Adaptive radiation therapy: When, how and what are the benefits that literature provides?

PURPOSE: To identify from the current literature when is the right time to replan and to assign thresholds for the optimum process of replanning. Nowadays, adaptive radiotherapy (ART) for head and neck cancer plays an exceptional role consisting of an evaluation procedure of the prominent anatomical and dosimetric variations. By performing complex radiotherapy methods, the credibility of the therapeutic result is crucial. Image guided radiotherapy (IGRT) was developed to ensure locoregional control and thus changes that might occur during radiotherapy be dealt with. MATERIALS AND METHODS: An electronic research of articles published in PubMed/MEDLINE and Science Direct databases from January 2004 to October 2020 was performed. Among a total of 127 studies assessed for eligibility, 85 articles were ultimately retained for the review. RESULTS: The most noticeable changes have been reported in the middle fraction of the treatment. Therefore, the suggested optimal time to replan is between the third and the fourth week. Anatomical deviations>1cm in the external contour, average weight loss>10%, violation in the dose coverage of the targets>5%, and violation in the dose of the peripherals were some of the thresholds that are currently used, and which lead to replanning. CONCLUSION: ART may decrease toxicity and improve local-control. Whether it is beneficial or not, depends ultimately on each patient. However, more investigation of the changes should be performed in future prospective studies to obtain more accurate results.

Symptomatic retropharyngeal space lipoma. A patient with Madelung disease.

BACKGROUND: Retropharyngeal space lipomas (RSL) are rare benign tumors of the head and neck region. They can, sporadically, occur as part of syndromic lipomatosis, such as Madelung disease. Symptoms are caused due to increasing pressure on surrounding structures. Description of case: We present a 64-year-old male patient with symptomatic RSL and symmetric lipomatosis, who was treated surgically. CONCLUSION: RSL can grow to a large size before becoming symptomatic. Their diagnosis and treatment can be challenging due to their anatomical site, diverse symptomatology, and diffuse growth pattern. Imaging is necessary for diagnosis. In the vast majority of cases, RSLs are treated surgically with a favorable outcome. HIPPOKRATIA 2020, 24(2): 91-93.

Liquid biopsy: An emerging prognostic and predictive tool in Head and Neck Squamous Cell Carcinoma (HNSCC). Focus on Circulating Tumor Cells (CTCs).

Molecular diversity and continuing evolution of metastatic tumors are not easily captured by tissue biopsies. Development of non-invasive diagnostic tools, such asanalysis of circulating tumor DNA (ctDNA), Circulating Tumor Cells (CTCs) and exosomes provides the opportunity to assess a blood sample in order to monitor tumor change and extract molecular information from cancers at a given time. "Liquid biopsy", which refers to molecular analysis of tumor's genetic features based on circulating genetic material in the peripheral blood, is already used to monitor disease response and track mechanisms of drug resistance in solid tumors. Head and Neck Squamous Cell Carcinoma (HNSCC) is a malignancy associated with advanced disease at presentation and dismal outcomes; furthermore, there is lack of biomarkers to monitor disease burden. Incorporation of liquid biopsy in the management of HNSCC might help identify patients with occult metastatic disease earlier and in a non-invasive manner. Herein, we aim to review current knowledge regarding CTCs and ctDNA in HNSCC and address open questions in this fast-evolving field of research.

Cartilage tympanoplasty: a reliable technique for smokers.

The aim of this study was to report our experience with cartilage tympanoplasty (CT) in smokers and compare it with that of non-smokers using a retrospective chart review at a tertiary referral center. Between September 2008 and September 2010, cartilage tympanoplasty was performed in 52 patients. Among them, 27 were active smokers and 25 former or non-smokers. The entire tympanic membrane was replaced with conchal cartilage, shaped either as a shield for cases with intact canal wall mastoidectomies, or crashed for cases with canal wall down procedures. The mean post-operative follow-up was 12 months (range 6-18 months). A complete pre- and post-operative audiologic evaluation was obtained in all patients. Graft take was successful in all patients. The overall average pre-operative and post-operative pure tone average air-bone gaps (PTA-ABG) was 52.2 dB ± 17.7 dB and 35.4 dB ± 17.9 dB, respectively, with an overall improvement of 16.8 dB (p < 0.001). A post-operative PTA-ABG of 25 dB or less was achieved in 39 (75 %) patients (p < 0.001). In smokers, the hearing improvement was 17.6 dB (p < 0.001) with a PTA-ABG of 25 dB or less in 19 (70 %). In non-smokers, the average hearing improvement was 16.8 dB (p < 0.0005) with a post-operative PTA-ABG of 25 dB or less in 19 (76 %), (p < 0.001). The results showed that the CT technique is a very effective procedure for smokers. Excellent graft take and satisfactory hearing results can be accomplished regardless of smoking habits.

Hearing results following intratympanic gentamicin perfusion for Ménière's disease.

OBJECTIVE: To evaluate hearing results following intratympanic gentamicin perfusion in patients with Ménière's disease. MATERIALS AND METHODS: Middle-ear perfusion of 0.4 ml of gentamicin 40 mg/ml solution was performed in Ménière's disease patients who had previously failed to respond to other medical treatment. RESULTS: Between May 1999 and November 2005, 22 patients (mean age 58.5 years) underwent intratympanic gentamicin perfusion. Mean follow up was 30 months. At the first post-perfusion visit (four to six weeks following perfusion), three of the 22 patients (13.63 per cent) had a pure tone average improvement of at least 10 dB, 15 (68.18 per cent) showed no change and four (18.18 per cent) demonstrated a decrease in hearing of more than 10 dB. Regarding speech discrimination scores, one patient (4.54 per cent) exhibited an improvement of at least 15 per cent, 15 (68.18 per cent) showed no change and six (27.27 per cent) showed a decrease of at least 15 per cent. After long-term follow up (12-40 months following perfusion), 10 patients (45.45 per cent) showed stable hearing, and 12 (54.54 per cent) exhibited a pure tone average decrease of more than 10 dB. Six patients (27.27 per cent) showed a speech discrimination score decrease of at least 15 per cent, while 16 (72.72 per cent) had no change. Complete cessation of vertigo was reported by 20 of the 22 patients (90.9 per cent), while two (9.09 per cent) reported episodic vertigo spells. CONCLUSION: Intratympanic gentamicin perfusion provides effective control of vertigo in patients with Ménière's disease. However, significant hearing loss may occur immediately after perfusion; therefore, this treatment should be considered only for patients whose hearing has already been affected by the disease.