Readiness for return to work and its influencing factors among head and neck cancer patients: a cross-sectional study.

PURPOSE: This study aims to investigate the Readiness for Return-to-Work (RRTW) of patients with head and neck tumours and to analyse the relationships among self-efficacy, disease uncertainty, psychosocial adaptation, and RRTW in head and neck cancer (HNC) patients. METHODS: A cross-sectional study was conducted with 259 HNC patients with a discharge length of ≥1 month at a tertiary hospital in Liaoning Province. The research tools included a self-designed general information questionnaire, the Readiness for Return-to-Work (RRTW) Scale, the General Self-Efficacy Scale (GSES), the Mishel Uncertainty in Illness Scale (MUIS), and the Self-Reporting Psychosocial Adjustment to Illness Scale (PAIS-SR). Descriptive statistical analysis, the rank sum test, Spearman correlation analysis, and ordered multiple and dichotomous logistic regression analyses were used. RESULTS: The overall RRTW among HNC patients was low (41.9%). HNC patients who did not return to work were mainly in the precontemplation stage (38.1%) and contemplation stage (29.9%). HNC patients who returned to work were mainly in the active maintenance stage (64.2%). Children's status (OR = 0.218, 95% CI 0.068-0.703), self-efficacy (OR = 1.213, 95% CI 1.012-1.454), unpredictability (OR = 0.845, 95% CI 0.720-0.990), occupational environment (OR = 0.787, 95% CI 0.625-0.990), and family environment (OR = 0.798, 95% CI 0.643-0.990) influence the RRTW of HNC patients who have not returned to work. Educational level (OR = 62.196, 95% CI 63.307-68.567), children's status (OR = 0.058, 95% CI 1.004-2.547), self-efficacy (OR = 1.544, 95% CI 3.010-8.715), unpredictability (OR = 0.445, 95% CI 1.271-2.280), and psychological status (OR = 0.340, 95% CI 1.141-2.401) influence the RRTW of HNC patients who have returned to work. CONCLUSION: Children's status, education level, self-efficacy, illness uncertainty, and psychosocial adjustment are crucial to RRTW. This study provides a theoretical basis for formulating intervention measures aimed at improving the RRTW of patients.

Real-time detection of laryngopharyngeal cancer using an artificial intelligence-assisted system with multimodal data.

BACKGROUND: Laryngopharyngeal cancer (LPC) includes laryngeal and hypopharyngeal cancer, whose early diagnosis can significantly improve the prognosis and quality of life of patients. Pathological biopsy of suspicious cancerous tissue under the guidance of laryngoscopy is the gold standard for diagnosing LPC. However, this subjective examination largely depends on the skills and experience of laryngologists, which increases the possibility of missed diagnoses and repeated unnecessary biopsies. We aimed to develop and validate a deep convolutional neural network-based Laryngopharyngeal Artificial Intelligence Diagnostic System (LPAIDS) for real-time automatically identifying LPC in both laryngoscopy white-light imaging (WLI) and narrow-band imaging (NBI) images to improve the diagnostic accuracy of LPC by reducing diagnostic variation among on-expert laryngologists. METHODS: All 31,543 laryngoscopic images from 2382 patients were categorised into training, verification, and test sets to develop, validate, and internal test LPAIDS. Another 25,063 images from five other hospitals were used as external tests. Overall, 551 videos were used to evaluate the real-time performance of the system, and 200 randomly selected videos were used to compare the diagnostic performance of the LPAIDS with that of laryngologists. Two deep-learning models using either WLI (model W) or NBI (model N) images were constructed to compare with LPAIDS. RESULTS: LPAIDS had a higher diagnostic performance than models W and N, with accuracies of 0·956 and 0·949 in the internal image and video tests, respectively. The robustness and stability of LPAIDS were validated in external sets with the area under the receiver operating characteristic curve values of 0·965-0·987. In the laryngologist-machine competition, LPAIDS achieved an accuracy of 0·940, which was comparable to expert laryngologists and outperformed other laryngologists with varying qualifications. CONCLUSIONS: LPAIDS provided high accuracy and stability in detecting LPC in real-time, which showed great potential for using LPAIDS to improve the diagnostic accuracy of LPC by reducing diagnostic variation among on-expert laryngologists.

Application of prolonged submental perforator flap to repair the postoperative defect of upper airway malignancy.

OBJECTIVES: To explore the feasibility of making a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint under the guidance of neck-enhanced CT and repairing the postoperative defect of upper airway malignancy. MATERIALS AND METHODS: This study retrospectively analysed 19 cases of upper airway malignant tumours treated in our department from January 2021 to September 2022, including 17 males and 2 females, aged 43-70 years. SITE OF LESIONS: 15 cases were in the laryngopharynx, 2 cases in the nasal cavity and paranasal sinus and 2 cases on the soft palate. All the lesions were malignant and at stages T2-4N0-2M0. SURGICAL METHOD: The extended submental perforator flap (size 22-15 × 6-7 cm) was prefabricated distal to the connecting line between the mastoid and the sternoclavicular joint. After tumour resection, the flap was used to repair the postoperative defect. Fifteen cases of laryngopharyngeal malignant tumours were repaired using the extended submental perforator flap with the vascular pedicle located on the opposite side of the tumour body. Two cases of nasal cavity and paranasal sinus tumours were repaired using the extended submental perforator flap combined with the temporalis muscle flap. The soft palate was completely removed in two patients with soft palate cancer and repaired using the folded extended submental perforator flap. RESULTS: Before the surgery, the reflux vein was observed by neck-enhanced CT, including 12 cases returning to the internal jugular vein and 7 cases to the external jugular vein. All 19 cases in which flaps were used survived, and 1 case had a postoperative infection. All the patients had nasal feeding removed after surgery. The tracheal cannula was removed from the patients with laryngeal preservation, and the pronunciation was satisfactory. Among them, patients with soft palate cancer repair had mild nasal reflux symptoms with smooth breathing. During the follow-up period of 4-24 months, 18 patients had no tumour recurrence or metastasis, and 1 patient had cervical lymph node metastasis. CONCLUSIONS: This study highlights the use of a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint to repair postoperative defects for upper airway malignancy as an innovative surgical approach that provides more tissue and good arteriovenous blood supply to adjacent sites. This method has high clinical value and provides an effective option for repairing postoperative defects of upper airway malignancy.

The Effect of Intensity-Modulated Radiotherapy to the Head and Neck Region on the Oral Innate Immune Response and Oral Microbiome: A Prospective Cohort Study of Head and Neck Tumour Patients.

Neutrophils, also known as polymorphonuclear leukocytes (PMNs), form a significant component of the innate host response, and the consequence of the interaction between the oral microbiota and PMNs is a crucial determinant of oral health status. The impact of radiation therapy (RT) for head and neck tumour (HNT) treatment on the oral innate immune system, neutrophils in particular, and the oral microbiome has not been thoroughly investigated. Therefore, the objective of this study was to characterize RT-mediated changes in oral neutrophils (oPMNs) and the oral microbiome in patients undergoing RT to treat HNTs. Oral rinse samples were collected prior to, during and post-RT from HNT patients receiving RT at Dental Oncology at Princess Margaret Cancer Centre. The oPMNs counts and activation states were analysed using flow cytometry, and the oral microbiome was analysed using 16S rRNA gene sequencing. Statistically significant (p < 0.05) drops in oPMN counts and the activation states of the CD11b, CD16, CD18, CD64 and H3Cit markers from pre-RT to post-RT were observed. Moreover, exposure to RT caused a significant reduction in the relative abundance of commensal Gram-negative bacteria and increased the commensal Gram-positive microbes. Ionizing radiation for the treatment of HNTs simultaneously decreased the recruitment of oPMNs into the oral cavity and suppressed their activation state. The oral microbiome composition post-RT was altered significantly due to RT which may favour the colonization of specific microbial communities unfavourable for the long-term development of a balanced oral microbiome.

Metastatic sebaceous cell carcinoma, review of the literature and use of electrochemotherapy as possible new treatment modality.

BACKGROUND: Metastatic extraorbital sebaceous carcinoma is a rare event that could involve the head and neck. The treatment of choice for the initial stage of the disease is surgery and/or radiotherapy. The treatment of recurrent or advanced disease is still controversial. MATERIAL AND METHODS: Extensive literature search was done, and the treatment options are discussed. RESULTS: Results. The literature search found several treatment modalities in use for the treatment of metastatic extraorbital sebaceous carcinoma. Electrochemotherapy was not included in the reported treatments. We used this technique for a man of 85 years old with a recurrent and locally metastatic extraorbital sebaceous carcinoma of the scalp. During the period of 8 months, two sessions of electrochemotherapy were employed, which resulted in an objective response of the tumour and good quality of life. CONCLUSIONS: Electrochemotherapy has shown to be a interesting tools for treatment of metastatic extraorbital sebaceous carcinoma when other radical options are not available or convenient.

Development of a prognostic model of overall survival in oropharyngeal cancer from real-world data: PRO.M.E.THE.O.

Objective: The PRO.M.E.THE.O. study (PredictiOn Models in Ent cancer for anti-EGFR based THErapy Optimization) aimed to develop a predictive model (PM) of overall survival (OS) for patients with locally advanced oropharyngeal cancer (LAOC) treated with radiotherapy (RT) and cetuximab (Cet) from an Italian dataset. Methods: We enrolled patients with LAOC from 6 centres treated with RT-Cet. Clinical and treatment variables were collected. Patients were randomly divided into training (TS) (80%) and validation (VS) (20%) sets. A binary logistic regression model was used on the TS with stepwise feature selection and then on VS. Timepoints of 2, 3 and 5 years were considered. The area under the curve (AUC) of receiver operating characteristic of 2, 3 and 5 year and confusion matrix statistics at 5-threshold were used as performance criteria. Results: Overall, 218 patients were enrolled and 174 (79.8%) were analysed. Age at diagnosis, gender, ECOG performance, clinical stage, dose to high-risk volume, overall treatment time and day of RT interruption were considered in the final PMs. The PMs were developed and represented by nomograms with AUC of 0.75, 0.73 and 0.73 for TS and 0.713, 0.713, 0.775 for VS at 2, 3 and 5 years, respectively. Conclusions: PRO.M.E.THE.O. allows the creation of a PM for OS in patients with LAOC treated with RT-Cet.

Cellular mechanism of action of 2-nitroimidazoles as hypoxia-selective therapeutic agents.

Solid tumours are often poorly oxygenated, which confers resistance to standard treatment modalities. Targeting hypoxic tumours requires compounds, such as nitroimidazoles (NIs), equipped with the ability to reach and become activated within diffusion limited tumour niches. NIs become selectively entrapped in hypoxic cells through bioreductive activation, and have shown promise as hypoxia directed therapeutics. However, little is known about their mechanism of action, hindering the broader clinical usage of NIs. Iodoazomycin arabinofuranoside (IAZA) and fluoroazomycin arabinofuranoside (FAZA) are clinically validated 2-NI hypoxic radiotracers with excellent tumour uptake properties. Hypoxic cancer cells have also shown preferential susceptibility to IAZA and FAZA treatment, making them ideal candidates for an in-depth study in a therapeutic setting. Using a head and neck cancer model, we show that hypoxic cells display higher sensitivity to IAZA and FAZA, where the drugs alter cell morphology, compromise DNA replication, slow down cell cycle progression and induce replication stress, ultimately leading to cytostasis. Effects of IAZA and FAZA on target cellular macromolecules (DNA, proteins and glutathione) were characterized to uncover potential mechanism(s) of action. Covalent binding of these NIs was only observed to cellular proteins, but not to DNA, under hypoxia. While protein levels remained unaffected, catalytic activities of NI target proteins, such as the glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and the detoxification enzyme glutathione S-transferase (GST) were significantly curtailed in response to drug treatment under hypoxia. Intraperitoneal administration of IAZA was well-tolerated in mice and produced early (but transient) growth inhibition of subcutaneous mouse tumours.

Mucoepidermoid carcinoma of the anterior lingual salivary gland: A rare case report.

Mucoepidermoid carcinomas (MECs) are rare head and neck malignant tumours that were originally considered to be benign. It has been estimated that ~20% of MECs in the major salivary glands, such as the parotid gland, and 50% in the several minor salivary glands found in the oral cavity, are malignant. The diagnosis of MECs is mainly based on ancillary and immunohistochemistry testing. However, owing to the difficulty in harvesting adequate material for histological examination, the histopathological diagnosis of intraoral MECs may be particularly challenging. We herein report a rare case of an 82-year-old patient who presented to the Department of Oral and Maxillofacial Surgery of Ryukyu University Hospital with complaints of a progressive swelling and pain in the ventral surface of the apex of the tongue. The patient had previously undergone needle biopsy and the histopathological analysis of the tumour suggested a diagnosis of irritation fibroma. To ensure a more accurate histopathological assessment, an incisional biopsy was performed, in addition to the haematological and radiological assessments. Examination of the obtained surgical specimen confirmed low-grade MEC of the anterior lingual gland. The tumour was surgically excised, the patient healed uneventfully and no recurrence was detected on the regular 3-year follow-up. Although MECs are relatively more common in the minor salivary glands of the oral cavity, they are a rare occurrence in the anterior lingual gland. Therefore, adequate histological material should be surgically harvested to perform a complete evaluation of the morphology and cytology of the tumour and ensure the accuracy of diagnosis.

Identification of proteins and cellular pathways targeted by 2-nitroimidazole hypoxic cytotoxins.

Tumour hypoxia negatively impacts therapy outcomes and continues to be a major unsolved clinical problem. Nitroimidazoles are hypoxia selective compounds that become entrapped in hypoxic cells by forming drug-protein adducts. They are widely used as hypoxia diagnostics and have also shown promise as hypoxia-directed therapeutics. However, little is known about the protein targets of nitroimidazoles and the resulting effects of their modification on cancer cells. Here, we report the synthesis and applications of azidoazomycin arabinofuranoside (N3-AZA), a novel click-chemistry compatible 2-nitroimidazole, designed to facilitate (a) the LC-MS/MS-based proteomic analysis of 2-nitroimidazole targeted proteins in FaDu head and neck cancer cells, and (b) rapid and efficient labelling of hypoxic cells and tissues. Bioinformatic analysis revealed that many of the 62 target proteins we identified participate in key canonical pathways including glycolysis and HIF1A signaling that play critical roles in the cellular response to hypoxia. Critical cellular proteins such as the glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and the detoxification enzyme glutathione S-transferase P (GSTP1) appeared as top hits, and N3-AZA adduct formation significantly reduced their enzymatic activities only under hypoxia. Therefore, GAPDH, GSTP1 and other proteins reported here may represent candidate targets to further enhance the potential for nitroimidazole-based cancer therapeutics.

Imaging of head and neck lipoblastoma: case report and systematic review.

Lipoblastoma is a rare and benign tumour arising from embryonal fat cells, predominantly diagnosed in children younger than 3 years old. The most frequent locations are the extremities and trunk, while the head and neck areas are more rarely affected (10-15% of total cases). Clinically, the most common presentation is a fast-growing painless mass. Ultrasound is the first-line imaging examination, but Magnetic Resonance Imaging (MRI) allows for better definition of the relationships with the adjacent vascular and muscular structures. It can help to identify the lipomatous components, and it is useful for preoperative planning. However, the definitive diagnosis is provided by histopathological examination. Complete surgical excision is the first-line treatment, with a good prognosis in case of total eradication. We report the case of a 7-month-old male child with a rapidly growing mass that had typical radiological features of lipoblastoma.

Head and Neck Cylindroma Masquerading as Squamous Cell Carcinoma: A Case Report.

Cylindroma is an uncommon skin appendageal tumor encountered by otorhinolaryngologists in the head and neck. We present a case of a 70-year-old lady who presented with an ulcerative lesion in the pre auricular region. These appendageal tumours can mimic more sinister lesions like squamous cell carcinoma which might warrant overtreatment. This report highlights the importance of harbouring knowledge of these benign tumours in order to provide appropriate management.

Transnasal devascularisation of a sinonasal hypervascular tumour (glomangiopericytoma) with direct injection of liquid polymer agent (Squid®).

The technique of direct intratumoral injection of permanent liquid agents has evolved significantly over the past few decades. The percutaneous direct puncture technique is being utilised more and more for embolisation of head and neck hypervascular lesions. We describe a case treated via the direct percutaneous transnasal (TN) puncture technique for embolisation of a sinonasal hypervascular tumour, performed in a 21-year-old male patient. Due to extensive vascularisation of the tumour, preoperative embolisation was requested by our otolaryngologist team in order to minimise intraoperative bleeding and reduce surgical morbidity. A primary attempt at trans-arterial embolisation through selective ophthalmic artery catheterisation was unsuccessful due to unfavourable anatomy. An extensive devascularisation of the nasal fossa lesion was obtained using a single injection of low-density polymeric embolic agent (SQUID®). Post-operative eradication was uneventful. Final histopathology exam revealed vascular tumour consistent with a rare sinonasal glomangiopericytoma. To our knowledge, this is the first reported case of a rare sinonasal glomangiopericytoma treated by direct TN injection, utilising the liquid polymer agent SQUID®.

Combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible following salvage surgery for recurrent head and neck tumours.

This study was performed to evaluate the outcomes of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible. The subjects were six patients with recurrent malignant tumours who underwent salvage surgeries and reconstruction with combined flaps based on the transverse cervical vessels (TCVs). All patients had combined bone (four type H, one type LCL, and one type C) and extensive soft tissue defects (through-and-through defects) following salvage surgery. All tumours were removed and the complex defects restored successfully. Two patients experienced minor complications: one minor intraoral flap failure and one case of wound dehiscence at the donor site. The appearance of the face and neck was satisfactory or acceptable in all patients. No patient showed severely limited range of motion of the upper limb. The patients were followed up for 10 to 18months. One patient was living with no evidence of disease. The use of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps based on the TCVs may be an effective approach for the restoration of through-and-through defects of the mandible and may provide satisfactory or acceptable functional and aesthetic outcomes following salvage surgery for advanced head and neck tumours.

Predictors of free flap loss in the head and neck region: A four-year retrospective study with 451 microvascular transplants at a single centre.

INTRODUCTION: Microvascular free flaps have become an essential part of reconstructive surgery following head and neck tumour ablation. The authors' aim was to investigate the influence of cardiovascular risk factors, preoperative irradiation, previous operations and metabolically active medication on free flap loss in order to predict patients at risk and to improve their therapy. MATERIALS AND METHODS: All patients who underwent reconstructive surgery with microvascular free flaps in the head and neck region between 2009 and 2013 were retrospectively analysed. Uni- and multivariate logistic regressions were performed to determine the association between possible predictor variables for free flap loss. RESULTS: We included 451 patients in our analysis. The overall free flap failure rate was 4.0%. Multivariate regression analysis revealed significantly increased risks of free flap failure depending on prior attempts at microvascular transplants (p < 0.001, OR = 14.21) and length of hospitalisation (p = 0.007, OR = 1.05). CONCLUSIONS: With consistently low rates of flap failure, microvascular reconstruction of defects in the head and neck region has proven to be highly reliable, even in patients with comorbidities. The expertise of the operating team seems to remain the main factor affecting flap success. The only discerned independent predictor was previously failed attempts at microvascular reconstruction.

Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours.

The aim of this study was to determine the value of fine needle aspiration cytology (FNAC) and frozen section (FS) in the diagnosis of malignant parotid tumours. One hundred and thirty-eight patients who underwent FNAC and FS of a parotid tumour between 2006 and 2011 were analyzed retrospectively. The sensitivity, specificity, and positive and negative predictive values of FNAC and FS were determined using final histological diagnosis as the gold standard. Of the 138 tumours assessed in our study, 30 were malignant and 108 benign. For FNAC, the sensitivity was 73%, specificity 87%, positive predictive value 61%, and negative predictive value 90%. For FS, the sensitivity was 80%, specificity 98%, positive predictive value 92%, and negative predictive value 94%. Four false-negative results by FNAC were corrected by FS, and surgery was completed. Two false-positive results were identified by both FNAC and FS. FNAC is an important examination that provides valuable information for the preoperative diagnostic work-up and alerts the surgeon to the possible presence of malignancy. However, FNAC cannot be used alone, and FS has a very important place in the intraoperative management of parotid tumours.

PET Scan in Head and Neck Tumours in a Developing Country Like India: Is It a Must?

To study the impact of Positron emission tomography (PET) and its incremental value in diagnosing an unknown primary tumour with secondaries in the head and neck; recurrent head and neck cancers (confirmation of suspected recurrences and re-staging); and staging of head and neck tumours. This was a prospective observational study where 60 patients of head and neck tumours under the clinical settings as described above were evaluated. Thorough clinical examination and necessary radiological and histopathological investigations were done. All patients underwent a PET scan, the results of which were correlated with histopathological examination. Sensitivities, specificities, positive and negative predictive values, false positives and false negatives of PET scan in the different indications were calculated. The study included 11 patients of unknown primary, 28 patients with suspected recurrent tumours and 21 patients where PET scan was done for initial staging. PETCT scan was able to detect the primary in 3 out of 11 patients (27.27 %) who presented with cervical metastases with an unknown primary. In 2 of the 8 patients where a primary tumour was not found, PETCT detected distant metastases. For recurrent tumours, PETCT scan showed sensitivity, specificity, positive predictive value and negative predictive value as 100, 72.72, 85 and 100 % respectively. In restaging of recurrent disease, 4 out of 28 patients were detected to have distant metastases. In 7 cases of locoregionally advanced tumors, where PETCT scan was used for pre-treatment staging, it detected distant metastases in 4 of 7 patients. In the patients with N0 neck status PETCT scan showed a sensitivity, specificity, positive predictive value and negative predictive value of 100, 66.67, 50 and 100 % respectively. PETCT scan was able to alter the plan of management in 15 out of 60 patients. Thus, in carefully selected patients PETCT scan can provide incremental information that proves invaluable in these circumstances even in a developing country like India. In all the settings, PETCT scan demonstrated a very high negative predictive value. Hence, negative PETCT scan could be interpreted as absence of disease with reasonable assurance.

Malignant peripheral nerve sheath tumours in the head and neck region: retrospective analysis of clinicopathological features and treatment outcomes.

Malignant peripheral nerve sheath tumours (MPNST) are rare soft tissue sarcomas. The aim of this study was to assess clinicopathological characteristics and prognostic factors in order to improve the treatment of such tumours in the head and neck region. We performed a retrospective analysis of head and neck MPNST patients in our hospital between 1996 and 2012. Clinical features and pathological findings of these cases (n=43) were summarized. In addition, prognostic variables were evaluated by univariate and multivariate analyses. The median age of the patients at presentation was 41 years. Surgery was the main treatment approach. Pertinent information regarding the presence of neurofibromatosis type 1 was found in 13 patients (30.2%). Two-thirds of these patients were admitted for a primary tumour (n=27, 62.8%), while one-third (n=16, 37.2%) were treated for recurrent neoplasms. The overall survival rate was 46.5%. Multivariable analysis identified tumour size, surgical margins, and postoperative radiotherapy to be independent prognostic factors. MPNST of the head and neck is extremely difficult to manage. Surgery with postoperative radiation may be the optimum choice of treatment for primary head and neck MPNST.