Classificatory updates in verrucous and cuniculatum carcinomas:Insights from the 5^(th) edition of WHO-IARC head and neck tumor classification

The International Agency for Research on Cancer(IARC)and World Health Organization(WHO)collaboratively produce the'WHO Blue Books'essential tools standardizing the diagnostic process for human cancers.Regular updates in this classification accommodate emerging molecular discoveries,advances in immunohistochemical techniques,and evolving clinical insights.The 5th edition of the WHO/IARC classification of head and neck tumors refines the'Oral Cavity and Mobile Tongue'chapter,including sections for non-neoplastic lesions,epithelial tumors,and tumors of uncertain histogenesis.Notably,the epithelial tumors section is rearranged by tumor behavior,starting with benign squamous papillomas and progressing through potentially malignant oral disorders to oral squamous cell carcinoma(OSCC).The section on OSCC reflects recent information on epidemiology,pathogenesis,and histological prognostic factors.Noteworthy is the specific categorization of verrucous carcinoma(VC)and carcinoma cuniculatum(CC),both associated with the oral cavity and distinct in clinical and histologic characteristics.This classification adjustment emphasizes the oral cavity as their predominant site in the head and neck.Designating specific sections for VC and CC aims to provide comprehensive insights into these unique subtypes,elucidating their clinical features,distinct histological characteristics,prevalence,significance,and clinical relevance.By categorizing these subtypes into specific sections,the 5th edition of the WHO classification aims to provide a more nuanced and detailed account,enhancing our understanding of these specific variants within the broader spectrum of head and neck tumors.

Association between the nutritional status and radiation pharyngeal mucositis in patients with head and neck cancer during radiotherapy:A longitudinal study

Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.

Factors influencing comfort level in head and neck neoplasm patients receiving radiotherapy

Objective:To determine factors that influence comfort in head and neck neoplasm patients receiving radiotherapy.Methods:In total,200 head and neck neoplasm patients receiving radiotherapy were recruited from three tertiary first class hospitals.They were assessed by Radiotherapy Comfort Questionnaire for patients with head and neck neoplasm,Social Support Scale,and Medical Coping Modes Questionnaire.Results:The total score of comfort was 60.54±8.32.Multiple linear regression analysis indicated that number of radiation treatments,family accompaniment,educational level,resignation coping mode,complications due to diabetes,accompanying chemotherapy,and the utilization of social support significantly influenced comfort level(p<0.05).Among these,number of radiation treatments,complications due to diabetes,accompanying chemotherapy,and resignation coping were negative factors.Conclusion:Encouraging utilization of social support systems and a positive coping mode is important for increasing comfort level in head and neck neoplasm patients during radiotherapy.Nurses should pay particular attention to those patients during later stages of radiotherapy or chemotherapy,with diabetes,without family accompaniment,and with lower education level.

Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic:Current practice and lessons for the future

The coronavirus disease 2019(COVID-19)pandemic has imposed a radical change in daily life and work routine.In this context,health systems have suffered important and serious repercussions in all fields.Among the changes brought about by the state of global health emergency,adjustments to guidelines,priorities,structures,professional teams,and epidemiological data stand out.In light of this,the oncological field has witnessed several changes in the approach to cancer,whether due to delay in diagnosis,screening deficit,personnel shortage or the psychological impact that the pandemic has had on cancer patients.This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency.In this period,the oral and maxillofacial surgeons have faced many obstacles.The proximity of maxillofacial structures to the airways,the need of elective and punctual procedures in cancerous lesions,the aggressiveness of head and neck tumors,and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field.One of the possible surgical'solutions'to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps,which in the pre-COVID-19 era were less used than free flaps.However,during the health emergency,its use has been widely reassessed.This setback may represent a precedent for opening up new reflections.In the course of a long-term pandemic,a reassessment of the validity of different medical and surgical therapeutic approaches should be considered.Finally,given that the pandemic has highlighted vulnerabilities and shortcomings in a number of ways,including the issues of essential resource shortages,underinvestment in public health services,lack of coordination and versatility among politicians,policymakers and health leaders,resulting in overloaded health systems,rapid case development,and high mortality,a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out.This should be directed especially towards improving the management of health systems,their coordination as well as reviewing related practices,even in the surgical field.

Oral Health Management of Three Head and Neck Cancer Patients Performed by Dental Hygienists

Introduction: Oral health management is often difficult in patients after surgical tumor resection and/or radiotherapy due to defects, bulky flaps, limitation of tongue movement, and trismus. In addition, patients who have undergone radiotherapy have serious disabilities such as oral mucositis, mucosal weakening, soft tissue fibrosis, salivary gland disorder, and osteoradionecrosis. Dental hygienists must understand the characteristics of patients after surgical tumor resection and/or radiotherapy. In this report, the oral health management of three patients after maxillectomy, mandibulectomy, and radiotherapy was shown. Case Description: Case 1: A 53-year-old male patient visited our clinic after chemotherapy, radiotherapy, and partial maxillectomy for cancer of the right maxillary gingiva. Case 2: A 65-year-old male patient visited our clinic after radiotherapy for a right-sided tongue cancer, partial mandibulectomy of the right tongue to the oropharynx, a right-sided segmental mandibulectomy and a speech aid and a mandibular prosthesis were provided. Case 3: A 36-year-old female visited our clinic for radiotherapy for left-sided tongue cancer. Dental hygienists provided oral health management to the patients. In oral health management, it was suggested that intervention before cancer treatment, oral hygiene instructions tailored to patients’ symptoms, and frequent professional care are important. Conclusion: Oral health management by dental hygienists is extremely important for patients undergoing maxillofacial cancer treatment to maintain their quality of life in the long term.

Radiation Therapy of Head and Neck Paragangliomas: Experience from Radiotherapy Department at the National Institute of Oncology in Rabat (Morocco)

Background and Purpose: Paragangliomas are rare tumors of the head and neck. Their management remains problematic and varies considerably depending on the center. This study reported 14 years of experience in the management of head and neck paraganglioma (HNPGls). We aimed to assess the therapeutic results of these tumors in terms of local control and overall survival. Materials and Methods: We included 16 patients followed for HNPGls and treated by radiotherapy from January 2006 to June 2018 in the National Institute of Oncology in Rabat. Results: The median age was 44.5 years (15 - 67). 13 patients were female and three male with a sex ratio of 4.3. Cervical mass was the common sign (56.3%). All patients received radiation therapy. This radiation was exclusive in 43.7% of cases or adjuvant to partial surgical resection in 56.3%. The median dose of radiotherapy was 54 Gy (46 - 60) and it was delivered by a three-dimensional conformal radiotherapy technique in 15 patients and volumetric modulated arc therapy in one. There were few acute complications such as grade I and II mucositis and dermatitis. After a median follow-up of 5.6 years (2 - 13.4), local control, defined by radiological stability or regression, was obtained in 14 patients, two patients progressed and one died. Progression-free survival rates at 5 and 7 years were 93.8% and 78.1% respectively, and overall survival at 5 and 7 years was 92.3%. Conclusions: Surgery is the first-line treatment for HNPGls. When surgery is not possible or incomplete, radiotherapy has its place in the therapeutic strategy of this rare disease for long-term local control.

Prognostic value of post-treatment ^(18)F-FDG PET/CT for advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy

Objective：To clarify the prognostic value of post-treatment 18F-fluorodeoxyglucose （FDG） positron emission tomography （PET）/computed tomography （CT） in patients with advanced head and neck squamous cell carcinoma （HNSCC） after combined intra-arterial chemotherapy and radiotherapy （IACR）.Methods：Thirty-six patients with HNSCC who underwent IACR were recruited.The period from the end of IACR to the last post-treatment 18F-FDG PET/CT examination was 8-12 weeks.Both patient-based and lesion-based analyses were used to evaluate the PET/CT images.For lesion-based analysis,36 regions （12 lesions of recurrences and 24 scars at primary sites） were selected.The Kaplan-Meier method was used to assess the overall survival （OS） stratified by 18F-FDG uptake or visual interpretation results.Results：Twelve patients with recurrence were identified by six months after IACR.The sensitivity and specificity in the patient-based analysis were 67％ （8/12） and 88％ （21/24）,respectively.The mean OS was estimated to be 12.1 months （95％ CI,6.3-18.0 months） for the higher maximum standardized uptake value （SUVmax） group （n=7） and 44.6 months （95％ CI,39.9-49.3 months） for the lower SUVmax group （n=29）.OS in the higher SUVmax group （cut-off point,6.1） or positive visual interpretation group was significantly shorter than that in the lower SUVmax or negative visual interpretation group （P＜0.001 and P＜0.05,respectively）.Conclusions：The SUVmax and visual interpretation of HNSCC on post-IACR 18F-FDG PET/CT can provide prognostic survival estimates.

Nimotuzumab with Concurrent Chemo-Radiotherapy in Patients with Locally Advanced Squamous Cell Carcinoma of Head and Neck (LASCCHN)

Background: Head and neck cancers (HNCs) constitute 5% of all cancers globally and are the most common cancers in India. Chemotherapy and radiotherapy have not been proved to be effective in advanced cases and the prognosis remains dismal. This underscores the need for newer treatment options in these cases. Nimotuzumab, an anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibody, was safer when combined with chemo- or radio-therapy. Aim: To evaluate the safety and efficacy of concurrently administered nimotuzumab with chemo-radiotherapy in patients with advanced inoperable squamous cell carcinomas of head and neck (LASCCHN). Methods:?This was an open-label, single arm study evaluating 57 patients with histologically confirmed inoperable LASCCHN (stages III and IV) and eastern co-operative oncology group (ECOG) performance status < 2. Informed consent was obtained from all patients. The patients were administered IV cisplatin 30 mg/m2?and IV nimotuzumab 200 mg weekly for 6 weeks, along with radiotherapy of 6600 cGy over 33 fractions. Patients were evaluated over response evaluation criteria in solid tumors (RECIST) criteria 24 weeks after the last cycle of chemotherapy. Results: Mean age of patient was 50 years old (29 - 79 years old). The most common site of cancer was oral cavity (56.1%). Forty six patients (80.7%) completed 6 cycles of therapy. Objective response rate (ORR) was 80.7%, with 34 patients (59.6%) achieving complete response (CR), and 12 (21%) achieving partial response (PR). Stable disease (SD) was noted in 8 (14%) patients and progressive disease in 3 (5.2%) patients. Conclusion: Addition of nimotuzumab is a safe and efficacious option in patients with inoperable LASCCHN. Our observations confirm the available Phase II data. The long term survival benefits based on this encouraging response rate need to be further evaluated in this subset of cancer patients.

HIGH DOSE FRACTION RADIOTHERAPY FOR MUCOSAL MALIGNANT MELANOMA OF THE HEAD AND NECK

Objective: To evatuate the results of high dose fraction radiotherapy for mucosal malignant melanoma of the head and neck (HNMM) Methods: From 1984—1994, 35 patients with HNMM were enrolled in this study Among them, 27 cases localized to the nasal cavity or para nasal sinus, 8 to the oral cavity All patients received high dose fraction radiotherapy (6—8 Gy/fraction) with the total dose ranged from 40 to 60 Gy Results: The minimum follow up was 2 years (ranged 2—7 years) The overall 3 and 5 year survival rate was 45 7% and 24%, respectively Conclusion: High dose fraction radiotherapy is effective for local control of HNMM

Usability of Deformable Image Registration for Adaptive Radiotherapy in Head and Neck Cancer and an Automatic Prediction of Replanning

Deformable image registration (DIR) has been an important component in adaptive radiotherapy (ART). Our goal was to examine the accuracy of ART using the dice similarity coefficient (DSC) and to determine the optimal timing of replanning. A total of 22 patients who underwent volume modulated arc therapy (VMAT) for head and neck (H&N) cancers were prospectively analyzed. The planning target volume (PTV) was to receive a total of 70 Gy in 33 fractions. A second planning CT scan (rescan) was performed at the 15th fraction. The DSC was calculated for each structure on both CT scans. The continuous variables to predict the need for replanning were assessed. The optimal cut-off value was determined using receiver operating characteristic (ROC) curve analysis. In the correlation between body weight loss and DSC of each structure, weight loss correlated negatively with DSC of the whole face (rs = -0.45) and the face surface (rs = -0.51). Patients who required replanning tended to have experienced rapid weight loss. The threshold DSC was 0.98 and 0.60 in the whole face and the face surface, respectively. Patients who showed low DSC in the whole face and the face surface required replanning at a significantly high rate (P < 0.05 and P < 0.01). Weight loss correlated with DSC in both the whole face and the face surface (P < 0.05 and P < 0.05). The DSC values in the face predicted the need for replanning. In addition, weight loss tended to correlate with DSC. DIR during ART was found to be a useful tool for replanning.

PET/CT and Hypo-Fractionated Radiotherapy of Patients with Head and Neck Cancer

Positron emission tomography/Computer tomography (PET/CT) is a multimodality imaging diagnostic technique that analyzes the uptake and retention of different radiopharmaceuticals by cells providing metabolic information on biochemical processes. PET/CT has been used for radiotherapy planning, providing useful information to the Radio-oncologist about the localization, size and metabolic activity of tumor lesions. In this paper, we show advantages of the 18F-FDG PET/CT respect to simple CT imaging for target volume delineation in patients with diagnosis of Squamous Head and Neck Carcinoma that has been scheduled to undergo a hypofractionated radiotherapy treatment. On ten studied patients, the target volume defined from PET/CT images was less extensive than those defined from simple CT images. In six patients the target volume was significantly less extensive and in two of them a new lymph node disease was reported, re-staging and corresponding target volume was also delineated with less extensive margins from PET/CT images. A greater accuracy in delineating the volumes and improving the distribution of doses in the planning of the radiant treatment in these patients was possible, allowing a high precision in the delivery of the prescribed dose to the target volume diminishing the maximum dose to the adjacent healthy tissues. In conclusion we show that the use of 18F-FDG PET/CT was superior than the simple CT as the primary modality of imaging for hypofractioned radiotherapy treatment planning in patients with Squamous Head and Neck Carcinoma.

Estimation of Thyroid Hormones Levels &Lung Function in Conventional Radiotherapy of Breast, Head and Neck Cancer’s

Consequences of breast, head and neck cancers (HNC) radiotherapy are common among developing country patients;hence the aim of this work was to assess the impact of HNC (nasopharyngeal, laryngeal and hypopharyngeal and parotid) radiotherapy in thyroid and lungs functions. The data (tumor dose, dose histogram) has been retrieved from treatment planning system (TPS) and the thyroid hormones (T3, T4 and TSH) level pre/post radiotherapy was measured by radioimmunoassay (RIA) technique. Ages (18 - 55 for HNC and 20 - 65 for breast cancer) derived from PACS and respiratory rate (RR) assessed by counting the number of breathing/minutes. The analyzed data using Excel showed that: the impact of HNC without parotid and supraclavicular irradiation was significant (P = 0.00) reduction on T3 & T4, and increasing TSH hormones relative to applied tumor dose. The average doses (2.8, 30, 32, 33 and 20.5 Gy) received by thyroid gland from irradiation of parotid, larynx, breast, hypopharynx and nasopharynx respectively reduced T4/T3 hormones to 125.9/0.8, 109/0.6, 67.8/0.4, 33.9/0.3 and 105.8/0.7 respectively and increased TSH to 4.5, 6.3, 8.1, 11.5 and 0.65 mU/l respectively. The RR increased significantly (P = 0.05) from 19.1 ± 3.6 to 22.1 ± 3.4 in average due to tangential fields irradiation of breast. Conclusion addressing that: conventional radiotherapy for HNC & breast induce a significant reduction in thyroid hormones and increment of RR.

Evaluation of Quality of Life and Oral Changes of Patients in Head and Neck Radiotherapy: Observational Study

Radiotherapy (RT) in the head and neck, despite coming from technological evolution, is challenged by the acute and late side effects of local irradiation, including permanent loss of saliva, osteoradionecrosis, dental caries induced by radiation and necrosis of the oral cavity, mucositis, xerostomia and secondary infections like candidiasis. Since these manifestations are limiting and the integrity of the vital organs contemplates the patient’s general health status, the oral health-related quality of life (OHRQoL) can be significantly affected by the treatment of head and neck cancer (HNC), since cancer can cause important changes in vital functions related to communication, food and social contact, causing disturbances in the patient’s life. An observational and longitudinal study was carried out with 16 cancer patients submitted to RT in the head and neck, between the years 2019-2020 with the objectives of collecting clinical and epidemiological data on the main oral changes caused by RT in the head and neck and correlating them with the impact on OHRQoL. To analyze the OHRQoL, the University of Washington’s Quality of Life Assessment questionnaire (UW-QOL) was applied once a week for 4 weeks and to observe oral manifestations, a dental clinic file standardized by the researchers was applied. The main oral manifestations clinically observed were hyposalivation, trismus and oral mucositis. The UW-QOL presented pain, chewing and taste as the main complaints reported by patients, however, appearance, salivation and chewing showed statistically significant differences over the weeks. The main manifestations observed were hyposalivation, trismus and oral mucositis, the physical limitations resulting from these manifestations impact the OHRQoL of cancer patients in terms of appearance, salivation and chewing.

The problems of nutritional support for head and neck malignant tumor patients undergoing radiotherapy

Nutritional support is a vital approach to improve symptoms of head andneck cancer, which are caused by radiotherapy. Although nutritional supporthas rapid progress, it could appear a variety of problems in nutritionaltreatment for head and neck cancer patients during radiotherapy. It is introducedthat how to implement nutritional support for head and neck cancerpatients during radiotherapy. It is more important to analyze the problemsin nutrition assessment and nutrition support and intervention. It could bedesigned more convenient nutrition assessment system and try to find outmore sufficient and effective nutrition markers. It also needs to enhancethe nutrition education for patients and their family. In addition to, it couldbe more work to do in oral, nasal feeding and gastrostomy nutrition supplementationand parenteral nutrition support and intervention. Thus, it isa long way to make nutritional support be better in head and neck cancerpatients during radiotherapy.

Radiation-induced sarcomas of the head and neck

With improved outcomes associated with radiotherapy, radiation-induced sarcomas(RIS) are increasingly seen in long-term survivors of head and neck cancers, with an estimated risk of up to 0.3%. They exhibit no subsite predilection within the head and neck and can arise in any irradiated tissue of mesenchymal origin. Common histologic subtypes of RIS parallel their de novo counterparts and include osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma/sarcoma nitricoxide synthase, and fibrosarcoma. While imaging features of RIS are not pathognomonic, large size, extensive local invasion with bony destruction, marked enhancement within a prior radiotherapy field, and an appropriate latency period are suggestive of a diagnosis of RIS. RIS development may be influenced by factors such as radiation dose, age at initial exposure, exposure to chemotherapeutic agents and genetic tendency. Precise pathogenetic mechanisms of RIS are poorly understood and both directly mutagenizing effects of radiotherapy as well as changes in microenvironments are thought to play a role. Management of RIS is challenging, entailing surgery in irradiated tissue and a limited scope for further radiotherapy and chemotherapy. RIS is associated with significantly poorer outcomes than stagematched sarcomas that arise independent of irradiationand surgical resection with clear margins seems to offer the best chance for cure.

Targeting head and neck tumoral stem cells： From biologicalaspects to therapeutic perspectives

Head and neck squamous cell cancer(HNSCC) is the sixth most common cancer in the world. Effective therapeutic modalities such as surgery, radiation, chemotherapy and combinations of each are used in the management of the disease. In most cases, treatment fails to obtain total cancer cure. In recent years, it appears that one of the key determinants of treatment failure may be the presence of cancer stem cells(CSCs) that escape currently available therapies. CSCs form a small portion of the total tumor burden but may play a disproportionately important role in determining outcomes. CSCs have stem features such as self-renewal, high migration capacity, drug resistance, high proliferation abilities. A large body of evidence points to the fact that CSCs are particularly resistant to radiotherapy and chemotherapy. In HNSCC, CSCs have been increasingly shown to have an integral role in tumor initiation, disease progression, metastasis and treatment resistance. In the light of such observations, the present review summarizes biological characteristics of CSCs in HNSCC, outlines targeted strategies for the successful eradication of CSCs in HNSCC including targeting the self-renewal controlling pathways, blocking epithelial mesenchymal transition, niche targeting, immunotherapy approaches and highlights the need to better understand CSCs biology for new treatments modalities.

Optimal management of the elderly patient with head and neck cancer: Issues regarding surgery, irradiation and chemotherapy

Head and neck cancer(HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients older than 65 years of age at diagnosis is not rare and up to one fourth of cases occurs in patients older that 70 years at age. Because elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary therapeutic approaches. The frailty of elderly patients with HNC is attributed to the high incidence of smoking and alcohol abuse in this malignancy and the presence of substantial cardiovascular, respiratory or metabolic comorbidities. In the current work, I provide an overview of current and emerging treatment approaches, in elderly patients with HNC. In particular, I discuss modern surgical approaches that improve radical excision rates while preserving functionality, the incorporation of modern radiotherapeutic techniques and the introduction of novel chemotherapeutic combinations and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. Finally, there is an urgent need to increase accrual and active participation of elderly patients with HNC in clinical trials, including biomarker evaluation in biopsy specimens towards an individualized therapeutic approach.

Clinical Investigation of ^(99m)Tc-MIBI Imaging in Head and Neck Tumors

Objective： To investigate the diagnostic potential value of ^99Tc-MIBI imaging in head and neck tumors. Methods： Ninety-one patients with malignant and benign head and neck lesions were subjected to ^99mTc-MIBI tomography, and 20 healthy volunteers served as control group. Results： The overall sensitivity,specificity, accuracy and positive predictive accuracy of early/delay ^99mTc-MIBI imaging in diagnosis of head and neck malignant tumors were 78.7%/72.3%, 72.1%/88.4%, 75.6%/80.0% and 75.5%/87.2% respectively. The results of ^99mTc-MIBI Imaging in diagnosis of nasopharyngeal cancer and sinonasal non-Hodgkin＇s lymphoma were more satisfactory than those in maxillary sinus cancer. In distinguishing recurrent/residual nasopharyngeal carcinoma and sinonasal non-Hodgkin＇s lymphoma, ^99mTc-MIBI scintigraphy was superior to CT/MRI. Conclusion： ^99mTc-MIBI imaging is a promising useful tool in identifying head and neck tumor, and it has a special value to evaluate the local invasion and metastasis involved.

Relationship between head and neck cancer therapy and some genetic endpoints

Head and neck cancer(HNC) is the sixth most common human malignancy worldwide. The main forms of treat ment for HNC are surgery, radiotherapy(RT) and che motherapy(CT). However, the choice of therapy de pends on the tumor staging and approaches, which are aimed at organ preservation. Because of systemic RT and CT genotoxicity, one of the important side effects is a secondary cancer that can result from the activity of radiation and antineoplastic drugs on healthy cells Ionizing radiation can affect the DNA, causing single and double-strand breaks, DNA-protein crosslinks and oxidative damage. The severity of radiotoxicity can be directly associated with the radiation dosimetry and the dose-volume differences. Regarding CT, cisplatin is stil the standard protocol for the treatment of squamous cell carcinoma, the most common cancer located in theoral cavity. However, simultaneous treatment with cisplatin, bleomycin and 5-fluorouracil or treatment with paclitaxel and cisplatin are also used. These drugs can interact with the DNA, causing DNA crosslinks, double and single-strand breaks and changes in gene expression. Currently, the late effects of therapy have become a recurring problem, mainly due to the increased survival of HNC patients. Herein, we present an update of the systemic activity of RT and CT for HNC, with a focus on their toxicogenetic and toxicogenomic effects.

Reliability and validity of the Chinese version of the Head and Neck Information Needs Questionnaire for patients with head and neck cancer and their caregivers

Objectives:This study aimed to assess the reliability and validity of the Chinese version of the Head and Neck Information Needs Questionnaire(HaNiQ).Methods:The HaNiQ was translated into a Chinese version using internationally recognized forwardand back-translation procedures.The reliability and validity of the HaNiQ were measured using Cronbach’s a coefficient,split-half reliability,exploratory factor analysis,and Pearson correlation analysis.Results:A total of 207 patients in different head and neck cancer(HNC)stages and 174 caregivers completed the Chinese version of the HaNiQ.Internal consistencies varied between good and very well(Cronbach’s α coefficient 0.74-0.90);the split-half coefficient and the content validity index(CVI)of the questionnaire were 83.5%and 83.33%,respectively.The cumulative contribution rates of the 5 subscales in patients with HNCand their caregivers were 62.41%and 61.19%,respectively.However,there are some differences between the Chinese questionnaire for caregiver and the original questionnaire regarding the attribution of items.Items 22,23,and 27 in the Psychosocial subscale of the English version were assigned to the Survivorship subscale in the Chinese version for caregivers.Conclusions:The results demonstrated that the Chinese version of the HaNiQ is a reliable and valid instrument for measuring the information needs of patients with HNC and that of their caregivers.Though the structure of the Chinese versionwas different from the English version for caregivers of HNC patients,the Chinese version of the HaNiQ appears to be reliable and would benefit from further testing.