How to diagnose mould allergy? Comparison of skin prick tests with specific IgE results.

BACKGROUND: Diagnosis of mould allergy is complicated due to the heterogeneity of the test material and the decrease in the number of commercial mould skin test solutions that are currently available. OBJECTIVES: The aim of this study was to compare skin prick tests (SPT) from different manufacturers to one another and concurrently with sIgE tests for Aspergillus fumigatus (Asp f), Cladosporium herbarum (Cla h), Penicillium chrysogenum (Pen ch), Alternaria alternata (Alt a) and Aspergillus versicolor (Asp v) to ascertain a feasible diagnostic procedure for mould sensitization. METHODS: In this multi-centre study, 168 patients with mould exposure and/or mould-induced respiratory symptoms were included. Mould SPT solutions were analysed biochemically and tested in duplicate on patients' arms. Specific IgE (sIgE) concentrations to corresponding mould species and mould mix (mx1) were measured by ImmunoCAP. SPTs in accordance with one another and with sIgE were further considered. The test efficiency was calculated using receiver-operating characteristic (ROC) analysis. RESULTS: Mould sensitization was more frequently detected by the SPT (90 of 168) than by the sIgE tests (56 of 168). Concordances of double SPT positives were only sufficient (≥ 80%) for environmental allergens, two Asp f and three Alt a SPT solutions, whereas all other mould solutions revealed concordances < 80%. The antigen content of SPT solutions was positively associated with concordant SPT double values as well as with sIgE. Taking sIgE as the 'positive standard', all mould SPT solutions revealed test efficiencies > 80%, but varied up to 20% in sensitivity and positive predictive value with the exception of Alt a. CONCLUSIONS: SPT solutions are sensitive and essential diagnostic tools for the detection of mould sensitization. Our recommendation for diagnosis would be to test at least Alt a, Asp f and Pen ch using SPT and additional sIgE test to mx1.

Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study.

Antibiotic prophylaxis is commonly used in head and neck oncologic surgery, due to the clean-contaminated nature of these procedures. There is a wide variety in the use of prophylactic antibiotics regarding the duration of application and the choice of agent. The purpose of this study was to determine whether short-term or long-term antibiotic prophylaxis has an impact on the development of head and neck surgical wound infection (SWI). Retrospective chart review was carried out in 418 clean-contaminated head and neck surgical oncology cases at our department. More than 50 variables including tumour type and stage, type of surgical treatment, co-morbidities, duration and choice of antibiotic prophylaxis, and the incidence of SWI were analysed. Following descriptive data analysis, Chi square test by Pearson and Fisher's exact test were used for statistical evaluation. Fifty-eight of the 418 patients (13.9 %) developed SWI. Patients with advanced disease and tracheotomy showed a significantly higher rate of SWI than those with early stage disease and without tracheotomy (p = 0.012 and p = 0.00017, respectively). However, there was no significant difference between the SWI rates in the short term and long term treatment groups (14.6 and 13.2 %, respectively; p = 0.689). Diabetes and body weight were not found to be risk factors for SWI. Long-term antibiotic prophylaxis was not associated with a decrease in SWI in the entire cohort of patients undergoing clean-contaminated major head and neck oncologic surgery. Our data confirmed the extent of surgery and tracheotomy as being risk factors for postoperative SWI.

First results of Endonasal dilatation of the Eustachian tube (EET) in patients with chronic obstructive tube dysfunction.

For years, several surgical and non-surgical therapeutic strategies in Eustachian tube dysfunction have been described. The Endonasal dilatation of the Eustachian tube (EET) utilising a balloon catheter is a feasible option in patients with symptoms of chronic obstructive Eustachian tube dysfunction. However, long-term results in a large series are missing. In a prospective case series, 217 patients (342 cases) with symptoms of chronic Eustachian tube dysfunction underwent uni- or bilateral EET at the ENT Department of the University of Hamburg, Germany, between September 2010 and April 2013. A tube score consisting of the type of tympanogram and the R value of the tubomanometry was used to evaluate pre- and postoperative tube function. All patients underwent follow-up with a post-operative interval of 3-12 months. The mean value of the pre-treatment tube score was 2.23 ± 1.147 and significantly improved to 2.68 ± 1.011 1 year after EET. There was a significant increase in the tube score during follow-up. The co-variables time period, tympanoplasty and pressure range showed a significant impact on the tube score. EET is a minimally invasive and effective treatment of chronic obstructive tube dysfunction. It is a safe procedure without causing significant complications. Nevertheless, long-term results of larger, placebo-controlled multicentre studies are needed to confirm its effectiveness.

[Treatment of head and neck squamous cell carcinoma recurrences and distant metastases : Highlights of the ASCO Meeting 2016]. / Therapie der rezidivierten und fernmetastasierten Kopf-Hals-Tumoren : Highlights des ASCO-Meetings 2016.

This year particularly phase II studies were presented at the 2016 ASCO Annual Meeting, in which new drugs (monoclonal antibodies, small molecules) were investigated in patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M-HNSCC). Notably, there was a great number of studies investigating carcinoma of the nasopharynx. The studies presented in this article summarize the different therapeutic concepts in the treatment of R/M-HNSCC and represent the variety of therapeutic approaches in the recurrent and metastatic setting.

[Immunotherapeutic studies of head and neck tumors : Highlights of the 2016 ASCO Annual Meeting]. / Immuntherapeutische Studien bei Kopf-Hals-Tumoren : Highlights der ASCO-Jahrestagung 2016.

Immunotherapeutic drugs in the form of novel immune checkpoint inhibitors have had a significant impact on and revival of the treatment standards for head and neck tumors. Recently, at the annual meeting of the American Society of Clinical Oncology (ASCO) several innovative immunotherapies in head and neck cancer were presented, which might lead to a paradigm shift in the palliative as well as curative setting in the near future.The most common approaches are antibodies targeting the programmed cell death 1 (PD-1) axis. These therapies seem to be effective in a significant proportion of patients (independent of human papillomavirus) and show an extended duration of response.In a phase III trial for palliative second-line therapy, the PD-1 antibody nivolumab demonstrated a significant improvement in survival in patients with head and neck squamous cell carcinoma (HNSCC) who were experiencing disease progression after platinum-based therapy; therefore, the Food and Drug Administration gave it a breakthrough therapy designation.Further clinical trials focusing on first-line palliative treatment (compared with the EXTREME protocol) as well as neoadjuvant therapies using immune checkpoint-inhibitors are ongoing. However, valid testing systems (e. g., PD-L1 testing) as well as reliable predictive markers for patient selection are necessary to avoid increasing public health costs and to protect patients from potentially serious adverse events.

[New aspects in the treatment of thyroid cancer : Highlights of the ASCO Annual Meeting 2016]. / Neue Aspekte in der Therapie von Schilddrüsenkarzinomen : Highlights des ASCO-Kongresses 2016.

The annual meeting of the American Society of Clinical Oncology (ASCO) took place at the beginning of June 2016 in Chicago. This year a total of 28 studies on the treatment of patients with thyroid cancer were presented, described in this review article according to the degree of cancer cell differentiation. The leading curative treatment modality is still surgery. In contrast, kinase inhibitors are being used increasingly within palliative concepts. The latest state of the art of thyroid cancer treatment, both surgical and medical, is summarized in this review.

[Study results of primary therapy for head and neck tumors : Highlights of the 2016 ASCO Annual Meeting]. / Studienergebnisse zur Primärtherapie von Kopf-Hals-Tumoren : Highlights der ASCO-Jahrestagung 2016.

At the annual meeting of the American Society of Clinical Oncology (ASCO) 2016, results of current trials dealing with primary therapy for head and neck squamous cell carcinoma (HNSCC) were presented. Current trials investigate in particular therapy regimens for the treatment of locally advanced HNSCC. Concomitant chemoradiotherapy (CRT) remains the standard therapy approach. Current trials focus on sequential chemoradiation with modifications in induction chemotherapy (ICT) or the subsequent CRT schedule. Studies investigating the combination of targeted therapy with the epidermal growth factor receptor (EGFR) antibody cetuximab and concomitant, sequential, or adjuvant therapy were presented. The most important trials are summarized in this article.

[Is (chemo)radiotherapy really the future standard in the treatment of oropharyngeal carcinoma?]. / Ist Radio(chemo)therapie wirklich der zukünftige Standard für die Behandlung von Oropharynxkarzinomen?

Treatment of patients with oropharyngeal squamous cell carcinoma (OPSCC) requires interdisciplinary collaboration. Besides oncologic control, organ and function preservation are important priorities. One treatment option is primary concomitant chemoradiotherapy (CRT), particularly for locally advanced head and neck cancer. Another option is sequential CRT, where induction chemotherapy may be followed either by radiation alone or by CRT. An important aspect of these modalities is the development of functional sequelae with regards to swallowing as a direct consequence of radiogenic fibrosis, as well as tissue ctoxicity associated with cisplatin-based chemotherapy. Conventional open surgical approaches are being increasingly replaced by transoral surgical modalities with less treatment-related morbidity. As a further, equally important goal of appropriately indicated surgery, adjuvant (C)RT may be omitted or the dose significantly reduced. The advantages of primary surgery over primary CRT may be less obvious in cases still requiring adjuvant treatment, although not necessarily completely eliminated. For patients with human papillomavirus (HPV)-driven OPSCC, it is important to note that primary surgery may provide comparable or even increased survival benefit. To date, there is no evidence for a clear advantage of primary CRT over primary surgery in this group. In these cases, a de-escalated treatment package may be the preferred option. Here, the application of radioimmunotherapy as well as a reduced radiation dose may minimize long-term treatment-related morbidities.

Oncologic treatment landscape for head and neck squamous cell carcinoma : Treatment infrastructure in German-speaking countries.

BACKGROUND: The treatment of head and neck squamous cell carcinoma (HNSCC) is highly complex and requires a multimodal approach. However, guidelines for the treatment of most forms of HNSCC do not exist in German-speaking countries with the exception of oral cavity cancer. The aim of this cross-sectional study was to describe the current treatment landscape and infrastructure in German-speaking countries. METHODS: From November 2013 to July 2014, 204 departments of otorhinolaryngology (ORL) in Germany, Austria, and the German-speaking part of Switzerland were contacted and invited to take part in a web-based survey on the treatment of HNSCC. In order to cover the study in its entirety, we published three consecutive papers of which this paper is the first. RESULTS: In all, 62 treatment centers (30.4 %) participated in the survey. These centers included 21 university hospitals, 16 certified cancer centers, and 35 large centers, which diagnose at least 75 HNSCC patients annually. In 91.9 % of all cases, there were outpatient consultation hours (that were monodisciplinary in 61.4 %). A multidisciplinary tumor board was existent in 98.4 % of the cases. Of 62 ORL departments, 50 had a hospital cancer registry, 41 of 62 conducted oncological studies, and 35 of 62 assessed their patients' quality of life. CONCLUSION: The infrastructure of the treatment for HNSCC can be considered mostly well-developed and supports interdisciplinary cooperation. Potential improvements can be made regarding the standardization of tumor boards, the participation in clinical trials, and the availability of cancer registries and the data gathered therein.

Palliative treatment standards for head and neck squamous cell carcinoma : Survey of clinical routine in German-speaking countries.

BACKGROUND: The EXTREME (Erbitux in First-Line Treatment of Recurrent and Metastatic Head and Neck Squamous Cell Carcinoma) protocol is generally considered the gold standard in palliative first-line treatment. However, there is some disagreement about its effectivity, toxicity, and applicability in daily clinical routine. The purpose of this cross-sectional survey was to describe the palliative treatment offered in German-speaking countries. METHODS: From November 2013 to July 2014, 204 departments of otorhinolaryngology (ORL) in Germany, Austria, and the German-speaking parts of Switzerland were contacted and invited to take part in a web-based survey on the treatment of HNSCC. RESULTS: In all, 62 of 204 treatment centers (30.4 %) participated in the survey. Of these, 58 departments offered palliative systemic therapy to their patients; 19 of 58 (32.8 %) treated patients undergoing palliative chemotherapy in their own ORL departments, while 40 of 58 (69 %) upheld a cooperation with medical oncologists in the same hospital and 24 of 58 (41.4 %) with medical oncologic practices. Many of these treatment centers offered multiple locations for treatment. Of the 58 departments, 56 provided an institutional standard for first-line palliative treatment, 13 for second-line, and two for third-line treatment. In 42 of 58 departments the EXTREME protocol was the institutional standard of care for first-line treatment. Moreover, 12 of 58 departments mentioned an individual protocol and two of 58 the inclusion in clinical trials as their local standard. The assessment of patients who could be treated with the first-line standard ranged from 0 to 95 % with a mean of 44.5 %. CONCLUSION: Palliative systemic therapy seems to be well standardized for first-line treatment, whereas there is little standardization in second- and third-line treatments. A large variation was found regarding the estimate of the applicability of the institutional standard. Reasons for this could be the physicians' individual experience as well as the varying assessment regarding the toxicity of palliative systemic therapy.

Curative treatment of head and neck squamous cell carcinoma : Organ preservation strategies in clinical routine in German-speaking countries.

INTRODUCTION: For the treatment of head and neck squamous cell carcinoma (HNSCC), there are currently no official standard of care guidelines in German-speaking countries, with the exception of oral cavity cancer. In order to learn about the applied treatment modalities in the clinical routine, we conducted a web-based survey to evaluate the local standards of palliative and curative treatment of HNSCC. This article focuses on the curative treatment options and organ preservation strategies. MATERIALS AND METHODS: The survey consisted of a web-based questionnaire that was performed between November 2013 and July 2014. The questionnaire included ten multiple-choice questions and four open questions in the section about curative treatment. RESULTS: Altogether, 62 of the 204 addressed centers participated in the survey. For primary chemoradiation (CRT), most centers used a platinum-based chemotherapy (52/54, 96.3 %). Induction chemotherapy (ICT) was offered in 37 of the 62 centers (60 %). In oral cavity cancer, CRT and ICT were used in 37.5 and 4.3 % of the cases, respectively. In oropharyngeal cancer, CRT and ICT were applied in 44.5 and 10.3 % of cases, respectively. For hypopharyngeal cancer, 44.8 % of the patients received CRT and 11.8 % received ICT, while for laryngeal cancer 35.9 % received CRT and 9.4 % underwent ICT. CONCLUSION: Our data showed that a variety of treatments are used for HNSCC within German-speaking countries. Many centers offer ICT. The majority of the hospitals uses platinum-based therapy as a conservative first-line option in their organ preservation protocols.

[The most important study results concerning nonsurgical primary treatment of locally advanced head and neck cancer: Highlights of the ASCO Meeting 2015]. / Die wichtigsten Studienergebnisse zur nichtchirurgischen Primärtherapie lokal fortgeschrittener Kopf­Hals­Tumoren: Highlights des ASCO-Kongresses 2015.

At the Annual Meeting of the American Society of Clinical Oncology (ASCO) 2015, results of current trials dealing with nonsurgical primary treatment of locally advanced head and neck cancer were presented. Regarding concomitant chemoradiotherapy (CRT), studies focused on the dosage and sequence of cisplatin administration are currently particularly featured. Amongst these, a study on dosage reduction in human papilloma virus (HPV)-positive patients was presented. Other investigations addressed substances as alternatives for cisplatin, particularly carboplatin and targeted therapeutic agents. The comparison of concomitant and sequential CRT (induction chemotherapy (ICT) prior to CRT) is still one of the main topics. In addition, studies modifying the ICT regimen or combining subsequent radiotherapy (RT) with the epidermal growth factor receptor (EGFR) antibody cetuximab were presented. A selection of the most important trials are summarized in this article.

[New aspects in thyroid cancer treatment: Highlights of the ASCO Annual Meeting 2015]. / Neue Aspekte in der Therapie von Schilddrüsenkarzinomen: Highlights des ASCO-Kongresses 2015.

At the beginning of June 2015, the Annual Meeting of the American Society of Clinical Oncology (ASCO) took place in Chicago. A total of 24 studies in the field of thyroid oncology were presented, being discussed in the present review article according to the degree of cancer cell differentiation. The leading curative treatment modality is still surgery. Kinase inhibitors are used primarily in the context of palliative treatment concepts. The most recent treatment options in thyroid oncology, both surgical and medical, are summarized in the following article.

[Treatment of head and neck squamous cell carcinoma recurrences and distant metastases: Highlights of the ASCO Meeting 2015]. / Therapie der rezidivierten und fernmetastasierten Plattenepithelkarzinome des Kopf-Hals-Bereichs: Highlights des ASCO-Meetings 2015.

This year also saw a great number of phase II and III studies presented at the ASCO Annual Meeting, in which new drugs (monoclonal antibodies, small molecules) were investigated as an alternative to or in combination with established mono- and polychemotherapy in patients with recurrences or distance metastases from head and neck squamous cell carcinoma (R/M-HNSCC). The studies now presented here describe the different concepts being applied to drug-based treatment of R/M-HNSCC and illustrate the variety of therapeutic approaches to treatment of recurrences and metastases.

[Overview of Alternative Methods of Cochleostomy with Focus on Laser Ablative Techniques]. / Überblick der Cochleostomieverfahren mit Fokussierung auf neue Laserablationstechniken.

BACKGROUND: Bone removal during mastoidectomy and cochleostomy or round window enlargement prior to electrode insertion is typically performed with a drill. The present work is a review of alternate methods of mastoidectomy and cochleostomy/round window enlargement that may reduce the risk of acoustic inner ear trauma associated with use of surgical drills during cochlear implant surgery. MATERIALS AND METHODS: MEDLINE database search was conducted using PubMed and Google Scholar search engines. Inclusion criteria for this study was the use of a laser to ablate the bone respectively the opening of Cochlear in terms of Cochleostomy. RESULTS: For the experimental studies, a total number of 4 papers were found, which deal with the application of the widely used CO2 laser. A comparison of the works could only partially under the above criteria, since no single study protocol was used and not always the sound pressure levels were determined occurring or evidence of damage to the inner ear missing. But for all that, a comparison of the work has been attempted because it is the authors' opinion about a promising approach to the atraumatic opening of the inner ear. CONCLUSION: There are promising approaches, using a laser to realize the erosion of bone and perform the opening of the inner ear. Nevertheless, there is a significant need for further investigations and in particular, the acoustic injury is not well enough understood here.

TORS for head and neck squamous cell carcinoma (HNSCC): the Hamburg experience.

OBJECTIVE: To report 2.5-year survival outcomes for head and neck squamous cell carcinoma treated primarily with transoral robotic-assisted resection. PATIENTS AND METHODS: Fifty consecutive, appropriately staged patients were enrolled prospectively, and underwent transoral robotic surgery between September 2011 and August 2013. There were 18 patients with overall Stage I-II and 32 patients with Stage III-IV disease. Adjuvant treatment could be spared for 20 patients. Another 5 patients refused the recommended adjuvant treatment. Seventeen patients received 60 Gy adjuvant radiotherapy and 8 patients underwent 66 Gy adjuvant chemo-radiotherapy. RESULTS: Overall survival was 94% with two disease-specific deaths and one unrelated death. The 2.5-year disease free survival rate was 88%, and the 2.5-year recurrence-free survival was 80%. Local recurrence rate was 10% after 2.5 years. CONCLUSION: Using TORS as their primary modality, 40% of the patients did not need adjuvant treatment and showed similar survival rates to that of conventional surgery or primary chemoradiotherapy. In another 34% of the patients, adjuvant chemotherapy could be spared and adjuvant radiotherapy could be reduced by 10 Gy, compared to primary chemoradiotherapy of 70 Gy. This invited report is based on previously published data by the same authors.

Inventory of economic evaluation of head and neck oncology from the German perspective.

New treatment strategies for head and neck neoplasms include induction chemotherapy and biomarker treatment. Moreover, different therapeutic modalities, especially robotic surgery, induction chemotherapy, biotherapy and altered fractionation schedules of chemo-(radio)therapy are newly combined to optimize treatment benefit and minimize treatment-associated morbidity. Often, overall survival does not change significantly between the competing treatment schedules. Therefore, the evaluation of the patient's treatment-related quality of life (QoL) and organ function becomes more and more important. Finally, the sponsor's financial resources are restricted, which makes it necessary to evaluate therapies for pricing and effectiveness. In head and neck cancer in Europe, analyses of the current situation are lacking. Selective literature research for publications on economic cost-effectiveness analyses was performed. An overview of the current situation with a special focus on Europe is provided. Cost-effectiveness values and QoL assessments should be respected in former prospective study construction to gain systematic information on this topic.

Circulating tumor cells in head and neck cancer: clinical impact in diagnosis and follow-up.

Metastasis and the associated loss of function of vital organs in the course of the disease is one of the main causes of death in head and neck cancer patients. An earlier and more reliable determination of metastasis and recurrence than currently obtained by common imaging methods could improve therapy and therefore the prognosis of head and neck cancer patients. The detection of tumor cells, which circulate in the blood of cancer patients, known as circulating tumor cells and those that can be found in the bone marrow, called disseminated tumor cells (DTC) provides a diagnostic source especially for those patients at high risk of locoregional recurrence or distant failure. Circulating tumor cells (CTC) have been identified as a prognostic factor in different solid tumors. In head and neck squamous cell carcinoma, there are data for a similar prognostic relevance. The methods of detection of CTC/DTC, the role in diagnosis and follow-up in head and neck cancer are summarized in this review. Furthermore, the future technical and clinical challenges to be addressed to establish CTC/DTC in clinical routine are being critically discussed.

New treatment strategies for HPV-positive head and neck cancer.

Epidemiological studies show an increasing incidence of human papilloma virus-associated oropharyngeal cancer. HPV-positive head and neck squamous cell carcinoma (HNSCC) is recognized as a special subgroup of HNSCC. Because HPV-positive patients are often younger and have an outstanding prognosis, long-term toxicities of therapy have become an important issue. Current clinical trials focus on a reduction of treatment-related toxicity and the development of HPV-specific therapies. New treatment strategies include a dose reduction of radiotherapy, the use of cetuximab instead of cisplatin for chemoradiation and transoral robotic surgery (TORS). Increasing comprehension of the molecular background of HPV-associated HNSCC has also lead to more specific treatment attempts including immunotherapeutic strategies. Whereas recently published data shed light on immune mechanisms resulting in a tolerogenic niche for HPV and HPV-associated HNSCC, other studies focus on specific vaccination of HPV-positive HNSCC. This study will summarize current therapy approaches and illustrate ongoing clinical trials in the field of HPV-positive HNSCC.

[Main results of studies on primary therapy of head and neck squamous cell carcinoma : highlights of the ASCO Meeting 2014]. / Die wichtigsten Studienergebnisse in der Primärtherapie von Kopf-Hals-Tumoren : Highlights des ASCO-Meetings 2014.

The two available options for primary radiochemotherapy (RCT) of locally advanced head and neck squamous cell carcinoma are discussed in the current study: concomitant and sequential RCT. At the annual meeting of the American Society of Clinical Oncology (ASCO) 2014, results of current trials on the primary nonsurgical therapy of locally advanced head and neck tumors were presented. A selection of the most important trials will be summarized in this article. Studies including cisplatin-based RCT as standard therapy for locally advanced head and neck tumors, alternatives for cisplatin, combination with targeted therapy, application of the epidermal growth factor receptor (EGFR) antibody cetuximab and the comparison of concomitant and sequential RCT are discussed. The first completely recruited phase III trial comparing concomitant and sequential RCT will also be presented.