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Arcovito G, Palomba A, Gallo O, Franchi A. The Histological Background of Recurrence in Laryngeal Squamous Cell Carcinoma: An Insight into the Modifications of Tumor Microenvironment. Cancers (Basel) 2023; 15:3259. [PMID: 37370868 DOI: 10.3390/cancers15123259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Recurrent laryngeal carcinoma presents differences from the primary tumor that largely depend on the treatment. In this article, we review the histologic and molecular treatment-induced changes that may affect the diagnosis of recurrent laryngeal carcinoma, the assessment of predictive markers, and the response to treatment with immune checkpoint inhibitors. Radiotherapy induces profound modifications that are strictly related to necrosis of different tissue components, fibrosis, and damage of the tumor vessels. Postradiotherapy recurrent/persistent laryngeal squamous cell carcinoma typically presents a discohesive growth pattern within a fibrotic background associated with significant changes of the tumor immune microenvironment, with both important immunosuppressive and immunostimulatory effects. Overall, the increase of immunoregulatory cells and immune checkpoints such as CTLA-4, TIM-3, PD-1, and PD-L1 induced by radiotherapy and chemotherapy strongly supports the use of immune checkpoint inhibitors in recurrent/persistent laryngeal carcinoma. Future studies aiming to identify predictive factors of the response to immune checkpoint inhibitors should consider such treatment-induced modifications.
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Affiliation(s)
- Giorgia Arcovito
- Section of Pathology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Annarita Palomba
- Unit of Histopathology and Molecular Diagnostic, Azienda Ospedaliera Universitaria Careggi, 50139 Florence, Italy
| | - Oreste Gallo
- Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy
| | - Alessandro Franchi
- Section of Pathology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
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Licci G, Locatello LG, Maggiore G, Cozzolino F, Caini S, Gallo O. The Same-Up-Down Staging System for Recurrent Early Glottic Cancer. Cancers (Basel) 2023; 15:cancers15030598. [PMID: 36765555 PMCID: PMC9913356 DOI: 10.3390/cancers15030598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
(1) Background: The treatment of recurrent early glottic cancer (rEGC) remains challenging. We wanted to investigate how the oncological outcomes are affected by the initial and recurrent stages, in order to propose our newly developed Same-Up-Down (SUD) staging system. (2) Methods: In our cohort of 258 rEGC patients, we retrospectively assessed the prognostic performances of the rTNM (the TNM staging system for recurrence), CLRSS, CLRSS-2, and SUD staging systems by univariate and multivariate Cox analysis, comparing their predictive capability using Harrell's C-index. (3) Results: The SUD classification satisfactorily predicted both overall survival (p = 0.022) and second-recurrence-free survival (p = 0.024, as same + down vs. upstage) in our cohort. It also outperformed the other three systems in terms of prediction of survival, with an improvement of 1.52%, 1.18%, and 3.96% in the predictive capacity of overall survival, disease-specific survival, and second-recurrence-free survival, respectively. (4) Conclusions: The SUD staging system can efficiently predict survival in rEGC patients, whose prognosis heavily depends on both the initial and recurrent locoregional extension.
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Affiliation(s)
- Giuseppe Licci
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Academic Hospital “Santa Maria della Misericordia”, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Flavia Cozzolino
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 48, 50134 Florence, Italy
- Correspondence:
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Comparison of Oncologic Outcomes Between Radiation Therapy and Transoral Laser Microsurgery for Early Glottic and Supraglottic Squamous Cell Carcinoma; a Retrospective Cohort Study with Literature Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-117504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Laryngeal cancer is known as the second most common airway cancer. These tumors are usually diagnosed early; thus, it is important to choose the optimal treatment modality. Several studies are comparing transoral laser microsurgery (TLM) and radiotherapy in early-stage laryngeal cancer. Due to a paucity of high-quality research and the lack of conclusive randomized prospective studies, standard care for early glottic cancer is still a matter of controversy. Methods: In this retrospective cohort study, T1-T2N0M0 laryngeal cancer patients who underwent TLM or radiotherapy were compared with statistical methods in terms of Recurrence Rate, Organ (Larynx) Preservation Rate, Mortality Rate, and Overall Survival. Results: A total of 123 patients were evaluated in this study, 65 of whom underwent TLM and 58 underwent radiotherapy. There was no significant difference in demographic and medical characteristics of patients. The rate of recurrence was 27.3% in the TLM group and 43.6% in the radiotherapy group. There was no significant difference between the two groups (P = 0.114). Overall mortality rate (5.4% vs 39.6%, P = 0.001), Disease-specific mortality rate (5.5% vs 39.9%, P = 0.001), and aorgan preservation rate (98.5%vs 89.7%, P = 0.035) were all in favor of TLM. Conclusions: TLM appears to be the treatment of choice in patients with early laryngeal cancer due to a better overall survival rate, lower disease-specific mortality rate, and better organ preservation rate than definitive radiotherapy.
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de Carvalho GB, Kohler HF, de Mello JBH, Lira RB, Pellizzon ACDA, Vartanian JG, Kowalski LP. Organ preservation and oncological outcomes in early laryngeal cancer: a propensity score-based study. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2021; 41:317-326. [PMID: 34533535 PMCID: PMC8448187 DOI: 10.14639/0392-100x-n0870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The rates of laryngeal preservation according to therapeutic modality in patients with initial laryngeal squamous cell carcinoma (LSCC) are still controversial. This study evaluated the rates of laryngeal preservation in patients who underwent treatment with surgery or radiotherapy. METHODS This retrospective cohort study evaluated 151 patients with stage I or II LSCC. Ninety-six patients were matched using a propensity-score and outcomes were compared within this group. RESULTS Regarding overall, cancer-specific survival and larynx preservation, no differences were observed according to the therapeutic modalities, but patients who underwent radiotherapy had a higher rate of local recurrence than those who underwent surgery. Patients classified as ASA 3 or 4 and treated with radiotherapy showed a tendency of higher risk of larynx loss. CONCLUSIONS Patients with stage I or II laryngeal tumours can be submitted to surgery or radiotherapy with similar rates of laryngeal preservation.
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Affiliation(s)
| | - Hugo Fontan Kohler
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Julia Bette Homem de Mello
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
- Carcinogenesis Molecular Program, National Institute of Cancer - INCA, Rio de Janeiro, RJ, Brazil
| | - Renan Bezerra Lira
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - José Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
- Head and Neck Surgery Department and LIM 28, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Vander Poorten V, Meulemans J, Beitler JJ, Piazza C, Kowalski LP, Mäkitie AA, Paleri V, Rinaldo A, Robbins KT, Rodrigo JP, Silver CE, Sjögren EV, Strojan P, Takes RP, Ferlito A. Salvage surgery for residual or recurrent laryngeal squamous cell carcinoma after (Chemo)radiotherapy: Oncological outcomes and prognostic factors. Eur J Surg Oncol 2021; 47:2711-2721. [PMID: 34059377 DOI: 10.1016/j.ejso.2021.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
Nonsurgical primary treatment of early and advanced laryngeal squamous cell carcinoma, employing radiotherapy with or without chemotherapy, is considered a standard of care in many centers throughout the world. When patients have persistent or recurrent disease after non-surgical treatment, salvage surgery is frequently the only remaining potentially curative treatment. Depending on the extent of the residual/recurrent disease, different surgical salvage options are at the surgeon's disposal. In selected cases with limited local disease, salvage transoral laser microsurgery, transoral robotic surgery and open partial laryngectomies can be employed to achieve cure while preserving laryngeal function. For more advanced cases total laryngectomy is necessary. Identifying situations with unacceptable results from surgical salvage may guide future therapies.
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Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil; Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki, University Hospital, FI-00029, HUS Helsinki, Finland
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, The Institute of Cancer Research, Brompton Road, London, UK
| | | | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Elisabeth V Sjögren
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Locatello LG, Bruno C, Gallo O. Early glottic cancer recurrence: A critical review on its current management. Crit Rev Oncol Hematol 2021; 160:103298. [PMID: 33716199 DOI: 10.1016/j.critrevonc.2021.103298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Recurrent early glottic cancer (rEGC) poses several issues in terms of timely diagnosis, correct re-staging, and treatment. We want to critically review the latest evidence about rEGC considering its epidemiology, biology, diagnostic challenges, and treatment strategies. METHODS A systematic search of the literature using PubMed from 1990 to October 31, 2020 was performed. RESULTS There are many different treatment options available (open surgery, transoral mini-invasive surgery, radiotherapy), and many factors related to the patient's status and previous treatments must be considered when planning the best management strategy for rEGC. While its overall prognosis remains satisfactory, it is of the utmost importance to appreciate all the clinical implications derived from the choice of the initial therapeutic modality, and from a correct primary and recurrent staging. CONCLUSION The balance between oncological and voice and swallowing functions represents the fundamental principle underlying rEGC management. Future studies should focus on molecular profiling of rEGC, and on the results of the emerging radiation delivery techniques and mini-invasive procedures.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Gallo O, Locatello LG. All that glitters is not gold: Clinical implications from the genetic analysis of head and neck cancer recurrences. Oral Oncol 2021; 117:105187. [PMID: 33582000 DOI: 10.1016/j.oraloncology.2021.105187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy.
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Carvalho GBD, Kohler HF, Lira RB, Vartanian JG, Kowalski LP. Survival results of 3786 patients with stage I or II laryngeal squamous cell carcinoma: a study based on a propensity score. Braz J Otorhinolaryngol 2020; 88:337-344. [PMID: 32771434 PMCID: PMC9422720 DOI: 10.1016/j.bjorl.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/08/2020] [Accepted: 06/20/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Laryngeal squamous cell carcinoma is the second most prevalent malignancy among head and neck tumors, and the treatment of patients with stage I or II disease can be performed with surgery or radiation therapy. National population studies describing therapeutic results comparing these modalities are unusual, but they can be very important to direct treatment guidelines. Objective To evaluate the survival results of patients with laryngeal squamous cell carcinoma at clinical stages I or II, according to the main therapeutic modalities used. Methods Cross-sectional, population-based study using the database of Fundação Oncocentro de São Paulo from January 2000 to March 2019. Inclusion criteria were patients with laryngeal squamous cell carcinoma in clinical stages cT1-2N0. To compensate for the non-random allocation of patients and the imbalance between confounding variables between groups, we used the propensity score methodology. Results A total of 3786 patients met the inclusion criteria. Regarding the cT stage, there were 2171 patients (57.3%) with cT1 tumors. Patients in the public health system had a longer time between diagnosis and treatment (p < 0.001). The analysis by propensity score showed that patients treated with surgery had a tendency towards better disease-specific survival (p = 0.012). Comparing radiotherapy alone versus its combination with radiochemotherapy, radiotherapy alone showed a tendency towards a better survival rate (p < 0.001). Conclusion Analysis by propensity score identified better results for disease-specific survival in patients with laryngeal squamous cell carcinoma at clinical stages I and II treated by surgery when compared to radiotherapy.
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Affiliation(s)
- Genival Barbosa de Carvalho
- A C Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil.
| | - Hugo Fontan Kohler
- A C Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - Renan Bezerra Lira
- A C Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - José Guilherme Vartanian
- A C Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- A.C. Camargo Cancer, Centro de Referência de Tratamento dos Pacientes com Tumores de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia de Cabeça e Pescoço e LIM 28, São Paulo, SP, Brazil
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Locatello LG, Maggiore G, Bruno C, Gallo O. Transoral laryngeal videosurgery under the direct guidance of narrow band imaging: a preliminary report. Lasers Med Sci 2020; 35:2065-2068. [PMID: 32430660 DOI: 10.1007/s10103-020-03022-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/16/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
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Gallo O, Cannavicci A, Bruno C, Maggiore G, Locatello LG. Survival Outcomes and Prognostic Factors of Open Partial Laryngeal Surgery: A Thirty Years' Experience. Ann Otol Rhinol Laryngol 2020; 129:669-676. [PMID: 32028778 DOI: 10.1177/0003489420905616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Open partial laryngeal surgery (OPLS) represents a wide array of procedures that can be fitted to treat different types of laryngeal cancer (LC). We would like to present our 30-years' institutional experience, to analyze survival outcomes and to critically discuss prognostic factors. METHODS We reviewed all cases of OPLS performed at our Institution from 1982 to 2016 for LC. Survival analysis by Kaplan-Meier estimate was performed and prognostic variables by multivariate analysis were identified. RESULTS Mean follow-up time was 68.3 months, 30-day mortality 0.2%, subsequent functional total laryngectomy (TL) was 1.01%. Over 80% of cases were stage I to II. We had 25 local, 62 regional and eight distant recurrences. Local control was 94.9%, overall survival (OS) was 83.4% and disease-specific survival (DSS) was 87.7%. The two major risk factors significantly associated with the risk of death were cT and cN stage. CONCLUSIONS: We have confirmed that OPLS represents an oncologically sound option in the treatment of LC despite the emergence of non-surgical strategies and new transoral mininvasive techniques. Our results highlight that accurate staging, correct selection of the patient and a strong surgical expertise are of paramount importance in this type of surgery.
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Affiliation(s)
- Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Angelo Cannavicci
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
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