Analysis of durability and replacement of vocal prostheses in total laryngectomy patients at a head and neck surgery referral center.

PURPOSE: The use of tracheoesophageal prostheses has become the gold standard in vocal rehabilitation of patients undergoing total laryngectomy. However, this method also has limitations, such as the need for frequent replacement of prostheses due to leakage or other complications. We have designed a study to access the clinical profile of patients using tracheoesophageal prostheses as vocal rehabilitation after total laryngectomy and to determine the average rate of changes, as well as the main causes of prostheses replacement. METHODS: A retrospective cohort study was performed based on patients who underwent rehabilitation with voice prostheses after total laryngectomy between 2008 and 2017. RESULTS: The sample consisted of 93 patients and 432 vocal prostheses replacement events. The median change of prostheses per patient was 210.25 days, (range 57.33 to 651.50). The most frequent cause of prostheses replacement was leakage through the prostheses, 218 (50.46%). Lower level of education was associated to higher prostheses replacement rate. CONCLUSION: The results of this study show that the median of prostheses durability is higher than that presented in the literature, the main cause of replacement was protheses leakage and that low educational level is associated to higher replacement rate.

miR-99a-5p as a biomarker for lymph node metastasis prediction in oral squamous cell carcinoma patients.

BACKGROUND: Metastatic lymph node involvement influences therapy decisions and serves as a prognostic indicator in oral squamous cell carcinoma (OSCC). However, many early-stage patients with clinically negative lymph nodes exhibit no metastasis upon surgical staging. This study aimed to identify differentially expressed miRNAs capable of distinguishing pathologically positive (pN+) from negative (pN0) nodes in OSCC patients without clinical evidence of lymph node metastases (cN0). METHODS: Expression levels of 798 miRNAs were assessed in tumor samples from 10 pN+ and 10 pN0 patients using the Nanostring nCounter platform. Validation was performed in an independent cohort of 15 pN+ and 24 pN0 patients through RT-qPCR. RESULTS: Eight miRNAs exhibited differential expression between pN0 and pN+ patients. Notably, hsa-miR-99a-5p demonstrated high sensitivity and specificity in predicting patients at higher risk of positive lymph nodes. CONCLUSIONS: These findings highlight hsa-miR-99a-5p as a potential biomarker for detecting lymph node metastasis in primary OSCC tumors.

HPV-Induced Oropharyngeal Squamous Cell Carcinomas in Brazil: Prevalence, Trend, Clinical, and Epidemiologic Characterization.

BACKGROUND: Tobacco or human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCC) represent different clinical and epidemiologic entities. This study investigated the prevalence of HPV-positive and HPV-negative OPSCC in a reference cancer hospital in Brazil and its association with clinical and demographic data, as well as its impact on overall survival. METHODS: HPV infection was determined by p16-IHC in pre-treatment formalin-fixed paraffin-embedded samples from all patients with OPSCC diagnosed at Barretos Cancer Hospital between 2008 and 2018. The prevalence of HPV-positive cases and its temporal trend was assessed, and the association of clinical and demographic data with HPV infection and the impact on patient overall survival was evaluated. RESULTS: A total of 797 patients with OPSCC were included in the study. The prevalence of HPV-associated tumors in the period was 20.6% [95% confidence interval, 17.5-24.0] with a significant trend for increase of HPV-positive cases over the years (annual percentage change = 12.87). In a multivariate analysis, the variables gender, level of education, smoking, tumor sublocation, region of Brazil, and tumor staging had a significant impact in HPV positivity, and a greater overall survival (OS) was observed in HPV-positive patients (5-year OS: 47.9% vs. 22.0%; P = 0.0001). CONCLUSIONS: This study represents the largest cohort of Brazilian patients with OPSCC characterized according to HPV status. We report significant differences in demographics and clinical presentation according to HPV status, and an increasing trend in prevalence for HPV-induced tumors. IMPACT: These findings can potentially contribute to a better stratification and management of patients as well as assist in prevention strategies.

Efficacy and safety of a cisplatin and paclitaxel induction regimen followed by chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma.

BACKGROUND: The purpose of this phase II trial was to evaluate the tolerability, safety, and efficacy of a non-5-fluorouracil (5-FU)-based induction chemotherapy followed by chemoradiotherapy (CRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). METHODS: Sixty patients with stage III to IV HNSCC were treated with induction paclitaxel and cisplatin (TP; paclitaxel 175 mg/m(2) and cisplatin 80 mg/m(2) , 3 cycles) followed by CRT (cisplatin 100 mg/m(2) ; D1, 22, and 43 of radiotherapy). RESULTS: Fifty-six patients (93.3%) completed 3 cycles of induction TP (no treatment-related deaths), 52 (86.7%) completed definitive CRT per protocol (adverse event [AE] grade ≥2 in 53.3%). The overall response rate after induction TP was 82.5% for patients with resectable disease and 55.5% for unresectable disease (p = .023), and complete response (CR) rate after CRT was 70.0% for patients with resectable disease and 30.0% for unresectable disease (p = .005). CONCLUSION: Induction TP followed by cisplatin based-CRT was well-tolerated, safe, and had high overall response rate in selected patients with locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E970-E980, 2016.

Malignant fat-forming solitary fibrous tumor (lipomatous hemangiopericytoma) in the neck: Imaging and histopathological findings of a case.

Fat-forming solitary fibrous tumor (SFT) is a rare variant of solitary fibrous tumor, a mesenchymal fibroblastic neoplasia with a particular branching hypervascular pattern. This tumor is usually classified as benign and only very few fat-forming SFTs with malignant histologic features have been reported. We report a histologically malignant fat-forming solitary fibrous tumor in a 61-year-old man, located in his neck. Ultrasonography examination was first performed showing a heterogeneous lesion, predominantly hyperechoic, with sound beam attenuation, containing two hypoechoic solid nodules. Magnetic resonance imaging and computed tomography examinations demonstrated a heterogeneous and predominantly adipose mass, containing post contrast enhancing solid nodules and thin septations. Treatment consisted of total removal of the lesion. Histologically, the tumor showed hypercellularity, numerous mitoses and cytological atypia, fulfilling the criteria for malignancy. The patient had no metastasis. This rare tumor may be confused with other fat-containing lesions on imaging examinations, mainly liposarcoma.

Schwanoma de palato duro - relato de caso / Hard palate schwannoma - case report

Introdução: Tumores neurogênicos constituem uma porcentagemmuito baixa entre das neoplasias de cabeça e pescoço. Dentreos schwanomas extracranianos, aproximadamente 25% a45% ocorrem nessa topografia, sendo a localização maiscomum a região lateral do pescoço. A incidência é baixa naregião oromaxilofacial, sendo 1% de origem intra-oral. Entreesses últimos, a língua e o soalho da boca são os sítios maiscomumente afetados e, menos frequentemente, o palatoduro. Quando acomete esse sítio, um diagnóstico diferencialimportante são os tumores de glândulas salivares menores, muitomais frequentes nessa localização. Objetivos: Descrever umcaso de schwanoma intra-oral, mais especificamente localizadono palato duro, e discutir o diagnóstico e tratamento desta lesãorara. Relato do caso: Relata-se um caso de um schawanoma depalato duro tratado em nosso serviço cuja suspeita diagnósticainicial era de tumor de glândula salivar. Os aspectos histológicose achados imuno-histoquímicos são apresentados e discutidos àluz da literatura consultada. Considerações finais: Descreve-seum caso raro de schwanoma intra-oral localizado no palato duro.Dada a maior prevalência de tumores de glândulas salivaresnesta topografia, o exame imuno-histoquímico é essencial paraum diagnóstico preciso permitindo um tratamento adequadodessa doença.

Pesquisa do linfonodo sentinela em carcinomas espinocelulares de cavidade oral classificados como T1 e T2 N0 / Sentinel lymph node in oral cavity squamous cell carcinoma classified as T1 and T2 N0

Introdução: A abordagem cervical em pacientes portadores decarcinoma epidermoide (CE) de cavidade oral classificados comoT1 ou T2 N0 ainda é controversa. A pesquisa do linfonodo sentinela(PLS), representa um menor risco de morbidades para o pacientecom uma boa acurácia para detecção de metástases ocultas.Objetivo: Avaliar a evolução de pacientes submetidos à PLS empescoço clinicamente N0. Método: É um estudo retrospectivoque avaliou os pacientes portadores de CE de cavidade oralclassificados como T1 ou T2 N0 submetidos ressecção do tumorprimário e PLS entre Junho de 2008 até Fevereiro de 2011 noHospital de Câncer de Barretos. Resultados: Foram incluídos 26pacientes, a maioria eram homens (73,0%), a média de idade foide 58 anos e o local mais frequente dos CE foi a língua (50,0%).Os carcinomas foram estadiados como T1 em 8 pacientes (33,3%)e T2 em 16 (66,7%). A PLS mostrou-se positiva em 5 pacientes(19,2%). Todos os pacientes em que a pesquisa do LS mostrousepositiva, foram submetidos a esvaziamento cervical seletivo.O seguimento médio dos pacientes foi de 11 meses, nesteperíodo a recorrência no pescoço homolateral a PLS ocorreu em2 pacientes (7,7%). Conclusão: Neste estudo o LS foi positivo19,2% e a recidiva cervical ocorreu em 7,7%. Observou-se que atécnica de PLS é factível e segura como único procedimento paraestadiamento do pescoço apresentando resultados oncológicoscomparáveis à realização do esvaziamento cervical seletivo comoprimeira opção para estes pacientes.