T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO2 Laser Microsurgery a Safe Option?

[Abstract] Objectives: Transoral CO2 laser therapy represents the treatment of choice for early-stage laryngeal tumors. The anterior commissure involvement (ACI) is related to a worse local control and a lower rates of organ preservation. The objective of this study is to analyze the differences in survival, local control, and organ preservation in T1b glottic patients according to the presence of ACI. Methods: Observational prospective study in pT1b treated with transoral CO2 laser between 2009 and 2014. Results: Forty patients (37 male and 3 female) with a mean age of 66.43 ± 8.16 years were recruited. Anterior commissure involvement was present in 70% of the patients. The 5-year specific cause survival was 91.66%, with 32.50% of local recurrences. Laryngeal preservation was 80%, being lower in the group with local recurrence (P < .000). The involvement of the anterior commissure does not influence the organ preservation (P = .548), the appearance of local recurrences (P = .391), or the survival (P = .33). Conclusions: Transoral CO2 laser therapy is an effective and reproducible treatment for early-stage laryngeal tumors. The results obtained are similar to previous studies, although they present discrepancies in relation to the role of the ACI. Prospective randomized trials are required focusing also on the patients’ quality of life and functional outcome in order to clarify the role of the ACI and the need to implement changes in its evaluation, staging, and evolution

Persistent Tracheostomy after Organ Preservation Protocol in Patients Treated for Larynx and Hypopharynx Cancer

Introduction  Squamous cell carcinoma of the larynx is currently the second most common malignancy of the airway after lung cancer, and hypopharyngeal cancer accounts for fewer than 5% of head and neck cancers. The nonsurgical options for patients with this disease are related to significant long-term toxicities and the need for persistent tracheostomy, which adversely affects the quality of life of these patients. Objective  To evaluate the need for tracheostomy, and the influence of this in the overall and specific survival rates of patients diagnosed with all stages of laryngeal carcinoma treated by chemoradiotherapy. Methods  A retrospective study of patients diagnosed with laryngeal carcinoma was performed according to the criteria of the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) 7th edition, in a tertiary hospital. Results  A total of 21 patients were evaluated, 8 patients required a tracheotomy (31%) during the treatment protocol, 7 (35%) men and 1 (100%) women. According to subsite 4/4 patient with glottis cancer (p ≤ 0.001), 2/10 patients with supra glottis cancer and 2/7 patients with hypopharyngeal cancer. During follow up, just in 1 patient was possible to close the tracheostomy. Conclusion  Persistent tracheostomy dependence after primary chemoradiation increases significantly the morbidity, and decreases the quality of life of those patients. Patients with glottis cancer are prone to need a tracheostomy, but no statistical difference regarding the oncological stage and the need for a tracheostomy were detected. A more thorough selection of the patients is needed to improve the quality of life and reduce permanent tracheostomy dependence

CO2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis. A Literature Review

Carbon Dioxide transoral laser microsurgery represents a reliable option for the treatment of early glottic carcinoma (Tis-T2), with good functional and oncological outcomes, nowadays representing one of the main options in larynx preservation protocols. The development and improvement of laser devices means surgeons are able to use more precise instruments compared with classic cold dissection in laser-assisted phonosurgery. Secondary effects on voice, swallowing, or quality of life as well as complications have been well documented. Also, with the introduction of a new proposal for staging systems following the principle of the three-dimensional map of isoprognostic zones, the use of narrow-band imaging in clinical evaluation and intraoperative, and the implementation of diffusion-weighted magnetic resonance during preoperative evaluation, the development of new tools to improve surgical quality and preliminary reports regarding the use of carbon dioxide laser in transoral robotic surgery suggests an exciting future for this technique

Biomarkers in Laryngeal Squamous Cell Carcinoma: The Literature Review

Laryngeal squamous cell carcinoma (LSCC) is the second most common cancer among head and neck cancers. Despite a lower incidence of laryngeal carcinoma, new diagnostic techniques, and more targeted therapies, the overall survival has not changed significantly in the last decades, leading to a negative prognosis in advanced stages. Recently, several studies have focused on the identification of biomarkers that may play a critical role in the pathogenesis of LSCC. Reviewing the literature on the main databases, this study aims to investigate the role of some biomarkers in LSCC that are correlated with oxidative stress and inflammation: heat shock proteins; metallothioneins; nuclear factor erythroid 2-related factor 2; heme oxygenase; cyclooxygenase-2; and micro ribonucleic acids. This review shows that biomarker expression depends on the type, grade of differentiation, stage, and site of carcinoma. In addition, the role of these biomarkers in LSCC is still little-known and little-studied. However, the study of biomarker expression and the detection of a possible correlation with patients’ epidemiological, clinicopathological, and therapeutics data may lead to better awareness and knowledge of the tumor, to the identification of the best therapeutic strategy, and the most proper follow-up protocol tailored for each patient. In conclusion, the achievement of these goals may improve the prognosis of LSCC patients

Improving heat and moisture exchanger therapy with a hydrogel base adhesive in laryngectomized patients: an open randomized crossover trial

[Abstract] Objective: To assess individual’s preference, symptoms and compliance between habitual use of Provox XtraFlow and the combination of Provox XtraFlow during the day and Provox Luna during the night for heat and moisture exchanger therapy in laryngectomized patients. Methods: Open randomized crossover trial for 25 days. After this first follow-up and a 5 days wash-out period, a treatment switching was performed for another 25 days. Results: A total of 28 subjects, were enrolled. Differences were found (p=0.009) in the incidence of dermatological problems with XtraFlow (46.4%) versus Provox Luna (14.3%), as well as in the need to abandon the use of adhesives (46.4%vs.10.7%; p=0.003). The 60.7% of the patients referred the Provox Luna system as their preference for heat and moisture exchanger therapy. Conclusions: The Provox Luna system is a viable additive to heat and moisture exchanger therapy, especially in the setting of compliance concerns and in subjects who desire dermatological relief overnight

Malignant carotid body tumors: What we know, what we do, and what we need to achieve. A systematic review of the literature

: Malignant carotid body tumors (MCBT) are rare and diagnosed after detection of nodal or distant metastases. This systematic review (SR) focuses on MCBT initially approached by surgery. Preferred Reporting Items for SR and Meta-Analysis (MA) guided the articles search from 2000 to 2023 on PubMed, Scopus, and Web of Science. Among 3548 papers, 132 (337 patients) were considered for SR; of these, 20 (158 patients) for MA. Malignancy rate was 7.3%, succinate dehydrogenase (SDH) mutation 17%, age at diagnosis between 4th and 6th decades, with a higher prevalence of females. MCBTs were mostly Shamblin III, with nodal and distant metastasis in 79.7% and 44.7%, respectively. Malignancy should be suspected if CBT >4 cm, Shamblin III, painful or otherwise symptomatic, at the extremes of age, bilateral, with multifocal disease, and SDHx mutations. Levels II-III clearance should be performed to exclude nodal metastases and adjuvant treatments considered on a case-by-case basis

Chromosome translocations, gene fusions, and their molecular consequences in pleomorphic salivary gland adenomas

Salivary gland tumors are a heterogeneous group of tumors originating from the major and minor salivary glands. The pleomorphic adenoma (PA), which is the most common subtype, is a benign lesion showing a remarkable morphologic diversity and that, upon recurrence or malignant transformation, can cause significant clinical problems. Cytogenetic studies of >500 PAs have revealed a complex and recurrent pattern of chromosome rearrangements. In this review, we discuss the specificity and frequency of these rearrangements and their molecular/clinical consequences. The genomic hallmark of PA is translocations with breakpoints in 8q12 and 12q13-15 resulting in gene fusions involving the transcription factor genes PLAG1 and HMGA2. Until recently, the association between these two oncogenic drivers was obscure. Studies of the Silver-Russel syndrome, a growth retardation condition infrequently caused by mutations in IGF2/HMGA2/PLAG1, have provided new clues to the understanding of the molecular pathogenesis of PA. These studies have demonstrated that HMGA2 is an upstream regulator of PLAG1 and that HMGA2 regulates the expression of IGF2 via PLAG1. This provides a novel explanation for the 8q12/12q13-15 aberrations in PA and identifies IGF2 as a major oncogenic driver and therapeutic target in PA. These studies have important diagnostic and therapeutic implications for patients with PA.info:eu-repo/semantics/publishedVersio

COVID-19 Pandemic and its Impact on the Management of Head and Neck Cancer in the Spanish Healthcare System

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has represented a major challenge for healthcare systems worldwide, changing the habits of physicians. A reorganization of healthcare activity has been necessary, limiting surgical activity to essential cases (emergencies and oncology), and improving the distribution of health resources. Objective To analyze the impact of the COVID-19 pandemic on head and neck cancer surgery management in Spain. Methods A cross-sectional study, through an anonymous and voluntary online survey distributed to 76 Spanish otorhinolaryngology departments. Results A total of 44 centers completed the survey, 65.9% of which were high-volume. A total of 45.5% of them had to stop high-priority surgery and 54.5% of head and neck surgeons were relocated outside their scope of practice. Surgeons reported not feeling safe during their usual practice, with a decrease to a 25% of airway procedures. A total of 29.5% were "forced" to deviate from the "standard of care" due to the epidemiological situation. Conclusions Approximately half of the departments decreased their activity, not treating their patients on a regular basis, and surgeons were reassigned to other tasks. It seems necessary that the head and neck surgeons balance infection risk with patient care. The consequences of the reported delays and changes in daily practice should be evaluated in the future in order to understand the real impact of the pandemic on the survival of head and neck cancer patients

Complications after radiotherapy in the ENT area

[ES] Introducción: La radioterapia forma parte del complejo tratamiento que requiere la patología tumoral de cabeza y cuello, siendo útil como estrategia terapéutica y complementaria. Es posible asociarla a quimioterápicos o radiosensibilizantes para aumentar su efectividad así como también utilizar medidas de radioprotección para evitar la sobreexposición de tejidos sanos. Sin embargo y a pesar de todo esto existen descritas múltiples complicaciones secundarias al uso de la radioterapia. Materiales y métodos: A continuación exponemos una serie de complicaciones que se presentaron en la fase tardía del tratamiento radioterápico en 4 pacientes. Resultados: un total de 4 pacientes de los cuales 3 presentaran el diagnostico de carcinoma de cavum y uno de ellos de carcinoma de cuerdas vocales, los cuales presentaran como complicaciones: estenosis critica de arteria carótida derecha, fístula cutánea a nivel cervical más radionecrosis de vértebras C5 y C6, radionecrosis de musculatura pre-vertebral y de vértebras C1 y C2 y pseudoaneurisma de arteria carótida izquierda. Conclusiones: en nuestra serie la utilización de cámara hiperbárica favoreció la mejoría en cuanto a necrosis tisular, en cuanto a la estenosis crítica el paciente requirió tratamiento anticoagulante, mientras que el pseudoaneurisma requirió embolización por parte de radiología intervencionista. Por lo tanto es incuestionable el efecto terapéutico de la radioterapia en el campo de la oncología de cabeza y cuello, pero las complicaciones a causa de esta deben ser tenidas en cuenta a la hora de valorar de forma sucesiva al paciente. [EN] Introduction: Radiotherapy is part of the treatment of oncological pathology of head and neck, being useful as therapeutic and supplementary strategy. It is possible associate to chemotherapeutic or radiosensitizing to enhance their effectiveness as well as radiation protection measures used to prevent overexposure of tissues. However, despite all this there are multiple potential complications secondary to the use of radiotherapy.Materials and Methods: Here we present a series of complications that occurred in the late phase of radiation therapy in 4 patients.Results: A total of 4 patients of which 3 presented the diagnosis of nasopharyngeal carcinoma and one vocal cord carcinoma, which presented complications: critical stenosis of left carotid artery in the cervical cutaneous fistula more radionecrosis of vertebrae C5 and C6, radionecrosis of pre-vertebral muscles and C1 and C2 vertebrae and left carotid artery pseudoaneurysm.Conclusions: In our series the hyperbaric chamber favored the improvement in terms of tissue necrosis, in terms of critical stenosis the patient required anticoagulation, while the pseudoaneurysm required embolization by interventional radiology. So unquestionably the therapeutic effect of radiotherapy in the field of head and neck oncology, but complications because of this should be taken into account when assessing the patient successively