Dose-adjusted EPOCH-R vs.R-CHOP in frontline management of Waldeyer’s ring diffuse large B-cell lymphoma:a retrospective study from a single institution

Background: To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer’s ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution. Methods: This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS). Results: During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P = 0.025 and P = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11;95% CI: 0.01-0.88) and 0.042 (HR: 0.19;95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups. Conclusion: Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.

Anatomy and physiology of the palatine tonsils, adenoids, and lingual tonsils

Objective::This review aims to discuss the basic anatomy and physiology of the palatine and pharyngeal tonsils,with reference to how this foundational understanding may affect patient management and surgical procedures in these regions of the upper airway.Methods::A literature search was performed using PubMed and Google Scholar using the MeSH terms tonsils,adenoids,anatomy,physiology,and adenotonsillectomy.Primary sources were excluded if they were abstracts only,non-English language,or non-human studies.Thirty-five sources were included in this review.Results and conclusions::The pharyngeal and palatine tonsils are compact yet physiologically complex mucosa-associated lymphoid tissues that make up a portion of Waldeyer’s ring.As part of the mucosal immune system,these structures function in exogenous antigen sampling and stimulation of immune responses.Aberrant immune activation and/or regulation can lead to a myriad of pathologies,with adenotonsillar hypertrophy,chronic tonsillitis/adenoiditis,and recurrent otitis media among the most commonly encountered conditions by otolaryngologists.While the pathophysiology of these conditions is still incompletely understood,current evidence and future investigations may reveal patterns amenable to targeted medical management.When medical management fails,tonsillectomy and/or adenoidectomy may be indicated for patient care.Though routine procedures,the execution of tonsil and/or adenoid removal requires a thorough understanding of the anatomy of these lymphoepithelial organs so as to minimize the risk for rare serious complications that can occur.