华放射肿瘤学杂志

Radiotherapy-induced oral mucositis (RTOM) is a category of oral mucosal injury caused by radiotherapy, which is the most common complication of radiotherapy in patients with head and neck tumors. Severe RTOM may interrupt the treatment and lower the clinical efficacy. In recent years, new accomplishment on the prevention and treatment of RTOM has been reported. Nevertheless, unified standards and guidelines are still lacking in China. This expert consensus refers to clinical practice guideline abroad, reviews and summarizes the prevention and management of RTOM at home and abroad, aiming to provide recommendations and suggestions for the prevention and treatment of RTOM in patients with head and neck tumors in China.

Nutritional treatment of radiotherapy-induced mucosal injury / 中华放射肿瘤学杂志

Mucosal injury is the most common complication of radiotherapy for head and neck neoplasms.The relevant symptoms include oral pain,dysphagia,decreased diet intake,and secondary infection,which can lead to the interruption of treatment and even affect the clinical efficacy and quality of life.Wound repair depends on nutrition supply.Inappropriate nutrition plan may affect the healing process.Therefore,proper nutritional strategy plays a pivotal role in promoting the healing of mucosal injury.Based on current researches on radiotherapy-induced mucosal injury and the effect of nutrients on wound healing,the epidemiology,pathophysiology,clinical manifestations and nutritional therapy for radiotherapy-induced mucosal injury were reviewed,aiming to provide references for clinical practice.

The supraclavicular artery island flap: a salvage option for head and neck reconstruction / 대한악안면성형재건외과학회지

BACKGROUND: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review. CASE PRESENTATION: Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites. CONCLUSION: SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.