Head Neck Research Articles

Overexpression of XRCC1 is Associated with Poor Survival in Patients with Head and Neck Squamous Carcinoma and Has Potential to Be Used as Targeted Therapy by Synthetic Lethality.

Background: Head neck squamous cell carcinoma (HNSC) is globally prevalent cancer attributed to tobacco habit. Despite the significant advances in early diagnosis and treatment of HNSC chemo-radio resistance are routinely observed in patients. Aberrant DNA repair mechanisms mainly microhomology mediated DNA end joining (MMEJ) pathway causing deleterious mutations and is implicated in treatment resistance. X-ray cross complimenting group 1 (XRCC1) has recently been shown to play an essential role in MMEJ making XRCC1 a potential therapeutic target to render tumors chemo-radiosensitive. This study analyzes the correlation between the expression level of XRCC1 gene with survival, regulation by miRNA and synthetic lethality partners in HNSCC. Materials and Methods: XRCC1 gene expression was evaluated in 520 HNSC patients and 44 of normal tissues using the UALCAN (TCGA) database and its correlation with survival outcome of HNSC patients was analyzed by Kaplan-Meier plot. Infiltration of immune cells in tumors was analyzed by “Tumor-Infiltrating Immune Estimation Resource (TIMER) and promoter methylation status of XRCC1 in samples was analysed by UALCAN. STRING was used to find gene interacting partners of XRCC1. Results: XRCC1 was significantly overexpressed in primary tumor of HNSCC and significantly increased with tumor stages and grade and associated with poor survival rate. High XRCC1 expression in HNSC was positively correlated with infiltration level of B cells naïsve, CD4+ and macrophages. Conclusion: These results indicate that XRCC1 is a prognostic marker for predicting survival in HNSC patients. Understanding how XRCC1 leads to treatment resistance and modulate immune response can lead to development of targeted therapy.

Epidemiological and clinical presentation of head and neck neoplasia: a review

Head and neck squamous cell carcinoma (HNSCC) stand at the sixth position most, amongst all the malignancies worldwide. Neoplasms arising in the oral cavity, larynx, pharynx, salivary gland and nasal cavity are all included in the head and neck malignancies. More than 90% of malignancies of the oral cavity are squamous cell carcinomas (SCC). Among the four head neck cancer sub-sites combined, the mean age at the time of diagnosis has risen, in the last four decades. Studies have documented a male predilection. A small percentage of SCC cases are inherited or are familial. Cigarette smoking, alcohol consumption, betel quid chewing, poor nutrition, poor oral hygiene, HPV, Epstein-Barr virus and Candida albicans infections are the etiological agents who have the ability to cause HNSCC. Non healing ulcer, difficulty in swallowing, change in voice, swelling, sore throat- that doesn’t get better- are the symptoms of head and neck cancers. Moreover, there may be unusual bleeding, facial swelling or difficulty in breathing.

The Microvascular Health Status Predicts Radio-Induced Acute Toxicities in Breast, Prostate and Head and Neck Cancer Patients

investigate the role of healthy/unhealthy microcirculation in predicting acute toxicity (tox) after breast (BC), prostate (PC) and Head & Neck (HNC) cancer RT. We enrolled BC patients (pts) treated with hypofractionated-RT after conservative surgery (42.4 Gy + 10 Gy boost to tumor bed), PC pts receiving radical-RT (65 Gy / 25 fractions), HNC pts treated with conventional RT (54-70 Gy @ 1.8-2 Gy/fr) or moderately hypofractionation (56.1-69.96 Gy @ 1.7-2.12 Gy/fr). We assessed baseline sublingual-microvasculature (MV) health status before RT using a sidestream dark-field camera coupled to the GlycoCheck™ software. The system records videos showing the live movement of red blood cells (RBCs) in the microvessels. It computes 5 functional parameters: (a) perfused boundary region (PBR) estimating the penetration of RBCs into the permeable part of the endothelial glycocalyx (higher PBR values result from damaged glycocalyx, indicating impaired microcirculation); (b) density of capillaries (1/mm2); (c) blood flow in the recorded area (103 μm3/s/mm2); (d) recruitment capacity (quantifying the ability to recruit additional capillaries); (e) a global MV_HealthScore (MVHS), higher values indicate healthier MV. MVHS is computed by weighting information from the previous parameters. The computation of MVHS needs a prolonged video acquisition not reached by less compliant patients. Endpoint for this analysis was acute tox. We selected a clinically relevant tox endpoint for each cancer site: grade≥2 erythema (G2+E) for BC, any grade≥3 tox (G3Tox) for HNC and persistent grade≥1 tox simultaneously present in gastrointestinal and genitourinary domains (G1+GIGU) for PC. We used logistic regression to assess MV functional parameters' association with toxicity. We evaluated 63 BC, 38 PC, 39 HNC pts. 77 (55%) had an evaluation for MVHS. 23/63 BC pts presented with G2+E, 12/38 PC pts with G1+GIGU, 12/39 HNC pts with G3Tox. Average MVHS was 3.6, 3.2, 2.7 in BC, HNC and PC, respectively (P>0.15). The MVHS associated with tox: healthy MV protects from tox (continuous, OR = 0.66 for 1 point increase, p = 0.01, AUC 0.69). Categorizing pts as low MVHS (<2.5), average MVHS (2.5-6.5) and high MVHA (>6.5), the observed toxicity rates in the 3 classes were 50%, 26%, 0% (p = 0.02). Also, a 3-variate model including the separated functional parameters predicted tox (AUC 0.67) on the 144 pts: higher PBR is a risk (OR = 7.6), higher capillary density protects (Logarithm, OR 0.002), higher blood flow is a risk (Logarithm, OR = 14.2). These data suggest an interaction of compromised MV with repair mechanisms. The MVHS model predicts acute toxicity in BC/PC/HN pts proving (i) a quantitative relationship between MV state and radio-susceptibility and (ii) in an organ-agnostic way. The systemic functional information derived by the sublingual microscope could boost the personalization of predictive models and tailor them to the single-patient functional status. Funded by AIRC IG 21479.

Impact of Family Caregiver and Patient Related Factors on Quality of Life in Head Neck Cancer Patients

To study an impact of family caregiver and patient related factors on quality of life in head- neck squamous cell carcinoma (HNC) patients. A descriptive cross-sectional study was conducted in department of radiation oncology at a rural tertiary cancer center from August 2019 to January 2022. Marathi speaking, newly diagnosed, non-metastatic, histopathology proven HNC patients who consented for study were included. Marathi version of an updated head neck specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-H&N43) was used. Indigenously prepared and validated interviewer administered questionnaire (IAQ) for patients and respective family caregiver (FCG) were used to understand attitude towards HNC(ATHNC) and FCG's attitude as a caregiver (ATC). Total score was directly proportional to ATHNC and inversely proportional to ATC. Graph-Pad, Instat-3 (California Inc) was used for statistical analysis. A total of 210 patients and respective FCG were interviewed. Subgroup analysis of QOL was done for 201 radically treated patients (RTP) with respect to age, sex, education, socioeconomic status, place of residence, duration of symptoms, stage and disease sub-site. QOL of palliative treatment group (N = 9) was compared with RTP. All these parameters had impact on QOL with medium to large effect size difference and minimum important difference/change. ATHNC was significantly better for young (p = 0.022), literate (p = 0.004) and upper socioeconomic class (USC) (p = 0.043) FCGs. It was significantly better for male (p = 0.003), literate (p = 0.001), USC (p = 0.004) patients presenting in early stage of disease (p = 0.013). Though it was not significant on multivariate analysis. ATHNC score of FCGs had significant effect on QOL of patients with respect to role function (RF) (p = 0.032), financial difficulties (FI) (p = 0.017) and sexuality (SX) (p = 0.048). Patients with higher ATHNC score had significantly better QOL with respect to social function (SF) (p = 0.0004), FI (p = 0.0002), body image (BI) (p = 0.0033) and social contact (SC) (p = 0.0057). QOL of patients having FCGs with lower ATC score was significantly better. QOL of patients with younger FCGs was significantly better with respect to FI (p = 0.0244) while it was significantly better for pain (PA) (p = 0.0462) and emotional function (EF) (p = 0.0144) if FCG was male. Suboptimal literacy and accountability level were few short comings of this study. Informer bias cannot be ruled out CONCLUSION: Age, sex, place of residence, educational level, socioeconomic status, duration of symptoms, stage, and site of lesion affects different QOL parameters differently and hence an individual QOL needs to be addressed. FCGs parameters affect QOL of patients. Understanding the determinants and its pattern of effect on QOL of patients will guide us to offer timely care and interventions in a pragmatic mode.

Efficacy of Single-Fraction Postoperative Radiotherapy in Resected, Early-Stage Merkel Cell Carcinoma with High-Risk Features

Merkel cell carcinoma (MCC) is an aggressive skin cancer with a high recurrence risk. Postoperative radiotherapy (PORT) improves the local recurrence rate (LRR) in early-stage MCC with risk factors per NCCN guidelines: primary tumor size > 1cm, head/neck (HN) location, immunosuppression, lymphovascular invasion (LVI), and positive/narrow surgical margins. Conventionally fractionated PORT (C-PORT, ∼50 Gy in 25 fractions) is often recommended for localized MCC with these risk factors; however, some institutions elect observation. Prior studies suggest LRR of ∼20% for stage I/II MCC with high-risk features managed with surgery alone. C-PORT significantly decreases LRR but may cause significant morbidity and financial toxicity. We have previously reported that single fraction (SF)-PORT with 8 Gy achieves high rates of in-field control both in the metastatic and adjuvant settings with minimal morbidity. Here, we present updated long-term outcomes of SF-PORT, offered as an alternative to C-PORT with the hypothesis that it improves LRR relative to observation while minimizing toxicity, for resected stage I/II MCC. A retrospective, single-institution analysis was completed for stage I/II MCC patients receiving SF-PORT following surgical management. The primary objective was estimating the LRR, defined as recurrence within 2 cm of the primary tumor. Patients with resected, stage I/II MCC with at least one high-risk feature were offered C-PORT as standard of care or SF-PORT as an alternative. Forty-six patients (median age: 74.5; range 50-96 years) received SF-PORT to the primary tumor site at a median 44 days after wide local excision (85%), shave/excisional biopsy (13%), or Mohs (2%). Fifty-four percent of patients had 1 high-risk feature, 35% had 2, and 11% had 3 or more. HN (74%) was the most common primary site, 26% of tumors were > 1cm, 26% were LVI+, and 15% of patients were immunosuppressed (pathological margin status was often not available). There were no local recurrences (LRR = 0%) at a median follow-up time of 2.3 years. In-field locoregional control was 96% (44/46 patients) with 2 in-field, regional recurrences observed in draining nodal basins of HN primary lesions. There were 2 out-of-field regional nodal recurrences (1 patient with IMS; neither received elective nodal SFRT). Of 9 patients who received elective nodal SF-PORT, 8 did not have a successful sentinel lymph node biopsy. No MCC-specific deaths were observed. The most common side effect was in-field, grade 1 erythema (13%); no side effects > grade 1 (CTCAE v5) were noted. SF-PORT is associated with a very low LRR which has proven durable with long-term follow-up. The LRR for SF-PORT appears lower than historical controls treated with surgery alone for patients with resected, stage I/II MCC with high-risk features.

A Retrospective Analysis of Immediate Postoperative Electron Radiotherapy for Keloids

The increasing incidence of keloid has seriously affected people's physical and mental health, and the postoperative recurrence rate is as high as 50-80%. Postoperative radiotherapy has been shown to significantly reduce the recurrence of keloid. Given the different treatment patterns in different institutions, we tried to analyze the data of patients in our center. We retrospectively analyzed the clinical data of 455 patients with 498 keloids treated in our institution from 2010 to 2017. All patients received a four-fraction electron radiotherapy with single dose of 4 Gy within 24 hours of surgery. The recurrence and adverse reaction of immediate adjuvant radiotherapy in these patients was evaluated. At the last follow-up date, 130 (26.5%) keloids had recurred after a middle follow-up of 68.1 months (42.6-129.9 months). The recurrence rates of 1 year, 3 years and 5 years were respectively14.5%, 18.7% and 21%. Recurrence rates vary depending on the keloid location. Among them, the recurrence rate of ear was low with 14% (43/298). Face, head neck and limbs was moderate with 38.8% (17/44) and 33.3% (8/24). Chest and Suprapubic region had a high recurrence rate of 50.8% (32/64) and 47.8% (33/69). Among the patients with recurrence, 16.9% (22/130) felt that their symptoms were better than before treatment, and 37.7% (49/130) were not worsen, which was acceptable. Multivariate analysis showed that age and duration of postoperative pruritus pain were correlated with recurrence (P = 0.036; P = 0.02). Radiotherapy combined with steroid and silicone reduced the recurrence rate compared with radiotherapy alone (P = 0.015). During treatment and follow-up, Infection occurred in 2 patients and cutaneous fibroblastoma in 1 patient. Our radiotherapy regimen can effectively reduce the recurrence rate and improve the symptoms of patients with keloids, especially ear keloids. High recurrence sites need further improvement of radiotherapy dose and fraction. Combination of multiple treatments is better than single treatment.

Next-Generation Sequencing Analysis of Mutations in Circulating Tumor DNA from the Plasma of Patients with Head-Neck Cancer Undergoing Chemo-Radiotherapy Using a Pan-Cancer Cell-Free Assay.

Using next-generation sequencing (NGS), we investigated DNA mutations in the plasma tumor cell-free circulating DNA (ctDNA) of 38 patients with inoperable squamous cell head neck cancer (SCHNC) before and after the completion of chemoradiotherapy (CRT). Baseline mutations of the TP53 were recorded in 10/38 (26.3%) and persisted in 4/10 patients after CRT. ΤP53 mutations were further detected post CRT in 7/38 additional patients with undetectable mutations at baseline (overall rate 44.7%). Furthermore, 4/38 patients exhibited baseline mutations of the EGFR, AR, FGFR3, and FBXW3, and four new gene mutations were detected after CRT (MTOR, EGFR3, ALK, and SF3B1). Τ4 stage was related with a significantly higher rate of mutations (TP53 and overall). Mutations were observed in 8/30 (26.6%) responders (complete/partial response) vs. in 6/8 (75%) of the rest of the patients (p = 0.03). Significant poorer LRFS was noted for patients with mutations detected before and after CRT (p = 0.02). Patients who had detectable mutations either before or after CRT had significantly worse DMFS (p = 0.04 overall, and p = 0.02 for TP53 mutations). It was concluded that assessment of mutations before and after the end of CRT is essential to characterize patients with a high risk of locoregional recurrence or metastatic progression.

A General Assessment of India's Extremely Low Number of Transgender Cancer Patients

Physiological transgender (TJ) is one of the most marginalized and oppressed community in the Indian subcontinent. The observable percentage of physiological transgender (TJ) cancer patients is extremely low. This concise report aims to assess the factors that contribute to the scarcity of transgender cancer patients. The hospital database (2012-2021) of 2 centers in New Delhi (population 32 million) & 1 in Kolkata (15 million) were evaluated. In addition, 28 senior oncologists (ONC) and 17 trans women (TWs) completed a six-point questionnaire. ONC was asked how many TJ patients they had seen in their career, as well as histopathology/site. Furthermore, the data was extrapolated to account for all clinicians' cumulative years of experience. The questions for TWs were age and where they go if you have a disease or illness. And, do they know any TJ cancer patients? India's last census (2011) revealed a half-million TJ population. TJ density must be at least 1 million to be comparable to the rest of the world. Hospital databases counted 10,486 patients, with no patient identified as TJ. A total of 37 TJ cancer patients were reported by 28 ONC with an average and collective years of their medical service of 23.1±4.1 and 646 years; distributed in 3 metropolis of 67 million (combined) population (Kolkata, New Delhi, and Mumbai). The average lifetime number of TJ cancer patients/oncologist was 1.3±1.1. Total 12 cases were head neck cancers, with 4 caused by human papillomavirus. The remaining 25 patients have 5 lung, 5 gynecological, 4 breast, 3 brain cancers, 2 soft tissue sarcomas, and 6 cases of unknown origin. The density of 5-year prevalent cancer cases in India is 0.2%, with an estimated 0.007% of TJ cancer patients. TW could not identify any cancer patients in their community. Being transgender is a social taboo in this part of the world. Their legal rights and classification as the third gender are uncommon. TJs are denied access to standard education, mainstream occupations, and social respect. Although the exact number has never been determined, it is estimated that a large proportion (≈90%) of TJ people are forced to choose roadside begging and working as cheap sex workers. There is no clinical reason why TJs should have fewer cancer incidents, they should be more susceptible to cancer due to unhealthy living conditions, unprotected sex, lack of medical care, proper nutrition, and all other factors associated with their very low socioeconomic status. Nonetheless, it's difficult to find single TJ cancer patients in both public and private hospital OPD. They may be unable to access a traditional clinic due to social discrimination, financial constraints, or they may be unwilling to disclose their true sex. Even TJ's do not show up at free public clinics. The disclosure of true sex may be beneficial in obtaining better treatment, but the more prevalent reason is social unacceptability, which can be overcome through proper education and community economic growth.

Prevalence and Infestation of Ectoparasite in Dabung Ducks in Some Districts in Bangkalan Madura

Identify the type of ectoparasite prevalence and infestation pattern of ectoparasite on Dabung duck in Bangkalan Madura regency. This research conducted from February to April 2022 with sample of 55 tails and identified in parasitology laboratory of the Veterinary Parasitology Division, Faculty of Veterinary Medicine, Airlangga University, Surabaya with the permanent mounting method without coloring. This research was a descriptive research, study survey, and cross sectional study analytical. The type of ectoparasite that attacked Dabung duck in Geger subdistrict, Dabung village and Galis subdistrict, Pekaan Dajah village were Menacanthus stramineus, Menopon gallinae, Lipeurus caponis with a prevalence of 100% from a sample 55 tails of Dabung duck. The analysis results of infestation pattern of ectoparasite infestation on Dabung ducks used correspondence text on the body regions of Dabung ducks in Geger subdistrict, Dabung village showed that M. stramineus ticks on chest region, M. gallinae in head neck region and L. caponis in wing region. Burneh subdistrict, Burneh village founded M. stramineus ticks in abdomen region, M. gallinae in head-neck region, and L. caponis in wing region. Galis subdistrict, Pakaan Dajah village showed that M stramineus lice in head-neck region, L. caponis in wing region and M. gallinae in spine region.

Association Between Opium Smoking and Neck and Upper Spine Posture Disorders

Background: Many studies have shown that non-ergonomic positioning of the spine is one of the main causes of postural deformity. In this regard, opium smoking requires sitting in non-ergonomic positions, which increases the possibility of posture disorders due to exposure for several hours a day and over many years. Objectives: This study aimed to compare neck pain and disability, forward head posture (FHP), and the curvature of the thoracic spine (thoracic hyperkyphosis [THK]) in opium users and non-drug users. Methods: In this comparative cross-sectional study, 80 opium smokers were compared with 74 non-drug users in terms of craniovertebral angle (FHP), THK, and neck pain (Visual Analog Scale [VAS]) and disability (neck disability index [NDI]). Data were analyzed by Kolmogorov-Smirnov and independent t-tests using SPSS version 23. Results: The difference between the 2 groups was significant in all variables, including VAS (P = 0.004), NDI (P &lt; 0.001), craniovertebral angle (P = 0.003), and THK (P = 0.006). Conclusions: Forward head posture, THK, neck pain, and neck disability are more prevalent in opium smokers than non-drug users. This could be due to the long hours of the non-ergonomic position while smoking opium.

A Comparative Study of Fiberoptic Laryngoscopy (FOL) and Indirect Laryngoscopy in the Diagnosis of Patients with Vocal Cord Lesions

Background: Change of voice is one of the common complaints in ENT practice and hoarseness of voice is the commonest symptom of changed voice quality. Hoarseness is invariably the earliest manifestation of conditions directly or indirectly affecting the voice apparatus. Though most common causes of hoarseness are benign and vocal abuse is the commonest among them, but we should always investigate for more sinister pathology like malignancy. The aim of this study was to compare the diagnostic yields of fibreoptic laryngoscopy (FOL) with that of indirect laryngoscopy in the diagnosis of vocal cord lesions. Objectives: To compare fibreoptic laryngoscopy (FOL) and indirect laryngoscopy in the diagnosis of vocal cord lesions as the cause of voice change. Methods: This is a cross-sectional study which has been conducted in the Department of ENT and Head Neck Surgery, SSMC Mitford Hospital with a sample size of 87 cases for a period of six months from 10th February’ 2020 to 9th August’ 2020. The patients with vocal cord lesions were selected according to the eligibility criteria by purposive sampling. Results : On indirect laryngoscopic examinations, 29.89% were vocal cord polyp, 16.09% suspected vocal cord neoplasm, 14.94% vocal cord edema, 11.49% vocal cord nodule, 5.74% vocal cord palsy and 2.61 were ulcerative lesion of vocal cords whereas poor view were in 18.39% cases. On fibreoptic laryngoscopy (FOL), 29.89% were vocal cord polyp, 19.54% suspected vocal cord neoplasm, 17.24% vocal cord edema, 16.09% vocal cord nodule, 8.04% vocal cord palsy and 6.90% were ulcerative lesion of vocal cord. 2.30% revealed normal study. Study showed that fibreoptic laryngoscopic examination is superior to indirect laryngoscopy in diagnosing vocal cord lesions. Conclusion : Fibreoptic laryngoscopy (FOL) is significantly superior to indirect laryngoscopy in the diagnosis of vocal cord lesions. Indirect laryngoscopy sometimes may miss to diagnose a sinister disease like malignancy. Bangladesh J Otorhinolaryngol 2023; 29(1): 24-31

Clinical application of modified hip joint lateral position in femoral neck fracture

BackgroundTo show the femoral neck better in hip lateral view of X-ray, we design a modified hip lateral view and then investigate the value in femoral neck fractures.MethodsCT images of 10 normal hip joints for 3D reconstruction were selected, the Mimics Medical 21.0 was used, and rotating the proximal femur was to find the most suitable angle for showing the femoral neck well, designed the modified lateral view according to this angle. We collected 35 healthy cases and 35 femoral neck fractures as the normal and fracture group. And two groups were all taken hip anteroposterior view, cross-table lateral view and modified lateral view, which were analyzed by two radiologists to score the anatomical structures of the articular surface, femoral head, head neck junction, femoral neck, basal region and intertrochanteric region. Friedman test was used to analyze the score of femoral neck at different angles. T test and Wilcoxon signed-rank test were to compare inter-groups.ResultsThe modified lateral view was designed as follows: The subjects were supine, with the sagittal axis biased toward the healthy side at an angle of approximately 20° to the long axis of the examination table, the hip joint flexed at 45°, the lower extremity abducted at 40°, the centerline inclined 45° toward the head and the centerline aligned with the center of the groin. The modified lateral view showed the femoral head, head neck junction and femoral neck more clearly than the cross-table lateral view, but the cross-table lateral view showed the femoral neck basal and intertrochanteric region better. In addition, the time of taking the modified lateral view was significantly less than the cross-table lateral view (normal group: 0.789 min ± 0.223 vs 0.623 min ± 0.207, P < 0.001; fracture group: 1.131 min ± 0.362 vs 0.946 min ± 0.390, P < 0.001).ConclusionsThe modified lateral view can obtain a standard sagittal image of femoral neck, which can show the dislocation and angulation of the sagittal femoral neck fracture clearly, and improve the accuracy of diagnosis. And it is more convenient and easier for patients to cooperate, which is worthy promoting and applying in clinical work.

Pathophysiological Effect of Enlarged Adenoid on Middle Ear in Children

Objective: To identify the incidence of otitis media with effusion (OME) in children with enlarged adenoid. Methodology: This is a cross sectional observational study was carried out at Department of Otolaryngology and Head Neck surgery of Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2014 to June 2016. One Hundred and Fifty (150) children with enlarged adenoid were included in this study. All patients were subjected for history, local physical examination, evaluation of adenoid size by X ray of nasopharynx lateral view. Pure tone audiometry &amp; tympanometry were done in all patients. Informations were recorded in a specially designed data collection sheet. Result: Among 150 children with enlarged adenoid 30(20%) patient had OME, majority of patients (60%) were age group 7-9 years. Male were predominant (60%) than female (40%). Among 150 patients grade- I was 16%, grade II- was 26%, grade-III was 54% and grade IV was 4%.According to the grading of enlarged adenoid cases , grade I, grade II , grade III and grade IV had 8.33%,15.38% ,23.46% and 50% cases had OME respectively. Hearing loss was in 33(22%) children. According to tympanometry, type A curve was in 118(78.67%) children, type B 26(17.33%) and type C 6(4%) children. Conclusion: Enlarged adenoid is associated with otitis media with effusion. Incidence of Otitis media with effusion increases with the proportion of severity of nasopharyngeal obstruction by enlarged adenoid. Bangladesh J Otorhinolaryngol 2023; 29(1): 11-16

Prevalence of Recurrence in Early Tongue Cancer T1 or T2 with or Without Neck Dissection

Background: Patients with T1 T2 N0 mouth or tongue cancer that has been confirmed by a doctor may choose to have a neck dissection. Some say that nodal return of a T1 original tumor is well controlled, while others say that salvage is more often the exception than the rule. Objective: To determine the likelihood of recurrence in T1 or T2 early tongue carcinoma with or without neck dissection. Methods: The prospective cross-sectional clinical study was conducted from March 2021 to March 2023 at the Department of ENT and Head Neck Surgery, Combined Military Hospital, Dhaka. All 100 patients who presented with clinically determined T1 and T2 disease, as defined by the American Joint Committee on Cancer (AJCC), were treated at the Department of Otolaryngology of the Combined Military Hospital in Dhaka and underwent primary surgical resection of the tumor with or without neck dissection. The study eliminated cases of cancer involving the base of the tongue or recurring oral tongue cancer. Results: In the neck dissection group, 3(6%) experienced local recurrence, 2(4%) experienced regional recurrence, and 1 (2%) experienced both (local and regional recurrence). There will be no dissection. 10(20%) Local recurrence, 3 (6%), Regional recurrence, and 1 (2% combined local and regional recurrence). Recurrence was 4(8%) in the neck dissection group and 14(28%) in the no dissection group. Conclusion: In this study, the overall recurrence rate was 8% in neck dissection and 28% in no neck dissection. The overall recurrence rate in the no neck dissection group was significantly greater than in the neck dissection group. Bangladesh J Otorhinolaryngol 2023; 29(1): 5-10

Electrical Stimulation for Treatment of Dysphagia Post Head Neck Cancer: A Systematic Review and Meta-Analysis.

Introduction Dysphagia induced by radiotherapy in the head and neck region comprises a challenging scenario and sometimes difficult rehabilitation due to the severity of the adverse effects. Some resources such as electrical stimulation have emerged as an alternative to complement the therapeutic process, but there is still no consensus on its use. Objective The purpose of the present study was to evaluate, through a meta-analysis, the effect of electrical stimulation on the rehabilitation of dysphagia generated after head and neck cancer treatment. Data Synthesis Four randomized controlled trials with a total of 146 participants were included. The age of the participants was 58.37 ± 1.8 years old and there was a predominance of males. The time to start the intervention ranged from 50.96 ± 40.12 months after cancer treatment. The intervention showed great heterogeneity regarding the positioning of the electrodes, parameters, duration of the stimulus, number of sessions, and intensity. No difference was identified in the following aspects: oral transit time, hyoid elevation, penetration and/or aspiration after electrostimulation. The quality of the evidence ranged from very low to moderate and high risk of bias. Conclusion In this meta-analysis, we found weak evidence for small and moderate swallowing benefits in patients after radiotherapy for head and neck cancer in short-term clinical trials.

Analysis of myosin genes in HNSCC and identify MYL1 as a specific poor prognostic biomarker, promotes tumor metastasis and correlates with tumor immune infiltration in HNSCC

Head neck squamous cell carcinoma (HNSCC) is one of the most common malignant tumors which ranks the sixth incidence in the world. Although treatments for HNSCC have improved significantly in recent years, its recurrence rate and mortality rate remain high. Myosin genes have been studied in a variety of tumors, however its role in HNSCC has not been elucidated. GSE58911 and GSE30784 gene expression profile analysis were performed to detect significantly dys-regulated myosin genes in HNSCC. The Cancer Genome Atlas (TCGA) HNSCC database was used to verify the dys-regulated myosin genes and study the relationship between these genes and prognosis in HNSCC. The results showed that MYL1, MYL2, MYL3, MYH2, and MYH7 were down-regulated, while MYH10 was up-regulated in patients with HNSCC. Interestingly, MYL1, MYL2, MYH1, MYH2, and MYH7 were shown to be unfavorable prognostic markers in HNSCC. It is also worth noting that MYL1 was a specific unfavorable prognostic biomarker in HNSCC. MYL1, MYL2, MYL3, MYH2, MYH7, and MYH10 promoted CD4 + T cells activation in HNSCC. MYL1 was proved to be down-regulated in HNSCC tissues compared to normal tissues at protein levels. MYL1 overexpression had no effect on proliferation, but significantly promoted migration of Fadu cells. MYL1 increased EGF and EGFR protein expression levels. Moreover, there is a positive correlation between MYL1 expression and Tcm CD8 cells, Tcm CD4 + cells, NK cells, Mast cells, NKT cells, Tfh cells and Treg cells in HNSCC. Overall, MYL1 facilitates tumor metastasis and correlates with tumor immune infiltration in HNSCC and these effects may be associated with the EGF/EGFR pathway.

Shared decision making in head neck cancer

Shared decision making in head neck cancer

Republication de : Letter in reply to “The first wave of COVID-19 did not cause longer wait times in head and neck cancer. Experience of a French expert center” by Vanderhaegen et al. Ann Otorhinolaryngol Head Neck Dis 2022;139:261–267

Republication de : Letter in reply to “The first wave of COVID-19 did not cause longer wait times in head and neck cancer. Experience of a French expert center” by Vanderhaegen et al. Ann Otorhinolaryngol Head Neck Dis 2022;139:261–267

Comprehensive treatment strategies for head neck tumors

Comprehensive treatment strategies for head neck tumors

ETV5 facilitates tumor progression in head-neck squamous cell carcinoma.

E26 transformation-specific (ETS) factors have emerged as key mediators underlying human tumorigenesis. Here, we sought to characterize the expression pattern, biological roles, and clinical significance of ETS Variant Transcription Factor 5 (ETV5) in head neck squamous cell carcinoma (HNSCC). ETV5 expression pattern in HNSCC was determined by bioinformatics interrogations and immunohistochemical staining in primary samples. The associations between its abundance with clinicopathological parameters, and patient survival were evaluated. Colony formation, CCK-8, flow cytometry, wound healing, and Transwell invasion assays, as well as xenograft models, were utilized to determine the phenotypic changes after ETV5 silencing in vitro and vivo. The potential binding of ETV5 in the Slug promoter was determined by ChIP-qPCR. ETV5 was significantly overexpressed in HNSCC samples. Its overexpression is significantly associated with aggressiveness features and reduced survival. ETV5 knockdown significantly inhibited cell proliferation, migration, invasion, and induced apoptosis in vitro, and impaired tumor growth in vivo. Moreover, ETV5-activated Slug transcription by binding its promoter region in HNSCC cells. Patients with ETV5highSlughigh had the worst survival across multiple HNSCC cohorts. Our findings reveal that ETV5 serves as a novel prognostic biomarker and putative oncogene for HNSCC progression likely by activating Slug transcription.