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1.
Front Immunol ; 15: 1467306, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39267732

RESUMO

Background: Immune checkpoint inhibitors have demonstrated promising therapeutic outcomes in recurrent/metastatic (R/M) Head and Neck Squamous Cell Carcinoma (HNSCC), prompting numerous clinical trials to investigate the safety and efficacy of this approach in neoadjuvant therapy. This systematic review aims to consolidate and analyze the findings from various clinical trials combining neoadjuvant immunotherapy for HNSCC, with the goal of identifying the most effective neoadjuvant immunotherapy regimen. Methods: The system conducted searches across electronic databases including PubMed, Embase, the Cochrane Library and Web of science from their inception to July 1, 2024. The primary focus was on evaluating efficacy (particularly pathological complete response (pCR), major pathological response (MPR), and overall response rate (ORR)) and safety (primarily assessed by grade 3-4 treatment-related adverse reactions). Results: A total of 1943 patients from 32 studies were analyzed. Combining neoadjuvant immunotherapy with chemotherapy or radiotherapy demonstrated superiority over neoadjuvant immunotherapy alone in terms of the MPR rate, while showing no statistically significant difference in the pCR rate. Furthermore, the combination of neoadjuvant immunotherapy with chemotherapy or radiotherapy exhibited a lower CR rate compared to neoadjuvant immunotherapy with radiotherapy alone, but a higher PR rate and SD rate. Apart from the neoadjuvant immunotherapy group in isolation, there were no statistically significant differences in grade ≥3 treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs) among the other three combination therapy groups. Conclusion: This systematic review and meta-analysis indicate that patients with locally advanced HNSCC might benefit from neoadjuvant immunotherapy, particularly when used in conjunction with chemotherapy or radiotherapy. Nonetheless, additional data is required to definitively confirm its efficacy. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=553753, identifier CRD42024553753.


Assuntos
Neoplasias de Cabeça e Pescoço , Imunoterapia , Terapia Neoadjuvante , Carcinoma de Células Escamosas de Cabeça e Pescoço , Humanos , Terapia Neoadjuvante/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Carcinoma de Células Escamosas de Cabeça e Pescoço/imunologia , Imunoterapia/efeitos adversos , Imunoterapia/métodos , Neoplasias de Cabeça e Pescoço/terapia , Neoplasias de Cabeça e Pescoço/imunologia , Resultado do Tratamento , Terapia Combinada , Inibidores de Checkpoint Imunológico/efeitos adversos , Inibidores de Checkpoint Imunológico/uso terapêutico
2.
Cancer Med ; 13(17): e70232, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39268626

RESUMO

BACKGROUND: The aim of this study is comparison the effectiveness of stereotactic, hypofractionated and conventional radiotherapy assessed by the tumor volume changes of paraganglioma located in the head and neck region concerning fractional and total doses. METHODS: We analyzed 76 patients after radiotherapy due to paraganglioma who were assigned to 3 groups considering fractional (≤2 Gy, 3-5.5 Gy, ≥6 Gy) and total (≤20 Gy, 21-40 Gy, >40 Gy) doses. The volumes of irradiated tumors were measured and compared based on diagnostic images performed before and after the treatment. RESULTS: The mean tumor volume after the treatment with the lowest fractional dose (≤2 Gy) was decreased by 14.4 cm3. In patients treated with higher fractional doses (>2 Gy), the mean tumor volumes decreased by less than 1 cm3 for hypofractionated and stereotactic radiotherapy. 15.9 cm3 reduction of the mean tumor volume after the treatment with the highest RT total dose (>40 Gy) was stated. In patients treated with total doses ≤20 Gy and 21-40 Gy, the mean tumor volume was stable and reduced by 1.15 cm3, respectively. The analysis demonstrates a statistically significant (p < 0.05) treatment advantage in patients after the lowest fractional and highest total doses. CONCLUSION: The reduction of the tumor's volume was reported after conventional and unconventional radiotherapy. The most significant depletion of the paraganglioma volume was noted after a factional dose ≤2 Gy and a total dose >40 Gy.


Assuntos
Neoplasias de Cabeça e Pescoço , Paraganglioma , Radiocirurgia , Carga Tumoral , Humanos , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/patologia , Carga Tumoral/efeitos da radiação , Feminino , Masculino , Radiocirurgia/métodos , Pessoa de Meia-Idade , Paraganglioma/radioterapia , Paraganglioma/patologia , Paraganglioma/diagnóstico por imagem , Adulto , Idoso , Resultado do Tratamento , Hipofracionamento da Dose de Radiação , Fracionamento da Dose de Radiação , Dosagem Radioterapêutica , Adulto Jovem
3.
BMC Cancer ; 24(1): 1144, 2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39272022

RESUMO

BACKGROUND: HPV status in a subset of HNSCC is linked with distinct treatment outcomes. Present investigation aims to elucidate the distinct clinicopathological features of HPV-positive and HPV-negative HNSCC and investigate their association with the HNSCC patient survival. MATERIALS AND METHODS: The total RNA of exosomes from HPV-positive (93VU147T) and HPV-negative (OCT-1) HNSCC cells was isolated, and the transcripts were estimated using Illumina HiSeq X. The expression of altered transcripts and their clinical relevance were further analyzed using publicly available cancer transcriptome data from The Cancer Genome Atlas (TCGA). RESULTS: Transcriptomic analyses identified 3785 differentially exported transcripts (DETs) in HPV-positive exosomes compared to HPV-negative exosomes. DETs that regulate the protein machinery, cellular redox potential, and various neurological disorder-related pathways were over-represented in HPV-positive exosomes. TCGA database revealed the clinical relevance of altered transcripts. Among commonly exported abundant transcripts, SGK1 and MAD1L1 showed high expression, which has been correlated with poor survival in HNSCC patients. In the top 20 DETs of HPV-negative exosomes, high expression of FADS3, SGK3, and TESK2 correlated with poor survival of the HNSCC patients in the TCGA database. CONCLUSION: Overall, our study demonstrates that HPV-positive and HPV-negative cells' exosomes carried differential transcripts cargo that may be related to pathways associated with neurological disorders. Additionally, the altered transcripts identified have clinical relevance, correlating with patient survival in HNSCC, thereby highlighting their potential as biomarkers and as therapeutic targets.


Assuntos
Exossomos , Neoplasias de Cabeça e Pescoço , Carcinoma de Células Escamosas de Cabeça e Pescoço , Humanos , Exossomos/metabolismo , Exossomos/genética , Carcinoma de Células Escamosas de Cabeça e Pescoço/genética , Carcinoma de Células Escamosas de Cabeça e Pescoço/virologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/metabolismo , Neoplasias de Cabeça e Pescoço/genética , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/virologia , Neoplasias de Cabeça e Pescoço/metabolismo , Masculino , Feminino , Regulação Neoplásica da Expressão Gênica , Perfilação da Expressão Gênica , Infecções por Papillomavirus/virologia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/genética , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Pessoa de Meia-Idade , Linhagem Celular Tumoral , Transcriptoma , Prognóstico , Idoso
4.
Cancer Control ; 31: 10732748241283621, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39275798

RESUMO

OBJECTIVES: Radiation-induced oropharyngeal injury is a dose-limiting toxicity in head and neck cancer patients. Delineation of the "oropharyngeal mucosa" and limiting its dose to spare the oropharynx was investigated. METHODS: In this retrospective study, computed tomography imaging from eight patients with previously untreated head and neck cancer was employed. An adaptive contouring brush within the planning software Monaco was used to create an air cavity within the oropharynx, and then the air cavity was expanded uniformly 2 mm to create the "oropharyngeal mucosa". Three plans were independently generated for each patient: Plan1: dose constraint was applied for the oropharynx; Plan2: dose constraints were applied for the oropharynx and the "oropharyngeal mucosa"; Plan3: dose constraint was applied for the "oropharyngeal mucosa". T-tests were used to compare the dosimetry variables. RESULTS: All plans had adequate target coverage and there were no statistical differences among plans. The mean dose, D30%, D45%, D50%, D85%, D90%, D95%, D100%, V25 Gy, V30 Gy, V35 Gy, V40 Gy, and V45 Gy of the oropharynx and "oropharyngeal mucosa" in Plan1 were significantly higher than those in Plan2 and Plan3. There were no significant differences between Plan2 and Plan3. There were no significant differences in the dosimetric parameters of any other organs at risk. CONCLUSION: Delineation of the "oropharyngeal mucosa" and limiting its dose should be an easy and effective method to spare the oropharynx.


Radiation-induced oropharyngeal injury is dose-limiting toxicity in head and neck cancer patients. Delineation of "oropharyngeal mucosa" and limiting its dose should be an easy and effective method to spare the oropharynx.


Assuntos
Neoplasias de Cabeça e Pescoço , Orofaringe , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Humanos , Neoplasias de Cabeça e Pescoço/radioterapia , Estudos Retrospectivos , Planejamento da Radioterapia Assistida por Computador/métodos , Orofaringe/efeitos da radiação , Orofaringe/diagnóstico por imagem , Masculino , Órgãos em Risco/efeitos da radiação , Feminino , Radioterapia de Intensidade Modulada/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Mucosa/efeitos da radiação , Lesões por Radiação/prevenção & controle , Lesões por Radiação/etiologia
5.
Sci Rep ; 14(1): 21541, 2024 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-39278971

RESUMO

This population-based study investigated the risk of having had prior herpes zoster within five years preceding a diagnosis of head and neck cancer. We conducted a case-control study that included 9,191 patients with a diagnosis of head and neck cancer in Taiwan's Longitudinal Health Insurance Database 2010 and 36,764 matched controls. We assessed the odds of patients with head and neck cancer having had a diagnosis of herpes zoster during the five years preceding head and neck cancer using multiple logistic regression analysis. The prevalence of prior herpes zoster among the total sample was 4.6%, 7.9% and 3.8% among patients with and without head and neck cancer, respectively (p < 0.001). The odds ratio of herpes zoster among the head and neck cancer- versus control group was 2.198 (95% CI = 2.001 ~ 2.415) after adjusting for sociodemographic characteristics and hypertension, diabetes, hyperlipidemia, tobacco use disorder, HPV infection, and alcohol dependence syndrome. Statistically significant excess odds were observed for all specific subtypes of head and neck cancer except for sinonasal cancer. Herpes zoster infection within the 5 years preceding a diagnosis of head and neck cancer may be a harbinger of developing head and neck cancer.


Assuntos
Neoplasias de Cabeça e Pescoço , Herpes Zoster , Humanos , Herpes Zoster/epidemiologia , Herpes Zoster/complicações , Masculino , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/virologia , Pessoa de Meia-Idade , Idoso , Estudos de Casos e Controles , Taiwan/epidemiologia , Adulto , Prevalência , Fatores de Risco , Razão de Chances , Idoso de 80 Anos ou mais
7.
Int J Mol Sci ; 25(17)2024 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-39273129

RESUMO

Head and neck paragangliomas (HNPGLs) are rare neoplasms arising from paraganglia of the parasympathetic nervous system. HNPGLs are characterized by high vascularity and are located in proximity to major vessels and nerves, which may be potential sources of microbial invasion in these tumors. There have been no studies in the literature on the microbiota in HNPGLs. Investigation of the microbiome associated with paragangliomas is important for understanding tumor pathogenesis. In this study, we investigated the microbiome composition in two sets of HNPGLs. First, 29 fresh frozen (FF) tissues were subjected to 16S rRNA gene sequencing; concurrently, a panel of candidate laboratory-derived contaminants was investigated. Second, we analyzed microbial reads from whole transcriptome sequencing data obtained for 82 formalin-fixed paraffin-embedded (FFPE) HNPGLs. The bacterial diversity in FF tumors was found to be significantly lower than that observed in FFPE HNPGLs. Based on 16S rRNA gene sequencing, only seven bacterial families were identified as potential tumor inhabitants: Bryobacteraceae, Enterococcaceae, Neisseriaceae, Legionellaceae, Vibrionaceae, Obscuribacteraceae, and Mycobacteriaceae. However, RNA-Seq demonstrated higher sensitivity for identifying microbiome composition and revealed abundant bacterial families that partially correlated with those previously described in pheochromocytomas and extra-adrenal paragangliomas. No viruses were found in HNPGLs. In summary, our findings indicated the presence of a microbiome in HNPGLs, comprising a number of bacterial families that overlap with those observed in pheochromocytomas/paragangliomas and glioblastomas.


Assuntos
Neoplasias de Cabeça e Pescoço , Microbiota , Paraganglioma , RNA Ribossômico 16S , Humanos , Neoplasias de Cabeça e Pescoço/microbiologia , Microbiota/genética , RNA Ribossômico 16S/genética , Paraganglioma/microbiologia , Paraganglioma/genética , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação
8.
Support Care Cancer ; 32(10): 659, 2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39271541

RESUMO

PURPOSE: Social eating (SE) is a corner stone of daily living activities, quality of life (QoL), and aging well. In addition to feeding functional disorders, patients with head and neck cancer (HNC) face individual and social psychological distress. In this aging population, we intended to better assess the influence of age on these challenges, and the role of self-stigmatization limiting SE in patients with and beyond HNC. METHODS: This was an exploratory multicenter cross-sectional mixed method study. Eligibility criteria were adults diagnosed with various non-metastatic HNC, before, during, or until 5 years after treatment. SE disorders were explored with the Performance Status Scale Public Eating rate (PSS-HN PE). In the quantitative part of the study, SE habits, Functional Assessment of Cancer Therapy Body Image Scale (FACT-MBIS) and specific to HNC (FACT-HN35) were also filled in by the patients. In the qualitative study, the semi-structured interview guide was drawn out to explore stigma, especially different dimensions of self-stigmatization. RESULTS: A total of 112 patients were included, mean age 64.7 years, 23.2% of female. One-third (n = 35) of patients had an abnormal PSS-HN PE rate < 100. Younger patients had more often an impaired Normalcy of Diet mean (70.4 vs 82.7, p = .0498) and PE rates (76 vs 86.9, p = .0622), but there was no difference between age subgroups in MBIS nor FACT-HN scores. Seventy patients (72.2%) found SE and drinking « important¼ to « extremely important¼ in their daily life. The qualitative study reported self-stigmatization in two older patients and strategies they have developed to cope with in their behaviors of SE. CONCLUSION: This study confirms that SE remains of high concern in patients with and beyond HNC. Even in older patients experiencing less often functional feeding disorders, body image changes and SE issues are as impaired as in younger patients and need to be addressed.


Assuntos
Neoplasias de Cabeça e Pescoço , Qualidade de Vida , Humanos , Feminino , Masculino , Estudos Transversais , Pessoa de Meia-Idade , Neoplasias de Cabeça e Pescoço/psicologia , Idoso , França , Fatores Etários , Estigma Social , Adulto , Idoso de 80 Anos ou mais , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Imagem Corporal/psicologia , Comportamento Alimentar/psicologia
9.
J Med Case Rep ; 18(1): 440, 2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39267156

RESUMO

BACKGROUND: In this report, we describe an uncommon instance of fungating synovial sarcoma affecting the posterior aspect of the neck. Although the existing literature has documented a limited number of cases, this particular case contributes to the knowledge about it, which is scarce. CASE PRESENTATION: A total of 5 months before the examination, a Pakistani-Asian male, age 20 years, complained of a malodorous fungating swelling on the posterior aspect of his neck. An examination revealed a foul-smelling, 10 × 13 cm fungating enlargement surrounded by maggots and hemorrhaging at the site of the incision. A hemoglobin level of 6 and a total leukocyte count (TLC) of 23,000 indicated the patient's disoriented and pallid appearance. He was expeditiously admitted, and preoperatively, the general well-being of the patient was optimized. After a comprehensive discussion with the medical team, a strategy for marginal excision and coverage with a latissimus dorsi (LD) flap and grafting was devised. The tumor was successfully excised, and an LD flap with graft was conducted on the patient during surgery; however, the infection caused the failure of half of the graft. Following that, the lesion was debrided, and re-grafting was performed. The patient was subsequently administered 5 cycles of chemotherapy and 32 cycles of radiotherapy. He was diagnosed with pulmonary metastasis 2 years later. Sadly, the patient died during a follow-up visit 3.5 years later. CONCLUSIONS: The patient's unfavorable prognosis after surgical intervention, radiotherapy, and chemotherapy, despite undergoing all-encompassing treatments, underscores the importance of early detection and intervention in fungating tumor cases.


Assuntos
Neoplasias de Cabeça e Pescoço , Sarcoma Sinovial , Humanos , Masculino , Sarcoma Sinovial/terapia , Sarcoma Sinovial/cirurgia , Sarcoma Sinovial/patologia , Adulto Jovem , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Neoplasias de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos
10.
J Otolaryngol Head Neck Surg ; 53: 19160216241251701, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39276012

RESUMO

BACKGROUND: The diagnosis and treatment of head and neck cancer (HNC) is associated with several life-altering morbidities including change in appearance, speech, and swallowing, all of which can significantly affect quality of life and cause psychosocial stress. COMMENTARY: The aim of this narrative review is to provide an overview of the evidence on psychosocial interventions for patients with HNC. Evidence regarding screening tools, psychological interventions, smoking and alcohol cessation, and antidepressant therapy in the HNC population is reviewed. CONCLUSION: There is a large body of evidence describing various psychosocial interventions and several of these interventions have shown promise in the literature to improve psychosocial and health outcomes in the HNC population. Psychosocial interventions should be integrated into HNC care pathways and formal recommendations should be developed.


Assuntos
Neoplasias de Cabeça e Pescoço , Qualidade de Vida , Humanos , Neoplasias de Cabeça e Pescoço/psicologia , Neoplasias de Cabeça e Pescoço/terapia , Intervenção Psicossocial , Estresse Psicológico
11.
Cancer Immunol Immunother ; 73(11): 229, 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39249543

RESUMO

Immune checkpoint inhibitors are approved for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) but the response rate is only 13-18%. For an effective antitumor immune response, trafficking of immune cells to the tumor microenvironment (TME) is essential. We aimed to better understand immune cell migration as well as the involved chemokines in HNSCC. A transwell assay was used to study immune cell migration toward TME-conditioned medium. While T cell migration was not observed, conventional dendritic cell (cDC) migration was induced by TME-conditioned media. cDC migration correlated with various proteins in the TME secretome. CCL8, CXCL5, CCL13 and CCL7 were tested in validation experiments and addition of these chemokines induced cDC migration. Using single cell RNA-sequencing, we observed expression of CCL8, CXCL5, CCL13 and CCL7 in cancer-associated fibroblasts (CAFs). Depleting fibroblasts led to reduced cDC migration. Thus CAFs, while often seen as suppressors of antitumor immunity, play a role in attracting cDCs toward the head and neck cancer TME, which might be crucial for effective antitumor immunity and response to therapies. Indeed, we found RNA expression signatures of the indicated chemokines, cDC and CAF subpopulations, to be significantly higher in baseline tumor specimen of patients with a major pathological response to pre-surgical anti-PD-1 treatment compared to non-responding patients.


Assuntos
Movimento Celular , Células Dendríticas , Neoplasias de Cabeça e Pescoço , Microambiente Tumoral , Humanos , Neoplasias de Cabeça e Pescoço/imunologia , Neoplasias de Cabeça e Pescoço/metabolismo , Neoplasias de Cabeça e Pescoço/patologia , Microambiente Tumoral/imunologia , Células Dendríticas/imunologia , Células Dendríticas/metabolismo , Secretoma/metabolismo , Carcinoma de Células Escamosas de Cabeça e Pescoço/imunologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/metabolismo , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Fibroblastos Associados a Câncer/metabolismo , Fibroblastos Associados a Câncer/imunologia , Quimiocinas/metabolismo
12.
Appl Radiat Isot ; 213: 111479, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39226628

RESUMO

In vivo treatment monitoring in ion therapy is one of the key issues for improving the treatment quality assurance procedures. Range verification is one of the most relevant and yet complex task used for in vivo treatment monitoring. In carbon ion therapy, positron emission tomography is the most widely used method. This technique exploits the ß+-activity of positron emitters created by nuclear interactions between the incoming beam and the irradiated tissue. Currently, high computational efforts and time-consuming Monte Carlo simulation platforms are typically used to predict positron emitter distributions. In order to avoid time-consuming simulations, an extended filtering approach was suggested to analytically predict positron emitter profiles from depth dose distributions in carbon ion therapy. The purpose of this work is to investigate such an analytical prediction model in patient anatomies of varying complexity, highlighting its potential and the need of further improvements, especially in highly heterogeneous anatomies where many air cavities are present in the beam path. The accuracy of range verification showed a mean relative error of ∼3% and a deviation between the simulation and the prediction below 2mm for the three patient cases analysed: a brain case and two head and neck cases. Additional investigations demonstrated the region of applicability of the method for cases of patient data. The analytical method enables range verification in carbon ion therapy by replacing computing-intensive Monte Carlo simulations and thus minimize the PET monitoring burden on the clinical workflow.


Assuntos
Algoritmos , Radioterapia com Íons Pesados , Método de Monte Carlo , Tomografia por Emissão de Pósitrons , Humanos , Tomografia por Emissão de Pósitrons/métodos , Simulação por Computador , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/diagnóstico por imagem , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos
13.
World J Surg Oncol ; 22(1): 242, 2024 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-39256833

RESUMO

BACKGROUND: Recent randomized phase III trials have demonstrated the efficacy of anti-programmed cell death 1 (PD-1) immune checkpoint inhibitors (ICIs) in treating patients with recurrent or metastatic head and neck squamous cell carcinoma (RMHNSCC). However, a large proportion of such patients still have poor response. This study aimed to identify biomarkers for predicting anti-PD-1 ICI treatment outcomes . METHODS: We retrospectively analyzed 144 patients with RMHNSCC who received anti-PD-1 ICIs after progression to platinum-based chemotherapy between January 2017 and December 2022 at Kaohsiung Chang Gung Memorial Hospital. Data on clinicopathological parameters, albumin levels, calcium levels, and other pretreatment peripheral blood biomarkers, including total lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and prognostic nutritional index (PNI) were collected and correlated with the treatment outcome of anti-PD-1 ICIs. RESULTS: Low tumor proportion score (TPS), low combined positive score (CPS), NLR ≥ 5, PLR ≥ 300, hypercalcemia, hypoalbuminemia, and PNI < 45 were significantly correlated with poor response of ICIs. The overall response rates were 25% and 3% in patients with calcium < 10 mg/dL and calcium ≥ 10 mg/dL, respectively (P = 0.007). The overall response rates were 6% and 33% in patients with albumin < 4 g/dL and albumin ≥ 4 g/dL, respectively (P < 0.001). Univariate survival analysis showed that low TPS, low CPS, NLR ≥ 5,, hypercalcemia, hypoalbuminemia, and PNI < 45 were significantly associated with worse progression-free survival (PFS) and inferior overall survival (OS). Multivariate analysis revealed that calcium ≥ 10 mg/dL and albumin < 4 g/dL were independent poor prognosticators for worse PFS and inferior OS. The two-year OS rates were 26% and 9% in patients with calcium < 10 mg/dL and ≥ 10 mg/dL, respectively (P < 0.001). The two-year OS rates were 10% and 33% in patients with albumin < 4 g/dL and ≥ 4 g/dL, respectively (P < 0.001). CONCLUSIONS: Hypercalcemia and hypoalbuminemia can potentially predict poor treatment outcomes of anti-PD-1 ICIs in patients with RMHNSCC. Blood calcium and albumin levels may be helpful in individualizing treatment strategies for patients with RMHNSCC.


Assuntos
Neoplasias de Cabeça e Pescoço , Hipercalcemia , Hipoalbuminemia , Inibidores de Checkpoint Imunológico , Recidiva Local de Neoplasia , Carcinoma de Células Escamosas de Cabeça e Pescoço , Humanos , Masculino , Feminino , Estudos Retrospectivos , Inibidores de Checkpoint Imunológico/uso terapêutico , Carcinoma de Células Escamosas de Cabeça e Pescoço/tratamento farmacológico , Carcinoma de Células Escamosas de Cabeça e Pescoço/sangue , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/imunologia , Pessoa de Meia-Idade , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/sangue , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/imunologia , Idoso , Hipercalcemia/tratamento farmacológico , Hipercalcemia/sangue , Hipercalcemia/etiologia , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Prognóstico , Taxa de Sobrevida , Hipoalbuminemia/complicações , Hipoalbuminemia/etiologia , Adulto , Seguimentos , Idoso de 80 Anos ou mais , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Biomarcadores Tumorais/sangue
14.
Microsurgery ; 44(6): e31232, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39268849

RESUMO

BACKGROUND: Vessel grafting is an important technique in head and neck free tissue transfer (FTT) reconstruction when a tension-free anastomosis is not otherwise feasible. To our knowledge, there are limited data regarding interposition artery grafts for arterial anastomoses in head and neck reconstruction. Here, we present a multi-institutional cohort of arterial interposition grafts for FTT reconstruction for head and neck defects. METHODS: A retrospective review was conducted at four tertiary care institutions for patients who underwent FTT reconstruction for head and neck defects which utilized an interposition artery graft for the arterial anastomosis. Charts were reviewed for type and length of artery grafts harvested, surgical indication, indication for artery graft, types of flaps harvested, and various preoperative characteristics (including history of radiation or previous FTT reconstruction surgery). Postoperative complications within postoperative day 30 were measured and reported. RESULTS: Nine patients met inclusion criteria. The lateral circumflex femoral artery (either transverse or descending branches) (n = 3) and facial artery (n = 3) were the most commonly harvested arteries. The scalp (n = 5) was the most common primary defect site. Seven grafts were harvested initially and in a planned fashion, while two were harvested as salvage techniques (either for flap salvage or vein graft failure). In planned grafts, arteries were the preferred interposition grafting method due to either size match preferences (n = 4) or similarities in wall thickness (n = 3) between graft and recipient artery. There were no reported cases of unplanned readmission, postoperative hematoma, fistula formation, wound infection, or donor site morbidities. Two patients required unplanned return to the operating room for flap compromise, both of which ultimately resulted in flap failure secondary to clot formation at both arterial and venous anastomoses. CONCLUSIONS: When arterial pedicle length is insufficient, interposition artery grafting is both a feasible and viable technique to achieve tension-free arterial anastomoses for select cases of highly complex head and neck free tissue reconstruction.


Assuntos
Anastomose Cirúrgica , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço , Procedimentos de Cirurgia Plástica , Humanos , Estudos Retrospectivos , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Procedimentos de Cirurgia Plástica/métodos , Anastomose Cirúrgica/métodos , Masculino , Pessoa de Meia-Idade , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Idoso , Adulto , Artérias/transplante , Resultado do Tratamento , Enxerto Vascular/métodos
16.
JCO Glob Oncol ; 10: e2400173, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39236283

RESUMO

PURPOSE: Most research on artificial intelligence-based auto-contouring as template (AI-assisted contouring) for organs-at-risk (OARs) stem from high-income countries. The effect and safety are, however, likely to depend on local factors. This study aimed to investigate the effects of AI-assisted contouring and teaching on contouring time and contour quality among radiation oncologists (ROs) working in low- and middle-income countries (LMICs). MATERIALS AND METHODS: Ninety-seven ROs were randomly assigned to either manual or AI-assisted contouring of eight OARs for two head-and-neck cancer cases with an in-between teaching session on contouring guidelines. Thereby, the effect of teaching (yes/no) and AI-assisted contouring (yes/no) was quantified. Second, ROs completed short-term and long-term follow-up cases all using AI assistance. Contour quality was quantified with Dice Similarity Coefficient (DSC) between ROs' contours and expert consensus contours. Groups were compared using absolute differences in medians with 95% CIs. RESULTS: AI-assisted contouring without previous teaching increased absolute DSC for optic nerve (by 0.05 [0.01; 0.10]), oral cavity (0.10 [0.06; 0.13]), parotid (0.07 [0.05; 0.12]), spinal cord (0.04 [0.01; 0.06]), and mandible (0.02 [0.01; 0.03]). Contouring time decreased for brain stem (-1.41 [-2.44; -0.25]), mandible (-6.60 [-8.09; -3.35]), optic nerve (-0.19 [-0.47; -0.02]), parotid (-1.80 [-2.66; -0.32]), and thyroid (-1.03 [-2.18; -0.05]). Without AI-assisted contouring, teaching increased DSC for oral cavity (0.05 [0.01; 0.09]) and thyroid (0.04 [0.02; 0.07]), and contouring time increased for mandible (2.36 [-0.51; 5.14]), oral cavity (1.42 [-0.08; 4.14]), and thyroid (1.60 [-0.04; 2.22]). CONCLUSION: The study suggested that AI-assisted contouring is safe and beneficial to ROs working in LMICs. Prospective clinical trials on AI-assisted contouring should, however, be conducted upon clinical implementation to confirm the effects.


Assuntos
Inteligência Artificial , Humanos , Órgãos em Risco/efeitos da radiação , Neoplasias de Cabeça e Pescoço/radioterapia , Feminino , Masculino , Planejamento da Radioterapia Assistida por Computador/métodos , Radio-Oncologistas/educação , Adulto , Pessoa de Meia-Idade
17.
Nat Commun ; 15(1): 7835, 2024 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-39244563

RESUMO

HPV-positive and HPV-negative head and neck squamous cell carcinoma (HNSCC) are recognized as distinct entities. There remains uncertainty surrounding the causal effects of smoking and alcohol on the development of these two cancer types. Here we perform multivariable Mendelian randomization (MR) to evaluate the causal effects of smoking and alcohol on the risk of HPV-positive and HPV-negative HNSCC in 3431 cases and 3469 controls. Lifetime smoking exposure, as measured by the Comprehensive Smoking Index (CSI), is associated with increased risk of both HPV-negative HNSCC (OR = 3.03, 95%CI:1.75-5.24, P = 7.00E-05) and HPV-positive HNSCC (OR = 2.73, 95%CI:1.39-5.36, P = 0.003). Drinks Per Week is also linked with increased risk of both HPV-negative HNSCC (OR = 7.72, 95%CI:3.63-16.4, P = 1.00E-07) and HPV-positive HNSCC (OR = 2.66, 95%CI:1.06-6.68, P = 0.038). Smoking and alcohol independently increase the risk of both HPV-positive and HPV-negative HNSCC. These findings have important implications for understanding the modifying risk factors between HNSCC subtypes.


Assuntos
Consumo de Bebidas Alcoólicas , Neoplasias de Cabeça e Pescoço , Análise da Randomização Mendeliana , Infecções por Papillomavirus , Fumar , Carcinoma de Células Escamosas de Cabeça e Pescoço , Humanos , Consumo de Bebidas Alcoólicas/efeitos adversos , Neoplasias de Cabeça e Pescoço/virologia , Neoplasias de Cabeça e Pescoço/genética , Neoplasias de Cabeça e Pescoço/epidemiologia , Fumar/efeitos adversos , Infecções por Papillomavirus/virologia , Infecções por Papillomavirus/epidemiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/virologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/genética , Carcinoma de Células Escamosas de Cabeça e Pescoço/epidemiologia , Masculino , Feminino , Fatores de Risco , Papillomaviridae/genética , Pessoa de Meia-Idade , Estudos de Casos e Controles , Polimorfismo de Nucleotídeo Único
18.
Support Care Cancer ; 32(10): 651, 2024 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-39256281

RESUMO

PURPOSE: Metallic taste (MT) is frequently observed during head and neck cancer treatments, but very little is known about its impact on nutritional status. The aim of this study was to explore the impact of MT on the quality of life and nutritional status in patients with head and neck cancer expressing MT. METHODS: Questionnaires on quality of life, MT, weight, and food intake were filled out by 44 patients with head and neck cancer before, during, and up to 1 year after their treatment. Patients were divided into two groups based on their reported experience of MT. RESULTS: MT was commonly observed (n = 12, 27.2%), always during the treatment phase, and mostly linked with radiotherapy or radiochemotherapy. Reported MT intensity was moderate (n = 6, 40%) to high (n = 4, 26.7%). MT had a significant negative impact on quality of life linked to dysgeusia (p = 0.025). The negative impacts of MT on food intake and on weight were not significant, possibly due to a combination of sample size, dropouts, and duration of observation. Further research in this area could provide additional insights into how to better address the issue related to MT and enhance the quality of care provided to this patient population. CONCLUSION: Metallic taste, experienced by 27.2% of the 44 patients with head and neck cancer, contributes to dysgeusia and results in a significant decline in quality of life associated with dysgeusia. TRIAL REGISTRATION: ClinicalTrials.gov trial registration number: NCT03558789.


Assuntos
Disgeusia , Neoplasias de Cabeça e Pescoço , Estado Nutricional , Qualidade de Vida , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Inquéritos e Questionários , Disgeusia/etiologia , Disgeusia/epidemiologia , Adulto , Ingestão de Alimentos/fisiologia , Idoso de 80 Anos ou mais , Paladar , Distúrbios do Paladar/etiologia
19.
Cancer Control ; 31: 10732748241274216, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39240755

RESUMO

INTRODUCTION: Malignant wounds are lesions caused by metastasis from distant primary cancers or by direct invasion of the cutaneous structures of a primary cancer, and are most common in patients with breast or head and neck cancers. Malignant wounds not only cause physical symptoms, but also affect survival. Recognizing prognosis in terminal-stage cancer patients is necessary for both patients and health care providers. The prognostic impact of malignant wounds in patients with head and neck cancer has been poorly investigated. METHODS: This is a secondary analysis of the results of a prospective cohort study that investigated the dying process in patients with advanced cancer in 23 palliative care units in Japan. The primary outcome of this study was the prognostic impact of malignant wounds in patients with head and neck cancer. The difference in survival between patients with head and neck cancer who had malignant wounds and those who did not was compared using the log-rank test. RESULTS: Of 1896 patients admitted to palliative care units, 68 had head and neck cancer, and 29 of these had malignant wounds. Overall survival was significantly shorter in patients with malignant wounds than that in those without (median: 19.0 days vs 32.0 days, P = 0.046). CONCLUSION: Patients with head and neck cancer who had malignant wounds had worse overall survival than those who did not.


Assuntos
Neoplasias de Cabeça e Pescoço , Cuidados Paliativos , Humanos , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/mortalidade , Prognóstico , Estudos Prospectivos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Japão/epidemiologia , Idoso de 80 Anos ou mais , Adulto
20.
Surg Oncol Clin N Am ; 33(4): 669-681, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39244286

RESUMO

This article examines disparities in head and neck cancer across the cancer care continuum. It provides a public health lens to understand multilevel determinants of health behavior and the importance of social determinants of health. This article reviews the evidence base showing profound differences in incidence, treatment, and survival for patients with head and neck cancer by race, ethnicity, socioeconomic status, and geography. Continued research is needed to understand and address disparities for patients with head and neck cancer.


Assuntos
Neoplasias de Cabeça e Pescoço , Disparidades em Assistência à Saúde , Humanos , Neoplasias de Cabeça e Pescoço/terapia , Fatores Socioeconômicos , Acessibilidade aos Serviços de Saúde
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