Recent Developments of ICG-Guided Sentinel Lymph Node Mapping in Oral Cancer

Sentinel lymph node (SLN) biopsy has gained attention as a method of minimizing the extent of neck dissection with a similar survival rate as elective neck dissection in oral cancer. Indocyanine green (ICG) imaging is widely used in the field of surgical oncology. Real-time ICG-guided SLN imaging has been widely used in minimally invasive surgeries for various types of cancers. Here, we provide an overview of conventional SLN biopsy and ICG-guided SLN mapping techniques for oral cancer. Although ICG has many strengths, it still has limitations regarding its potential use as an ideal compound for SLN mapping. The development of novel fluorophores and imaging technology is needed for accurate identification of SLNs, which will allow precision surgery that would reduce morbidities and increase patient survival.ope

Crosstalk Mechanisms Following Targeted Therapy in Head and Neck Cancer.

Head and neck squamous cell carcinoma has emerged as the sixth most commonly occurring cancer worldwide and despite advances in diagnostics and therapeutics, the treatment results and survival outcomes still remain poor, especially in advanced cancers. Due to the complexity of the local anatomic structures and the importance as vital functioning organs, the head and neck area following conventional treatment modalities such as surgery, chemotherapy, or radiotherapy often result as a devastating consequence both esthetically and functionally. In order to minimize the treatment related sequelae and at the same time maximize treatment effect, tumor-specific molecular targeted therapy has become an area under active research. Several molecular targeted agents, including the representative epidermal growth factor receptor (EGFR)-inhibitors have been developed and its therapeutic effects investigated. However, therapeutic resistance has newly risen as a main problem following targeted therapy due to a variety of resistance mechanisms. This review article looks at the major acquired resistance mechanisms following targeted agents administration including EGFR inhibitors and many others and strategies to overcome the resistance to achieve precision medicine.ope

FOXO3 induces ubiquitylation of AKT through MUL1 regulation

AKT (also known as protein kinase B, PKB) plays an important role in cell survival or tumor progression. For these reasons, AKT is an emerging target for cancer therapeutics. Previously our studies showed that mitochondrial E3 ubiquitin protein ligase 1 (MUL1, also known as MULAN/GIDE/MAPL) is suppressed in head and neck cancer (HNC) and acts as negative regulator against AKT. However, the MUL1 regulatory mechanisms remain largely unknown. Here we report that cisplatin (CDDP) induces thyroid cancer cell death through MUL1-AKT axis. Specifically, CDDP-induced MUL1 leads to ubiquitylation of active form of AKT. We also observed that the role of forkhead box O3 (FOXO3) is pivotal in CDDP-induced MUL1 regulation. FOXO3 knock-downed cells show resistance against CDDP-mediated MUL1-AKT axis. CDDP-mediated intracellular ROS increment plays an important role in FOXO3-MUL1-AKT signal pathway. The data provide compelling evidence to support the idea that the regulation of FOXO3-MUL1-AKT axis can be a novel strategy for the treatment of HNC with CDDP.ope

A Case of Benign Parotid Tumor Misdiagnosed for Parotid Cancer on Preoperative Cytology

Fine needle aspiration cytology as a diagnostic workup of parotid gland tumor is a simple and useful method. Although fine needle aspiration cytology could not predict accurate diagnosis in all cases, it is usually helpful in differentiating malignancy and benign lesions. A 35-year-old female was found to have a parotid mass for 1 year. Preoperative evaluation including computed tomography and magnetic resonance imaging were non-diagnostic, but, fine needle aspiration cytology on parotid mass showed the suspicion of a low-grade mucoepidermoid carcinoma. Superficial parotidectomy and selective neck node dissection were done based on cytology. However, final pathological examination confirmed benign pleomorphic adenoma. Here, the diagnostic accuracy and cautions in interpretation of result of fine needle aspiration cytology is discussed with respect to the case.ope

A low grade fibromyxoid sarcoma originating from the masseter muscle: a case report

INTRODUCTION: Low grade fibromyxoid sarcoma is a distinctive variant of fibrosarcoma. We recently experienced a rare case of low grade fibromyxoid sarcoma arising in the masseter muscle. CASE PRESENTATION: A 63-year-old Korean woman with a large growing mass in her right parotid gland area for 1 year visited our clinic. Complete removal of the tumor was achieved by parotidectomy with facial nerve preservation. The tumor measured over 4cm with pathologic findings compatible with low grade fibromyxoid sarcoma. CONCLUSIONS: Low grade fibromyxoid sarcoma is an extremely rare tumor, and report of the present case is noteworthy since it represents a rare localization of low grade fibromyxoid sarcoma in the head and neck. Close follow up on a long-term basis is considered necessary because of its high potential to metastasize.ope

A Case of Eccrine Adenocarcinoma Misdiagnosed as Epidermal Cyst

Sweat gland cancer is very rare with a reported incidence of less than 0.005% of all tumor specimens resected surgically. Diagnosis and management of these cancers are difficult, due to the limited reports in the literature. Here we present a case of an eccrine adenocarcinoma in the retroauricular area and report this case with a review of the literature.ope

Dose de-escalation to the normal larynx using conformal radiotherapy reduces toxicity while maintaining oncologic outcome for T1/T2 glottic cancer

We evaluated the efficacy of dose de-escalation to the normal larynx using conformal radiotherapy (CRT) for T1/T2 glottic cancer. For conventional RT (2DRT, n = 38), the laryngeal box received a median equivalent dose in 2 Gy fractions (EQD2) of 66 Gy. For CRT (n = 42; 3D-CRT, 20; intensity-modulated RT, 22), clinical target volume (CTV)1 (gross tumor with a 3-mm margin) and CTV2 (laryngeal box) received median EQD2s of 66.6 Gy and 52.2 Gy, respectively. With a 71-month median follow-up, five-year local control and overall survival rates for 2DRT vs. CRT were 88.1% vs. 95.1% (p = 0.405) and 94.7% vs. 90.7% (p = 0.102), respectively. Grade 2 and 3 pharyngitis rates were 52.6% and 5.3% for 2DRT vs. 35.7% and 2.4% for CRT (p = 0.121). Grade 2 and 3 dermatitis rates were 42.1% and 2.6% for 2DRT vs. 35.7% and 0% for CRT (p = 0.013). The maximum phonation time increased from 12.1 ± 7.1 to 14.0 ± 6.6 seconds after 2DRT (p = 0.375) and from 12.0 ± 5.5 to 13.8 ± 10.1 seconds after CRT (p = 0.313). Fundamental frequency decreased from 150.6 ± 40.3 to 121.9 ± 30.2 Hz after 2DRT (p = 0.039) and from 138.5 ± 31.9 to 126.1 ± 23.7 Hz after CRT (p = 0.058). CRT can effectively de-escalate the normal larynx dose while maintaining oncologic outcome and voice quality.ope

Epidemiological association of olfactory dysfunction with hearing loss and dysphonia in the Korean population: A cross-sectional study

The aim of the study is to investigate the association between olfactory dysfunction (OD), hearing loss, and dysphonia.The cross-sectional data for 17,984 adults who completed the Korea National Health and Nutrition Examination Surveys (2010-12) were analyzed. OD, hearing loss, and dysphonia were assessed using self-reporting questionnaires. The association of OD with hearing loss and dysphonia was evaluated.Hearing loss and dysphonia were significantly more prevalent in patients with OD than in those without OD (hearing loss, 28.1% vs 11.3%; dysphonia, 11.1% vs 5.9%; both P < .0001). After adjusting for confounders, including mental stress and metabolic syndrome, the risk of OD was significantly associated with hearing loss and dysphonia, and was greater in those with combined hearing loss and dysphonia than in both patients without these dysfunctions and in those with a single dysfunction (odds ratio 3.115, 95% confidence interval 1.973-4.917).OD was significantly associated with hearing loss and dysphonia.ope

Clinical outcomes of transoral robotic surgery for head and neck tumors

OBJECTIVES: In order to reduce treatment-related morbidity rates and increase patients' quality of life, robot-assisted surgery using the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, California) has been studied actively in the field of head and neck surgery. This study analyzes our experiences therewith in order to evaluate the feasibility and efficacy of robot-assisted surgery via a transoral approach in the head and neck area. METHODS: Between April 2008 and December 2011, 141 patients were treated with robot-assisted surgery via a transoral approach. RESULTS: Robot-assisted surgeries were successfully completed via a transoral approach in all patients. The mean robotic operative time was 69.3 minutes, and the mean time for setup of the robotic system was 10.4 minutes. The average blood loss during the operation was 29.6 mL (range, 0 to 300 mL). Patients who underwent robot-assisted surgery were satisfied with their cosmetic results and treatment outcomes. CONCLUSIONS: Robot-assisted surgery via a transoral approach was confirmed to be feasible and efficient in the field of head and neck surgery. Further research is needed to investigate the long-term functional and oncological results of robot-assisted surgery.ope

Treatment of Hemorrhagic Vocal Polyps by Pulsed Dye Laser-Assisted Laryngomicrosurgery

OBJECTIVE: Conventional surgical techniques of laryngomicrosurgery (LMS) on hemorrhagic vocal polyps are often difficult due to obscuration of the surgical field by inadvertent bleeding from the lesion, and there are often significant amounts of mucosal epithelium loss. Here, we introduce our surgical technique using pulsed dye laser (PDL), which can effectively resect the polyp with vocal fold mucosa preservation. METHODS: Patients who were diagnosed with hemorrhagic vocal polyp and who were surgically managed using PDL from March 2013 to October 2014 were retrospectively reviewed. Preoperative and postoperative clinical outcomes and surgical findings were evaluated. RESULTS: A total of 39 patients were treated with PDL-assisted enucleation LMS. The average age was 43.7 years (range 20-73), and there were 20 males and 19 females (17 professional voice users). In all cases, the hemorrhagic polyp was successfully enucleated after application of PDL, thereby preserving the overlying epithelium. Postoperative voice outcomes were favorable with clear preservation of the vocal fold mucosal wave. CONCLUSION: PDL-assisted enucleation LMS for the treatment of hemorrhagic vocal polyps can be a safe and effective surgical technique. It can be considered a promising treatment option for hemorrhagic vocal polyps.ope