Prognostic scores in laryngeal cancer.

PURPOSE: To evaluate the utility of various pre-treatment prognostic scoring systems for overall survival (OS) in laryngeal cancer, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), modified Glasgow Prognostic Score (mGPS) and systemic immune-inflammatory index (SIII). METHODS: We undertook a retrospective 5-year study of 220 patients with laryngeal squamous cell carcinoma undergoing active treatment. RESULTS: On multivariate analysis, low NLR (≤ 2.415, p = 0.001, OR 3.851), low PLR (≤ 269.855, p = 0.002, OR 5.520), high LMR (> 2.225, p < 0.001, OR 0.458) and low SIII (≤ 1144.465, p = 0.003, OR 3.673) were significantly associated with improved OS, accounting for confounding factors of tumour subsite, T-stage and performance status. C-reactive protein (CRP) alone (p = 0.264) and mGPS (p = 0.350) were not significantly associated with OS. CONCLUSIONS: NLR, PLR, LMR and SIII represent inexpensive, easily obtainable adjuvant decision-making tools which could help tailor individualised treatment regimes. Further investigation into the utility of combination scores and the role of different laryngeal subsites may be of interest.

Investigation of serum calcium and vitamin D levels in superior semicircular canal dehiscence syndrome: A case control study.

Objective: It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence (SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in SSCD patients compared to a control group. Methods: This was a prospective case-control study performed in a tertiary referral center, university teaching hospital in the UK. It included all new patients with SSCD seen in a dedicated skull base clinic over a 5-year period (2015-2019) compared to a gender and age matched control group. The main outcome of the study was adjusted calcium and Vitamin D levels between the two groups. Results: A total of 31 SSCD patients were recruited with a matched number of control patients. The mean Vitamin D level on the SSCD group was 44.8 nmoL/l (SD: 20.8) compared to 47.5 nmoL/l (SD: 27.4) on the control group (p = 0.702). Mean Adjusted calcium level was 2.34 mmoL/l (SD: 0.7) for SSCD compared to 2.41 mmoL/l (SD: 0.11) for controls (p = 0.01), being within normal limits for both the SSCD and the control group. Conclusion: Our study did not identify a link between Vitamin D levels and presence of SSCD. Normal adjusted calcium values were found in both groups. Despite that a statistically significant lower calcium level was found in the SSCD group which could indicate that suboptimal levels of calcium may affect the micro-environment of the otic capsule at the SSC region.

Does recreational drug use influence survival and morbidity associated with laryngeal cancer.

Background: The use of opioids is considered a risk factor for laryngeal cancer. A retrospective study was performed to explore the relationship between recreational drug exposure and laryngeal cancer. Methods: Patients diagnosed between the 1st of January 2013 and the 31st of December 2017 using ICD-10 CD-32 coding were identified from the Head and Neck Multidisciplinary Team database. We divided the study population into two cohorts (RD and non-RD) and compared the demographics, morbidity, and outcomes of these two populations. In addition, we performed case-matched analysis to control for potential confounding factors including gender, alcohol use and cigarette smoking. Findings: 329 patients in Glasgow, Scotland were included with a mean age of 64.96 ± 10.94 and a follow-up of 24 ± 13.91 months. Of these, 39 reported recreational drug use (RD). RD was associated with younger age (53.0 vs. 66.6, p<0.001) at diagnosis with laryngeal cancer. A greater proportion of tumours occurred in the supraglottic subsite (p=0.041). Furthermore, these patients were more likely to undergo tracheostomy (RR=2.50, 95% CI: 1.41-4.44, p=0.008) and laryngectomy (RR=2.25, 95% CI: 1.57-3.21, p<0.001). Recreational drug users were more likely to require enteral feeding support (RR= 1.44, 95% CI: 1.13-1.84, p=0.02) during oncological treatment. No survival differences were noted at 1, 2, or 3-years (plog-rank=0.83). Case matched analysis correcting for smoking, alcohol and gender confirmed that recreational drug users were younger at diagnosis with a predilection for the supraglottic subsite. Conclusion: Recreational drug use is associated with an increased burden of disease and morbidity in laryngeal cancer. We suggest that clinicians view recreational drug exposure as a red flag in those with suspected laryngeal cancer regardless of patient age.

Imaging Post Stereotactic Radiosurgery for Vestibular Schwannomas-When Should We Scan?

OBJECTIVE: To identify the optimal time for imaging following stereotactic radiosurgery (SRS) in patients with vestibular schwannomas (VS). STUDY DESIGN: Retrospective case series. SETTING: Tertiary, university center. PATIENTS: Patients with VS treated with SRS. INTERVENTIONS: Pre- and post-SRS surveillance with magnetic resonance imaging (MRI); patients should have at least two pre- and two post-SRS scans available to be included. MAIN OUTCOME MEASURES: Patient demographics, tumor size, and growth per month ratio pre- and post-SRS and time interval between serial MRI. RESULTS: Forty-two patients fulfilled the inclusion criteria. The average tumor size before the treatment was 16.9 mm (range, 10-28 mm) while 2 years posttreatment it was 16 mm (range, 7-25 mm) (p = 0.5). Average time of the first MRI post-SRS was 11 months (range, 5-14) with an average change in tumor size at that time of +0.53 mm (range, -5-8). Average time to second MRI was 22.3 months (range, 12-33) with an average change in tumor size at second scan of -1.14 (range, -5-2) mm (p = 0.117). The average growth/mo ratio before SRS was 0.26 mm/mo (range, 0-1), while post-SRS 0.05 mm/mo (range, -0.3-0.5) and -0.16 mm/mo (range, -18-0.25) at the time of the first and second scan, respectively (p < 0.001). CONCLUSIONS: Given the initial increase in size following SRS, unless clinically indicated, MRI post-SRS at less than 1 year has no clinical value. The growth per month ratio provides more meaningful values for response to treatment than tumor size measurements.