Up-to-date opportunities of cervical lymph nodes ultrasound investigation in patients, suffering from oral cavity cancer

Background. Incidence of oral cancer in Russia is 4.52 and mortality – 2.44. Head and neck cancer is characterized by the high risk of development of metastases in regional lymph nodes. Lymph nodes status exerts influence on the treatment plan and appears to be the major predictive factor. Regional metastases result into two-fold decrease of five-year survival. Therefore, evaluation and treatment of metastatic lymph nodes is of prime importance. Objective. The aim of this manuscript was to illustrate and summarize publications devoted to modern methods of ultrasound evaluation of cervical lymph node status in patients with squamous cell carcinoma of the oral cavity. Results. Numerous studies have demonstrated, that standard ultrasound investigation (in B-mode) is characterized by high sensitivity and specificity (specificity varies from 71.0 to 96.4 %, and specificity – from 46.6 to 91.0 %, according to different studies). In addition, ultrasound efficiency exceeds that of CT. Accuracy of ultrasound as the method of cervical lymph node investigation has increased after implementation of such methods, as elastography and elastometry (this techniques allow to achieve sensitivity of 98.1 % and specificity of 100 %)

Evaluation of capability of ultrasound with elastometry and elastography for diagnosis of subclinical regional metastases of cancer of the oral mucosa

Objective. Evaluation of ultrasound capabilities for diagnosis of subclinical regional metastases of squamous cell carcinoma of the oral mucosa.Introduction. Incidence of oral cancer in Russia is 3.86 per 100,000 population, and it’s increasing with the mean annual rate of 1.88 %. Head and neck cancer is characterized by high risk of metastases in regional lymph nodes which varies from 40 to 80 %. Lymph nodes status affects the treatment plan and appears to be the main predictive factor. Therefore, evaluation of the pathways of regional lymphatic outflow in oral mucosa cancer is of prime importance for disease prognosis and treatment selection. Ultrasound investigation (USI) is one of the main instrumental methods of regional lymph node investigation in oral mucosa cancer patients. Nevertheless, effectiveness of B-mode USI, elastometry and elastography for diagnosis of occult metastases of squamous cell carcinoma of the oral mucosa has not been investigated. There is no consensus on the threshold values of S-wave velocity and elastographic parameters in diagnosis of occult metastases.Materials and methods. Patients with oral mucosa squamous cell carcinoma (stage cT1–3N0M0) were included in the study. All patients had morphologically verified diagnosis. At the first stage (outpatient) before inclusion into the study, all patients were evaluated by palpation and B-mode USI. If during USI metastases were suspected, FNAB was performed. Patients with cytologically confirmed metastases were not eligible for the study. During the clinical trial, 102 (82.3 %) patients underwent B-mode USI, and 22 (17.7 %) patients underwent USI with elastometry and elastography. USI results were compared with results of histological examination of cervical lymph nodes. Statistical evaluation of USI in different modes was performed.Results. B-mode USI was characterized by 88.2 % specificity, 0 % sensitivity, 80.4 % accuracy, and 44.1 % efficacy. Positive predictive value (PPV) was estimated as 0 %, and negative predictive value (NPV) as 90.1 %. USI with elastography was characterized by 100 % specificity, 83.3 % sensitivity, 95.5 % accuracy, and 91.7 % efficacy. PPV was estimated as 100 %, and NPV as 94.1 %. Threshold value of elastometry for diagnosis of occult metastases was 2.42 m/s with 83.3 sensitivity, and 87.5 % specificity. Method was characterized by 86.4 % accuracy, 85.4 efficacy, 71.4 % PPV and 93.3 % NPV.Conclusion. B-mode USI is characterized by low capability for diagnosis of subclinical regional metastases of squamous cell carcinoma of the oral mucosa. Elastometry and elastography offer a possibility to increase USI accuracy for diagnosis of subclinical regional metastases from 80 % to 86-95.5 % and efficacy from 44 % to 85–92 %

ROLE OF INTAOPERATIVE ULTRASOUND INVESTIGATION IN SURGICAL TREATMENT OF THYROID CARCINOMA (A REVIEW OF LITERATURE)

Head and neck cancers, including thyroid carcinomas, are characterized by high risk of metastasizing in regional lymph nodes. Lymph nodes status determines treatment of thyroid cancer as well as disease prognosis. Excision of affected lymph nodes is associated with risk reduction of relapse and reduction of mortality. However surgical treatment can be associated with some difficulties. Due to technologic progress modern ultrasonographs offer the possibility to visualize minimal tumor nodes (5–10 mm), which are characterized with complexity of localization during surgical manipulation, particularly in patients with relapses, that previously passed treatment (surgery and/or radiation therapy). These lymph nodes can be missed during surgical treatment, which will lead to reduction of treatment efficacy. The paper details utility of intraoperative ultrasound investigation as a method of obtaining information about localization of nonpalpable tumor nodes, cancer extension, reduction the possibility of non-radical surgical treatment and unnecessary extension of surgical treatment in patients with thyroid cancers, characterized with regional lymph nodes involvement

Mammary analogue secretory carcinoma of the salivary gland with NTRK fusions: new approaches for diagnostics and targeted therapy (review)

Mammary analogue secretory carcinoma (MASC) of the salivary gland is a rare salivary cancer, histologically resembling to secretory carcinoma of the breast. In 2017 World Health Organization reported MASC is a new salivary cancer subtype. The aim of this article is to collect and analyze data about MASC, particularly clinical, histological and molecular profile, to evaluate targeted therapy effects. We discuss a case report of dramatic and durable response with entrectinib and the development of acquired resistance in an NTRK3-fusion positive salivary cancer, detected by next-generation sequencing. Next-generation sequencing as a comprehensive molecular profiling, that helps to investigate molecular profile of rare tumors and gives an opportunity to use an effective therapeutic options. Identifying ETV6-NTRK3 positive MASC provides a better prognosis for metastatic disease by using a novel effective targeted therapy with tyrosine kinase inhibitors (entrectinib, larotrectinib). Despite a durable and dramatic response, we showed an interesting case of the development of acquired resistance to tyrosine kinase inhibitors mediated by the appearance of a novel NTRK3 G623R mutation. Finally, we believe in great perspectives of comprehensive molecular profiling and targeted therapy for rare malignancies with NTRK gene fusions, including second-generation tyrosine kinase inhibitors

Percutaneous dilatational tracheostomy in patients with head and neck tumors: literature review and institutional experience

Introduction. Patients with head and neck tumors are often require tracheostomy. This procedure represents complex surgical manipulation and is associated with risk of certain complications, including life-threatening. The study objective is to essess the results of percutaneous tracheostomy with the new SafeTrach technique. Materials and methods. The study included 21 patients. All patients had a tracheostomy performed using the SafeTrach technique. Results. Mean duration of tracheostomy with SafeTrach technique was 11.8 ± 3.4 minutes independently of patients’ body mass index or previous treatment (correlation coefficients r = 0.08, p = 0.7 and r = 0.08, p = 0.73, respectively). Among all possible complications of tracheostomy only 1 (4.7 %) case of bleeding in postoperative period was noted in our study. Conclusion. The SafeTrach technique combines all the benefits of open and percutaneous tracheostomy. It is characterized by simplicity, it does not require endoscopic control, that indicates the feasibility of its widespread implementation

Efficacy of vandetanib in the treatment of medullary thyroid cancer: literature review and case report

Medullary thyroid cancer (MTC) is a rare disorder that accounts for approximately 1.7 % of all thyroid malignancies. MTC is usually detected at early stages; however, approximately 10–15 % of patients are diagnosed with locally advanced MTC and distant metastases. Treatment of such patients is challenging due to biological characteristics of the disease and very few effective treatment approaches available. The investigation of mechanisms of carcinogenesis, as well as advances in pharmacology, allowed the development of a new group of targeted drugs, namely tyrosine kinases, which efficacy against progressive unresectable locally advanced or metastatic MTC has been demonstrated in multiple clinical trials. Vandetanib has been registered for MTC treatment in the Russian Federation. MTC is very rare, thus, each case of vandetanib use for its treatment is particularly interesting. Moreover, since the approval of this drug in 2011 by the U. S. Food and Drug Administration (FDA), new data on the clinical use of vandetanib have been accumulated. Importantly, clinical trials are usually well designed and conducted in near-ideal conditions, whereas the real conditions can be different and patients may have individual characteristics. Therefore, the aim of this study was to update the information on the efficacy and safety of vandetanib by retrospective analysis of available publications and to report a case of MTC treated with vandetanib

Combination of concurrent targeted and immune-therapy with nivolumab and cetuximab: new perspectives for squamous cell carcinoma treatment

Head and neck squamous cell carcinoma (HNSCC) is the most common cancer among head and neck malignancies and causes of cancer death. More than 50 % of patiens have relapses within first 3 years after treatment, with median survival less than 6 months. Cetuximab is the first targeted agent for HNSCC, is considered as alternative regiment in case of intolerance to platinum-based chemotherapy, and also can activate an antigenspecific T-cell immunity in head and neck cancer patients. Nivolumab is a check-point inhibitor, that improves overall survival of patients with advanced recurrent/metastatic HNSCC, due to the CheckMate-141 study results. The results of phase II study сoncurrent cetuximab and nivolumab in patients with recurrent and/or metastatic HNSCC showed a benefit for patients without prior check-point inhibitor exposure and overall well tolerated. Thus, we have 6 cases of HNSCC, treated with combination of nivolumab and cetuximab, resulted in durable (12 months) partial response or stabilization without severe adverse events. In our study, all 6 patients had prior check-point inhibitor exposure with nivolumab. Cetuximab was added to a treatment protocol after evidence-based progression during check-point inhibitor therapy. We demonstrate a case report of recurrent locally advanced HNSCC, treated with combination of nivolumab and cetuximab and resulted in stabilization. Only 1 patient had a progression after concurrent targeted and immune-therapy with nivolumab and cetuximab. New combination was well tolerated without severe adverse events. To our opinion, first results are challenging and we believe in great perspectives of comprehensive molecular profiling and combination of targeted and immune-therapy for better results

Mucoepidermoid carcinoma of the hard palate in a 9-year-old girl (clinical case)

The objective of the work is to demonstrate the signs of mucoepidermoid carcinoma of the minor salivary glands in pediatric patients on a clinical example.Clinical case. In August 2017, a girl of 9 years old appeared in the area of the right half of the hard palate. The dentist at the place of residence diagnosed an abscess in the area of the hard palate, performed the lancing and drainage of the “abscess”, prescribed antibiotic therapy. After 3.5 months (in December 2017), hyperemia and an increase in the volume of the mucous membrane reappeared in the same zone. Reapplied to the dentist. The girl was sent to the Oral and Maxillofacial Surgery Department, where the hard palate formation was removed on 23.01.2018; according to histological examination a highly differentiated tumor of the hard palate was diagnosed. The girl was sent for a consultation to the N. N. Blokhin National Medical Research Center of Oncology, where histological preparations were reviewed: a fragment of the mucous membrane of the hard palate covered with squamous epithelium, with the growth of low-grade mucoepidermoid cancer (from the minor salivary glands of the hard palate). A biopsy of the postoperative scar 3 mm long and of the formation of a hard palate 1 mm in diameter was performed; during histological examination of the biopsy material tumor cells were not detected (the material was represented by fibrous tissue). Despite the biopsy results, taking into account the medical history, the results of a review of histological preparations, the rarity and high aggressiveness of the tumor, poor prognosis for relapse, lack of data for regional and distant metastases, at the concilium it was accepted the decision to conduct repeated surgery. In the Surgical Department No. 1 of the Research Institute of Pediatric Oncology and Hematology, N. N. Blokhin National Medical Research Center of Oncology on 13.03.2018 a resection of the hard palate was performed with plastic surgery of the defect with a mixed skin-muscle flap on the vascular pedicle.Conclusion. Mucoepidermoid cancer of the minor salivary glands of the hard palate in children and adolescents can be manifested by the presence of a slowly growing, painless, pale blue tumor. For a correct clinical and morphological diagnosis, a biopsy of the tumor is necessary, further the removal of the tumor is recommended with resection of the hard palate, in view of the high risk of tumor spreading in the thickness of the bone

Role of hyaluronic acid in the prevention and treatment of radiation-induced oropharyngeal mucositis

One of the earliest and most common adverse events of radiotherapy in patients with oropharyngeal cancers is mucositis. Radiation-induced mucositis significantly impairs the quality of life, patient compliance, and sometimes even long-term treatment outcomes. Currently, there is a wide range of drugs and techniques for the prevention and treatment of this complication. Nevertheless, these methods are not always highly effective and often have their own adverse events; therefore, the search for a universal method still continues. The present review aims to analyze the efficacy of hyaluronic acid in the prevention and treatment of oropharyngeal mucositis