Efficacy of chemoradiotherapy in elderly patients with stage IV inoperable head and neck cancer.

OBJECTIVES: This study aimed to compare the efficacy of chemoradiotherapy (CRT) with radiotherapy (RT) alone for elderly patients (≥ 65 years) with stage IV inoperable head and neck cancer (IV-HNC). METHODS: Elderly patients diagnosed with inoperable IV-HNC from 2010 to 2015 were identified using the SEER database. Then, we performed a 1:1 propensity-score matched (PSM) analysis to reduce treatment selection bias, and the prognostic role of CRT was investigated using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard models. The main outcome was overall survival (OS), and the secondary outcome was cancer-specific survival (CSS). RESULTS: A total of 3318 patients were enrolled, of whom 601 received RT alone and 2717 received CRT. Through PSM, 526 patients were successfully matched, and balances between the two treatment groups were reached. In the matched dataset, multivariable Cox analysis revealed that CRT was associated with better OS (HR = 0.580, P < 0.001) and CSS (HR = 0.586, P < 0.001). Meanwhile, subgroups of patients with IV-HNC (younger age, male sex, being married, black race, grade I-II, oral cavity site, T3-T4 stage, N0-N1 stage, M1 stage) were inclined to benefit more from CRT treatment. Furthermore, the survival benefit of CRT was more pronounced in patients aged 65 to 80 years, but was absent in patients aged 80 years or older. CONCLUSIONS: This study indicated that CRT resulted in better survival than RT alone in elderly patients with inoperable IV-HNC, especially for those subpopulations that benefit more from CRT treatment.

Primary and Recurrent Intraosseous Adenoid Cystic Carcinoma-Analysis of Two Cases and Literature Review.

Adenoid cystic carcinoma (ACC) is a rare malignant tumor that mostly occurs in minor glands, especially in the palate. Intraosseous adenoid cystic carcinoma (IACC) is rarer. There is no clear conclusion on the clinical, radiologic and pathological characteristics of IACC because of few reported IACC cases, leading to insufficient understanding of IACC. We reviewed 52 previous reports of primary IACC (PIACC) and analyzed the clinical features of those patients involved, attempting to provide a better understanding of PIACC. Moreover, we present a case of primary PIACC and a case of recurrent IACC (RIACC). The two patients showed similarities in clinical and pathological results, along with slight differences in radiological and immunohistochemical results. The patient of case 1 seemed to display a worse prognosis, which can only be proved after long term follow-up.

Effect of asymmetric force on the condylar cartilage, subchondral bone and collagens in the temporomandibular joints.

This study aimed to define the effects of asymmetric force on rat temporomandibular joints (TMJs). A total of 232 10-week-old rats were used in the experiment. Their left TMJs were kept forward and upward with 40g or 120g. The histological and osteogenic changes, as well as the expression of type I, II and III collagens were observed. Our results showed that the curve of the cartilage thickness changes in the anterior part of the treated side in the heavy force group (HS) decreased first and increased later during the strength and the recovery periods, while the reverse changes were shown in the middle and posterior parts. The cartilage thickness change on the other side in the heavy force group (HO) was the opposite. Additionally, the cartilage thickness change on the treated side and the other side of the light force group (LS and LO) were similar to but not as significantly changed as HS and HO. There were significant differences among the experimental groups. The subchondral bone trabecula also decreased after the pressure loading and removing, then recovered, without significant differences among these groups. Furthermore, more pathological changes such as fractures, bone cysts, the degradation of type II collagen and the increased expression of type III collagen were observed on the treated sides following the application of heavy force. In contrast, more osteogenesis and more active changes were found in the light force group. In conclusion, our study demonstrated that asymmetric force exerted different effects on the cartilage, subchondral bone and collagens of TMJs. Greater changes occurred in the heavy force group, and light force provided more benefits for TMJs remodelling.