Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis.

PURPOSE: The objective of this study was to determine the incremental staging information provided by positron emission tomography/computed tomography (PET/CT) and its impact on management plans in patients with untreated stage III-IV head and neck squamous cell carcinoma (HNSCC). METHODS: We prospectively studied, between September 2011 and February 2013, 84 consecutive patients [median age 63.5 years (39-84); 73 men] with histologically confirmed HNSCC. First, based on a conventional work-up (physical examination, CT imaging of the head, neck and chest), the multidisciplinary Head and Neck Tumour Board documented the TNM stage and a management plan for each patient, outlining the modalities to be used, including surgery, radiation therapy (RT), chemotherapy or a combination. After release of the PET/CT results, new TNM staging and management plans were agreed on by the multidisciplinary Tumour Board. Any changes in stage or intended management due to the PET/CT findings were then analysed. The impact on patient management was classified as: low (treatment modality, delivery and intent unchanged), moderate (change within the same treatment modality: type of surgery, radiation technique/dose) or high (change in treatment intent and/or treatment modality → curative to palliative, or surgery to chemoradiation or detection of unknown primary tumour or a synchronous second primary tumour). TNM stage was validated by histopathological analysis, additional imaging or follow-up. Accuracy of the conventional and PET/CT-based staging was compared using McNemar's test. RESULTS: Conventional and PET/CT stages were discordant in 32/84 (38 %) cases: the T stage in 2/32 (6.2 %), the N stage in 21/32 (65.7 %) and the M stage 9/32 (28.1 %). Patient management was altered in 22/84 (26 %) patients, with a moderate impact in 8 (9.5 %) patients and high impact in 14 (16.6 %) patients. PET/CT TNM classification was significantly more accurate (92.5 vs 73.7 %) than conventional staging with a p value < 0.001 (McNemar's test). CONCLUSION: PET/CT should be implemented in the routine imaging work-up of stage III-IV HNSCC.

Long-term impact on quality of life of subthalamic nucleus stimulation in Parkinson's disease.

Long-term impact of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on health-related quality of life (HRQOL) and associated factors in patients with Parkinson's disease (PD) are not clear. In this prospective study, we included 69 PD patients (64 % men, mean age 61.3 ± 7.4 and disease duration 13.2 ± 5.7 years) undergoing STN-DBS. They were evaluated preoperatively (baseline), 1 and 5 years postoperatively assessing 39-item Parkinson's Disease Questionnaire (PDQ-39), Schwab and England Activities of Daily Living Scale (SEADL), Unified Parkinson's Disease Rating Scale (UPDRS) off- and on-medication, patient diaries, dopaminergic treatment, mortality and surgical complications. Five years postoperatively, off-medication, there were improvements from baseline in UPDRS-II and III total (27.2 and 26.7 %, respectively) and SEADL (18.6 % more completely independent patients) (p < 0.05) scores, while on-medication, there was a deterioration in UPDRS-III (37.8 %, mainly axial signs) (p < 0.05) and minor improvements in SEADL (3.7 %). While at 1 year PDQ-39, the summary index improved substantially (36.5 %) (p < 0.05), at 5 years patients regressed (only 8.8 %) (p < 0.05), though changes in PDQ-39 subscores remained significant, with improvements in ADL (18.8 %), emotional well-being (19.0 %), stigma (36.4 %) and discomfort (20.6 %), despite worsening in communication (47.8 %) (p < 0.05). Lower preoperative PDQ-39 summary index and greater 1-year UPDRS-III-off total score gain predicted better long-term HRQOL. STN-DBS produces long-term improvements in HRQOL in PD. Preoperative HRQOL and short-term postoperative changes in off-medication motor status may predict long-term HRQOL in PD following STN-DBS.

Oral and maxillary metastases: retrospective clinical analysis of 21 cases / Metástasis orales y maxilares: análisis clínico retrospectivo de 21 casos

OBJECTIVE: Retrospective descriptive study of 21 oral soft tissue and/or maxillary bone metastatic cases. MATERIALS AND METHODS: Hospital records of our own department are reviewed for a 12-year period. Lymphoproliferative diseases, skin metastases, salivary glands, other craniofacial bones and cervical lymph-nodes are excluded. Epidemiologic, personal health, clinical, treatment and follow-up data are recollected and analysed in frequency statistics. RESULTS: Male:Female ratio is 1.3:1, year-old range 52-82 and ethnic group 100 % white-caucasian. 19.0 % have carcinogenic occupational exposure, 52.4 % tobacco abuse, 61.9 % some kind of alcohol use, 57.1 % cardiovascular risk, 19.0 % cardiologic records, 28.6 % pulmonary, 19.0 % gastrointestinal, 19.0 % endocrine, 14.3 % genitourinary, 9.5 % other primary malignancy and 23.8% a first-degree relative with a neoplasm. 33.3 % patients have taken osteonecrosisrelated drugs or received craniofacial radiotherapy. Metastasis is the debut in 7 patients while it corresponds to infirmity progression in 14. The chief reason for consultation is a mass. 8 lesions affect soft tissue and 13 the bone. 81.0 % have epithelial neoplasm lineages. The organ of origin is: 23.8 % lung, 23.8 breast, 23.8 % kidney, 9.5 % skin, 9.5 % soft parts, 4.8 % prostate and 4.8 % thyroid. 100 % have other location metastases. 14.3 % patients undergo surgery, 38.1 % receive radiotherapy, 47.6 % chemo- or targeted therapy, and 28.6 % symptomatic treatment. After a 1-124 months range of followup, 17 patients die and 4 are alive. CONCLUSIONS: Craniomaxillofacial metastases, usually with multiple visceral or axial skeleton lesions, have an ominous prognosis. Multidisciplinary management could benefit the patient status and lead to more favourable outcomes. There are exceptional cases of long-term survival

OBJETIVO: Estudio descriptivo retrospectivo de 21 casos de metástasis en tejidos blandos orales y/o huesos maxilares. MATERIAL Y MÉTODOS: Revisión a 12 años de actas de nuestro departamento, excluyendo procesos linfoproliferativos, metástasis cutáneas, glándulas salivales, otros huesos craneofaciales y ganglios cervicales. Se recopilan datos epidemiológicos, antecedentes, clínicos, tratamiento y seguimiento, y analizan mediante estadísticos de frecuencia. RESULTADOS: La proporción varón:mujer es 1,3:1, entre 52-82 años y todos de etnia blancocaucásica. El 19,0 % tiene exposición laboral carcinógena, el 52,4 % tabaquismo, el 61,9 % consumo de alcohol, el 57,1 % riesgo cardiovascular, el 19,0 % patología cardiaca, el 28,6 % pulmonar, el 19 % gastrointestinal, el 19 % endocrina, el 14,3 % genitourinaria, el 9,5 % otro tumor maligno primario y el 23,8 % un familiar de primer grado con una neoplasia, el 33,3 % ha tomado fármacos asociados a osteonecrosis o recibido radioterapia craneofacial. Siete pacientes debutan con la metástasis y 14 como progresión de neoplasia conocida. El motivo de consulta principal es una masa. Ocho lesiones afectan a tejidos blandos y 13 al hueso. El 81 % son tumores de estirpe epitelial. El origen es: 23,8 % pulmón, 23,8 % mama, 23,8 % renal, 9,5 % piel, 9,5 % partes blandas, 4,8 % próstata y 4,8 % tiroides. El 100 % tiene metástasis en otras localizaciones. El 14,3% pacientes son tratados con cirugía, el 38,1 % con radioterapia, el 47,6 % con quimioterapia dirigida, y el 28,6 % con tratamiento sintomático. 17 pacientes fallecidos y 4 vivos con rango 1-124 meses de seguimiento. CONCLUSIONES: Las metástasis craneomaxilofaciales, habitualmente con múltiples lesiones viscerales o en esqueleto axial, tienen pronóstico infausto. El manejo multidisciplinar podría beneficiar el estado basal del paciente y llevar a mejores resultados: Existen casos excepcionales de supervivencia a largo plazo