Virome Analysis Reveals No Association of Head and Neck Vascular Anomalies with an Active Viral Infection.

BACKGROUND/AIM: Vascular anomalies encompass different vascular malformations [arteriovenous (AVM), lymphatic (LM), venous lymphatic (VLM), venous (VM)] and vascular tumors such as hemangiomas (HA). The pathogenesis of vascular anomalies is still poorly understood. Viral infection was speculated as a possible underlying cause. MATERIALS AND METHODS: A total of 13 human vascular anomalies and three human skin control tissues were used for viral analysis. RNA derived from AVM (n=4) and normal skin control (n=3) tissues was evaluated by RNA sequencing. The Virome Capture Sequencing Platform for Vertebrate Viruses (VirCapSeq-VERT) was deployed on 10 tissues with vascular anomalies (2×AVM, 1×HA, 1×LM, 2×VLM, 4×VM). RESULTS: RNA sequencing did not show any correlation of AVM with viral infection. By deploying VirCapSeq-VERT, no consistent viral association was seen in the tested tissues. CONCLUSION: The analysis does not point to the presence of an active viral infection in vascular anomalies. However, transient earlier viral infections, e.g. during pregnancy, cannot be excluded with this approach.

Safety and Efficacy of Botulinum Toxin to Preserve Gland Function after Radiotherapy in Patients with Head and Neck Cancer: A Prospective, Randomized, Placebo-Controlled, Double-Blinded Phase I Clinical Trial.

This prospective, randomized, placebo-controlled, double-blinded phase I clinical trial investigates safety and efficacy of botulinum toxin (BoNT) to preserve gland function after radiotherapy in patients with head and neck cancer. Twelve patients with advanced head and neck cancer were injected with BoNT into the submandibular glands prior to primary radiochemotherapy. Six patients received BoNT/A and 6 patients BoNT/A and B, half of each subgroup into their left and the other half into their right gland. As an internal control, sodium chloride was injected into the respective contralateral gland (placebo). For the evaluation of the salivary gland function, technetium pertechnetate salivary gland scintigraphy was performed before and after the end of radiotherapy. BoNT/A and B were well tolerated. Analysis of the scintigraphic data revealed no statistically significant difference between BoNT and placebo regarding the scintigraphic uptake difference (pBoNT/A = 0.84 and pBoNT/A-B = 0.56 for BoNT/A vs. placebo and BoNT/A-B vs. placebo, respectively). We also found no significant difference in treatment between BoNT and placebo in terms of salivary excretion fraction (pBoNT/A = 0.44; pBoNT/A-B = 0.44). This study demonstrates that BoNT can be safely combined with radiochemotherapy. Dosing and timing of BoNT injection should be further investigated for efficacy analysis. Trial Registration German Registry for Clinical Trails DRKS00004595.

Extent of Salvage Neck Dissection in Advanced Oro- and Hypopharyngeal Cancer.

BACKGROUND/AIM: Primary radiochemotherapy (RCT) is becoming increasingly important in patients with oro- and hypopharyngeal cancer. However, debate exists on the extent of salvage neck dissection (ND) in those patients. The purpose of the present study was to evaluate the regional control after salvage ND. PATIENTS AND METHODS: Clinical, histological and radiological data, results of 51 patients with oro- or hypopharyngeal cancer and N2 neck who underwent selective ND in case of radiological evidence of residual neck disease, were retrospectively analyzed. RESULTS: Altogether 52 metastases were detected in 20 (39.2%) patients by histological examination. They were localized in level II (n=23), III (n=13), IV (n=11) and V (n=5). Regional recurrence occurred in 4 patients (7.8%) in previous dissected neck levels in the follow-up. CONCLUSION: Selective ND of suspicious neck levels for residual disease after RCT of oro- and hypopharyngeal cancer seems to be a sufficient treatment.

Prognostic value of level IV metastases from head and neck squamous cell carcinoma.

BACKGROUND: The purpose of this study was to evaluate the prognostic value of level IV metastases in head and neck squamous cell carcinoma (HNSCC). METHODS: The clinical and histopathological data of 111 patients with HNSCC with pN+ neck who underwent a primary tumor resection with unilateral or bilateral neck dissection were analyzed. RESULTS: Level IV metastases were histopathologically proven in 33 patients (29.7%). Pulmonary metastases were observed in 12 of 33 patients (36.4%) with level IV metastases, and in 13 of 78 patients (16.7%) without level IV metastases (p = .04). Multivariate analyzes revealed a significant association between level IV metastases and pulmonary metastases (p = .038). However, an influence on overall (p = .65) or disease-free survival (p = .66) was not observed. CONCLUSION: Level IV metastases seem to be a predictive factor for pulmonary metastases but not for overall and disease-free survival in patients with HNSCC.

The value of elective parotidectomy in advanced squamous cell carcinoma of the skin of the head.

BACKGROUND: Parotid metastases from cutaneous squamous cell carcinoma (CSCC) are associated with poor prognosis. However, the incidence of occult parotid lymph node metastases in high-risk CSCC is unclear. Therefore, the role of elective parotidectomy is still controversial. The purpose of the present study was to analyze the value of elective parotidectomy in patients with high-risk CSCC. PATIENTS AND METHODS: The clinical data including histological and radiological results, as well as surgery-related complications, of 13 patients with high-risk CSCC who underwent elective parotidectomy were retrospectively analyzed. RESULTS: Occult parotid lymph node metastases were detected by histological examination in only 1 out of 13 patients after elective parotidectomy. Surgery-related complications and morbidity were not observed. CONCLUSION: In the absence of clinical disease in the parotid gland, the risk of occult metastases is not high enough to warrant for elective parotidectomy in patients with CSCC.

Differences of radiological artefacts in cochlear implantation in temporal bone and complete head.

OBJECTIVES: Accurate radiological evaluation of cochlear implants is essential for improvement of devices and techniques and also for assessing the position of the electrodes within the cochlea. Radiological study of implants has focused on isolated temporal bones. Previous studies showed relevant sizes of artefacts (dimensions of the radiological image compared with the actual dimensions of the electrode) in visualization of cochlear implants in computed tomography and cone beam computed tomography (CBCT). In this study, we aimed to obtain CBCT images of cochlear electrodes in isolated temporal bones and in whole heads and to assess the differences in image quality between the two. METHODS: Cochlear electrodes were implanted in three complete human heads. Radiological examinations were performed using a single CBCT scanner with varying x-ray tube currents, voltages, and rotation angles. The temporal bones were then removed and the same radiological examinations were repeated, with and without the receiver coils. Artefacts from a basal electrode (electrode 9) and an apical electrode (electrode 2) were calculated. These were compared with each other by measuring the diameter of the image of the electrode (electrode inclusive of imaging artefacts) and with the real electrode diameters from the manufacturer's data. Additionally, the radiological diameters (inclusive of artefact) of the electrodes were compared to the cross-sectional diameters of the basal and apical coils of the cochlea at the locations of these two electrodes. RESULTS: In comparison to the real electrode diameters, radiological artefact proportions of 51-58% for electrode 9 and 56-61% for electrode 2 were calculated. The differences between whole head images (group 1) and temporal bone images with and without the receiver coil (groups 2 and 3) were highly significant for each protocol (P < 0.001). DISCUSSION AND CONCLUSION: These results indicate that it is not possible reliably to determine the exact intracochlear positions of electrodes using CBCT. Imaging of isolated temporal bones produced significantly greater artefacts than imaging of the whole head. Evaluations of image quality based only on results for isolated temporal bones are not transferable to clinical situations, and should be assessed critically.

The chorioallantoic membrane assay is a promising ex vivo model system for the study of vascular anomalies.

UNLABELLED: The present feasibility study evaluated the chorioallantoic membrane (CAM) assay established in cancer and angiogenesis research as a tool for the study of vascular anomalies (VAs) in the head and neck area, since the lack of appropriate model systems poses a major obstacle in VA research. MATERIALS AND METHODS: VA tissues from three patients, two with an arteriovenous and one with a lymphatic malformation, were analyzed and evaluated in the CAM assay. RESULTS: The arteriovenous malformations induced a potent angiogenic reaction, resulting in new vessel growth and reperfusion by chicken embryo blood, which was comparable in extent with the positive vascular endothelial growth factor control. An angiogenic reaction, although less pronounced, was also observed in the single-tested lymphatic malformation. CONCLUSION: Our observations indicate the CAM assay to be a suitable model system for the study of VAs, as well as to show how treatment with pro- and antiangiogenic drugs affects VA growth patterns. The CAM assay has the potential to become a valuable tool for VA studies.