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Lechien JR, Chiesa-Estomba CM, Baudouin R, Hans S. Accuracy of ChatGPT in head and neck oncological board decisions: preliminary findings. Eur Arch Otorhinolaryngol 2024; 281:2105-2114. [PMID: 37991498 DOI: 10.1007/s00405-023-08326-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To evaluate the ChatGPT-4 performance in oncological board decisions. METHODS Twenty medical records of patients with head and neck cancer were evaluated by ChatGPT-4 for additional examinations, management, and therapeutic approaches. The ChatGPT-4 propositions were assessed with the Artificial Intelligence Performance Instrument. The stability of ChatGPT-4 was evaluated through regenerated answers at 1-day interval. RESULTS ChatGPT-4 provided adequate explanations for cTNM staging in 19 cases (95%). ChatGPT-4 proposed a significant higher number of additional examinations than practitioners (72 versus 103; p = 0.001). ChatGPT-4 indications of endoscopy-biopsy, HPV research, ultrasonography, and PET-CT were consistent with the oncological board decisions. The therapeutic propositions of ChatGPT-4 were accurate in 13 cases (65%). Most additional examination and primary treatment propositions were consistent throughout regenerated response process. CONCLUSIONS ChatGPT-4 may be an adjunctive theoretical tool in oncological board simple decisions.
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Affiliation(s)
- Jerome R Lechien
- Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Paris Saclay, Paris, France.
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France.
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium.
| | - Carlos-Miguel Chiesa-Estomba
- Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Robin Baudouin
- Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Paris Saclay, Paris, France
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France
| | - Stéphane Hans
- Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Paris Saclay, Paris, France
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France
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Wierzbicka M, Markowski J, Pietruszewska W, Burduk P, Mikaszewski B, Rogowski M, Składowski K, Milecki P, Fijuth J, Jurkiewicz D, Niemczyk K, Maciejczyk A. Algorithms of follow-up in patients with head and neck cancer in relation to primary location and advancement. Consensus of Polish ENT Society Board and Head Neck Experts. Front Oncol 2023; 13:1298541. [PMID: 38152365 PMCID: PMC10751934 DOI: 10.3389/fonc.2023.1298541] [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: 09/21/2023] [Accepted: 10/31/2023] [Indexed: 12/29/2023] Open
Abstract
Summary The algorithm of follow-up in patients with head and neck cancer (HNC) has been prepared by a board of Polish Head Neck and Oncology Experts. The aim of this research is to focus on the specificity of HNC monitoring, to review the current trends in follow-up, and to adapt the evidence-based medicine international standards to the capabilities of the local healthcare service. Materials and methods The first methodological step was to categorize HNCs according to the estimated risk of failure after the adequate first-line treatment and according to the possibility of effective salvage treatment, resulting in improved overall survival. The final method used in this work was to prepare an authors' original monitoring algorithm for HNC groups with a high, moderate, and low risk of recurrence in combination with a high or low probability of using an effective salvage. Results Four categories were established: Ia. low risk of recurrence + effective organ preservation feasible; Ib. low risk of recurrence + effective salvage feasible; II. moderate risk of recurrence + effective salvage feasible; III. high risk of recurrence + effective salvage feasible; and IV. high risk of recurrence + no effective salvage feasible. Follow-up visit consisting of 1. ENT examination + neck ultrasound, 2. imaging HN tests, 3. chest imaging, 4. blood tests, and 5. rehabilitation (speech and swallowing) was scheduled with a very different frequency, at the proposed monthly intervals, tailored to the needs of the group. The number of visits for individual groups varies from 1 to 8 in the first 2 years and from 1 to 17 in the entire 5-year monitoring period. Group IV has not been included in regular follow-up, visits on own initiative of the patient if symptomatic, or supportive care needs, having in mind that third-line therapy and immune checkpoint inhibitors are available. Conclusion Universal monitoring algorithm for HNC four groups with a high, moderate, and low risk of recurrence after the adequate treatment in combination with a high or low probability of using an effective salvage is an innovative approach to redeploying system resources and ensuring maximum benefit for patients with HNC.
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Affiliation(s)
- Małgorzata Wierzbicka
- Department of Otolaryngology, Regional Specialist Hospital Wroclaw, Research & Development Centre, Wroclaw, Poland
- Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Jarosław Markowski
- Department of Laryngology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Wioletta Pietruszewska
- Department of Otolaryngology Head Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - Paweł Burduk
- Department of Otolaryngology Phoniatrics and Audiology, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Bogusław Mikaszewski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Krzysztof Składowski
- Radiation and Clinical Oncology Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Piotr Milecki
- Department of Radiotherapy I, The Greater Poland Cancer Centre, Poznan, Poland
| | - Jacek Fijuth
- Department of Radiation Therapy, Oncology Chair, Medical University of Lodz, Lodz, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Adam Maciejczyk
- Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
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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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Hardman JC, Harrington K, Roques T, Sood S, Jose J, Lester S, Pracy P, Simo R, Repanos C, Stafford F, Jennings C, Winter SC, Wheatly H, Homer J, Kumar BN, Paleri V. Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative. BMC Med Res Methodol 2022; 22:189. [PMID: 35818027 PMCID: PMC9275134 DOI: 10.1186/s12874-022-01667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. METHODS A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. RESULTS Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached 'strong agreement' (n = 25, 2, 0 for each round, respectively), a single statement achieved 'agreement' only (round 3), and 'no agreement' could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. CONCLUSIONS The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.
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Affiliation(s)
- John C Hardman
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Tom Roques
- Department of Oncology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sanjai Sood
- Department of Otolaryngology, Head and Neck Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jemy Jose
- Department of Otolaryngology, Head and Neck Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Shane Lester
- Department of Otolaryngology, Head and Neck Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Paul Pracy
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ricard Simo
- Department of Otolaryngology, Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Costa Repanos
- Department of Otolaryngology, Head and Neck Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Frank Stafford
- Department of Otolaryngology, Head and Neck Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Chris Jennings
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stuart C Winter
- Department of Otolaryngology, Head and Neck Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hugh Wheatly
- Department of Otolaryngology, Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jarrod Homer
- Department of Otolaryngology, Head and Neck Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - B Nirmal Kumar
- Department of Otolaryngology, Head and Neck Surgery, Wrightington Wigan & Leigh NHS Foundation Trust, Wigan, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.
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Laryngectomy-free survival after salvage partial laryngectomy: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:3021-3027. [PMID: 35039895 DOI: 10.1007/s00405-022-07257-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Radiotherapy (RT) is widely used for early glottic cancer. Patients failing this treatment are referred to surgical management of their disease. Salvage partial laryngectomy (SPL) has the advantage of preserving laryngeal function with total laryngectomy (TL) remaining as a last resort. The purpose of this study was to determine the efficacy of SPL in preventing total laryngectomy, following failed RT, for early glottic cancer. METHODS A meta-analysis of all published English literature was performed. All publications that included patients undergoing SPL were reviewed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines. The search strategy identified 154 relevant articles. A total of 15 retrospective studies that included 323 suitable patients were subsequently analyzed in this meta-analysis. The main outcome measure was the rate of laryngectomy-free survival (LFS) following SPL. The indications for salvage TL (i.e., disease recurrence and poorly functional larynxes) as well as subgroup analyses for open and trans-oral SPLs were also calculated. RESULTS The overall rate of LFS following SPL was 81.2% (fixed effects model range: 75.7-86.8%). Salvage TL following SPL were performed in 96.8% due to disease recurrence and in 3.2% to poorly functional larynxes. A subgroup analysis showed a 90.4% LFS after open SPL and 78.6% following trans-oral SPL. CONCLUSION A high rate of successful salvage partial laryngectomies, regardless of surgical technique, is to be anticipated in well-selected patients after RT failure.
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