Combining Transoral Nasopharyngeal Brush and Plasma Epstein-Barr Virus DNA in Detecting Locally Recurrent Nasopharyngeal Carcinoma.

OBJECTIVE: To evaluate the sensitivities and specificities of Epstein-Barr virus (EBV) DNA in the detection of locally recurrent or persistent nasopharyngeal carcinoma (NPC) through nasopharyngeal (NP) brush biopsy and plasma, respectively, and whether a combination of both would be superior to the individual tests. STUDY DESIGN: A case-control study was conducted from September 2016 to June 2022. SETTING: A multicentre study at 3 tertiary referral centers in Hong Kong was conducted by the Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong. METHODS: Twenty-seven patients with biopsy-confirmed locally recurrent NPC were recruited as study subjects. Magnetic resonance imaging was performed to rule out regional recurrence. The control group consisted of 58 patients with a prior history of NPC who were now disease-free based on endoscopic and imaging findings. Patients underwent both the transoral NP brush (NP Screen®) and blood for plasma Epstein-Barr DNA levels. RESULTS: The sensitivity and specificity of the combined modalities were 84.62% and 85.19%, respectively. The positive predictive value was 73.33% and the negative predictive value was 92.0%. CONCLUSION: The combination of NP brush biopsy and plasma EBV DNA is potentially an additional surveillance modality in detecting the local recurrence of NPC. Further study with a larger sample size would be required to validate the cutoff values.

Retrospective Review on Role of Neck Dissection in Laryngectomy of Patients With N0 Laryngeal Carcinoma.

Objectives: The primary objective is to evaluate the incidence of occult nodal metastasis in patients undergoing total laryngectomy with cN0 disease. Other objectives are to compare the survival between different treatments of the neck, identify possible associated risk factors, and evaluate the effectiveness of elective neck dissection in this population with regards to oncological outcomes. Study Design: Retrospective review. Setting: Tertiary hospitals in Hong Kong. Methods: Retrospective study was performed on patients who underwent total laryngectomy from 2008 to 2017 in New Territories West and Hong Kong West Clusters of the Hospital Authority of Hong Kong as primary or salvage treatment for cN0 squamous cell carcinoma (SCC) of the larynx. Incidence of neck dissection, incidence of nodal involvement, possible predictors, and oncological outcomes were analyzed. Results: Seventy-seven patients were included, of whom 61 underwent either ipsilateral or bilateral neck dissection. Most (90.1%) of the patients with total laryngectomy done had locally advanced disease. Overall occult nodal metastasis rate was 20.6%, and only 3.8% of them had contralateral nodal metastasis. Occult nodal metastasis was significantly less in salvage laryngectomy (P = .045), while midline involvement and pT3/4 disease seem to be predictors for contralateral nodal metastasis. Conclusion: There is significantly lower incidence of occult nodal metastasis in cN0 laryngeal SCC in the salvage setting, and occult contralateral nodal metastasis is not common in the cohort. Neck dissection during a salvage laryngectomy for cN0 disease could be avoided while contralateral neck dissection might be considered in cases of locally advanced disease with midline involvement.

SMARCB1 (INI-1)-Deficient Sinonasal Carcinoma: A Systematic Review and Pooled Analysis of Treatment Outcomes.

(1) Background: SMARCB1 (INI-1)-deficient sinonasal carcinoma is a rare sinonasal malignancy; since its discovery and description in 2014, less than 200 cases have been identified. It is almost impossible to perform randomized-controlled trials on novel therapy to improve treatment outcomes in view of its rarity. We performed a systematic review of all the published case reports/series and included our patients for survival analysis. (2) Methods: In this systematic review, we searched from PubMed-MEDLINE, EMBASE, Scopus, Cochrane Library, CINAHL, and Google Scholar for individual patient data to identify and retrieve all reported SMARCB1-deficient sinonasal carcinoma. Clarification on treatment details and the most updated survival outcomes from all authors of the published case reports/series were attempted. Survival analysis for overall survival (OS) and identification of OS prognostic factors were performed. This systematic review was registered with PROSPERO (CRD42022306671). (3) Results: A total of 67 publications were identified from the systematic review and literature search. After excluding other ineligible and duplicated publications, 192 patients reported were considered appropriate for further review. After excluding duplicates and patients with incomplete pretreatment details and survival outcomes, 120 patients were identified to have a complete set of data including baseline demographics, treatment details, and survival outcomes. Together with 8 patients treated in our institution, 128 patients were included into survival analysis. After a median follow up of 17.5 months (range 0.3-149.0), 50 (46.3%) patients died. The 1-year, 2-year and 3-year OS rates were 84.3% (95% CI % 77.6-91.0), 62.9% (95% CI 53.1-72.7), and 51.8% (95% CI 40.8-62.8), respectively, and the median OS was 39.0 months (95% CI 28.5-49.5). Males (p = 0.029) and T4b disease (p = 0.013) were significant OS prognostic factors in univariable analysis, while only T4b disease (p = 0.017) remained significant in multivariable analysis. (4) Conclusions: SMARCB1-deficient sinonasal carcinoma is an extremely aggressive sinonasal malignancy with a dismal prognosis. Early diagnosis and a multimodality treatment strategy are essential for a better treatment and survival outcome.

Repair of Anterior Skull Base Defect by Dual-Layer/Split-Frontal Pericranial Flap.

INTRODUCTION: Normal skull base structures are destroyed either by the skull base pathology itself or during surgery that results in cerebrospinal fluid (CSF) leak. Skull base repair is usually performed transnasally by using a nasal septal flap. But when NSF is not available and failed repeated transnasal repair, a cranionasal repair with frontal pericranial flap (PF) can be attempted to achieve the highest successful chance. We performed a dual layer/split PF repair of a skull base defect using cranionasal approach and here we describe the technique. CASE DESCRIPTION: A 74-year-old man suffered from CSF leak and ventriculitis after multiple transnasal surgeries for pituitary macroadenoma despite multiple repairs with intranasal vascularized flaps. We performed repair by cranionasal approach and using frontal PF. The frontal PF was divided into left and right halves. The left half went intradural, through the chiasmatic window to reach the sella and cover the tubercular and sellar defect from above. The right half went through the nasion into the nose to cover the defect from below. So the defect was covered by two vascularized flap from a single frontal PF. The repair was successful with no CSF leak and infection successfully treated by antibiotics. CONCLUSION: We introduced the cranionasal dual layer/split PF technique to repair anterior skull base and successfully stopped the CSF leak in a patient after multiple EEA surgeries. This technique should only be considered in specific difficult situation where usual repair by EEA is impossible.

The Lymph Node Content of Supraclavicular Lymph Node Flap: A Histological Study on Fresh Human Specimens.

Introduction: Vascularized lymph node transfer (VLNT) has become the established treatment for secondary lymphedema. The proposed mechanisms of VLNT include lymphangiogenesis and absorptive action of transplanted lymphatic tissue. Therefore, in theory, the lymph node content of lymph node flap is crucial to clinical response. The supraclavicular lymph node flap (SCLNF) has been described as one of the flap options for VLNT. However, its lymph node content has not been fully studied. The aim of this study is to find out the lymph node content of SCLNF with histological examination. Methods: Patients who required radical neck dissection or modified radical neck dissection due to cervical lymph node metastasis from head and neck cancer were included in this study. The SCLNF harvesting was performed as the first part of neck dissection. After flap harvesting, neck dissection was continued. The fresh SCLNF specimens were then sent for histological study. Results: Twelve SCLNFs were studied. The mean age of patients was 67.5 (range, 54-84) years. There were 10 males and 2 females. Seven flaps were harvested from the left side of neck, while five flaps were harvested from the right side of neck. The mean width, height, and thickness of SCLNF were 5.9 ± 0.6, 4.0 ± 0.5, and 1.8 ± 0.2 cm, respectively. The mean number of lymph nodes per flap was 8 ± 4.7 (range, 3-15). Conclusion: The lymph node content of SCLNF was confirmed. Its lymph node content is comparable to other lymph node flaps used in VLNT.

Secondary head and neck cancer in patients with history of hematological malignancy.

BACKGROUND: Head and neck cancer is a common second cancer in patients with a history of hematological malignancies. The purpose of this study was present the clinical characteristics and treatment outcomes of this group of patients. METHODS: A retrospective analysis was conducted of all patients who had a history of hematological malignancy and developed head and neck cancer in a 10-year period. RESULTS: The cohort had 10 patients; median age was 45.8 years. Most patients were nonsmokers and nondrinkers. Seven patients had chronic graft-versus-host disease. The median interval between the completion of treatment of hematological malignancy and the development of head and neck cancers was 8.79 years (range, 2.33-26.83 years). Six patients were alive and disease-free, 3 developed local recurrence, and 3 had metachronous head and neck cancers. CONCLUSION: The risk factors and etiology of head and neck cancers in patients with hematological malignancy may be different from the ordinary population.

Efficacy of neck dissection for locoregional failures versus isolated nodal failures in nasopharyngeal carcinoma.

BACKGROUND: Neck dissection has been shown to be effective in controlling nodal failures in nasopharyngeal carcinoma. Its efficacy in controlling the disease in patients with synchronous locoregional failure is, however, not documented. METHOD: A retrospective review of all patients who underwent neck dissection for nodal failures with or without treated local failure within 6 months was conducted for this study. The survivals of these 2 groups of patients were analyzed. RESULTS: The 5-year overall survival of the whole cohort was 58%. There was no difference in 5-year disease specific survival (68% vs 40%; p = .121) and 5-year progression free survival (44% vs 36%; p = .334) when comparing patients with isolated nodal failures and synchronous locoregional failures. Multivariate analysis showed that only the initial N classification affects survival. CONCLUSION: Neck dissection is efficacious in patients with nasopharyngeal carcinoma with nodal failure, with or without synchronous local failures.

Efficacy of salvage neck dissection for isolated nodal recurrences in early carcinoma of oral tongue with watchful waiting management of initial N0 neck.

BACKGROUND: Recent studies have shown that salvage treatment may be effective for early tongue carcinoma with nodal failures after watchful waiting policy. We wanted to assess the efficacy of salvage neck dissection. METHODS: We conducted a retrospective review of all patients with pT1 and pT2 oral tongue cancer who underwent partial glossectomy without any neck surgery and determined the survival after salvage neck dissection in this group of patients. RESULTS: Seventy patients with N0 disease underwent partial glossectomy, 20 patients had development of isolated nodal failures after watchful waiting policy. Apart from the initial T classification, which found to have significant difference in 5-year disease specific survival rate (100% vs 46%, p = .023); other parameters including age, sex, tumor thickness, adjuvant radiotherapy and rN classification had shown no significance in affecting survival. CONCLUSIONS: Salvage neck dissection may not be effective for controlling isolated nodal recurrence in patients with oral tongue carcinoma with T2 disease.