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Nel periodo compreso tra gennaio 1990 e gennaio 1994, 80 pazienti affetti da neoplasia del massiccio facciale e della regione cervicale, non trattati precedentemente, sono stati sottoposti consecutivamente ad esame TC e RM della t...
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Nel periodo compreso tra gennaio 1990 e gennaio 1994, 80 pazienti affetti da neoplasia del massiccio facciale e della regione cervicale, non trattati precedentemente, sono stati sottoposti consecutivamente ad esame TC e RM della testa e del collo; tutti i casi hanno successivamente eseguito intervento chirurgico con stadiazione istopatologica. I risultati della valutazione TC e della RM sono stati confrontati tra loro e con la stadiazione istologica. Quarantotto su 52 casi T4 alla TC (89%) sono stati confermati dall'esame istopatologico postoperatorio; 7 su 13 T3 all'esame TC (54%) sono risultati alla chirurgia pT3 ed infine 8 su 15 (53%) T2 all'esame tomodensitometrico sono stati valutati pT2 all'esame istologico. La TC ha sovrastadiato 4 casi (T4) definiti all'esame istopatologico 2 pT2 e 2 pT3. Tutti i 54 casi T4 alla RM (100%) sono stati confermati dall'esame istologico. Dei 12 pazienti giudicati T3, 3 (25%) hanno subito una variazione del parametro «T» in seguito alla verifica istologica in quanto risultati pT4; infine, 4 dei 14 casi giudicati T2 (28%) sono risultati sottostadiati in quanto pT4 all'esame istologico definitivo. Un solo paziente, pT4 alla chirurgia ed alla TC, è stato giudicato erroneamente T3 dalla RM in quanto presentava infiltrazione dell'osso ioide non evidente all'esame RM, mentre in 6 casi la RM ha modificato correttamente la stadiazione del parametro «T» della TC. L'accuratezza globale dei due esami è stata del 79% e del 91% rispettivamente per la TC e la RM. I risultati della valutazione TC ed RM del parametro «N» sono i seguenti: sensibilità 70% contro 75%, specificità 80% contro 78% e accuratezza 75% contro il 76%. In solo due pazienti la RM ha determinato il corretto coinvolgimento linfonodale (stadio: N1, confermato dalla chirurgia) rispetto alla TC.
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The authors report acute toxicity in 14 patients with locally advanced head and neck squamous cell carcinoma treated with radiotherapy and cetuximab.
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Objectives Head and neck adenosquamous cell carcinoma (HN-ASCC) is a rare, aggressive neoplasm, with limited data reported in the literature. The aim of this study was to assess tumour behaviour and prognostic factors impacting ov...
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Objectives Head and neck adenosquamous cell carcinoma (HN-ASCC) is a rare, aggressive neoplasm, with limited data reported in the literature. The aim of this study was to assess tumour behaviour and prognostic factors impacting overall survival (OS) in a retrospective, single institution series. Methods A retrospective study on patients affected by HN-ASCC who were treated surgically between 2002 and 2019 at the Department of Otorhinolaryngology – Head and Neck Surgery of the University of Brescia was conducted. Demographics, clinical data, OS, and relative prognostic factors were analysed. Results The study included 32 patients, with a median age of 66 years, mostly males (84.4%) and untreated (68.8%). Adjuvant treatments followed surgery in 28.1% of patients. Compared to conventional SCC, ASCC showed a higher proportion of cases arising in the larynx (40.6%); no difference was found in other features. Advanced (pT3-4) local stage at presentation (p = 0.023), perineural invasion (PNI, p = 0.01), and positive margins (p = 0.007) were independent negative prognostic factors for OS. Conclusions HN-ASCC is a rare, aggressive cancer, most frequently arising in the larynx of elderly males, usually diagnosed in an advanced local stage. OS is generally poor, affected by local advanced stage, PNI, and positive resection margins. Obiettivo Il carcinoma adenosquamoso del distretto testa-collo (HN-ASCC) è una neoplasia rara e aggressiva, con pochi dati riportati in letteratura. Lo scopo del presente lavoro è quello di valutare il comportamento di questa neoplasia e i fattori prognostici che ne influenzano la sopravvivenza cruda mediante uno studio retrospettivo su una serie monocentrica. Metodi Il lavoro, retrospettivo, ha reclutato pazienti affetti da HN-ASCC trattati chirurgicamente dal 2002 al 2019 presso la Clinica Otorinolaringoiatrica dell’Università degli Studi di Brescia. Sono stati analizzati i dati demografici, clinici, di sopravvivenza cruda e i relativi fattori prognostici. Risultati Lo studio ha incluso 32 pazienti di età mediana pari a 66 anni, per lo più maschi (84,4%), mai trattati prima (68,8%). Il trattamento adiuvante è stato somministrato dopo la chirurgia nel 28,1% dei casi. Confrontato col più frequente SCC, l’ASCC insorge maggiormente a livello laringeo (40,6%); non sono state riscontrate altre differenze. Lo stadio locale avanzato (pT3-4) alla diagnosi (p = 0,023), l’infiltrazione perineurale (p = 0,01) e i margini positivi (p = 0,007) sono risultati fattori prognostici negativi indipendenti per la sopravvivenza cruda. Conclusioni L’HN-ASCC è una neoplasia rara, aggressiva, per lo più a origine laringea e in pazienti anziani, maschi, in stadio localmente avanzato alla diagnosi. La sopravvivenza cruda è solitamente scarsa e condizionata dallo stadio localmente avanzato, dalla presenza di invasione perineurale e dai margini positivi.
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Head and neck cancer (HNC) represents a heterogeneous group of neoplasms. These tumours may differ in location, pathogenesis, behavior, treatment, prognosis, and effect on quality of life 1 . According to the project RARECAREnet 2...
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Head and neck cancer (HNC) represents a heterogeneous group of neoplasms. These tumours may differ in location, pathogenesis, behavior, treatment, prognosis, and effect on quality of life 1 . According to the project RARECAREnet 2 , HNCs include epithelial tumours of the nasal cavity and sinuses, nasopharynx, hypopharynx, larynx, oropharynx, oral cavity, lip, eye and its adnexa, middle ear, major salivary glands and salivary-gland type tumours. Advanced skin cancer of HN area and complex thyroid cancers are also included for anatomical reasons. HNCs are rare since the incidence rate (IR) of each HNC subsite is < 6/100,000, although the IR varies with the highest value for larynx cancer and the lowest for paranasal sinus and salivary gland cancers. Overall, HNC is the sixth most common cancer worldwide with an annual incidence of approximately 850,000 cases and a mortality rate estimated at 450,000 in 2018, accounting for 3% of all cancers 3 . It is typically diagnosed in patients over 60 years of age with heavy use of alcohol and tobacco. In addition, cases of Human Papilloma Virus (HPV)-associated oropharyngeal cancer are being increasingly diagnosed worldwide, especially in younger individuals in the US and Europe 1 . HNC is associated with considerable burden and costs due to the complexity of treatments and treatment-related toxicities and, despite the latest advances in the management (e.g. transoral surgical approaches, intensity modulated radiation therapy, proton therapy, immune checkpoint inhibitors), survival has not significantly improved. For all these reasons, diagnosis and treatment of HNC must be tailored to the individual patient and disease. A highly specialised multidisciplinary team (MDT) is required in order to assure the best outcome and avoid or adequately treat any side effects through specific coordinated skills and communication across disciplines, considering that treatment differs according to tumour type (e.g. squamous cell carcinoma vs adenocarcinoma), as well as stage of disease (e.g. I-II vs III-IV), anatomical site (e.g oral cavity vs larynx/hypopharynx), and surgical accessibility (e.g. open approach vs transoral surgery) 1 . Indeed, data from the literature reported that a MDT-based approach is advantageous for HNC patients, improving diagnostic and staging accuracy, reducing the interval time between diagnosis and the beginning of therapy and, most importantly, is associated with higher survival rates 4 . In particular, a change in diagnostic and therapeutic approaches in up to 60% of cases has been reported with MDT management, especially for rare tumours such as those affecting paranasal sinuses, nasopharynx and salivary glands 5 . In addition, most HNC patients arrived at the MDT evaluation for a second opinion, once primary treatment has been already delivered 5 . This means that, in case of an incorrect primary approach, the possibility to regain control of the disease and to cure the patient is extremely small. For all these reasons, a multidisciplinary approach according to evidence-based guidelines is considered mandatory to provide the best diagnostic workup and define the optimal individual treatment strategy. Despite the benefits of MDT, it must be noted that this approach requires considerable time, effort and financial resources and is usually more frequent in highly organised and high-volume centers. Literature data on clinical research suggest that patients treated in high-accrual centers report better treatment outcomes compared to patients treated in low-volume centres. It is now well accepted that high-volume facilities should manage patients with HNC, especially in those with the rarest cancers 6 . In considering solutions to overcome barriers to better care of HNC patients and in healthcare access and utilisation, timely access to comprehensive oncology consultation can be improved by applying the principles of telemedicine to create a virtual MDT (vMDT). The utility of telemedicine has also become increasingly apparent during the COVID-19 pandemic, which led to completely new ways of managing patients remotely through vMDTs 7 . Telemedicine can also be used to connect university and community hospitals to accelerate dispersal of information of recent research, and it can also permit smaller centres to share resources with larger ones, contributing to increase enrolment in clinical trials. In addition, other several advantages can be foreseen, e.g. reduction of the time spent for travelling for the patient but even for the physician; overcoming geographical barriers; creation of clinical networks. The need to establish a vMDT on a national basis to discuss the most complex cases of HNC, including patients with rare tumours (e.g. those involving the salivary glands; nasopharynx; paranasal sinuses or unknown primaries) is stronger than ever. Rare or complex HNCs present numerous challenges in diagnosis and management, which include the scarce confiden
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Objectives To evaluate the prognostic value of pre-treatment prognostic-nutritional index (PNI) in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC). Methods A multi-institutional retrospective series of HPV...
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Objectives To evaluate the prognostic value of pre-treatment prognostic-nutritional index (PNI) in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC). Methods A multi-institutional retrospective series of HPV-negative, Stages II-IVB, HNSCCs treated with upfront surgery was evaluated. Correlation of pre-operative blood markers and PNI with 5-year overall (OS) and relapse-free (RFS) survival was tested using linear and restricted cubic spline models, as appropriate. The independent prognostic effect of patient-related features was assessed with multivariable models. Results The analysis was conducted on 542 patients. PNI ≥ 49.6 (HR = 0.52; 95% CI, 0.37-0.74) and Neutrophil-to-Lymphocyte Ratio (NLR) > 4.2 (HR = 1.58; 95% CI, 1.06-2.35) confirmed to be independent prognosticators of OS, whereas only PNI ≥ 49.6 (HR = 0.44; 95% CI, 0.29-0.66) was independently associated with RFS. Among pre-operative blood parameters, only higher values of albuninaemia and lymphocyte count (> 1.08 x 10 3 /microL), and undetectable basophile count (= 0 10 3 /microL) were independently associated with better OS and RFS. Conclusions PNI represents a reliable prognostic tool providing an independent measure of pre-operative immuno-metabolic performance. Its validity is supported by the independent prognostic role of albuminaemia and lymphocyte count, from which it is derived. Obiettivi Valutare il valore prognostico dell’indice prognostico-nutrizionale (PNI) pre-trattamento nei pazienti con carcinoma a cellule squamose testa-collo (HNSCC) HPV-negativi. Metodi è stata valutata una serie retrospettiva multi-istituzionale di HNSCC HPV-negativi, di stadio II-IVB, trattati con chirurgia upfront. La correlazione dei marcatori ematici pre-operatori e del PNI con la sopravvivenza globale (OS) e libera da recidiva (RFS) a 5 anni è stata testata utilizzando modelli linear and restricted cubic spline. L’effetto prognostico indipendente delle variabili correlate al paziente è stato valutato con modelli multivariabili. Risultati L’analisi è stata condotta su 542 pazienti. PNI ≥ 49,6 (HR = 0,52; 95%CI, 0,37-0,74) e Neutrophile-to-Lymphocyte Ratio (NLR) > 4,2 (HR = 1,58; 95%CI, 1,06-2,35) si sono confermati fattori prognostici indipendenti di OS, mentre solo PNI ≥ 49,6 (HR = 0,44; 95% CI, 0,29-0,66) era associato in modo indipendente a RFS. Tra i parametri ematici pre-operatori, solo valori più elevati di albuminemia e conta dei linfociti (> 1,08 10 3 /microL), e una conta dei basofili indosabile (= 0 10 3 /microL) erano indipendentemente associati a una migliore OS e RFS. Conclusioni Il PNI rappresenta uno strumento prognostico affidabile che fornisce una misura indipendente della performance immuno-metabolica pre-operatoria. La sua validità è supportata dal ruolo prognostico indipendente dell’albuminemia e della conta linfocitaria, da cui deriva.
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This prospective study reports the impact of weight loss on setup of head and neck (H&N) cancer patients treated by Intensity-Modulated Radiation Therapy (IMRT).
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Objectives Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate tumour identification and decrease potential complica...
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Objectives Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate tumour identification and decrease potential complications. We describe five cases of pre-operative USGW localisation of non-palpable head and neck lesions to facilitate surgical localisation and resection. Methods All patients undergoing pre-operative USGW localisation for non-palpable tumours of the head and neck region at London Health and Sciences Center, London, Ontario, Canada, were included. All the USGW localisations were performed by the same interventional radiologist, and the surgeries were performed by fellowship trained head and neck surgeons. Results Five patients were included. All patients were undergoing revision surgery for recurrent or persistent disease. All successfully underwent a pre-operative USGW localisation of the non-palpable lesion before revision surgery. All lesions were localised intra-operatively with no peri-operative complications. Conclusions USGW localisation is a safe and effective pre-operative technique for the identification of small non-palpable head and neck tumours. Obiettivi Il posizionamento ecoguidato di un repere in piccoli tumori non palpabili del distretto testa collo, può essere una valida opzione per facilitarne la localizzazione intra-operatoria e diminuire le potenziali complicanze. Lo scopo di questo articolo è dimostrare l’applicazione di questa tecnica tramite la descrizione di cinque casi clinici. Metodi Tutti i pazienti sottoposti a posizionamento ecoguidato di un repere in tumori difficilmente localizzzabili e non palpabili del distretto testa collo sono stati inclusi nello studio. Il repere è stato posizionato sempre dal medesimo radiologo interventista e l’intervento eseguito da chirurghi testa collo esperti. Risultati Sono stati inclusi cinque pazienti, tutti candidati a chirurgia di revisione per recidiva o persistenza di malattia. In tutti i casi il posizionamento ecoguidato del repere è avvenuto con successo prima della chirurgia. Tutte le lesioni sono state localizzate intra-operativamente, e asportate senza complicanze. Conclusioni Questa tecnica pre-operatoria si è dimostrata sicura ed efficace per la localizzazione di piccole neoplasie, altrimenti difficilmente localizzabili, del distretto testa collo.
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Objective Laryngeal chondritis (LC) is a rare complication of carbon dioxide transoral laser microsurgery (CO 2 TOLMS) for laryngeal tumours and can pose a diagnostic challenge. Its magnetic resonance (MR) features have not been p...
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Objective Laryngeal chondritis (LC) is a rare complication of carbon dioxide transoral laser microsurgery (CO 2 TOLMS) for laryngeal tumours and can pose a diagnostic challenge. Its magnetic resonance (MR) features have not been previously described. This study aims to characterise a cohort of patients who developed LC after CO 2 TOLMS and describe its clinical and MR findings. Methods Clinical records and MR images of all patients presenting with LC after CO 2 TOLMS between 2008 and 2022 were reviewed. Results Seven patients were analysed. Timing of LC diagnosis ranged from 1 to 8 months after CO 2 TOLMS. Four patients were symptomatic. Abnormal endoscopic findings included suspected tumour recurrence in 4 patients. MR documented focal or extensive signal changes involving the thyroid lamina and para-laryngeal space with T2 hyperintensity, T1 hypointensity and intense contrast enhancement (n = 7), and minimally reduced mean apparent diffusion coefficient (ADC) values (1.0-1.5 x 10 -3 mm 2 /s) (n = 6). A favourable clinical outcome was achieved in all patients. Conclusions LC after CO 2 TOLMS has a distinctive MR pattern. When tumour recurrence cannot be confidently excluded based on imaging, antibiotic therapy, close clinical and radiological follow-up and/or biopsy are recommended. Obiettivo La condrite laringea (CL) è una rara complicanza della microchirurgia laringea transorale laser (CO 2 TOLMS) per neoplasie laringee e può rappresentare una difficile diagnosi. Le caratteristiche in risonanza magnetica (RM) della CL non sono state descritte. Questo studio vuole caratterizzare una coorte di pazienti che hanno sviluppato CL dopo CO 2 TOLMS e descriverne i rilievi clinici e RM. Metodi Le cartelle cliniche e le RM dei pazienti che hanno presentato CL dopo CO 2 TOLMS dal 2008 al 2022 sono stati rivisti. Risultati Sette pazienti sono stati analizzati. Il tempo di comparsa della CL variava da 1 a 8 mesi dopo CO 2 TOLMS. Quattro pazienti erano sintomatici. Rilievi endoscopici anomali hanno incluso la sospetta recidiva in 4 pazienti. La RM ha mostrato alterazioni di segnale focali o diffuse delle lamine tiroidee e dello spazio paralaringeo con iperintensità T2, ipointensità T1, intenso enhancement in 7 pazienti e ADC medio minimamente ridotto (1,0-1,5 x 10 -3 mm 2 /s) in 6 pazienti. Tutti i casi hanno avuto un decorso clinico favorevole. Conclusioni La CL dopo CO 2 TOLMS ha una pattern RM distintivo. Quando la recidiva neoplastica non può essere esclusa sulla base dell’imaging, si raccomandano terapia antibiotica, stretto follow-up clinico e radiologico e/o biopsia.
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