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.

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.

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.

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.

Clinicopathological study of malignant peripheral nerve sheath tumors in the head and neck:Case reports and review of literature

BACKGROUND Malignant peripheral nerve sheath tumor(MPNST)is a rare and aggressive soft tissue sarcoma that poses a major diagnostic and therapeutic challenge.CASE SUMMARY We retrospectively reviewed patients with head and neck MPNSTs treated in our hospital from 2000 to 2021.The clinical features,pathological manifestations,treatments,and prognoses were summarized.We also reviewed the literature,focusing on MPNST in the mandible and maxilla.The study population consisted of five women and five men aged 22–75 years(mean age,49 years).Of the 10 patients,7 were initial cases and 3 were recurrent cases.All lesions were sporadic.The most common site was the mandible.The most frequently encountered symptoms were a progressive mass and local swelling.Complete or partial loss of trimethylation at lysine 27 of histone H3(H3K27me3)was evident on staining in four of nine cases(one case was excluded due to lack of tissue for evaluation of loss of H3K27me3).The 2-and 5-year disease-specific survival rates were 86%a nd 43%,respectively.The average survival time was 64 mo.CONCLUSION MPNST is a highly malignant tumor with a poor prognosis,prone to a high risk of recurrence and distant metastasis.Complete surgical resection is the main treatment.

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

Introduction: for organ and function preservation, chemoradiotherapy is gaining popularity for primary treatment of advanced head and neck cancer, re- serveing surgery for salvage. Methods: Retrospective outcome analysis to determine the results of salvage surgery after failure of primary treatment of advan- ced head and neck cancer by chemoradiotherapy. 104 patients with advanced head and cancer were initially treated by chemoradiotherapy. Follow-up was evalu- ated in 27 patients undergoing salvage surgery for re- current tumor (larynx n = 13;oral cavity n = 9;hypo- pharynx n = 5). The initial tumor is stage T3 in 11 cases and T4 in 16 cases. 10 patients had primary tumors stage III and 17 patients had tumors stage IV. Results: One postoperative death occured following surgery. The overall incidence of complications was 9/ 27 (%). Recurrent disease developed at the primary initially treated in 25 cases and in the neck in 2 cases after a mean follow-up of 11 months (3 - 136 months). After salvage surgery, loco-regional recurrence and/ or distant disease developed in 10/27 patients after a mean follow-up of 4 months. 6/10 (60%) patients died after re-recurrence despite salvage chemotherapy. Conclusion: Salvage surgery after failure of initial chemoradiotherapy is burdened with high morbi- dity and bad oncological outcome. We demonstrated that it is difficult to salvage locally recurrent head and neck cancer especially at more advanced T-stages or when tumor recur. The limited effect of surgical salvage for recurrent tumor need to be addressed when choosing the initial treatment plan.

Management of post-operative fistula in head and neck surgery: Sweeping it under the carpet?

The most dreaded complication in head and necksurgery is the development of fistula. Fistulas are common and devastating. The prevalence and the risk factors that contribute to fistula formation after head and neck procedures were discussed briefly. The main goal of this manuscript is to discuss current management of head and neck fistula. We believed that the best management strategy for head and neck fistulas is prevention. We recommend a holistic preventive approach during the perioperative period. The roles of different types of wound products and hyperbaric oxygen therapy were also discussed and highlighted. We also discussed the operative repair of fistulas, which relies on the tenet of providing wellvascularized tissue to an area of poor wound healing. Most often, the surgeon's preference and range of operative skills dictate the timing and the type of repair. We highlighted the use of the pectoralis major, a wellknown flap, as well as a novel technique in the surgical repair of complex, difficult-to-heal head and neck fistula.

Regenerative Surgery for the Rehabilitation of a Patient after Surgery and Radiation Therapy for Head and Neck Cancer: A Case Report

Oral cancer is usually treated combining surgery, radiation therapy and chemotherapy, following effective therapeutic protocols. Severe maxillary and mandibular bone atrophy resulting after therapies are usually treated with autologous bone grafting procedures even though these techniques often present a significant risk of postoperative complications and disadvantages. We describe the case of a 59-year-old woman presenting severe bone defect after being treated with surgery and radiotherapy for recurrent oral verrucous squamous cell carcinoma. We performed bone regeneration using Platelet-Derived Growth Factors (PDGF) in combination with autologous bone chips. Our procedure of bone regeneration allowed the placement of dental implants and the achievement of a good aesthetic and functional result. Regenerative surgery may enable the regeneration of substantial bone defects. Moreover, PDGF application decreases the risk of implant failure in irradiated patients.

Department of Otolaryngology Head and Neck Surgery of Chinese PLA General Hospital (National Key Discipline)

Institute of Otolaryngology of Chinese PLA ( Key Laboratory for the Prevention of Acoustic Trauma,PLA)Key Laboratory of Hearing Impairment Science(Chinese PLA Medical School)Ministry of Education Led by four generations of leadership from late Prof. JIANG Sichang (academician, Chinese Academy of Engineering), Prof.YANG Weiyan (Honorary President, Division of Otolaryngology

The Department of Otolaryngology Head and Neck Surgery,PLA General Hospital (national key academic unit) The PLA Institute of Otolaryngology (PLA key laboratory for acoustic trauma) The PLA Medical College Department of Deafness Education Key Laboratory

Led by four generations of leadership from late Prof.JIANG Sichang(academician,Chinese Academy of Engineering),Prof.YANG Weiyan(Honorary President,Division of Otolaryngology Head and Neck Surgery,Chinese Medical Association),Prof.HAN Dongyi(President Elected,Division of Otolaryngology Head and Neck Surgery,Chinese Medical Association)to now Prof.YANG Shiming(President,Division of Otolaryngologists,

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.

Restricting carbohydrates to fight head and neck cancer——is this realistic?

Head and neck cancers(HNCs) are aggressive tumors that typically demonstrate a high glycolytic rate, which results in resistance to cytotoxic therapy and poor prognosis. Due to their location these tumors specifically impair food intake and quality of life, so that prevention of weight loss through nutrition support becomes an important treatment goal. Dietary restriction of carbohydrates(CHOs) and their replacement with fat, mostly in form of a ketogenic diet(KD), have been suggested to accommodate for both the altered tumor cell metabolism and cancer-associated weight loss. In this review, I present three specific rationales for CHO restriction and nutritional ketosis as supportive treatment options for the HNC patient. These are(1) targeting the origin and specific aspects of tumor glycolysis;(2) protecting normal tissue from but sensitizing tumor tissue to radiation- and chemotherapy induced cell kill;(3) supporting body and muscle mass maintenance. While most of these benefits of CHO restriction apply to cancer in general, specific aspects of implementation are discussed in relation to HNC patients. While CHO restriction seems feasible in HNC patients the available evidence indicates that its role may extend beyond fighting malnutrition to fighting HNC itself.

Rupture of carotid artery pseudoaneurysm in the modern era of definitive chemoradiation for head and neck cancer:Two case reports

BACKGROUND Carotid blowout syndrome(CBS)is a rupture of the carotid artery and is mainly caused by radiation and resection of head and neck cancers or direct tumor invasion of the carotid artery wall.It is a life-threatening clinical situation.There is no established and effective mode of management of CBS.Furthermore,there is no established preceding sign or symptom;therefore,preventive efforts are not clinically meaningful.CASE SUMMARY We described two cases of CBS that occurred in patients with head and neck cancer after definitive chemoradiotherapy(CRT)using three-dimensional conformal intensity-modulated radiation therapy.Two men aged 61 and 56 years with locally advanced head and neck cancer were treated with definitive CRT.After completing CRT,both of them achieved complete remission.Subsequently,they had persistent severe pain in the oropharyngeal mucosal region and the irradiated neck despite the use of opioid analgesics and rehabilitation for relief of contracted skin.However,continuous follow-up imaging studies showed no evidence of cancer recurrence.Eleven to twelve months after completing CRT,the patients visited the emergency room complaining about massive oronasal bleeding.Angiograms showed rupture of carotid artery pseudoaneurysms on the irradiated side.Despite attempting to secure hemostasis with carotid arterial stent insertion and coil embolization,both patients died because of repeated bleeding from the pseudoaneurysms.CONCLUSION In patients with persistent pain in irradiated sites,clinicians should be suspicious of progressing or impending CBS,even in the three-dimensional conformal intensity-modulated radiation therapy era.

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.

38例头颈部髓外浆细胞瘤临床分析

目的探讨头颈部髓外浆细胞瘤(head and neck extramedullary plasmacytoma,HNEMP)的临床特征、危险因素、治疗及预后。方法回顾性分析2008年9月~2022年1月间北京同仁医院收治的38例新诊断且未治疗的HNEMP患者的临床资料,分析影响生存的因素及其预后。结果38例患者中,病变呈现鼻颅眶沟通性者5例(13.2%),肿瘤最大直径≥5 cm者8例(21.1%)。仅接受单纯手术切除的患者17例(44.7%),术后给予放疗者13例(34.2%),化疗者8例(21.1%),接受放化疗联合治疗者5例(13.2%)。治疗后评价疗效,完全缓解32例,部分缓解3例,疾病稳定1例,疾病进展2例。中位随访86个月,5年的无进展生存率和总生存率分别92.1%和94.7%。其中,颅鼻眶沟通病变患者中位无进展生存期仅13个月,5年的无进展生存率和总生存率为40%和60%,而其余组均为100%。此外,病变范围≥5 cm和累及鼻颅眶沟通是影响患者无进展生存率和总生存率的不良预后因素。结论HNEMP发病率低,治疗上以手术联合放疗为主,预后相对较好,颅鼻眶沟通病变及高肿瘤负荷为不良预后因素。

恶性肿瘤同步放化疗患者的营养状况及其影响因素

目的调查恶性肿瘤同步放化疗患者营养状况并分析其影响因素。方法以自设问卷方式收集2019年3-5月于北京大学肿瘤医院行同步放化疗恶性肿瘤患者的相关临床资料。采用患者参与主观整体评估量表(PG-SGA)评估患者的营养状况,并分析其影响因素。结果共收回有效问卷150份。150例患者的PG-SGA评分中位数为6.0(3.0,11.0)分。56例(37.3%)患者重度营养不良,49例(32.7%)患者中度营养不良。单因素分析显示,老年、食管癌或头颈部肿瘤、Ⅳ期、放疗次数>15次、化疗次数>4次、紫杉醇+铂或铂类单药治疗方案是患者营养不良的影响因素(Z=-3.839~-2.087,P<0.05)。二元logistic回归分析显示,老年、食管癌或头颈部肿瘤、放疗次数>15次是患者重度营养不良的独立危险因素(P<0.05)。结论恶性肿瘤同步放化疗患者营养不良比例高,尤其是老年、食管癌或头颈部肿瘤、同步放化疗后期患者。医务人员应动态评估、监测患者营养状况,并及时干预。

耳鼻咽喉头颈外科临床教学中采用PBL结合CBL方法的价值及对学生学习能力的影响

目的探析问题式学习(PBL)结合案例式教学(CBL)方法应用在耳鼻咽喉头颈外科临床教学中的效果。方法选取2019年8月至2021年8月苏州大学附属第二医院耳鼻咽喉头颈外科实习生54名配合研究,依据随机数表法分为两组,每组各27名。对照组采用传统教学方法,观察组采用PBL结合CBL方法。比较两组学生学习能力、教学满意度及考核成绩。结果教学前,两组学生学习能力评分比较,差异无统计学意义(P>0.05),教学后,观察组学生学习能力评分包括实践解决能力、组织管理能力、科研能力评分均高于对照组,差异有统计学意义(P<0.05)。观察组学生教学满意度及考核成绩高于对照组,差异有统计学意义(P<0.05)。教学后,观察组学生评判性思维能力评分为(295.58±22.23)分,显著高于对照组的(280.29±18.32)分,差异有统计学意义(P<0.05)。结论耳鼻咽喉头颈外科临床教学中采用PBL结合CBL方法可提升教学效果,学生学习能力明显提升,且对教学内容十分满意,学生考核成绩明显升高,临床上可借鉴及推广。

新辅助抗PD-1/PD-L1在可手术切除的头颈部鳞状细胞癌中的疗效及安全性分析与评价

目的 系统评价新辅助抗程序性死亡受体1(PD-1)或程序性死亡受体配体1(PD-L1)在可手术切除的头颈部鳞状细胞癌(HNSCC)患者中的疗效与安全性,为临床治疗提供参考。方法 检索PubMed、Embase、Cochrane Library和Web of science等数据库从建库至2023年11月前发表的研究,按照纳入及排除标准筛选文献,采用JBI评价工具对文献进行质量评价,并应用Revman 5.4进行单臂Meta分析。结果 共纳入15篇文献、496例患者。Meta分析结果显示:患者疾病客观缓解率为39%(95%CI:29%~54%),病理学缓解率为55%(95%CI:48%~63%),1年无进展生存率为84%(95%CI:75%~95%),1年总体生存率为86%(95%CI:78%~95%),患者的3级及以上不良反应的发生率为20%(95%CI:13%~31%)。12项研究报道了与治疗相关的手术延迟情况,仅有1项研究中出现1例患者因免疫治疗而延误原定手术时间。亚组分析比较了单用抗PD-1/PD-L1、双免疫检查点抑制剂、抗PD-1/PD-L1+放射治疗、抗PD-1/PD-L1+化学疗法及抗PD-1/PD-L1+基因靶向治疗的疗效及安全性,结果显示,这5种不同治疗方案之间的病理学缓解率和安全性差异无统计学意义,抗PD-1/PD-L1+基因靶向治疗组的客观缓解率(13%,95%CI:5%~37%)最低,抗PD-1/PD-L1+化学疗法的客观缓解率(90%,95%CI:75%~107%)最高,另3组治疗方案间的客观缓解率差异无统计学意义。结论 在本荟萃分析和系统回顾中,新辅助抗PD-1/PD-L1免疫治疗对可切除的HNSCC耐受性良好,可能具有组织病理学反应所暗示的治疗优势。在抗PD-1/PD-L1联合或不联合其他辅助治疗的方案中,抗PD-1/PD-L1联合化学疗法的客观缓解率较其他组合治疗组更高,期待更多的临床研究来探索长期疗效和最佳治疗组合。

人工智能在耳鼻咽喉头颈外科的应用

人工智能(artificial intelligence,AI)技术在医学领域的应用日益广泛,耳鼻咽喉头颈外科作为临床医学的一个重要分支,也开始逐渐应用AI技术来提高诊断、治疗和疾病管理的效率和精度。本文将从AI的发展历史、在医学领域的应用、可穿戴设备以及AI在耳鼻咽喉头颈外科中的应用等方面进行综述,探讨AI在医学领域应用中面临的挑战,并展望其未来发展前景。

头颈癌患者身体意象研究的范围综述

目的 对国内外头颈癌患者身体意象相关研究进行范围综述。方法 检索PubMed、Web of Science、Embase、The Cochrane Library、CINAHL、中国知网、万方数据库、维普中文科技期刊数据库的相关文献,检索时限为建库至2023年4月10日,并对纳入文献进行讨论分析。结果 共纳入33篇文献。结果显示,头颈癌患者身体意象的影响因素包括社会人口学特征、疾病治疗因素、心理和行为因素、其他因素。身体意象评估工具主要从身体意象相关的情感认知、生理功能、社会活动来进行评估。研究中头颈癌患者的干预措施主要包括美容修复技术、皮肤伪装计划、运动疗法、认知行为干预、表达性写作、积极心理干预。结论 身体意象的影响因素还需进一步探讨,未来研究应选择科学的评估工具,并在此基础上开展干预性研究,改善头颈癌患者身体意象水平。