Secondary Neck Research Articles

Association of Definitive Radiotherapy for Esophageal Cancer and the Incidence of Secondary Head and Neck Cancers: A SEER Population-Based Study.

Impact of radiotherapy (RT) for esophageal cancer (EC) patients on the development of secondary head and neck cancer (SHNC) remains equivocal. The objective of this study was to investigate the link between definitive RT used for EC treatment and subsequent SHNC. This study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database to collect the data of primary EC patients. Fine-Gray competing risk regression and standardized incidence ratio (SIR) and propensity score matching (PSM) method were used to match SHNC patients with only primary head and neck cancer (HNC) patients. Overall survival (OS) rates were applied by Kaplan-Meier analysis. In total, 14,158 EC patients from the SEER database were included, of which 9,239 patients (65.3%) received RT and 4,919 patients (34.7%) received no radiation therapy (NRT). After a 12-month latency period, 110 patients (1.2%) in the RT group and 36 patients (0.7%) in the NRT group experienced the development of SHNC. In individuals with primary EC, there was an increased incidence of SHNC compared to the general US population (SIR = 5.95, 95% confidence interval (CI): 5.15 - 6.84). Specifically, the SIR for SHNC was 8.04 (95% CI: 6.78 - 9.47) in the RT group and 3.51 (95% CI: 2.64 - 4.58) in the NRT group. Patients who developed SHNC after RT exhibited significantly lower OS compared to those after NRT. Following PSM, the OS of patients who developed SHNC after RT remained significantly lower than that of matched patients with only primary HNC. An association was discovered between RT for EC and increased long-term risk of SHNC. This work enables radiation oncologists to implement mitigation strategies to reduce the long-term risk of SHNC in patients who have received RT following primary EC.

Simultaneous primary posterior urethral valves ablation and bladder neck incision may decrease kidney and bladder failure in long-term follow-up in patients with bladder neck hypertrophy and poor bladder function at presentation: report of 301 cases

ObjectivesTo investigate the effects of bladder neck incision (BNI) and primary valves ablation on long-term kidney and bladder function in children with posterior urethral valves (PUV) and bladder neck hypertrophy (BNH).Patients and methodsFrom 1997 to 2016, a total of 1381 children with PUV were referred to our tertiary hospital. Of these patients, 301 PUV patients with bladder neck hypertrophy need concurrent BNI and valve ablation. All patients were followed up every 3–6 months on regular basis in first 2 post-surgical years and annually then after. The paired t-test and chi-square test were used to perform statistical analysis with p value < 0.05 defined as the level of significance.ResultsMean age at diagnosis was 7.22 ± 2.45 months (ranging from 7 days to 15 months) with a mean follow-up of 5.12 ± 2.80 years. The incidence of hydronephrosis was decreased from 266 (88.3%) at the baseline to 73 (24.3%) patients in long-term follow-up. At baseline, 188 (62.5%) patients were diagnosed with VUR, which decreased to 20 (6.6%) individuals at the end of follow-up. Bladder and renal function were improved in follow-ups following concomitant PUV ablation and BNI. No Myogenic failure was depicted in all patients with BNH. No ureteric reimplantation was needed during the two decades follow-up.ConclusionSimultaneous valve ablation with BNI may present further profits in children with PUV and BNH particularly cases of BNH with poor bladder function at the time of presentation. This method can improve the results of urodynamic and imaging studies after the surgery. We hypothesize every child with PUV presentation who has concurrent vesicoureteral reflux, CKD or persistent hydrourethronephrosis may suffer from secondary bladder neck obstruction. This secondary bladder outlet obstruction must be managed through BNI as the surgical relief.

Timeframe for lymphedema therapy for head and neck cancer survivors.

e13535 Background: More than 90% of head and neck cancer (HNC) survivors experience secondary head and neck lymphedema. Prompt identification and treatment are essential given the progressive nature of lymphedema and potential complications. Usual care includes complete decongestive therapy performed by a lymphedema therapist followed by lifelong home self-care. The ability to participate in lymphedema therapy (LT) is deleteriously impacted by numerous barriers. We are conducting a phase 3 multisite randomized trial involving HNC survivors with treatment-naïve lymphedema which compares usual lymphedema care to the use of an advanced pneumatic compression device (APCD). For patients treated on the usual care arm, data pertaining to LT delivery was collected prospectively. Herein we report the preliminary analysis from this dataset. Methods: Eligible patients were age ≥18 years, had pathologically confirmed HNC, completed curative intent cancer therapy with no evidence of active cancer, were diagnosed with internal or external head and neck lymphedema with at least one core lymphedema associated symptom and had not previously received treatment for lymphedema. Participants were randomized to either usual care with complete decongestive therapy directed by a lymphedema therapist followed by home self-care or daily self-directed use of APCD. Anatomic measurements and patient reported outcome measures were obtained at 2-, 4- and 6-month endpoints. The intervention phase lasted 6 months and therapy records were received for analysis. Key outcome measures included the time from referral to LT evaluation consultation, time from LT evaluation to treatment session and time from referral to treatment session. Results: At the time of this analysis, 87 participants randomized to usual care arm were eligible for inclusion in this assessment. Of the 87 patients, we were unable to document completion of LT consultation or therapy for 39 patients. Among the 48 participants who were referred for LT and received therapy, 72% were male and 28% were female, with 91% identifying as white, 7% as black, and 2% as other. The average age was 62. The mean time from referral by a health care provider to initial lymphedema consultation was 19.6 (σ 18.1) days. Of note, there was a wide-ranging timeframe from referral to LT treatment, varying from 0 to 93 days. The mean time from consultation to treatment was 1.7 days (σ 5.1) and referral to treatment was 21.3 (σ 17.8). Conclusions: A key finding of this study is the high rate (45%) of those referred for LT were not documented to complete a therapy consultation or to receive therapy. Of those patients who receive therapy, consultation and treatment were delay significantly in a high percentage of patients. These finding highlight the need for additional investigation into barriers to timely implementation of LT for head and neck cancer survivors. Guidelines and standards of care should be developed to guide practitioners. Clinical trial information: NCT04797390 .

Disease Control and Toxicity Outcomes after Intraoperative HDR Brachytherapy for Neck Recurrences in Patients Previously Irradiated Head and Neck Cancer

Despite recent advances in local and systemic therapies for head and neck squamous cell carcinomas (HNSCC), the most common types of treatment failure remain local and regional. Patients with HNSCC also have a higher risk of developing secondary head and neck tumors due to a field cancerization phenomenon. Treatment of these recurrences poses a challenge, particularly in patients having previously received full dose external beam radiotherapy (EBRT) to the head and neck region. This study evaluates the clinical outcomes of intraoperative Harrison-Anderson-Mick applicator (HAM) HDR brachytherapy (BT) after salvage neck dissection for neck recurrences in patients previously irradiated for HNSCC. All patients having received HAM BT for HNSCC neck recurrences at a single institution were identified. Demographic, treatment, disease control and toxicity data were collected retrospectively. Toxicity was graded as per Common Terminology Criteria for Adverse events version 5. The Kaplan Meier method was used to assess overall survival (OS) and ipsilateral regional control (IRC) from the time of HAM BT. Nineteen patients with regional recurrence of HNSCC were treated with HAM BT Ir-192 between July 2006 and June 2022, with a median follow-up for survival of 51.4 months (range: 2.5-186.7). The median BT dose was 12.5 Gy delivered intraoperatively at 5 mm tissue depth/1 cm from source. Fifteen patients (78.9%) also received postoperative EBRT to a median dose of 46 Gy in 23 fractions and 13 (68.4%) received systemic therapy. Six patients (31.6%) developed ipsilateral neck recurrences (4 who had adjuvant EBRT and 2 who did not), 2 patients had primary site recurrences and 5 patients developed distant metastases. In terms of acute toxicity, 4 patients had grade 3 dysphagia requiring feeding tube (FT) placement and one patient required surgical intervention for wound necrosis. In terms of late toxicity, 2 additional patients required FT placement and 1 was able to have it removed. No grade 4+ late toxicities were noted. The IRC at the site of HAM BT at 1 year was 71.5% and 63.6% at 5 years. The 1-year OS was 81.3% and 5-year OS was 40.9%. Intraoperative HAM BT resulted in favorable rates of IRC with acceptable toxicity in the reirradiation setting for HNSCC.

Microbial isolates and antibiotic sensitivity in patients hospitalized with odontogenic infections at a tertiary center over 10 years.

This study investigated causative strains and their antibiotic sensitivity in patients who were hospitalized for maxillofacial odontogenic infections at a tertiary center in South Korea over the past 10 years with the aim of providing guidelines for the selection of appropriate empirical antibiotics. Patients with head and neck fascial space abscesses due to odontogenic infections who underwent incision and drainage surgery with pus culture tests between 2013 and 2022 at the Department of Oral and Maxillofacial Surgery, Dankook University Hospital were included. The bacterial isolates and antibiotic sensitivity of each strain were analyzed for 2013-2022, 2013-2017, and 2018-2022. The affected fascial spaces were classified into primary, secondary, and deep neck spaces. In the 192 patients included in this study, 302 strains were detected. Viridans streptococcus had the highest frequency (51.7%), followed by Prevotella spp. (16.9%), Staphylococcus spp. (5.6%), and Klebsiella pneumoniae (4.6%). The identification rate of viridans streptococcus significantly increased from 41.8% in 2013-2017 to 60.9% in 2018-2022. Viridans streptococcus showed an antibiotic sensitivity of 80.5% to ampicillin; the sensitivity to penicillin antibiotics decreased over the study period. Antibiotic susceptibility was approximately 94% for third-generation cephalosporins. K. pneumoniae, which was identified at a high percentage in patients with deep neck space infection, showed increasing antibiotic resistance to most antibiotics over the study period. Viridans streptococcus was identified in head and neck fascial space abscesses with the highest frequency. Empirical antibiotics should be effective against this strain; penicillin antibiotics are considered inappropriate. For effective treatment of deep neck space abscesses, bacterial culture and antibiotic sensitivity tests performed as soon as possible are essential.

Long-Term Care and Follow-Up in Laryngeal Cancer Patients: A Multicenter Retrospective Analysis.

We conducted an outcome analysis on surgically treated laryngeal squamous cell carcinoma (LSCC) patients. A multicenter retrospective study with 352 patients was analyzed. A new nomogram that incorporates age, T- and N-classification, and treatment was created. Recurrence was observed in 65 (18.5%) patients after a mean time of 16.5 months. After 60 months, 91 (25.9%) of patients developed secondary primary tumors (SPT), most commonly in the lungs (n = 29; 8.2%) followed by other head and neck cancers (n = 21; 6.0%). Notably, the mean time to occurrence of secondary head and neck cancers was twice that of lung cancer (101.1 vs. 47.5 months). Recurrent disease is less common in LSCC patients and appears much earlier than SPT. Because one in every four laryngeal cancer patients develops SPTs within 5-10 years, long-term care and follow-up, including imaging studies, are highly recommended. The nomogram was useful for estimating survival.

Treatment of chronic mallet finger with swan neck deformity using a modified Spiral Oblique Retinacular Ligament (SORL) reconstruction procedure: A case series and technical note.

Chronic terminal extensor tendon injury produces mallet deformity and secondary swan neck deformity. It can be found in neglect cases and in a failed cases after conservative treatment or primary surgical repair. Surgery is considered in cases with extensor lag of more than 30° and functional deficit. Reconstruction of the spiral oblique retinacular ligament (SORL) has been reported in literatures to correct swan neck deformity by a dynamic mechanical basis. Three cases of chronic mallet finger associated with swan neck deformity were treated by the modified technique of SORL reconstruction. Range of motion (ROM) of distal interphalangeal (DIP) joints and proximal interphalangeal (PIP) joints were measured along with the complications. The clinical outcome was reported using the Crawford's criteria. All patients had an average age of 34years (20-54). Average time to surgery was 16.67months (2-24) and average of DIP extension lag was 66.67°. All patient gave excellent Crawford criteria at the latest follow up (average 15.3months). The average PIP joint ROM were -1.60 (00 to -50) of extension and 1100 (1000-1200) of flexion for the PIP joint and -1.60 (00 to -50) of extension and 83.330 (800-850) of flexion for the DIP joint. We present our technique to manage chronic mallet injury which only utilized two skin incisions and one button at the distal phalanx to minimize risk of skin necrosis and patient discomfort. This procedure can be considered as one of the options for the treatment of chronic mallet finger deformity associated with swan neck deformity.

Overlooked Factors Causing Renal Damage in Vesicoureteric Reflux!

Vesicoureteric reflux (VUR), recurrent urinary tract infection (RUTI), febrile urinary tract infection (FUTI), renal scarring, and renal damage are intimately related. Key factors of renal damage in VUR are suspected to be RUTI and FUTI. Hence, conventional treatments are targeted toward the prevention of RUTI and FUTI. However, literatures have witnessed that control of infection is not sufficient enough. That means we are missing some hidden, enigmatic, or overlooked factors which are essentially responsible for renal damage. We know RUTI occurs from the stasis of urine in system and stasis might occur from obstruction somewhere in system. Moreover, obstruction builds up back pressure in the bladder and ureters, and ultimately in kidneys; that pressure is independently harmful to renal function. Pressure is further harmful if this joins together with infection. We know that RUTI and FUTI along with pressure in the urinary tract are harmful to renal parenchyma. Nevertheless, search for the nexus of obstruction, pressure, stasis, infection, and damage (OPSID) of renal function is not yet focused on in VUR research. In this retrospective study on secondary VUR, we would like to find the overlooked factors or nexus of OPSID associated with VUR causing renal damage. A total of 170 renal units of 135 patients with VUR resulted from the posterior urethral valve and from repaired bladder exstrophy, from March 2005 to April 2019, had adequate data regarding control/correction of obstruction and urodynamic studies. The mean patient's age was 2.8 years (range 1 day-14 years). The diagnosis of VURs was made with postnatal cystogram in patients of the posterior urethral valve and of repaired continent augmented bladder exstrophy. We do cystogram not micturating cystogram following ultrasonography if showing dilated ureter/s. If we find no residual in ureter/s after 30 min in cystogram, we label it as "rise and fall" VUR (raf_VUR), i.e., without obstruction. On the other hand, if there is post void residual in ureter/s for more than 30 min, we label it as "rise and stasis" VUR (ras_VUR) means combination of VUR with uretero vesical junction obstruction (UVJO). Along with this, all patients were followed up with albumin creatinine ratio, creatinine clearance, USG Renometry, DTPA renal scan, uroflowmetry, and urodynamic study (UDS). Repeat cystoscopy, if necessary, was done following UDS for secondary bladder neck incision (BNI) or for repeat BNI if necessary. Mean duration of follow-up was 7.2 years (range 3-14 years). Out of 170 renal units, 132 renal units had VUR without VUJO, i.e., raf_VUR and 38 renal units had ras_VUR. All patients of UVJO were relieved either with anticholinergics or with DJ stenting or by re-implantations. Twenty-nine patients out of 135 had high pressure on UDS, and they needed BNI. We were able to prevent upstaging of chronic kidney disease (USCKD) in all 135 patients. Our tangible goal of treatment in VUR is the prevention of USCKD. We differentiated raf_VUR from ras_VUR with cystogram. Patients with ras_VUR and patients with raf_VUR with high bladder pressure were actively treated. This particular subset VUR was treated with prophylactic antibiotic and surgical corrections. We prevented renal damage by eliminating obstruction and stasis which helped to prevent RUTI and FUTI. Possibly, similar management might also help to manage "primary VUR." Possibly those overlooked factors which are essentially responsible for renal damage are veiled in nexus OPSID of the kidney.

Second Malignancy after Childhood AML Treatment - a Retrospective Analysis of the AML-BFM Stud

In the past decades the outcome in ped AML patients improved continuously. However, secondary malignancies seem to be a severe side-effect, affecting the quality of life in survivors. This retrospective data analysis in patients treated according to AML-BFM protocols, is focused the occurrence of secondary malignancies after AML treatment and evaluates the consequences thereof. Between 1993 - 2019 (total n=2797) 51 patients were documented with a secondary malignancy (SM) after AML treatment. 5 pat (10%) were excluded due to a lack of data concerning the SMs exact diagnosis or a clear differentiation from AMLs relapse. Patients were included if the de novo AML occurred before <18yrs. 46 pat (f=20; m=26) remained in the analysis. All pat were treated acc to the current AML-BFM protocol version at the time of their AML diagnosis and for their SM acc. to local standard of care. For AML treatment the cumulative dose of i.v.-cytarabine ranged from 41,380 to 51,380 mg/m2(median 47,380 mg/m2), i.th. cytarabine from 140 to 370 mg age and weight-depended (median 330 mg), etoposide was given constantly with 950 mg/m2 and from 2004 to 2017 anthracyclines with cumulative doses of 500 mg/m² were applied (idarubicin/mitoxantrone calculated with equivalence dosage of 1:5). Since 2004 the i.th. therapy was added with a max. dose of 70 mg prednisolone and 84 mg MTX, both depending on age and weight. The median age on initial AML was 7.3 yrs, ranged from 0.1-17.5 yrs while the median age at date of SM diagnosis was 14.4 yrs, ranged from 0.86-30.2 yrs. The median percentage of BM blasts was 61% (0 - 100%), the median WBC of 7,200/ μl (670 - 214,000/μl) and hemoglobin was 8.7 g/dl (4.6-14.2 g/dl). Acc. to the FAB classification, FAB M4/M5 (43%) was the largest group, followed by FAB M0/M1/ M2 (35%), FAB M6/M7 (6%), M3 (6%) and others (6%). In 63% of the cohort a normal karyotype was detected. Beside a single patient (2%) all others received CR during AML treatment. The median time between AML and SM was 3.6 yrs (0.6 to 19.7 years). Interestingly the median time differs between AML followed by blood cancers with 3.2 yrs (0.8- 15.2 yrs) to 8.1 yrs (0.6-19.7 yrs) for AML followed by a solid tumor. Leukemia (n=13, 28%), such as ALL (n=10) or CML (n=3), was the most frequent SM, however also secondary myelodysplastic syndromes (n=8, 17%; including RAEB and RAEB in transformation), lymphoma (n=7, 15%), head and neck tumors (n=6, 13%), skin cancer (n=3, 7%), CNS tumors (n=3, 7%) and other diagnoses (n=6, 13%) were reported. None of the patients was reported with known genetic disorders explaining the SM, but in 9 cases (20%) pre-existing diseases (malignant and non-malignant) was documented, often as multi-morbidity (e.g., heart, lung, neurological diseases). According to a median follow-up-period of 11.7 yrs (0.6-22.3 yrs) after AML diagnosis, the 5-yr-overall survival (OS) rate of the cohort was 97±2% after AML and decreases to 78±6% from the date of SM. The OS of 97±2% resulted from a single patient, which was diagnosed with the SM and died at the same day. The 5-yr-event-free-survival (EFS), defined as death by any cause, relapse (independently of AML or SM) and third malignancy, was 87±5% vs. 71±7%. Patients suffering from blood cancers as SM (n=29, 63%) had a slightly poorer outcome in comparison to solid tumor patients (n=17, 37%) with a 5-yr-OS of 79±8% vs. 88±2% (p 0.223) and 5-yr-EFS of 65±9% vs. 82±9% (p 0.097). With a cumulative incidence of 2%, SM are extremely rare after ped AML. In contrast, in the same period three times more t-AML cases were reported, therefor AML itself is the most frequent treatment-related malignancy in ped patients as previously published. The results showed a shorter period between AML followed by blood cancers than solid tumors, which suggesting either that AML and the SM are pathophysiologically related whereas solid tumors may be therapy-induced only or that hematopoiesis is more sensitive for toxic effects or shows a higher proliferation rate. Due to the very limited case numbers and lack of further genetic results to exclude e.g. predisposition syndromes, these hypotheses are speculative and cannot be proven. Based on the frequency of SM after ped AML and the outcome thereof, a further therapy intensification to improve especially the AMLs EFS is justifiable. Caused on the results and the revealed median intervals, a long-term follow up for ped AML patients into their adult life is highly recommendable to learn more about these rare events.

Optimization of the Mo-Cr binary system for Nanophase Separation Sintering

Like many refractory metals, molybdenum-based alloys present a host of desirable properties for high temperature applications, but have challenging processing constraints. Nanophase separation sintering (NPSS) is a novel sintering process that has been shown to promote rapid pressureless sintering in other BCC metals such as W and Cr. These unique traits are achieved through the development of a transient secondary solid phase neck that first forms and then resolutionizes during the sintering cycle. Both of these processes promote extra mass transport and therefore accelerate sintering to from a dense material. In the present work we use the design criteria for NPSS to identify Cr as a preferred NPSS sintering aid candidate for Mo, a base metal not previously sintered by NPSS. Constant heating rate sintering experiments and ex-situ SEM and EDS on Mo-Cr alloys confirm that the critical mechanisms associated with NPSS occur in this system. Further experiments explore the effect of lower temperature isothermal holds and sintering aid content on the densification of the material. Cr is a particularly desirable sintering aid because it is fully soluble, leaving no permanent second phase or promoting rapid grain growth, which might compromise the high temperature properties of a Mo-based alloy.

Morpho-dynamic evolution due to inertia-mediated impact of a compound drop on a deep liquid pool

A compound drop impacting on a liquid pool exhibits intriguing coalescence patterns that are primarily attributable to the complicated interplay of inertia with other physical parameters such as radius ratio of core to shell drop and density and viscosity contrasts of the two fluids. By executing comprehensive numerical investigations, here, we identify three different regimes based on the radius ratio of compound drop, viz., secondary drop pinch-off without bubble bursting, secondary drop pinch-off after bubble bursting, and compound breakage. Our findings also depict a transition in the shape of a secondary droplet from prolate to oblate or vice versa, a phenomenon non-trivially culminated by secondary drop pinch-off timing, neck radius, and amplitude and wavelength of capillary wave propagation. Our results bring out the fact that higher wavelength and amplitude of capillary waves are responsible for secondary drop pinch-off without bubble bursting. Furthermore, in the case of highly viscous core drop and surrounding fluid, we observe both complete and partial coalescence phenomena, which are critically dictated by the confluence of inertia and radius ratio of a compound drop leading to three different regimes, viz., complete coalescence without bubble bursting, complete coalescence with bubble bursting, and partial coalescence with bubble bursting, distinctively different from the observations for single droplet based investigations reported in earlier studies. These implications are likely to be beneficial in illustrating the physical functionalities accompanying the targeted release of encapsulated biological or pathological entities when they are transmitted under the action of an inertial force into another fluidic medium, a paradigm that has hitherto remained unexplored.

Hip fractures following intramedullary nailing fixation for femoral fractures

IntroductionProximal peri-implant femoral fractures occur following intramedullary nailing (IMN) fixation for trochanteric, femoral shaft, and distal femoral fractures. However, analyses of secondary hip fractures (SHFs) using large clinical samples are lacking. Therefore, we aimed to report the incidence and clinical outcomes of SHF after nailing fixation (IMN or cephalomedullary nailing [CMN]) for overall femoral fractures. In addition, we focused on IMN for femoral shaft fractures and investigated the risk factors for SHF. MethodsThis multicenter, retrospective, cohort study included 2,293 patients aged > 60 years who underwent nailing fixation for femoral fractures. The primary outcome was the incidence of SHF. In the assessment of clinical outcomes, we evaluated reoperation and the regaining of walking ability following SHF management. In addition, we conducted multivariable logistic regression analyses to examine the association between risk factors and SHF. ResultsSeventeen (0.7%) patients had SHFs, including 12 femoral neck fractures and 5 trochanteric fractures. Antegrade IMN was the most common type of nailing fixation. Multivariable analysis demonstrated that the absence of femoral head fixation was significantly associated with the incidence of SHF following IMN for femoral shaft fractures (odds ratio, 17.0; 95% confidence interval, 1.9–2265.7; p=0.006). In the assessment of clinical outcomes, there were two reoperations (16.7%) in the secondary femoral neck fracture group. Patients with secondary trochanteric fractures tended to have a lower probability of regaining walking ability than those with secondary femoral neck fractures (20% vs. 50%). ConclusionsIn this multicenter study, the incidence of SHF after nail fixation for femoral fractures was 0.7%. The absence of femoral head fixation was significantly associated with SHF, and the clinical outcomes were poor. Therefore, femoral head fixation at the initial IMN fixation for femoral fractures may be a fixation option for surgeons to consider as an SHF prevention measure.

Quality of life following treatment for T1a glottic cancer with surgery or radiotherapy: outcomes from the Head and Neck 5000 cohort.

To investigate the quality of life in patients treated with either RT or surgery alone for T1a glottic carcinoma. This prospective cohort study aims to assess generic- and disease-specific patient-reported QoL in patients treated with either surgery or RT for T1a glottic carcinoma. Multicentre, secondary care specialist head and neck units in the UK. Participants were recruited as part of the multicentre, prospective Head and Neck 5000 cohort between 2011 and 2014. Baseline demographic data were collected. All participants completed the EORTC QLQ C30 and EORTC QLQ H&N35 questionnaires at baseline, 4months, 12months and after 36months. One hundred and twenty three participants received radiotherapy only (n=68) or surgery only (n=55). Overall QoL scores were similar between both groups. The median (IQR) EORTC QLQ C30summary scores at 12months were 89.3 (79.1, 95.7) and 92.6 (74.4, 97.9) for the radiotherapy and surgery groups respectively. The equivalent summary scores for the EORTC QLQ H&N35 were 91.9 (83.8, 94.9) and 90.4 (85.5, 94.9). There was a modest difference in some QoL subscales between the groups, but no differences existed beyond 4months. Patient-reported QoL is similar following either radiotherapy or surgery for T1a glottic carcinoma. These data support current guidance recommended TLM for this disease.

Head and neck lymphoedema-research challenges during the COVID-19 pandemic.

Management of secondary head and neck lymphoedema has undergone little research investigation. Its treatment is time and labour intensive and involves multiple therapeutic modalities without a clear understanding of which is most effective. This study aimed to determine the feasibility of a randomised controlled trial comparing two therapeutic modalities to manage head and neck lymphoedema. The secondary objective was to evaluate the clinical effects of these treatments. Participants were randomised to receive treatment with manual lymphatic drainage or compression over 6 weeks, with the primary outcome-percentage tissue water-measured 12 weeks after treatment. Six participants were recruited until the study was ceased due to restrictions imposed by the COVID-19 pandemic. Some 86% of required attendances were completed. Percentage tissue water increased in all participants at 12 weeks. No consistent trends were identified between internal and external lymphoedema. The small number of people recruited to this study informs its feasibility outcomes but limits any conclusions about clinical implications.

The Structural Evolution and Densification Mechanisms of Nanophase Separation Sintering

Nanophase separation sintering (NPSS) facilitates low temperature, pressureless sintering through the formation of solid phase necks driven by phase separation. Systems that have been shown to exhibit this phenomenon are W–Cr, Cr–Ni and to a lesser degree Ti–Mg. Initial information on the average rate-limiting sintering kinetics in these systems was obtained using traditional master sintering curve analysis, but it is very clear that multiple processes occur during NPSS, and these should each have their own characteristic kinetics. Here we analyze these three systems in greater kinetic detail using densification rates in a Kissinger-style analysis derived explicitly for densification data. For the W–Cr and Cr–Ni systems two critical temperatures were identified: one at low temperatures for the formation of the secondary phase necks, and a second one at high temperatures corresponding to the onset of rapid densification. The activation energies of these processes are different, and reflective of bulk solute diffusion and interdiffusion, respectively. Combined with microstructural observations, these data show that the onset of rapid densification at high temperatures is facilitated by the presence of the second-phase necks, and occurs at the point where the system can fully interdiffuse, rehomogenizing those necks. These observations help explain why the Ti–Mg system does not densify well, because it does not exhibit redissolution at high temperatures. These results help clarify the conditions needed to achieve NPSS and may support design of new alloys for NPSS behavior.

Durable Remission of Refractory and Advanced Stage Mycosis Fungoides/Sezary Syndrome (MF/SS) Utilizing an “Outpatient” Alemtuzumab and Fludarabine-Based Reduced Intensity Allogeneic Peripheral Blood Stem Cell Transplantation (PBSCT)

Background:Advanced MF/SS carries a poor prognosis with most therapies failing to provide a long-term benefit. Allogeneic hematopoietic cell transplantation may result in durable remissions or clinically meaningful downstaging in a subset of patients. However, the risk of transplant related mortality has substantially curbed enthusiasm in the use of conventional allogeneic transplantation for this disease. In this study, we describe a novel allogeneic transplant approach in which a G-CSF mobilized, unmanipulated PBSC allograft from HLA-matched siblings was infused after conditioning with a regimen customized to maximally cytoreduce the disease and to provide the necessary immunosuppression to achieve sustained donor immune engraftment needed for the generation of a graft-vs-tumor effect (GVT). We theorized that this outpatient based reduced intensity transplant regimen would provide the essential tumor-debulking and a strategy to achieve sufficient degrees of donor T-cell chimerism necessary to result in the generation of curative GVT effects in patients with the most advanced forms of MF/SS.Patients and Methods:Between January 2004 and May 2014, 5 subjects (median age of 57, range 27-59) with refractory, advanced stage (III and IV) MF/SS who had failed a median 3 prior treatment regimens (range 2-7) underwent PBSCT following mostly outpatient conditioning with alemtuzumab (total of 193 mg), and fludarabine (total of 125 mg/m2). On day 0, subjects received a G-CSF mobilized unmanipulated PBSC allograft from an HLA identical sibling. CSA alone was used as GVHD prophylaxis. Donor lymphocyte infusions (DLI) were given to all patients to convert T-cell chimerism from mixed to full donor and when necessary to boost a GVT effect.Results:All 5 subjects initially had mixed lympho-hematopoietic chimerism but eventually converted to full donor chimeras in both myeloid and T-cell lineages; full donor T-cell chimerism was achieved at a median 7 months post-transplant (Figure 1). 3/5 subjects never became neutropenic and the 2 subjects who developed neutropenia had rapid neutrophil recovery occurring after 5 and 7 days. No patients developed severe anemia or thrombocytopenia and none required RBC or platelet transfusion support.No patients developed acute GVHD prior to DLI and only one (20%) developed acute GVHD (GI, grade IV) following DLI (the 2nd DLI for this patient). Three subjects (60%) developed limited cGVHD which resolved with short course of steroids.At a median follow-up of 3 years, 4 subjects achieved a complete remission, documented by labs, skin biopsy, and imaging. Remissions were delayed in onset, occurring at median 8 months post-transplant (Figure 1). 3 subjects remain alive in remission 13, 11, and 3 years after transplant. One subject with a heavy smoking history died in remission 3 years post-transplant from a secondary head and neck squamous cell carcinoma, and one subject died 7 months post-transplant from grade IV GI GVHD which followed a 2nd DLI given to treat progressive disease (Table 1).Among those at risk, 3 of 4 subjects (75%) developed CMV reactivation. None of the subjects developed CMV disease or PTLD.Conclusions:Our custom designed conditioning regimen 1) resulted in cytoreductive effects against advanced MF 2) proved to be immunosuppressive enough to allow sustained donor engraftment serving as a platform for subsequent DLIs which lead to curative GVT effects 3) could be performed in the outpatient setting avoiding severe neutropenia and its associated opportunistic infections and the need for platelet and RBC transfusion support. These data establish that long-term cures of even the most advanced refractory MF/SS can be achieved utilizing this alemtuzumab and fludarabine-based reduced intensity allogeneic hematopoietic cell transplant approach. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Revision Facelift and Neck Lift.

Facial rejuvenation procedures have become more commonly performed due to an increasing elderly population and greater general public acceptance. As a result, patients are now increasingly undergoing secondary and tertiary rhytidectomies to treat natural aging and/or to correct complications from prior procedures. Revision face and neck lifts are more complex by nature of the procedure and require a comprehensive preoperative assessment for enhanced outcomes. In this review, we discuss the preoperative evaluation, surgical challenges encountered, primary face and neck lift deformities, and their surgical management for patients undergoing secondary face and neck lifts.

A Simple Procedure for a Common Problem: Screw/Blade Exchange for Symptomatic Lateral Hardware Associated With Fracture Compression Following Dynamic Cephalomedullary Fixation of Pertrochanteric Hip Fractures

A Simple Procedure for a Common Problem: Screw/Blade Exchange for Symptomatic Lateral Hardware Associated With Fracture Compression Following Dynamic Cephalomedullary Fixation of Pertrochanteric Hip Fractures

The Effects of Clinical and Home-based Physiotherapy Programs in Secondary Head and Neck Lymphedema.

To determine the effects of complex decongestive physiotherapy (CDP) and home programs on external lymphedema, staging of lymphedema, fibrosis, and three-dimensional (3D) surface scanning and volume evaluation in head and neck lymphedema. A prospective randomized controlled study. Twenty-one patients were randomly divided into three groups: CDP (n:7), home program (n:7), and control (n:7). Assessment methods were applied at baseline and 4 weeks later for all groups. MD. Anderson Cancer Center Head and Neck Lymphedema Protocol was implemented to evaluate head and neck external lymphedema, staging of lymphedema, and fibrosis. A 3D scanner and a software were used to determine and calculate the volume of the head and neck region via 3D surface scanning. Head and neck external lymphedema and fibrosis assessment criteria were performed to evaluate visible soft tissue edema and the degree of stiffness. The severity and volume of lymphedema decreased in the CDP program group (P < .05). Besides, external lymphedema and fibrosis at submental region were decreased in both CDP program and home program groups (P < .05). While the benefits of home program are limited, a CDP program may be more effective in the management of lymphedema and fibrosis in patients diagnosed with head and neck cancer. The clinical trial registration number: NCT04286698, date: 02/25/2020, retrospectively registered. 4 Laryngoscope, 131:E1550-E1557, 2021.

Reirradiation with intensity-modulated radiation therapy for recurrent or secondary head and neck cancer: Meta-analysis and systematic review.

To summarize outcomes of reirradiation with intensity-modulated radiotherapy (IMRT) for recurrent or secondary head and neck cancer (HNC). Primary endpoints were 2-year local control (LC) and overall survival (OS). Studies involving only recurrent nasopharyngeal patients with cancer were excluded. A total of 17 studies involving 1635 patients were included. Fourteen (82%) of those were retrospective, and 15 (88%) were from single institution. Reirradiation with IMRT produced pooled 2-year LC and OS rates of 52% (95% confidence interval [CI], 46%-57%) and 46% (95% CI, 41%-50%), respectively. In subgroup analyses, the rate of salvage surgery (<42% vs ≥42%) influenced the pooled 2-year LC rate (45.9% vs 58.5%, P = .011). The pooled rates of late grade ≥ 3 and grade 5 toxicities were 26% (95% CI, 20%-32%) and 3.1% (95% CI, 2%-5%), respectively. Reirradiation with IMRT was an effective modality compared to historical outcomes in the pre-IMRT era.