Pharyngocutaneous Fistula Following Total Laryngectomy: a High-Volume Tertiary Centre Series.

Pharyngocutaneous fistula is the leading complication following total laryngectomy. It delays complementary treatments, speech rehabilitation and oral feeding. Despite evolving medical care, fistula incidence remains high. There is no consensus regarding risk factors for fistula development. A standard score for fistula prediction is lacking. Study population included all patients submitted to total laryngectomy (with or without pharyngectomy) due to laryngeal or hypopharyngeal tumours, occurring between January 1st, 2012, and December 31st, 2016. Patient demographics were recorded as well as disease and treatment variables. Statistical analysis was performed using the IBM SPSS Statistics 25®. A previously described predictive model for fistula occurrence was applied. A total of 212 patients were included, the vast majority with advanced local disease (97.5%). Only 10% were submitted to rescue surgery. Fistula incidence was 39.9%. Our rates of locally advanced tumours, with extensive hypopharyngeal involvement, were higher than in most series. Age, tumour location, diabetes, previous chemoradiotherapy, advanced local and regional disease, extensive pharyngectomy, flap reconstruction, manual suture and low post-operative albumin level were associated to fistula occurrence on univariate analysis. Only salvage surgery and advanced local disease remained significant on multivariate analysis. An adapted Cecatto score correlated with fistula occurrence but has not achieved statistical significance. Predictive models for fistula occurrence are lacking. Cecatto score showed promising results in our population but large multicentric studies are necessary for cut-off adjustments.

Comparison Between Clinical and Pathological Staging After Elective Neck Dissection in Head and Neck Cancer.

INTRODUCTION: Head and neck squamous cell carcinomas (HNSCC) are the most common malignancies in the head and neck. Previous studies have shown discrepancies in clinical and pathological staging, with a significant number of head and neck cancer patients who were not correctly staged. This has important implications regarding the treatment and prognosis of these patients. The aim of this study was to analyze potential disagreements in clinical and pathological staging in patients with head and neck cancer who underwent elective neck dissection. METHODS: A retrospective study of patients with squamous cell carcinoma of the head and neck, who underwent elective neck dissection, between January 2018 and December 2020. RESULTS: We analyzed 87 patients, with an average age of 64 ± 10.05 years, of whom 96.6% were male. The primary tumor location was the glottis (31%), oropharynx (26.4%), hypopharynx (19.5%), supraglottis (11.5%), and oral cavity (11.5%). In 87.3% there was a history of smoking and/or drinking. Pathological N (pN) staging was higher than clinical staging in 34.3% of patients (N1 in 22.9%; N2 in 8%; N3 in 3.4%). There were no significant differences between the number of nodes removed and the pN staging. However, there was a significant survival difference in patients with>15 nodes removed (p=0.05). There was also a significant difference in patients with pN up-staging regarding survival (p=0.005). Pathological T staging was different from clinical T staging (p<0.05), with an up-staging in 18.4% of the patients and a down-staging in 14.9%, without significant differences regarding survival or recurrence (p>0.05). Adjuvant treatment with radiotherapy was performed in 41.4% and with chemo-radiotherapy in 13.8% of the patients. Locoregional recurrence occurred in 17.5%. CONCLUSION: This study revealed that clinical and pathological N staging after elective neck dissection disagreed in a substantial number of patients, with pathological upstaging and significant differences regarding survival. With relation to T staging, there were no significant differences regarding survival. We should be aware of staging disagreements since they can have significant implications on the treatment and prognosis of cancer patients.

Risk Factors for Pharyngocutaneous Fistula Following Total Laryngectomy.

Pharyngocutaneous fistula is the leading complication following total laryngectomy. It delays complementary treatments, speech rehabilitation and oral feeding. Despite evolving medical care, fistula incidence remains high. There is no consensus regarding which patients are at higher risk for fistula development. This article comprised a literature review about risk factors for fistula development. All articles published on an on-line database (PUBMED™) using MESH terms "larynx cancer" and "fistula" in a 5-year period (January 1st, 2014 to January 27th, 2019) were included. Further articles were selected due to expert suggestion by one of the senior surgeons. Only articles written in Portuguese or English were included. Animal studies were excluded. 151 articles were selected and abstracts analysed. 82 articles were selected for full text revision. 32 were later excluded because they described single clinical cases, experimental surgical technics, irrelevant data or poor methodology. Final selection comprised 50 studies: 9 systematic reviews, one non-systematic review, 34 unicentric and 4 multicentric retrospective analysis and two prospective studies. There is no consensus regarding risk factors for fistula development. Patients submitted to salvage surgery for advanced disease seem to be at greater risk. Bad nutritional status is a logical contributor, but the ideal surrogate marker is still missing. Several variables are inconsistently pointed as risk factors and should be abandoned unless proved otherwise. There are no standard scores for fistula occurrence despite being a common complication following surgery.

Sinonasal adenocarcinomas: Retrospective analysis from an oncology center.

INTRODUCTION AND OBJECTIVES: Sinonasal adenocarcinomas are rare and heterogeneous tumors and for this reason remain understudied. Our purpose is to analyze clinical presentation, outcomes and factors affecting survival of patients with sinonasal adenocarcinomas, treated at our institution. MATERIAL AND METHODS: Retrospective review of clinical records of patients with sinonasal adenocarcinoma, treated at a tertiary oncology institution (January 2010 to December 2019). RESULTS: Sixty patients diagnosed with adenocarcinoma were included, with male preponderance (54.90%) and a mean age of 57.5±14.9 years. Adenocarcinoma was the most frequent type of sinonasal cancer, contrary to previous reports from our institution. In most patients, it was detected at an advanced disease stage, significantly decreasing their survival rate when compared to patients diagnosed at initial stages (p<0.029). Intestinal type adenocarcinoma was established in 47 patients, the most frequent being the colonic subtype (24%). Tumors with good/moderate histologic differentiation presented a survival advantage over those that were poorly differentiated (p=0.043). The most common treatment modality was surgery followed by radiotherapy. Endoscopic resection was performed in 53% of the patients and an external approach was used in 40% of the patients. Estimated overall survival rates at 3 and 5-years were 64% and 53%, respectively, and cancer specific survival 72% and 65%, for the same period. Recurrence rate was 32% and occurred mainly locally. Disease Free Survival rate was 71% at 3 years and 65% at 5 years. CONCLUSIONS: Despite being the most common sinonasal malignancy in our sample, in contrast to other series, sinonasal adenocarcinomas are still rare tumors with a substantial local failure rate of around 30%. Advanced stage at diagnosis and histologic differentiation grade negatively affected prognosis of these tumors.

Nasopharyngeal carcinoma in a non-endemic country-Validation of the new NPC staging system.

BACKGROUND: Nasopharyngeal carcinoma (NPC) staging has recently been updated, with the eighth edition of the AJCC/UICC. In the last ten years, Intensity Modulated Radiotherapy (IMRT) has become a standard treatment for NPC. The authors aim to assess the benefits of the new AJCC staging system in predicting prognosis, as well as the improvement in survival outcomes in the IMRT era, in non-edemic population. METHODS: Retrospective study selecting patients treated for NPC between January 2009 and December 2019 in a cancer treatment center in Portugal. Initial TNM staging (according to the seventh edition of the AJCC/UICC) was collected and each patient was restaged according to the new TNM staging system. Overall survival (OS) and Distant Metastasis Free Survival (DMFS) stratified by T and N classification and stage (according to the both TNM staging systems) were analyzed. Univariate and multivariate analysis was performed to evaluate which factors influence OS and DMFS. Data in this series was compared with a previous report from the same institution, before IMRT standard use. RESULTS: 113 patients were included, averaging 53.74 (±1.4) years old. With the new TNM staging, 5 patients were downstaged and 3 patients were upstaged. Over a median follow-up time of 41 months, the 5-year OS and DMFS were 77% and 79.8%, respectively. Neither the seventh nor the eighth editions of the AJCC/UICC staging system had good overall discrimination between each T classification OS and DMFS curves. Both the seventh and the eighth editions of the AJCC/UICC staging system had statistically significant overall discrimination between each N group and each stage group classification OS curves. Only N classification predicted OS in multivariate analysis. When comparing to a previous report from the same institution, OS has not improved majorly, especially in locoregionally advanced disease. CONCLUSIONS: TNM staging still presents limitations in adequately predicting OS and DMFS.

Elective Revision Surgery in Head and Neck Cancer Patients: A Retrospective Analysis at an Oncology Centre in Porto, Portugal.

Introduction Elective revision surgery in head and neck cancer is crucial for refining and optimizing outcomes, ensuring complete tumor removal, and enhancing both functional and aesthetic aspects, ultimately improving the overall quality of life for patients. The aim of this study is to analyze the overall survival (OS) of head and neck cancer patients who underwent elective revision surgery with or without adjuvant treatment between 2019 and 2022, reflecting on the practice between those years in IPO-Porto, Porto, Portugal. Methods This study included 58 patients who underwent 116 major neck surgeries. Multidisciplinary head and neck follow-up records were obtained for every patient. Overall survival and disease-specific survival (DSS) curves were calculated using the Kaplan-Meier method, and statistical significance was determined by the Log-Rank test. We did a retrospective study with an anterograde direction, evaluating the treatments that were previously done by the patients. Results The sample comprised 51 males (87.9%) and seven females (12.1%), with a mean age of 59.02±11.014 years. Head and neck pathology was mostly in the larynx (36.2%). The type of the first surgery was mainly directed to the primary tumor in 62.1% (n=36). In the other 37.9% (n=22), surgery was directed to the primary tumor in association with neck dissection. The type of the second surgery was mainly revision surgery. We found that T4 tumors (HR (hazard ratio) = 10.219, p = 0.006) and hypopharynx tumors (HR = 5.306, p =0.035) were significantly associated with inferior OS. Conclusion In our sample, we found that a T4 and a tumor located in the hypopharynx were significantly associated with inferior OS in elective head and neck oncologic revision surgery. Disease-free survival in patients undergoing revision surgery in our sample is generally poor. In our sample, there was a statistically significant difference in overall survival between the group who underwent surgery for microscopic evidence of persistent tumor (R1) versus clinical and imagiological tumoral persistency. In our sample, the time between the first and second surgeries wasn't linked with an inferior OS. Further studies with larger populations and prospective design, with longer follow-ups can be the road to a better understanding of this issue.

"Bone-shot fracture" - An unusual iliac wing fracture caused by a projectile of autologous bone fragment. A case report.

CASE: A young adult male sustained a high-energy crash suffering multiple injuries including a comminuted right femoral shaft fracture and an ipsilateral iliac wing fracture. The iliac fracture was caused by a femoral fragment which was projected and pierced the iliac wing. The patient underwent surgery with retrieval of the femoral fragment and fixation of the iliac and femoral fractures. The lesions healed uneventfully. CONCLUSION: This is the first reported case of an iliac fracture caused by a projectile of autologous bone. High-energy trauma may present unusual or never seen injury patterns to the trauma surgeon.

Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen's Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen' Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3-4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

Abstract Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen's Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen' Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3-4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Optimizing classical risk scores to predict complications in head and neck surgery: a new approach.

PURPOSE: To validate tools to identify patients at risk for perioperative complications to implement prehabilitation programmes in head and neck surgery (H&N). METHODS: Retrospective cohort including 128 patients submitted to H&N, with postoperative Intermediate Care Unit admittance. The accuracy of the risk calculators ASA, P-POSSUM, ACS-NSQIP and ARISCAT to predict postoperative complications and mortality was assessed. A multivariable analysis was subsequently performed to create a new risk prediction model for serious postoperative complications in our institution. RESULTS: Our 30-day morbidity and mortality were 45.3% and 0.8%, respectively. The ACS-NSQIP failed to predict complications and had an acceptable discrimination ability for predicting death. The discrimination ability of ARISCAT for predicting respiratory complications was acceptable. ASA and P-POSSUM were poor predictors for mortality and morbidity. Our new prediction model included ACS-NSQIP and ARISCAT (area under the curve 0.750, 95% confidence intervals: 0.63-0.87). CONCLUSION: Despite the insufficient value of these risk calculators when analysed individually, we designed a risk tool combining them which better predicts the risk of serious complications.

Is Increased Time From Diagnosis to Treatment in Advanced Hypopharynx Cancer Associated With Poorer Outcomes: A Single-Centre Analysis.

OBJECTIVE: To assess the potential influence of increased time from diagnosis to treatment on survival outcomes in patients with locoregionally advanced hypopharyngeal squamous cell carcinoma (HSCC). METHODS: Retrospective study of patients with a primary diagnosis of HSCC proposed for primary surgical treatment. RESULTS: The study population included a total of 121 Caucasian patients (121 males) with HSCC. Mean age at diagnosis was 60.4 years (range: 43-83 years). All patients had cT3 or cT4 hypopharyngeal tumors. The sample presented a 5-year overall survival (OS) of 59.6% and a disease-specific survival of 74.9%. Considering univariable analysis (unadjusted), duration of adjuvant treatment (T5), pN, margins, and extracapsular spread (ECS) are factors associated with poorer survival outcomes. An increase in T5 was associated with lower OS. Results revealed that T5 higher than 43 days, pN1, pN2, pN3, no free margins, and presence of ECS were associated with lower OS. These patients have 7.465 higher hazard of death. CONCLUSION: This study suggests that duration of adjuvant therapy may be more important than other timing metrics from diagnosis to treatment. For locoregionally advanced HSCC, duration of adjuvant therapy after primary surgery higher than 6 weeks is an important feature for worse survival outcome. Preventing strategies in order to avoid radiotherapy or chemoradiotherapy breaks should be developed and optimized.

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis.

OBJECTIVE: To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries. METHODS: A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate. RESULTS: In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization. CONCLUSION: The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.

Exploring sialyl-Tn expression in microfluidic-isolated circulating tumour cells: A novel biomarker and an analytical tool for precision oncology applications.

Circulating tumour cells (CTCs) originating from a primary tumour, lymph nodes and distant metastases hold great potential for liquid biopsies by providing a molecular fingerprint for disease dissemination and its temporal evolution through the course of disease management. CTC enumeration, classically defined on the basis of surface expression of Epithelial Cell Adhesion Molecule (EpCAM) and absence of the pan-leukocyte marker CD45, has been shown to correlate with clinical outcome. However, existing approaches introduce bias into the subsets of captured CTCs, which may exclude biologically and clinically relevant subpopulations. Here we explore the overexpression of the membrane protein O-glycan sialyl-Tn (STn) antigen in advanced bladder and colorectal tumours, but not in blood cells, to propose a novel CTC isolation technology. Using a size-based microfluidic device, we show that the majority (>90%) of CTCs isolated from the blood of patients with metastatic bladder and colorectal cancers express the STn antigen, supporting a link with metastasis. STn+ CTC counts were significantly higher than EpCAM-based detection in colorectal cancer, providing a more efficient cell-surface biomarker for CTC isolation. Exploring this concept, we constructed a glycan affinity-based microfluidic device for selective isolation of STn+ CTCs and propose an enzyme-based strategy for the recovery of viable cancer cells for downstream investigations. Finally, clinically relevant cancer biomarkers (transcripts and mutations) in bladder and colorectal tumours, were identified in cells isolated by microfluidics, confirming their malignant origin and highlighting the potential of this technology in the context of precision oncology.

Surgically-Treated Locoregionally Advanced Hypopharyngeal Cancer: Outcomes

Abstract Introduction Hypopharyngeal tumors are head and neck malignancies associated with a great mortality rate, and the treatment of advanced lesions constitutes a challenging problem. Pharyngolaryngectomy continues to be the gold standard treatment modality for locally-advanced diseases, and it is currently used as the primary treatment or in cases of relapse after an organ preservation strategy. Objective This study aims to compare the survival rates of patients with advanced hypopharyngeal tumors treated with pharyngolaryngectomy as a primary or salvage option, and identify possible prognostic factors. Methods All patients with advanced hypopharyngeal squamous cell carcinomas who performed pharyngolaryngectomy between 2007 and 2014 were reviewed retrospectively. Results A total of 87 patients fulfilled the aforementioned criteria, and the sample had a mean age of 57.2 years and a male predominance of 43:1. The tumors were located in the pyriform sinus walls (81 tumors), in the posterior pharyngeal wall (4 tumors) and in the postcricoid region (2 tumors). A total of 60 patients underwent surgery as the primary treatment option, and 27 were submitted to salvage pharyngolaryngectomy after a previous treatment with chemoradiotherapy or radiotherapy. The 5-year overall survival was of 25.9%, the 5-year disease-free survival was of 24.2%, and the disease-specific survival was of 29.5%. Conclusion The patients treated with pharyngolaryngectomy as the primary option revealed a better 5-year-disease free survival than the patients who underwent the salvage surgery (35.8% versus 11.7% respectively; p< 0.05). The histopathological criteria of capsular rupture of the lymph nodes (30.1% versus 19.8% respectively for the primary and salvage groups; p< 0.05) and vascular invasion (30.5% versus 22.5% respectively; p< 0.05) reduced the 5-year disease-free survival. Pharyngolaryngectomy as the primary intent revealed a lower local recurrence rate than the salvage surgery (40.6% versus 83.3% respectively; p< 0.05).

Head and Neck Cancer: Improving Patient-Reported Outcome Measures for Clinical Practice.

OPINION STATEMENT: Head and neck cancer includes a wide range of tumors that occur in several areas of the upper aerodigestive tract. Most head and neck cancer patients report treatment-related late effects (both physical and psycho-social). High-quality and patient-centered care in head and neck cancer depend on the understanding of the continuum patient's experience-the disease pathway. Healthcare has been improved by involving patients more actively in the disease process, and a few reports support that patient-reported outcomes-built around the patient's experience-given in a timely manner to oncologists are extremely valuable in oncology clinical care. Implementation and clinical use of patient-reported outcomes requires some procedures involving head and neck cancer patients, clinicians, researchers, and institutional leaders The unified and integrated vision is still absent and some current concerns are being discussed to optimize benefits of patient-reported outcomes use in clinical practice. The inclusion of all first-line caregivers, team formation and training, continuous monitoring improvement, and analysis are critical success factors to consider. Our team developed a broader and inclusive understanding of patient-reported outcomes. Patient-reported outcome (Health-Related Quality of Life) assessment is implemented as a systematic and routine process in Head and Neck Unit. Head and neck cancer patients consider the questionnaire administration as part of the clinical approach. We are currently working in a program (PROimp) using mathematical models to identify common head and neck cancer patterns and building prognostic predictive models, to predict future outcomes, to appraise risk/benefit of treatments (standard or new), and to estimate patient's risk of future disease development. It is our aim to better comprehend the singular and unexpected perceptions to really provide directed and personalized cancer care defining the patient pathway. The future holds promising for PROs that are ascending as a nuclear outcome in head and neck oncology.

Surgically-Treated Locoregionally Advanced Hypopharyngeal Cancer: Outcomes.

Introduction Hypopharyngeal tumors are head and neck malignancies associated with a great mortality rate, and the treatment of advanced lesions constitutes a challenging problem. Pharyngolaryngectomy continues to be the gold standard treatment modality for locally-advanced diseases, and it is currently used as the primary treatment or in cases of relapse after an organ preservation strategy. Objective This study aims to compare the survival rates of patients with advanced hypopharyngeal tumors treated with pharyngolaryngectomy as a primary or salvage option, and identify possible prognostic factors. Methods All patients with advanced hypopharyngeal squamous cell carcinomas who performed pharyngolaryngectomy between 2007 and 2014 were reviewed retrospectively. Results A total of 87 patients fulfilled the aforementioned criteria, and the sample had a mean age of 57.2 years and a male predominance of 43:1. The tumors were located in the pyriform sinus walls (81 tumors), in the posterior pharyngeal wall (4 tumors) and in the postcricoid region (2 tumors). A total of 60 patients underwent surgery as the primary treatment option, and 27 were submitted to salvage pharyngolaryngectomy after a previous treatment with chemoradiotherapy or radiotherapy. The 5-year overall survival was of 25.9%, the 5-year disease-free survival was of 24.2%, and the disease-specific survival was of 29.5%. Conclusion The patients treated with pharyngolaryngectomy as the primary option revealed a better 5-year-disease free survival than the patients who underwent the salvage surgery (35.8% versus 11.7% respectively; p < 0.05). The histopathological criteria of capsular rupture of the lymph nodes (30.1% versus 19.8% respectively for the primary and salvage groups; p < 0.05) and vascular invasion (30.5% versus 22.5% respectively; p < 0.05) reduced the 5-year disease-free survival. Pharyngolaryngectomy as the primary intent revealed a lower local recurrence rate than the salvage surgery (40.6% versus 83.3% respectively; p < 0.05).

Transoral laser microsurgery as standard approach to hypopharyngeal cancer. Survival analysis in a hospital based population.

OBJECTIVE: Cancer of the hypopharynx remains one of the most challenging chapters in head and neck oncology. The objective of this study is to ascertain the relevance of a transoral laser approach as a valid functional option for treatment of cancer of the hypopharynx in Portugal, and additionally, to confirm the reproducibility of survival and functional outcomes described in other reference centers. SUBJECTS AND METHODS: The outcomes of 37 out of 60 patients presenting hypopharyngeal carcinoma primarily treated by TLM (transoral laser microsurgery) and neck dissection and or adjuvant treatment when needed, with curative intention in tertiary referral center, were retrospectively evaluated and compared with published results. RESULTS: There were no patients in stage I. Three-year and five-year overall survival (Kaplan-Meier) were 83.5% and 63.5% for stage II (n=12), 57.1% (only 3-year overall survival evaluable for this stage) for stage III (n=7), and 53.1% and 39.8% for stage IVa (n=18), respectively. Five-year local control rates were 90% for stage II and 87.5% for stage IVa, respectively; only three-year local control rates were possible to evaluate for stage III, with a 100% control rate. Five-year total larynx preservation rate was 97.3%. CONCLUSIONS: TLM, alone or with neck dissection and adjuvant therapy, is a valid procedure for treatment of hypopharyngeal cancer in different stages. Furthermore, this kind of approach can be replicated in different oncologic centers with similar oncologic and functional results.

Treatment of Head and Neck Cancer with Photodynamic Therapy with Redaporfin: A Clinical Case Report.

Advanced head and neck squamous cell carcinoma, after locoregional treatment and multiple lines of systemic therapies, represents a great challenge to overcome acquired resistance. The present clinical case illustrates a successful treatment option and is the first to describe the use of photodynamic therapy (PDT) with Redaporfin, followed by immune checkpoint inhibition with an anti-PD1 antibody. This patient presented an extensive tumor in the mouth pavement progressing after surgery, radiotherapy, and multiple lines of systemic treatment. PDT with Redaporfin achieved the destruction of all visible tumor, and the sequential use of an immune checkpoint inhibitor allowed a sustained complete response. This case is an example of the effect of this therapeutic combination and may provide the basis for a new treatment modality.

Discrepancy between clinical and pathological neck staging in oral cavity carcinomas.

INTRODUCTION: The presence of cervical lymph node metastases in patients with oral cavity squamous cell carcinoma reduces survival by up to 50%. OBJECTIVE: The aims of this study are to assess the accuracy of clinical N staging versus pathological N staging and its impact on survival in order to identify predictive factors associated with the presence of occult neck metastases. METHODS: Outcomes of 105 patients with oral cavity squamous cell carcinoma who underwent surgical treatment of the primary tumor and neck were retrospectively evaluated. RESULTS: For pN0 and pN+ patients 5-year overall survival was respectively 53% and 27%; disease specific survival was 66% for pN0 and 33% for pN+. Patients with clinical negative lymph nodes were pathologically upstaged in 62% of cases. Disease specific survival according to staging discrepancy had statistically significant impact on survival (p=0.009). CONCLUSION: Clinical staging usually underestimates the presence of nodal disease. Neck dissection should be performed in cN0 oral cavity squamous cell carcinoma.