2-Deoxy-2[F-18]FDG-PET for Detection of Recurrent Laryngeal Carcinoma after Radiotherapy: Interobserver Variability in Reporting

Purpose: To evaluate accuracy and interobserver variability in the assessment of 2-deoxy-2[F-18]fluoro-d-glucose-positron emission tomography (FDG-PET) for detection of recurrent laryngeal carcinoma after radiotherapy. Procedures: Eleven experienced nuclear physicians from eight centres assessed 30 FDG-PET scans on the appearance of local recurrence (negative/equivocal/positive). Conservative (equivocal analysed as negative) and sensitive (equivocal analysed as positive) assessment strategies were compared to the reference standard (recurrence within 6months after PET). Results: Seven patients had proven recurrences. For the conservative and sensitive strategy, the mean sensitivity was 87% and 97%, specificity 81% and 63%, positive predictive values 61% and 46% and negative predictive values 96% and 99%, respectively. Interobserver variability showed a reasonable relation in comparison to the reference standard (kappa = 0.55). Conclusions: FDG-PET has acceptable interobserver agreement and yields good negative predictive value for detection of recurrent laryngeal carcinoma. It could therefore be used as first diagnostic step and may reduce futile invasive diagnostics

Prospective evaluation of voice outcome during the first two years in male patients treated by radiotherapy or laser surgery for T1a glottic carcinoma

In this prospective cohort study, we assessed voice outcome in patients before and up to 2 years after treatment for early glottic cancer either by radiotherapy or by laser surgery; 106 male patients, treated for T1aN0M0 glottic cancer either by endoscopic laser surgery (n = 67) or by radiotherapy (n = 39), participated in the study. Patients’ voices were recorded and analysed pre-treatment and 3, 6, 12 and 24 months post-treatment at their routine visit at the outpatient clinic. Average fundamental frequency (F0), percent jitter, percent shimmer and normalized noise energy (NNE) were determined. After 2 years, local control rate was 95% in the radiotherapy group and 97% in the laser surgery group. Larynx preservation rate was 95% after radiotherapy and 100% after laser surgery. Voice outcome recovers more quickly in patients treated with laser surgery in comparison to radiotherapy: 3 months after laser surgery there is no longer a difference with regard to normal voices except for the fundamental frequency, which remains higher pitched, even in the longer term. For patients treated with radiotherapy it takes longer for jitter, shimmer and NNE to become normal, where jitter remains significantly different from normal voices even after 2 years. According to these results, we believe that laser surgery is the first treatment of choice in the treatment of selected cases of T1a glottic carcinomas with good functional and oncological results

Contemporary management of cancer of the oral cavity

Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers

Bidirectional Relations between Daily Stress and Sleep among Black Emerging Adults

Background: Black adults experience higher levels of stress and more dysfunctional sleep patterns compared to their White peers, both of which may contribute to racial disparities in chronic health conditions. Dysfunctional sleep patterns are also more likely in emerging adults compared to other age groups. Daily stress-sleep relations in Black emerging adults are understudied.  Purpose: This study used ecological momentary assessment (EMA) and wrist-worn actigraphy to examine bidirectional associations between daily stress and sleep among Black emerging adults.  Methods: Black college freshmen (N = 50) completed an EMA protocol (i.e., five EMA prompts/day) and wore an accelerometer for 7 days. The first EMA prompt of each day assessed sleep duration and quality. All EMA prompts assessed stress. Wrist-worn actigraphy assessed nocturnal sleep duration, sleep onset latency, sleep efficiency, and waking after sleep onset. Results: At the within-person level, stress experienced on a given day was not associated with any sleep metrics that night (p >. 05). On evenings when actigraphy-based sleep duration was shorter (B = -0.02, p =. 01) and self-reported sleep quality was poorer (B = -0.12, p =. 02) than usual, stress was greater the following day. At the between-person level, negative bidirectional relations existed between stress and actigraphy-based waking after sleep onset (stress predicting sleep: B = -0.35, p =. 02; sleep predicting stress: B = -0.27, p =. 04).  Conclusions: Among Black emerging adults, associations between daily sleep and stress vary at the between- and within-person level and are dependent upon the sleep metric assessed. Future research should compare these relations across different measures of stress and different racial/ethnic groups to better understand health disparities.</p