Modern radiotherapy for head and neck cancer

Comparison between flattening filter and flattening filter-free photon beams in head and neck cancer patients using volumetric modulated arc therapy technique

This study aimed to evaluate the dosimetric and clinical outcomes of flattening filter (FF) versus flattening filter-free (FFF) beams in head and neck cancer (HNC) patients treated with volumetric modulated arc therapy (VMAT). Twenty-four patients with 70/59.4/54 Gy dose prescribed in 33 fractions with simultaneous integrated boost treatment were retrospectively analyzed to compare treatment delivery efficiency, target coverage, sparing of organs at risk (OARs), and remaining volume at risk (RVR) in two HNC groups (nasopharyngeal and oropharyngeal). Study findings indicate that FFF beams significantly reduce conformity index (CI) and homogeneity index (HI) by p-values (0.008, < 0.001, 0.002, 0.015) for PTV70 CI, PTV70 HI, PTV60 HI, and PTV54 HI, respectively. Gradient dose was significantly improved in FFF mode, and monitor units (MU) were increased (p < 0.001). In terms of OARs, the study revealed superior performance of FFF in most of structures and RVR especially in the oropharyngeal group. OARs sparing is notably enhanced for structures distant from the target (eyes, lenses, and optic pathway). Additionally, brainstem sparing shows significant improvement in oropharyngeal cases when using FFF plans (p = 0.046); however, FF plans demonstrate superior results in nasopharyngeal cases (p = 0.026). It is concluded that both FF and FFF photon beams are effective for treating HNC patients. VMAT plans using FFF mode offer clinically acceptable outcomes, demonstrating a significant reduction in gradient and integral dose. However, FF plans exhibit superior target homogeneity and reduced MU requirements. Therefore, the choice between these techniques should be based on a comprehensive evaluation of all relevant parameters.

Transoral Laser Microsurgery Versus Radiotherapy for T1-T2 Glottic Cancer with Anterior Commissure Involvement: A Systematic Review and Meta-Analysis

OBJECTIVE

To identify the most effective treatment modality for achieving favorable outcomes in early glottic tumors with anterior commissure involvement (ACI).

DATA SOURCES

PubMed, Embase, Web of Science, and ScienceDirect.

REVIEW METHODS

Random-effects proportional meta-analysis model is used to evaluate the oncological and functional outcomes of transoral laser microsurgery (TLM) versus radiation therapy (RT) in early glottic (T1-T2) cancer with ACI.

RESULTS

From a total of 736 studies, 40 studies were included, comprising 2666 early glottic tumor patients with ACI. TLM (52%) and upfront RT (48%) were the primary treatment groups. TLM had better 5-year overall survival (OS) (84.5% [80.3%-88.0%] vs. 79.4% [75.7%-82.7%]). Similarly, TLM-treated patients had better 3-year pooled disease-free survival (DFS) compared with RT-treated patients (82.7% [77.1%-87.1%] vs. 73.3% [23.8%-96.0%]). TLM exhibited a better 5-year local control rate (LCR) than RT (77.2% vs. 71.6%). In our temporal analysis, TLM had a higher 5-year LCR than RT (78.2% vs. 63.5%) in 2001-2012, with similar rates in 2013-2024 (76.8% vs. 78.4%). TLM-treated patients had higher laryngeal preservation rates compared with RT patients (93% [90.6%-94.8%] vs. 87.6% [82.8%-91.2%]).

CONCLUSIONS

Our meta-analysis is the first in the literature to compare the outcomes between TLM and RT-treated patients with ACI in early glottic tumors. TLM-treated patients appear to have superior 5-year OS and laryngeal preservation compared with upfront RT-treated patients. However, both TLM and RT exhibited comparable oncological outcomes in early glottic tumor patients with ACI during the recent period from 2013 to 2024. Laryngoscope, 2025.

Optimising (re-)irradiation for locally recurrent head and neck cancer: impact of dose-escalation, salvage surgery, PEG tube and biomarkers on oncological outcomes-a single centre analysis

INTRODUCTION

Locoregional recurrence (LR) is common in locally advanced head and neck cancer (HNSCC), posing challenges for treatment. We analysed outcome parameters and toxicities for patients being treated with radiotherapy (RT) for LR-HNSCC and investigated patient and disease related prognostic factors in this prognostically unfavourable group.

METHODS

This analysis includes 101 LR-HNSCC patients treated with RT, radio-chemotherapy (RCT) or radio-immunotherapy (RIT) between 2010 and 2018 at a high-volume tertiary centre. Patient characteristics, tumour and treatment details were retrospectively collected. Overall survival (OS), progression-free survival (PFS) and toxicities according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0 were assessed.

RESULTS

62% of patients were radiotherapy-naïve (initial RT group) while 38% were re-irradiated at site of LR (re-RT group). Median OS for initial RT was 24 months, for re-RT 12 months (p < 0.01). In the RCT subgroup, patients with initial RT had significantly longer OS with 35 months compared to re-RT 12 months (p < 0.05). Patients with UICC grade IV tumours and percutaneous endoscopic gastrostomy (PEG) tube had significantly shorter OS in multivariate analysis: initial RT 13 vs. re-RT 32 months and initial RT 12 vs. re-RT 32 months respectively. Salvage surgery before RT at recurrence was a positive prognostic factor for OS (initial RT 35 vs. re-RT 12 months). Other significant factors for longer OS in univariate analysis included low inflammatory status (Glasgow Prognostic Score 0) and radiation doses ≥ 50 Gy. We detected 37 (15%) ≥ CTCAE Grade 3 events for initial RT and 19 (15%) for re-RT patients.

CONCLUSION

In this analysis, we identified key prognostic factors including PEG tube and inflammation status that could guide treatment decision. Our findings suggest salvage surgery as preferred treatment option with postoperative RT at LR. Adverse events due to re-RT were acceptable. A radiation dose of ≥ 50 Gy should be administered to achieve better outcomes.

Preventing radiation-induced dysphagia and trismus in head and neck cancer-A randomized controlled trial

BACKGROUND

Radiation-induced dysphagia and restricted mouth opening are common problems among patients with head and neck cancer. The aim of the present randomized controlled trial was to determine if an exercise protocol could prevent swallowing and mouth opening impairment.

METHODS

Eighty-nine participants were randomly assigned to either an active group performing preventive swallowing and mouth opening exercises (n = 45) or to a control group (n = 44). Outcome measures were collected at baseline before radiotherapy and approximately 1-month post-treatment. Primary endpoints were changes in swallowing function according to the Penetration Aspiration Scale and mouth opening ability measured in millimeters. Intention-to-treat analysis was used.

RESULTS

Swallowing function and mouth opening deteriorated in both groups, with no statistically significant positive effect of the protocol detected at follow-up. Among patients who completed >75% of exercises, there was a trend toward better outcomes.

CONCLUSIONS

Preventive exercises did not improve short-term swallowing function and mouth opening after radiotherapy.

Effects of ionizing radiation on osteoblastic cells: In vitro insights into the etiopathogenesis of osteoradionecrosis

OBJECTIVE

This in vitro study aimed to analyze the effects of ionizing radiation on immortalized human osteoblast-like cells (SaOS-2) and further assess their cellular response in co-culture with fibroblasts. These analyses, conducted in both monoculture and co-culture, are based on two theoretical models of osteoradionecrosis - the theory of hypoxia and cellular necrosis and the theory of the radiation-induced fibroatrophic process.

DESIGN

SaOS-2 cells were exposed to ionizing radiation and evaluated for cell viability, nitric oxide (NO) production, cellular morphology, wound healing, and gene expression related to the PI3K-AKT-mTOR pathway. SaOS-2 cells were co-cultured with human gingival fibroblasts using transwell membranes and subjected to the same irradiation. Subsequent evaluations included cell viability, NO levels, and gene expression analysis.

RESULTS

After 24 hours, a 16 Grays dose reduced cell viability by 40 % (p < 0.0001) and increased NO production by 14 % (p < 0.05). Additionally, the nuclear area was enlarged by 18 % (p < 0.01), and the nucleus-to-cytoplasm ratio in non-stimulated cells was around 33 %, but after radiation, this ratio increased to nearly 100 %. Also, there was a delay in wound closure of 6.6 % (p < 0.0001) post-irradiation and a trend toward down-regulation of genes related to the PI3K-AKT-mTOR pathway (p > 0.05). Under co-culture conditions, the dose of 16 Grays did not affect cell viability but increased NO production by 14 % (p < 0.001) and tended to up-regulate markers of the PI3K-AKT-mTOR pathway (p > 0.05).

CONCLUSIONS

The findings of this study demonstrate that an irradiation dose of 16 Grays induces a reduction in cell viability, an increase in NO production, and various other metabolic and morphologic effects on osteoblastic cells while emphasizing the impact of intercellular interaction in the etiopathogenesis.

Impact of radiotherapy-related late toxicities of skin and soft tissue in the neck on quality of life in head and neck cancer patients: a multi-institutional observational study in Japan

PURPOSE

This multi-institutional observational study aimed to assess the incidence, severity, and impact of radiotherapy-related late toxicities of the cervical skin and soft tissue in head and neck cancer patients. We also explored patient interest in fat grafting as a potential treatment for skin and soft tissue sequelae.

METHODS

This study was conducted across 19 institutions in Japan. The study involved head and neck cancer patients who received ≥ 60 Gy of cervical radiotherapy concomitant with a history of neck dissection and were free of cancer recurrence ≥ 3 years after the final treatment. Consenting outpatients completed a self-administered questionnaire to collect data on symptom severity and the attending outpatient physicians reported data on demographics and treatments in a case report form.

RESULTS

A total of 222 patients were enrolled. The incidence proportion of late cervical skin and soft tissue toxicities was 96%, with 32% of patients reporting their symptoms as severe, and 69% of patients reporting an impact on quality of life (QOL). An interest in or consideration of fat grafting was reported by 34% of patients, with a greater desire among those with severe symptoms.

CONCLUSION

This study elucidated the incidence, severity, and life impact of late toxicities affecting the cervical skin and soft tissue after radiotherapy for head and neck cancer. These late toxicities were highly prevalent and significantly impacted QOL. There is a substantial demand for new treatments, such as fat grafting, to address these complications and enhance the QOL for survivors of head and neck cancer.

Biomineralization in magnetotactic bacteria: From diversity to molecular discovery-based applications

The synthesis of magnetic nanoparticles (Fe3O4 or Fe3S4) within the membrane-bound organelles known as magnetosomes in magnetotactic bacteria (MTB) is a remarkable example of microbial-controlled biomineralization. Studying MTB biomineralization is crucial not only for understanding the origin and evolution of magnetoreception and bacterial organelles but also for advancing biotechnological and biomedical applications of MTB cells and magnetosomes. After decades of research, MTB have revealed unexpected diversity and complexity. The mechanisms underlying magnetosome biomineralization in MTB have been continuously documented using a few model MTB strains. In this review, we provide an overview of recent findings related to MTB diversity and focus primarily on the current understanding of magnetosome biosynthesis. Additionally, we summarize the growing biotechnological and biomedical applications derived from molecular studies of MTB and their magnetosomes.

Automated treatment planning with deep reinforcement learning for head-and-neck (HN) cancer intensity modulated radiation therapy (IMRT)

Purpose.To develop a deep reinforcement learning (DRL) agent to self-interact with the treatment planning system to automatically generate intensity modulated radiation therapy (IMRT) treatment plans for head-and-neck (HN) cancer with consistent organ-at-risk (OAR) sparing performance.Methods.With IRB approval, one hundred and twenty HN patients receiving IMRT were included. The DRL agent was trained with 20 patients. During each inverse optimization process, the intermediate dosimetric endpoints' values, dose volume constraints' values and structure objective function losses were collected as the DRLstates. By adjusting the objective constraints asactions, the agent learned to seek optimal rewards by balancing OAR sparing and planning target volume (PTV) coverage. Reward computed from current dosimetric endpoints and clinical objectives were sent back to the agent to update action policy during model training. The trained agent was evaluated with the rest 100 patients.Results.The DRL agent was able to generate a clinically acceptable IMRT plan within12.4±3.1min without human intervention. DRL plans showed lower PTV maximum dose (109.2%) compared to clinical plans (112.4%) (p< .05). Average median dose of left parotid, right parotid, oral cavity, larynx, pharynx of DRL plans were 15.6 Gy, 12.2 Gy, 25.7 Gy, 27.3 Gy and 32.1 Gy respectively, comparable to 17.1 Gy, 15.7 Gy, 24.4 Gy, 23.7 Gy and 35.5 Gy of corresponding clinical plans. The maximum dose of cord + 5 mm, brainstem and mandible were also comparable between the two groups. In addition, DRL plans demonstrated reduced variability, as evidenced by smaller 95% confidence intervals. The total MU of the DRL plans was 1611 vs 1870 (p< .05) of clinical plans. The results signaled the DRL's consistent planning strategy compared to the planners' occasional back-and-forth decision-making during planning.Conclusion.The proposed DRL agent is capable of efficiently generating HN IMRT plans with consistent quality.

Automatic Treatment Planning for Radiation Therapy: A Cross-Modality and Protocol Study

Purpose

This study investigated the applicability of 3-dimensional dose predictions from a model trained on one modality to a cross-modality automated planning workflow. Additionally, we explore the impact of integrating a multicriteria optimizer (MCO) on adapting predictions to different clinical preferences.

Methods and Materials

Using a previously created 3-stage U-Net in-house model trained on the 2020 American Association of Physicists in Medicine OpenKBP challenge data set (340 head and neck plans, all planned using 9-field static intensity modulated radiation therapy [IMRT]), we retrospectively generated dose predictions for 20 patients. These dose predictions were, in turn, used to generate deliverable IMRT, VMAT, and tomotherapy plans using the fallback plan functionality in Raystation. The deliverable plans were evaluated against the dose predictions based on primary clinical goals. A new set of plans was also generated using MCO-based optimization with predicted dose values as constraints. Delivery QA was performed on a subset of the plans to assure clinical deliverability.

Results

The mimicking approach accurately replicated the predicted dose distributions across different modalities, with slight deviations in the spinal cord and external contour maximum doses. MCO optimization significantly reduced doses to organs at risk, which were prioritized by our institution while maintaining target coverage. All tested plans met clinical deliverability standards, evidenced by a gamma analysis passing rate >98%.

Conclusions

Our findings show that a model trained only on IMRT plans can effectively contribute to planning across various modalities. Additionally, integrating predictions as constraints in an MCO-based workflow, rather than direct dose mimicking, enables a flexible, warm-start approach for treatment planning, although the benefit is reduced when the training set differs significantly from an institution's preference. Together, these approaches have the potential to significantly decrease plan turnaround time and quality variance, both at high-resource medical centers that can train in-house models and smaller centers that can adapt a model from another institution with minimal effort.

Effect of a 1.1% NaF toothpaste containing Sr/F-doped bioactive glass on irradiated demineralized dentin: an in vitro study

OBJECTIVE

Patients receiving head and neck radiation are at high risk for radiation caries. This study aimed to evaluate the remineralizing effects of an experimental 1.1% NaF (5000 ppmF) toothpaste containing Sr/F-doped bioactive glass nanoparticles (BAG or B) on demineralized irradiated dentin.

MATERIALS AND METHODS

Fluoride concentration and pH stability of materials upon mixing with water were assessed using a fluoride-specific electrode (n = 3) for up to 3 months. Elemental release of materials in water was determined using ICP-OES (n = 3). Fourteen extracted molars were irradiated with a cumulative dose of 70 Gy. Each tooth was sectioned into 4 specimens (n = 14/group), demineralized, and subjected to pH cycling for 14 days. Groups were treated with Prevident (PV), E5000, E5000B, and deionized water twice daily. Remineralization was assessed using ATR-FTIR (mineral-to-collagen ratio) (n = 14). Mineral precipitation was additionally examined with SEM-EDX. The in vitro cytotoxicity of the materials on L929 mouse fibrosarcoma was evaluated with the MTT test (n = 3). Kruskal-Wallis test, followed by Dunn's procedure, was used to compare the data between groups.

RESULT

PV demonstrated greater pH and fluoride release stability than the experimental materials. E5000B exhibited a slight reduction of fluoride release (p < 0.01, R²=0.656) and an increase in pH with time (p = 0.006, R²=0.233). The highest increase in mineral-to-collagen ratio at 14 days was detected with PV (p < 0.05). E5000B also showed a significantly higher ratio than E5000 (p = 0.014). SEM-EDX detected mineral precipitation on dentin treated with PV and E5000B but not in E5000 and DI. The cell viability of PV (56%) was significantly lower than that of E5000 (94%) and E5000B (89%) (p < 0.05).

CONCLUSION

The use of 5000 ppm fluoride toothpaste enhanced the remineralization of irradiated demineralized dentin, highlighting a potentially valuable strategy for preventing radiation caries. Adding bioactive glass further promoted remineralization but may require formulation adjustments to maintain toothpaste stability for clinical use.

Lymph Node Metastasis of Head and Neck Cancer: A Bibliometric Analysis From 2000 to 2022

Lymph node metastasis (LNM) is a significant prognostic factor in head and neck cancer (HNC) patients. To obtain a better understanding of the worldwide prevalence and current research status, the authors conducted a comprehensive bibliometric analysis of literature published from 2000 to 2022. The contributions of institutions, journals, countries or regions, cited literature, keywords, and authors in global publications were concisely summarized using the COOC and VosViewer software tools. The data were extracted from the expansive Web of Science database. A total of 5478 papers were collected for analysis, and the number of publications has exhibited exponential growth over the last 22 years. The United States emerged as the most productive country, closely followed by China. Noteworthy institutions for their high productivity include the Sloan-Kettering Cancer Center, Sun Yat-Sen University, and the University of Texas MD Anderson Cancer Center. The Head & Neck and Oral Oncology journals lead in terms of publication volume. The main areas of research in this field were prognostication, radiotherapy, survival rates, sentinel lymph node biopsy, and the human papillomavirus. In addition, the analysis of author collaboration networks yielded valuable insights into the collaborative relationships within this research domain. Our research has identified the primary characteristics of highly impactful studies on LNM in HNC, providing significant insights into the advancements made in this area of research.

Definitive radiotherapy and trismus in HNC patients: A critical review

INTRODUCTION

Trismus is a potentially critical morbidity following curative-intended radiotherapy in head and neck cancer patients. However, in this setting, evidence regarding this side effect remains to be fully defined, particularly in terms of dosimetric parameters.

MATERIALS AND METHODS

Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used.

RESULTS

This paper contains a narrative report and a critical discussion of the evidence on radiation-induced trismus in the literature, particularly the dosimetric concerns.

CONCLUSIONS

The treatment goal should be to maintain high cure rates and limit the onset of complications. Further evaluations of dosimetric measures and clinical outcomes are warranted to identify patients at higher risk to target treatment tailoring.

Artificial Intelligence in Head and Neck Cancer Diagnosis: A Comprehensive Review with Emphasis on Radiomics, Histopathological, and Molecular Applications

The present review discusses the transformative role of AI in the diagnosis and management of head and neck cancers (HNCs). Methods: It explores how AI technologies, including ML, DL, and CNNs, are applied in various diagnostic tasks, such as medical imaging, molecular profiling, and predictive modeling. Results: This review highlights AI's ability to improve diagnostic accuracy and efficiency, particularly in analyzing medical images like CT, MRI, and PET scans, where AI sometimes outperforms human radiologists. This paper also emphasizes AI's application in histopathology, where algorithms assist in whole-slide image (WSI) analysis, tumor-infiltrating lymphocytes (TILs) quantification, and tumor segmentation. AI shows promise in identifying subtle or rare histopathological patterns and enhancing the precision of tumor grading and treatment planning. Furthermore, the integration of AI with molecular and genomic data aids in mutation analysis, prognosis, and personalized treatment strategies. Conclusions: Despite these advancements, the review identifies challenges in AI adoption, such as data standardization and model interpretability, and calls for further research to fully integrate AI into clinical practice for improved patient outcomes.

Effects of radiotherapy dose and application time on the load-to-failure values of teeth filled with different sealers

BACKGROUND

The materials used in root canal filling and radiotherapy (RT) application can affect the load-to-failure of the teeth. This study aimed to compare the load-to-failure of the teeth filled with AH Plus (AHP) or AH Plus bioceramic (AHPB) before or after 60 Gy- and 70 Gy-dose radiotherapy.

MATERIALS AND METHODS

One hundred and ten maxillary incisors were endodontically prepared up to ProTaper Next X4 instruments. The teeth were randomly divided into 5 main groups as: non-irradiated, root canal treatment (RCT) before 60 Gy radiotherapy, RCT before 70 Gy radiotherapy, RCT after 60 Gy radiotherapy, RCT after 70 Gy radiotherapy. These groups were divided into 2 subgroups for filling material: AHP ve AHPB. After filling and radiotherapy procedures, the teeth were fixed on the thermoplastic mask plane. The plane were placed in the middle of a rectangular prism shaped glass phantom, and irradiated via a linear accelerator device. The teeth were then embedded in cylindrical acrylic blocks and the force (N) that caused the fracture was recorded under the Universal testing device. Student t-test was used for statistical comparisons. Statistical significance level was determined as p < 0.05.

RESULTS

After 70 Gy dose radiotherapy, the group filled with AHPB showed statistically significantly lower fracture strength than the group filled with AHP (p < 0.05). In the control group, before 60 Gy RT group, after 60 Gy RT group, and before 70 Gy RT group, the sealers had statistically significantly similar load-to-failure. (p > 0.05).

CONCLUSION

The group filled with AHPB caused a lower fracture strength than the group filled with AHP following a 70 Gy dose of RT. The sealers in the control group, before 60 Gy RT group, after 60 Gy RT group, and before 70 Gy RT group exhibited comparable load-to-failure values.

Gingerol acts as a potent radiosensitizer in head and neck squamous cell carcinoma

Treatment options for advanced head and neck squamous cell carcinoma (HNSCC) are limited and often cause severe toxicity and debilitating long-term impacts. Developing effective and safer treatments is warranted. Several plant extracts have shown their effectiveness, but a comprehensive comparison between plant extracts in HNSCC has not been reported. Our aim was to investigate the effect of different plant extracts on the proliferation and viability of HNSCC cell lines. In addition, we investigated the efficacy of combining cytotoxic plant extracts with radiation. Since RT is a cornerstone in the treatment and management of HNSCC, it is desirable to enhance its efficacy through combination with cytotoxic agents that have minimal side effects. HNSCC cell lines were treated with various plant extracts at different concentrations. MTT assays were performed to identify the most potent anti-tumor plant extract. Colony-formation assays were performed to determine the radiosensitization effect. To investigate the effect on migration, transwell migration assays were performed. Annexin V staining was performed to analyze cell apoptosis. 6-gingerol resulted in the most significant dose-dependent inhibition in all cell lines compared to other plant extracts. Colony-formation assays showed a significant radiosensitizing effect when 6-gingerol was combined with radiation. In addition, the combination of 6-gingerol with radiation resulted in a significant decrease in HNSCC cell migration. Mechanistically, Annexin V staining showed that the combination of 6-gingerol and RT induces a synergistic apoptotic effect in MOC1, MOC2 and SCC9 cells compared to RT alone. In conclusion, 6-gingerol enhances the effect of radiation in HNSCC cell lines and could be a suitable candidate for combination therapy in HNSCC.

Volumetric measurement to evaluate treatment response to induction chemotherapy on MRI outperformed RECIST guideline in outcome prediction in advanced nasopharyngeal carcinoma

BACKGROUND

Treatment response evaluated by tumour size change is an important indicator for outcome prediction. Advanced nasopharyngeal carcinoma (adNPC) grows irregularly, and so the unidimensional measurement may not be accurately applied to adNPC for outcome prediction. This study aimed to evaluate values of unidimensional and volumetric measurements for treatment response to induction chemotherapy (IC) for outcome prediction in adNPC and compared the values with that of RECIST 1.1 guideline.

MATERIALS AND METHODS

Pre-treatment and post-IC magnetic resonance images (MRIs) from 124 patients with stage III-IVA NPC were retrospectively reviewed. Sums of the maximum unidimensional diameters (D) and volumes of the targeted tumours (primary tumour and two largest metastatic lymph nodes) on the pre- (Dpre and Vpre) and post-IC MRIs (Dpost-IC and Vpost-IC) and percentage changes in D (Δ D%) and V (ΔV%) between two scans were calculated and correlated with disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and distant metastases-free survival (DMFS) using Cox regression analysis. Area under the curves (AUCs) of independent measurements and RECIST groups (RECIST response and non-response groups) for predicting disease recurrence, locoregional recurrence, and distant metastases, respectively, were calculated and compared using the DeLong test.

RESULTS

Univariable analysis showed correlations between high Dpost-IC with poor DFS and DMFS (P < 0.05), but not with LRRFS (P = 0.07); high Vpost-IC and low ΔV% (less decrease in volume on post-IC) with poor DFS, LRRFS, and DMFS (P < 0.05); and no correlations between Dpre, ΔD%, and Vpre and the outcomes (P > 0.05). Multivariable analysis showed that ΔV% was the only independent measurement for outcomes (P < 0.05). Compared with RECIST groups, ΔV% of 47.9% (median value) showed a higher AUC for disease recurrence (0.682 versus 0.526, P < 0.01) and for locoregional recurrence (0.782 versus 0.585, P < 0.01), but not for distant metastases (0.593 versus 0.518, P = 0.26).

CONCLUSIONS

Volumetric measurement to evaluate treatment response to IC outperformed unidimensional measurement and RECIST guideline in outcome prediction in adNPC.

Clinical outcomes of NBF gel application in managing mucositis associated with xerostomia

BACKGROUND

Xerostomia, or dry mouth, can be a temporary or persistent symptom resulting from various factors, such as medication use, therapeutic radiation, chemotherapy, autoimmune conditions (e.g., Sjögren's syndrome), and hormonal imbalances. Xerostomia often leads to associated mucositis, which significantly impacts patients' quality of life. The nano-bio-fusion (NBF) gingival gel, a gel-type functional toothpaste containing vitamins C, E, propolis, and herbal extracts in a nano-emulsion state, has shown potential in accelerating the healing of oral mucosal lesions.

METHODS

A total of 127 patients (102 females, 25 males) with persistent xerostomia were treated from 2018 to 2023. Of these, 32 patients were treated exclusively with NBF Gel, while 95 patients received NBF Gel in combination with other medications, such as pilocarpine. The underlying causes of xerostomia included irradiation and chemotherapy (12 patients), medication (40 patients), hormonal imbalance (28 patients), and Sjögren's syndrome (47 patients). NBF Gel was applied 2-3 times daily to the tongue and oral mucosa. Treatment effectiveness was evaluated through physical examinations and a patient-reported scale ranging from 1 (no improvement) to 10 (complete improvement), focusing on the healing of mucosal lesions rather than saliva production.

RESULTS

Both treatment groups showed significant improvements in the healing of xerostomia-associated mucositis, particularly in severe cases with visible lesions. Patients treated with NBF Gel reported improved symptoms related to mucosal health, while those who received combination therapy also experienced reduced side effects of pilocarpine due to dose reduction. The most substantial improvements were observed in patients with drug-induced and hormonally-caused xerostomia-related mucositis. No adverse side effects from NBF Gel were reported during the study.

CONCLUSION

NBF gingival gel proved to be beneficial in accelerating the healing of mucositis associated with xerostomia, regardless of the underlying cause, including medication use, radiotherapy, chemotherapy, hormonal imbalances, and Sjögren's syndrome. It presents a promising adjunctive treatment to improve mucosal health and quality of life for patients suffering from xerostomia-associated mucositis.

A comprehensive review on p38MAPK signaling as a potent radioprotector in testis

BACKGROUND

Previous studies have shown that the activation of p38MAPK signaling plays a crucial role in regulating gonadal cell fate decisions in both mouse and human. Excessive activation of p38MAPK by radiation significantly causes testicular damage and negatively affects the male reproductive function. Therefore, fine-tuned regulation of p38MAPK signaling is critical in both physiological and pathological conditions.

RESULT

This review summarizes the impact of p38MAPK signaling on testicular germ cells and microenvironment under normal condition. The relationship between radiation, reactive oxygen species (ROS), and p38MAPK is summarized. In conclusion, radiation exposure triggers the overactivation of p38MAPK, which is regulated by ROS, resulting in testicular damage. Various p38MAPK-targeting agents are discussed, providing guidance for developing new strategies.

Epidemiology, Diagnostics, and Therapy of Oral Cancer-Update Review

Oral cavity and lip cancers are the 16th most common cancer in the world. It is widely known that a lack of public knowledge about precancerous lesions, oral cancer symptoms, and risk factors leads to diagnostic delay and therefore a lower survival rate. Risk factors, which include drinking alcohol, smoking, HPV infection, a pro-inflammatory factor-rich diet, and poor oral hygiene, must be known and avoided by the general population. Regular clinical oral examinations should be enriched in an oral cancer search protocol for the most common symptoms, which are summarized in this review. Moreover, new diagnostic methods, some of which are already available (vital tissue staining, optical imaging, oral cytology, salivary biomarkers, artificial intelligence, colposcopy, and spectroscopy), and newly researched techniques increase the likelihood of stopping the pathological process at a precancerous stage. Well-established oral cancer treatments (surgery, radiotherapy, chemotherapy, and immunotherapy) are continuously being developed using novel technologies, increasing their success rate. Additionally, new techniques are being researched. This review presents a novel glance at oral cancer-its current classification and epidemiology-and will provide new insights into the development of new diagnostic methods and therapies.

Enhancing Predictive Accuracy for Recurrence-Free Survival in Head and Neck Tumor: A Comparative Study of Weighted Fusion Radiomic Analysis

Despite advancements in oncology, predicting recurrence-free survival (RFS) in head and neck (H&N) cancer remains challenging due to the heterogeneity of tumor biology and treatment responses. This study aims to address the research gap in the prognostic efficacy of traditional clinical predictors versus advanced radiomics features and to explore the potential of weighted fusion techniques for enhancing RFS prediction. We utilized clinical data, radiomic features from CT and PET scans, and various weighted fusion algorithms to stratify patients into low- and high-risk groups for RFS. The predictive performance of each model was evaluated using Kaplan-Meier survival analysis, and the significance of differences in RFS rates was assessed using confidence interval (CI) tests. The weighted fusion model with a 90% emphasis on PET features significantly outperformed individual modalities, yielding the highest C-index. Additionally, the incorporation of contextual information by varying peritumoral radii did not substantially improve prediction accuracy. While the clinical model and the radiomics model, individually, did not achieve statistical significance in survival differentiation, the combined feature set showed improved performance. The integration of radiomic features with clinical data through weighted fusion algorithms enhances the predictive accuracy of RFS outcomes in head and neck cancer. Our findings suggest that the utilization of multi-modal data helps in developing more reliable predictive models and underscore the potential of PET imaging in refining prognostic assessments. This study propels the discussion forward, indicating a pivotal step toward the adoption of precision medicine in cancer care.

Cancer therapy-related salivary dysfunction

Salivary gland dysfunction is a common side effect of cancer treatments. Salivary function plays key roles in critical daily activities. Consequently, changes in salivary function can profoundly impair quality of life for cancer patients. We discuss salivary gland anatomy and physiology to understand how anticancer therapies such as chemotherapy, bone marrow transplantation, immunotherapy, and radiation therapy impair salivary function. We discuss approaches to quantify xerostomia in the clinic, including the advantages and limitations of validated quality-of-life instruments and approaches to directly measuring salivary function. Current and emerging approaches to treat cancer therapy-induced dry mouth are presented using radiation-induced salivary dysfunction as a model. Limitations of current sialagogues and salivary analogues are presented. Emerging approaches, including cellular and gene therapy and novel pharmacologic approaches, are described.

Effects of different nutritional support methods on nutritional status and immune function in patients undergoing radiotherapy for head and neck cancer

OBJECTIVE

This study aimed to analyze the effects of different nutritional support methods on nutritional status and immune function of patients undergoing radiotherapy for head and neck cancer (HNC).

METHODS

Patients with HNC were divided into the control (nutritional counseling and routine dietary guidance), parenteral nutrition (PN) (PN support on top of the control group), enteral nutrition (EN) (EN support on top of the control group), and EN + PN (EN combined with PN and routine dietary guidance) groups. After nutrition evaluation, the four groups were subjected to radiotherapy and nutritional support. Body mass index (BMI), serum albumin (ALB), prealbumin (PA), transferrin (TRF), hemoglobin (Hb), CD3+, CD4+, CD8+, CD4+/CD8+, natural killer (NK) and quality of life were compared among the four groups before radiotherapy and after radiotherapy dose irradiation completion. The incidence of adverse reactions was assessed and recorded at 2 weeks, 4 weeks and the end of radiotherapy.

RESULTS

The four groups experienced some degree of malnutrition during radiotherapy and the EN + PN group possessed the lowest degree of malnutrition. After radiotherapy dose irradiation completion (T1), the PN, EN, and EN + PN groups possessed improved BMI (21.42 ± 1.62, 21.40 ± 1.68, 22.98 ± 1.87 vs. 20.18 ± 1.32), serum ALB (31.59 ± 3.49, 32.24 ± 4.23, 37.58 ± 3.23 vs. 26.67 ± 3.03), PA (182.63 ± 13.57, 183.43 ± 14.19, 201.59 ± 10.53 vs. 165.36 ± 20.13), TRF (162.46 ± 24.34, 157.36 ± 18.58, 182.36 ± 20.37 vs. 137.56 ± 23.19), and Hb (128.54 ± 9.21, 125.36 ± 10.23, 140.26 ± 7.23 vs. 103.24 ± 9.47) levels, higher CD3+ (63.59 ± 2.88, 63.25 ± 3.17, 66.54 ± 1.32 vs. 59.36 ± 3.24), CD4+ (39.92 ± 3.16, 39.87 ± 3.23, 43.36 ± 2.87 vs. 37.12 ± 4.29), CD4+/CD8+ (1.80 ± 0.06, 1.78 ± 0.06, 2.07 ± 0.03 vs. 1.54 ± 0.10) and NK-cells (33.87 ± 3.62, 33.26 ± 3.59, 36.82 ± 3.19 vs. 27.36 ± 4.21) levels, lower CD8+ (22.18 ± 1.07, 22.36 ± 1.04, 20.46 ± 1.09 vs. 24.09 ± 1.21) levels, and improved quality of life (79.97 ± 7.96, 80.13 ± 7.98, 91.78 ± 7.38 vs. 71.53 ± 11.70) versus the control group, and the EN + PN group possessed the most pronounced effects (All P < 0.05). During radiotherapy, the incidence of radiotherapy adverse reactions was increased with time (P < 0.05).

CONCLUSION

PN and EN, alone or in combination, can improve the nutritional status, immune function and quality of life of patients undergoing radiotherapy for HNC, and PN combined with EN has the best improvement effect.

Incidence of cardiovascular mortality among head and neck cancer patients

BACKGROUND

While treatment advancements have prolonged the lives of patients with head and neck cancer, the subgroups of these patients at higher risk for cardiovascular disease (CVD) mortality remain unclear.

METHODS

We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with head and neck cancer from 2000 to 2019. We compared their CVD mortality against the general US population using standardized mortality ratios (SMRs).

RESULTS

Our analysis included 474,366 patients, identifying that 14% of deaths were due to CVD, with an SMR of 1.19. Notably, patients under the age of 39 had a CVD SMR increase of over 100-fold. Those with distant tumor stages showed the highest CVD SMR of 1.52 (95% CI 1.50-1.54). An upward trend in SMR to 2.53 (95% CI 2.51-2.56) was observed from 2011 to 2019. Within the initial 5-year post-diagnosis, the SMR for CVD was 3.17 (95% CI 3.14-3.20), which exceeded the general population's rates but declined in the 5-20-year range after diagnosis. Patients who did not any therapy had the greatest CVD SMR of 2.26 (95% CI 2.24-2.28). Hypopharyngeal cancer patients exhibited the highest CVD SMR of 1.54 (95% CI 1.52-1.56).

CONCLUSIONS

The study highlights that head and neck cancer patients, especially younger individuals and those with advanced disease stages, face substantial CVD mortality risks. The CVD SMR peaks within 5 years following diagnosis. Patients abstaining from treatment bear the highest risk of CVD mortality. Cardioprotective measures should be considered critical for this patient population.

Postoperative radiotherapy with docetaxel versus cisplatin for high-risk oral squamous cell carcinoma: a randomized phase II trial with exploratory analysis of ITGB1 as a potential predictive biomarker

BACKGROUND

Oral squamous cell carcinoma (OSCC) causes significant mortality and morbidity worldwide. Surgical resection with adjuvant radiotherapy remains the standard treatment for locally advanced resectable OSCC. Results from landmark trials have established postoperative concurrent cisplatin-radiotherapy (Cis-RT) as the standard treatment for OSCC patients with high-risk pathologic features. However, cisplatin-related toxicity limits usage in clinical practice. Given the need for effective but less toxic alternatives, we previously conducted a single-arm trial showing favorable safety profiles and promising efficacy of concurrent docetaxel-radiotherapy (Doc-RT).

METHODS

In this randomized phase 2 trial, we aimed to compare Doc-RT with the standard Cis-RT in postoperative OSCC patients. Eligible patients had AJCC stage III-IV resectable OSCC with high-risk pathologic features. Two hundred twenty-four patients were enrolled and randomly assigned to receive concurrent Doc-RT or Cis-RT. The primary endpoint was 2-year disease-free survival (DFS). Secondary endpoints included overall survival (OS), locoregional-free survival (LRFS), distant metastasis-free survival (DMFS), and adverse events (AEs). Integrin β1 (ITGB1) expression was analyzed as a biomarker for efficacy.

RESULTS

After a median 28.8-month follow-up, 2-year DFS rates were 63.7% for Doc-RT arm and 56.1% for Cis-RT arm (p = 0.55). Meanwhile, Doc-RT demonstrated comparable efficacy to Cis-RT in OS, LRFS, and DMFS. Doc-RT resulted in fewer grade 3 or 4 hematological AEs. Low ITGB1 was associated with improved Doc-RT efficacy versus Cis-RT.

CONCLUSIONS

This randomized trial directly compared Doc-RT with Cis-RT for high-risk postoperative OSCC patients, with comparable efficacy and less toxicity. ITGB1 merits further validation as a predictive biomarker to identify OSCC patients most likely to benefit from Doc-RT. Findings indicate docetaxel may be considered as a concurrent chemoradiation option in this setting.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov . NCT02923258 (date of registration: October 4, 2016).

Chemopreventive effect of modified zeng-sheng-ping on oral squamous cell carcinoma by regulating tumor associated macrophages through targeting tnf alpha induced protein 6

BACKGROUND

Oral squamous cell carcinoma (OSCC) is the most common malignancy of the head and neck. Zeng-Sheng-Ping, composed of Sophora tonkinensis Gagnep., Bistorta officinalis Delarbre, Sonchus arvensis L., Prunella vulgaris L., Dioscorea bulbifera L., and Dictamnus dasycarpus Turcz., was regarded as an anti-cancer drug with significant clinical efficacy, but was discontinued due to liver toxicity. Our research group developed a modified Zeng-Sheng-Ping (ZSP-M) based on original Zeng-Sheng-Ping that exhibited high efficiency and low toxicity in preliminary investigations, although its pharmacodynamic mechanism is still unclear. Here, we aimed to elucidate the pharmacodynamic material basis of ZSP-M and investigate its chemopreventive effect on OSCC by modulating tumor associated macrophages (TAMs).

METHODS

Components of ZSP-M were characterized using ultra-performance liquid chromatography-mass spectrometry. Chemopreventive effect induced by ZSP-M against experimental oral cancer was investigated using the 4-nitroquinoline N-oxide precancerous lesion mouse model. RNA sequencing analysis was used to gain a global transcriptional view of the effect of ZSP-M treatment. A cell co-culture model was used to study the targeted effect of ZSP-M on TAMs and the biological properties of OSCC cells and to detect changes in TAM phenotypes. The binding of ZSP-M active compounds to TNF alpha induced protein 6 (TNFAIP6) protein was analyzed by molecular docking and dynamic simulation.

RESULTS

Forty main components of ZSP-M were identified, the most abundant of which were flavonoids. ZSP-M inhibited the degree of epithelial dysplasia in precancerous lesions by inhibiting the expression of the TNFAIP6 and CD163 proteins in the precancerous lesions of the tongue. ZSP-M inhibited proliferation, colony formation, migration and invasion of SCC7 cells by targeting TAMs. ZSP-M reduced the expression of CD163+ cells, inhibited the expression of TNFAIP6 protein, Arg1 mRNA and Il10 mRNA in TAMs, and reduced IL-10 cytokine release in the co-culture environment. This effect was maintained after the addition of recombinant TNFAIP6 protein. Computer simulations showed that trifolirhizin and maackiain are well-connected to TNFAIP6.

CONCLUSIONS

ZSP-M counteracts the immunosuppressive action of TAMs by specific targeting of TNFAIP6, thereby exerting chemopreventive activity of OSCC.

Assessing radiation-induced carotid artery injury using ultrasound in patients with head and neck cancer

BACKGROUND AND PURPOSE

Radiotherapy (RT) can damage neck vessels in patients with head and neck cancer (HNC). This study investigated the early effects of RT on carotid artery, including the internal media thickness (IMT) and carotid plaques of the common carotid artery (CCA).

MATERIALS AND METHODS

This study included 69 patients with HNC who underwent RT at the First Hospital of Jilin University from March 2017 to September 2022, and 69 healthy participants as controls. Color Doppler ultrasound (CDUS) of the carotid artery was used to measure the CCA IMT and plaques.

RESULTS

Left CCA IMT increased from 0.60 mm (0.60, 0.70) before RT to 0.70 mm (0.60, 1.20) after RT (P < 0.0001). Right CCA IMT changed from 0.60 mm (0.60, 0.71) before RT to 0.60 mm (0.60, 1.10) after RT (P = 0.0002). CCA IMT was 0.60 mm (0.60, 0.70) and 0.80 mm (0.60, 1.20) in the ≤40 Gy and >40 Gy groups (P = 0.0004). The CCA plaques number increased significantly after RT on both the left and right sides (Pleft < 0.0001; Pright <0.0001). The CCA plaques volume increased from 0 mm3 (0, 11.35) and 0 mm3 (0, 8.55) before RT to 8.8 mm3 (0, 21.5) and 5.8 mm3 (0, 16.1) on the left and right sides. Correlation analysis revealed a correlation between CCA IMT and age (r = 0.283, P = 0.001), smoking status (r = 0.179, P = 0.020), and radiation dose (r = 0.188, P = 0.028).

CONCLUSION

RT significantly increased CCA IMT, and the growth was related to the radiation dose. The number and volume of the CCA plaques also increased after RT.

Oral Candida in post-radiotherapy patients with xerostomia/hyposalivation: A narrative review

OBJECTIVE

Head and Neck Cancer (HNC) patients receiving radiotherapy (RT) often suffer from xerostomia and/or hyposalivation. As saliva plays an important antimicrobial and cleansing roles, these patients are at higher risks of opportunistic infections. This narrative review aims to provide an overview of current evidence on oral Candida colonisation and infection in these patients.

METHODS

A literature review of clinical studies on oral Candida colonisation and candidiasis in HNC patients receiving radiotherapy/chemoradiotherapy was conducted.

RESULTS

Many clinical studies found high levels of Candida colonisation and a substantial proportion of post-RT HNC patients suffering from oropharyngeal candidiasis (OPC). Importantly, oral Candida could be a reservoir for life-threatening systemic infection in immunocompromised patients. The rising prevalence of non-albicans Candida species and drug-resistant infections has made identification of Candida species and antifungal susceptibility more important. Recent advances in oral microbiome and its interactions with Candida are discussed. This review also offers perspectives on limitations of current evidence and suggestions for future research.

CONCLUSION

Further research to better understand Candida carriage, microbiome, OPC, and xerostomia/hyposalivation post-RT would aid in devising a more comprehensive long-term management plan and novel therapeutic approaches for HNC patients to achieve the full benefits of RT while minimising side effects.

Defining the role of intensity modulation in electron conformal therapy for the treatment of head and neck cancer

Bolus electron conformal therapy (BECT) in the treatment of cancers of the head and neck is often limited by an inability to reduce dosimetric hot spots resulting from surface irregularity or tissue heterogeneity. We examined the potential benefits of using intensity modulation for electron therapy (IM-BECT) to reduce hotspots in patients undergoing electron beam therapy for superficial cancers of the head and neck (HN). Twenty patients with HN cancer previously treated with BECT were identified. Each case included the treatment targets and a primary organ at risk (OAR) that were defined by the radiation oncologist. A target +2 cm rind structure was created for analysis of the dose deposition in areas surrounding the target volume as a measure of conformality. Each patient plan was transferred into the novel IM-BECT planning software and each case was recomputed as per the original parameters. Next, each case was replanned with the inclusion of intensity modulation, as well as a new custom conformal bolus that was redesigned for optimized range compensation when paired with an intensity modulator. The plans were then normalized to prescription dose and compared for target coverage/dose and OAR dose. For patients who had a hotspot of 125% or greater, the hotspot was on average reduced by 13.1% with IM-BECT. For IM-BECT, the average primary OAR means dose and target+2cm rind mean dose increased slightly by 10.6% and 6.4%, respectively (primary OAR mean [p = 0.0001], and Target+2cm rind mean [p = 0.0001], paired t-test). IM-BECT is an effective method of reducing hotspots in patients with superficial HN cancer. Improvements came at the expense of slight increases in dose to the underlying tissues. This retrospective planning study represents the first example of IM-BECT to actual HN patient cases. Expanding the role of IM-BECT in other disease sites could potentially compared to conventional BECT.

Radioresistance or/and radiosensitivity of head and neck squamous cell carcinoma: biological angle

OBJECTIVE

This narrative review aimed to compile and summarize clinically relevant literature in radiation therapy and to discuss the potential in radioresistant and radiosensitive head and neck squamous cell carcinoma (HNSCC).

METHODS AND MATERIALS

Google Scholar, PubMed, and the Cochrane Library were retrieved using combined key words such as "radiotherapy" and "head and neck cancer." Search strings additionally queried were "radioresistant," "radiosensitive," "head and neck region," "squamous cell carcinoma," in combination with Boolean operators 'AND' and 'OR.' Subsequently, the resulting publications were included for review of the full text.

RESULTS

Radiotherapeutic responses currently in clinical observation referred to HNSCC scoping were selected into this review. The compiled mechanisms were then detailed concerning on the clinical significance, biological characteristics, and molecular function.

CONCLUSIONS

Brachytherapy or/and external-beam radiotherapy are crucial for treating HNSCC especially the early stage patients, but in some patients with locally advanced tumors, their outcome with radiation therapy is poor due to obvious radioresistance. The curative effects mainly depend on the response to radiation therapy so an updated review is needed to optimize further applications in HNSCC radiotherapy.

Higher Rates of Inadequate Adjuvant Radiation Dose Among Older Adults with Head and Neck Cancer

OBJECTIVE

To determine the rate of inadequate radiotherapy and identify risk factors associated with inadequate adjuvant radiotherapy for head and neck cancer among older adults.

METHODS

A retrospective review of the National Cancer Database (NCDB) was performed to identify patients diagnosed with squamous cell cancer of the head and neck between 2004 and 2017. Patients with a single malignancy, negative surgical margins, no extranodal extension, and receipt of adjuvant radiation without systemic therapy were included in the study cohort. The main outcome of interest was the adjuvant radiation dose received. Participant data were compared using univariable, multivariable, and correlation analyses to evaluate risk factors for inadequate radiation therapy (RT) dosing.

RESULTS

Among 7608 patients, 1010 patients (13.3%) received an inadequate radiation dose and 6598 (86.7%) received an adequate dose. Patients living in a higher income zip-code, younger age, and those who received intensity-modulated RT (IMRT) were more likely to receive an adequate radiation dose (p < 0.05). Patients older than 70 and 80 years old had a greater likelihood of receiving an inadequate radiation dose (≥70 vs. <70: 16.9% vs. 12.5%; p < 0.05 and ≥80 vs. <80: 20.6% vs. 13.0%%; p < 0.05). Similarly, increasing age was negatively correlated with radiation dose (correlation coefficient: -0.05; p < 0.001).

CONCLUSION

A substantial proportion of older patients receiving adjuvant radiation do not complete the full treatment. Older age, year of diagnosis, non-IMRT, and living in a lower-income zip code were associated with early termination of RT. Future studies should examine strategies to improve tolerance of adjuvant RT so that more patients complete the full treatment.

LEVEL OF EVIDENCE

3; Cohort Study Laryngoscope, 134:2206-2211, 2024.

Progression rate of radiation-induced carotid stenosis in head and neck cancer survivors after statin treatment: a retrospective cohort study

BACKGROUND AND AIMS

Whether statin treatment is effective in retarding the progression of radiation-induced carotid stenosis (RICS) in head and neck cancer (HNC) survivors has not been well studied. The purpose of this study was to assess the association of statin treatment with RICS progression rate in HNC survivors after radiotherapy.

METHODS

We conducted a retrospective cohort study at Sun Yat-sen Memorial Hospital, Sun Yat-sen University in Guangzhou, China. Between January 2010 and December 2021, we screened HNC survivors whose carotid ultrasound scans had shown stenosis of the common and/or internal carotid arteries. The primary outcome was the RICS progression rate. We compared eligible patients treated with statins with those who did not in multivariable Cox regression models.

RESULTS

A total of 200 patients were included in this study, of whom 108 received statin treatment and 92 did not. Over a mean follow-up time of 1.5 years, 56 (28.0%) patients showed RICS progression, 24 (42.9%) and 32 (57.1%) in the statin and control groups, respectively. The statin group showed less RICS progression than the control group (adjusted-HR 0.49, 95% CI 0.30-0.80, P = 0.005). In the subgroup analysis, there was no significant interaction in the effect of statins on lowering RICS progression rate in the subgroups stratified by baseline low-density lipoprotein cholesterol (LDL-C) levels (P for interaction = 0.53) or baseline degrees of stenosis (P for interaction = 0.50).

CONCLUSIONS

Statin treatment was associated with a lower risk of RICS progression in patients with HNC after radiotherapy, regardless of baseline LDL-C level and baseline stenosis degrees.

3D printing technology to produce intraoral stents for head and neck radiotherapy: A scoping review

INTRODUCTION

Radiotherapy remains one of the main treatments for head and neck cancer; however, it is accompanied by acute and chronic adverse effects. Use of three-dimensional (3D) oral stents to modulate radiation intensity to specific target areas have been developed to minimize these adverse effects. This study aimed to present a scoping review of studies published on 3D printing of oral stents and their clinical applicability.

METHODS

MEDLINE/Pubmed, Scopus, Web of Science and CENTRAL Cochrane data bases were searched, studies selected, and data collected by three independent reviewers up to December 2022. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis-Extension for Scoping Reviews (PRISMA-ScR).

RESULTS

The search resulted in 404 studies and 5 articles fulfilled the eligibility criteria and were considered for this review. Three-dimensional printed intraoral stents were produced for 56 patients with indication for radiotherapy. 3D-printed stents were well-tolerated by all tested patients and demonstrated great reproducibility of maxillomandibular relation, required less time for production and lower cost to manufacture. Two studies showed great protection of healthy tissues with 3D-printed stents during radiotherapy.

CONCLUSIONS

Three-dimensional printing is promising for production of intraoral stents, however, more studies are needed to improve the technique and further investigate the safety and prevention of oral toxicities from radiotherapy.

Unveiling NRlncRNAs as prognostic biomarkers and therapeutic targets for head-and-neck squamous cell carcinoma through machine learning

Head-and-neck squamous cell carcinoma (HNSCC) patients often exhibit insensitivity to immunotherapy, leading to treatment failure. Identifying potential biomarkers that can predict prognosis and improve the efficacy of treatment is crucial. In this study, we aimed to identify necroptosis-related long noncoding RNAs (NRlncRNAs) as potential therapeutic targets to improve the prognosis of HNSCC patients. By exploring the Genotype-Tissue Expression Project (GTEx) and the Cancer Genome Atlas (TCGA) databases, we identified NRlncRNAs and developed a risk model comprising 17 NRlncRNAs to predict the prognosis of HNSCC patients and to classify patients into two clusters based on their expression levels. We conducted various analyses, such as the Kaplan-Meier analysis, GSEA and IC50 prediction, to evaluate the differences in sensitivity to immunotherapy between the two clusters. Our findings suggest that NRlncRNAs have potential as therapeutic targets for improving the prognosis of HNSCC patients, and that individualized treatment approaches based on NRlncRNA expression levels can improve the sensitivity of immunotherapy and overall treatment outcomes. This study highlights new perspectives within clinical cancer informatics and provides insight into potential therapeutic strategies for HNSCC patients.

Exploring the Link between Inflammatory Biomarkers and Head and Neck Cancer: Understanding the Impact of Smoking as a Cancer-Predisposing Factor

Head and neck cancer (HNC) is associated with significant morbidity globally, with smoking recognized as a key risk factor. This study investigates the interplay between smoking and inflammatory biomarkers in HNC development. The study involved 50 HNC patients, divided into smoking and non-smoking groups, and a control group of 30 healthy individuals. Serum levels of 48 cytokines, chemokines, growth factors, and other inflammatory markers were meticulously assessed. Significant differences in the levels of an extensive panel of inflammatory markers were observed between the patient groups and healthy controls. Elevated macrophage colony-stimulating factor (M-CSF) in both HNC groups implicated increased activity in pathways known for immunomodulation, proliferation, and angiogenesis during HNC cancerogenesis. In contrast, non-smokers with HNC demonstrated higher levels of interleukin 10 (IL-10) and interleukin 15 (IL-15), suggesting a more robust immune response. Platelet-derived growth factor BB (PDGF-BB) levels were particularly high in smokers with HNC. Smoking seems to alter the levels of crucial biomarkers in HNC, potentially affecting disease progression and responses to treatment. The data indicate that smokers may experience a more aggressive cancer phenotype, while non-smokers maintain a profile suggestive of a more active and effective immune response against HNC.

Cell-type specific anti-cancerous effects of nitro-oleic acid and its combination with gamma irradiation

Nitro-fatty acids (NFAs) are endogenous lipid mediators capable of post-translational modifications of selected regulatory proteins. Here, we investigated the anti-cancerous effects of nitro-oleic acid (NO2OA) and its combination with gamma irradiation on different cancer cell lines. The effects of NO2OA on cell death, cell cycle distribution, or expression of p21 and cyclin D1 proteins were analyzed in cancer (A-549, HT-29 and FaDu) or normal cell lines (HGF, HFF-1). Dose enhancement ratio at 50 % survival fraction (DERIC50) was calculated for samples pre-treated with NO2OA followed by gamma irradiation. NO2OA suppressed viability and induced apoptotic cell death. These effects were cell line specific but not in general selective for cancer cells. HT-29 cell line exerted higher sensitivity toward NO2OA treatment among cancer cell lines tested: induction of cell cycle arrest in the G2/M phase was associated with an increase in p21 and a decrease in cyclin D1 expression. Pre-treatment of HT-29 cells with NO2OA prior irradiation showed a significantly increased DERIC50, demonstrating radiosensitizing effects. In conclusion, NO2OA exhibited potential for combined chemoradiotherapy. Our results encourage the development of new NFAs with improved features for cancer chemoradiation.

Effect of radiotherapy on head and neck cancer tissues in patients receiving radiotherapy: a bioinformatics analysis-based study

Radiotherapy is pivotal in treating head and neck cancers including nasopharyngeal, tongue, hypopharyngeal, larynx, maxillary sinus, parotid gland, and oral cancers. It holds the potential for curative effects and finds application in conjunction with chemotherapy, either as a radical method to preserve organ function or as an adjuvant postoperative treatment. We used bioinformatics analysis to investigate the effects of radiotherapy on head and neck cancer tissues in patients who had received radiotherapy. In this study, the expression and mutation profiles of The Cancer Genome Atlas-Head-Neck Squamous Cell Carcinoma were downloaded from the UCSC-Xena database, categorizing patients into two groups-those receiving radiotherapy and those not receiving radiotherapy. Subsequently, differential expression analysis and gene set enrichment analysis (GSEA) were performed. Following this, single-sample GSEA (ssGSEA) scores related to glucose and lipid metabolism were compared between the two groups. Additionally, immune cell infiltration analysis and single-cell verification were performed. Finally, the mutation profiles of the two groups were compared. The analyses revealed that patients receiving radiotherapy exhibited prolonged survival, enhanced apoptosis in head and neck cancer tissue, and diminished keratinocyte proliferation and migration. A comparison of ssGSEA scores related to glucose and lipid metabolism between the two groups indicated a reduction in glycolysis, tricarboxylic acid cycle activity, and fat synthesis in tissues treated with radiotherapy, suggesting that radiotherapy can effectively inhibit tumour cell energy metabolism. Analyses of immune cell infiltration and single-cell verification suggested decreased infiltration of immune cells post-radiotherapy in head and neck cancer tissues. A comparison of mutation profiles revealed a higher frequency of TP53, TTN, and CDKN2A mutations in patients receiving radiotherapy for head and neck cancer. In conclusion, the bioinformatics analyses delved into the effect of radiotherapy on patients with head and neck carcinoma. This study provides a theoretical framework elucidating the molecular mechanisms underlying radiotherapy's efficacy in treating head and neck cancer and presents scientific recommendations for drug therapy following radiotherapy.

Positive correlation between persistence of medical nutrition therapy and overall survival in patients with head and neck cancer

Background: Several factors can affect overall survival of head and neck cancer (HNC) patients, including characteristics of the cancer disease and response to treatments. However, patients' nutritional status and the effectiveness of medical nutrition therapy (MNT) can also impact overall survival. The primary goal of our research was to collect real-life data on the use of MNT in HNC patients and to specifically investigate the correlation between survival and the duration of uninterrupted (persistent) nutrition. Method: The data of this retrospective, analytical, cohort study was collected from electronic healthcare records from the Hungarian National Health Insurance Fund Management. Overall, 38,675 HNC patients' data of the period between 2012 and 2021 was used. We applied multi-step exclusions to identify patient groups accurately and to avoid biasing factors. Statistical analysis was done by the Kaplan-Meier method, log-rank test, and Cox regression analysis. Results: Throughout the investigated period 16,871 (64%) patients received MNT therapy out of 26,253 newly diagnosed patients (≥18 years). In terms of the persistence of MNT, we divided the patients into three groups (1-3; 4-6; ≥7-month duration of MNT). When comparing these groups, we found that patients receiving long-term (≥7 months) MNT had a significantly longer overall survival (p < 0.0001) than those who received MNT for a shorter duration, both in locally advanced and recurrent/metastatic cases. Conclusion: The main outcome of the study is that there is a positive correlation between the persistence of MNT and the overall survival in HNC patients when nutritional intervention lasts several months. It highlights the responsibility of the specialists during the patient journey to use MNT early and to continue its use for as long as it is beneficial to the patients.

Consideration of image guidance in patterns of failure analyses of intensity-modulated radiotherapy for head and neck cancer: a systematic review

BACKGROUND

Intensity-modulated radiation therapy (IMRT) is considered standard of care for head and neck squamous cell carcinoma (HNSCC). Improved conformity of IMRT and smaller margins, however, have led to concerns of increased rates of marginal failures. We hypothesize that while patterns of failure (PoF) after IMRT for HNSCC have been published before, the quality of patient positioning and image guided radiotherapy (IGRT) have rarely been taken into account, and their importance remains unclear. This work provides a systematic review of the consideration of IGRT in PoF studies after IMRT for HNSCC.

MATERIALS AND METHODS

A systematic literature search according to PRISMA guidelines was performed on PubMed for HNSCC, IMRT and PoF terms and conference abstracts from ESTRO and ASTRO 2020 and 2021 were screened. Studies were included if they related PoF of HNSCC after IMRT to the treated volumes. Data on patient and treatment characteristics, IGRT, treatment adaptation, PoF and correlation of PoF to IGRT was extracted, categorized and analyzed.

RESULTS

One-hundred ten studies were included. The majority (70) did not report any information on IGRT. The remainder reported daily IGRT (18), daily on day 1-3 or 1-5, then weekly (7), at least weekly (12), or other schemes (3). Immobilization was performed with masks (78), non-invasive frames (4), or not reported (28). The most common PoF classification was "in-field/marginal/out-of-field", reported by 76 studies. Only one study correlated PoF in nasopharyngeal cancer patients to IGRT.

CONCLUSION

The impact of IGRT on PoF in HNSCC is severely underreported in existing literature. Only one study correlated PoF to IGRT measures and setup uncertainty. Further, most PoF studies relied on outdated terminology ("in/out-of-field"). A clearly defined and up-to-date PoF terminology is necessary to evaluate PoFs properly, as is systematic and preferably prospective data generation. PoF studies should consistently and comprehensively consider and report on IGRT.

Worth of pan-immune-inflammation value in trismus prediction after concurrent chemoradiotherapy for nasopharyngeal carcinomas

OBJECTIVE

Radiation-induced trismus (RIT), one of the rare but serious side effects of concurrent chemoradiotherapy (C-CRT), is difficult to predict with high accuracy. We aimed to examine whether the pretreatment pan-immune-inflammation value (PIV) measures predict RIT in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) receiving C-CRT.

METHODS

Data of patients with LA-NPC who underwent C-CRT and had maximum mouth openings (MMO) > 35 mm were reviewed. Any MMO of 35 mm or less after C-CRT was considered RIT. All PIV values were computed using the complete blood count test results: PIV = (Platelets × Monocytes × Neutrophils) ÷ Lymphocytes. The receiver operating characteristic analysis was employed to dissect a possible association between pre-treatment PIV readings and RIT status. Confounding variables were tested for their independent relationship with the RIT rates using logistic regression analysis.

RESULTS

The research comprised 223 participants, and RIT was diagnosed in 46 (20.6%) at a median time from C-CRT to RIT of 10 months (range: 5-18 months). Pre-C-CRT PIV levels and RIT rates were analyzed using receiver operating characteristic curve analysis, with 830 being the optimal cutoff (area under the curve: 92.1%; sensitivity: 87.5%; specificity: 85.5%; Youden index: 0.730). RIT was significantly more prevalent in the PIV > 830 cohort than its PIV ≤ 830 counterpart (60.3% vs. 5%; hazard ratio 5.79; P < 0.001). Multivariate logistic regression analysis revealed that advanced T-stage (P = 0.004), masticatory apparatus dose V58Gy≥%32 (P = 0.003), and PIV > 830 (P < 0.001) were independently linked with significantly elevated rates of RIT.

CONCLUSION

The presence of elevated pre-C-CRT PIV is a unique biological marker that independently predicts increased RIT rates in LA-NPC undergoing C-CRT.

Evidence summary on managing radiotherapy-induced oral mucositis in patients with head and neck cancer

Objective

To summarize the best evidence for managing radiotherapy-induced oral mucositis in patients with head and neck cancer, and improve the quality of care.

Methods

According to the "6S" evidence pyramid model, we searched local and other part of world published clinical guidelines, expert consensus, evidence summary, and systematic review. The literature quality assessment followed the Appraisal of Guidelines for Research and Evaluation (AGREE II). for guidelines, AMSTAR-2 for systematic reviews, and Joanna Briggs Institute (JBI) Evidence-Based Health Care Center's quality evaluation tool for expert opinions and expert consensus articles. The quality of other literature was evaluated according to the type of original literature. If there were any conflicts about the conclusions drawn from different sources of evidence, this study followed the principle of high-quality evidence priority and the latest published authoritative literature priority. The "JBI Evidence Pre-grading and Evidence Recommendation Level System 2014" was adopted for the evidence lacking a grading system. Quality evaluation, evidence extraction, and summary were performed by 2 or more researchers, combined with the advice of the head and neck cancer radiotherapy professionals.

Results

Finally, a total of ten pieces of literature were included. Twenty-two best evidence items for radiotherapy-induced oral mucositis management were summarized from six aspects, including multidisciplinary management, oral assessment, basic oral care, pain management, nutritional support, and application of honey or propolis.

Conclusions

This study provides clinical caregivers with the evidence-based measures on managing radiotherapy-induced oral mucositis. Clinical backgrounds, patients' condition, willingness, economy, and cost-effectiveness should be fully considered when promoting evidence transformation. Applying evidence-based approaches with high feasibility, strong appropriateness, clinical significance and high effectiveness could reduce the incidence of severe radiotherapy-induced oral mucositis in patients with head and neck cancer.

Systematic review registration

This study has been registered on the Fudan University Centre for Evidence-based Nursing. Registration No. is ES20232732.

Biomechanical imaging biomarker during chemoradiotherapy predicts treatment response in head and neck squamous cell carcinoma

Objective. For response-adapted adaptive radiotherapy (R-ART), promising biomarkers are needed to predict post-radiotherapy (post-RT) responses using routine clinical information obtained during RT. In this study, a patient-specific biomechanical model (BM) of the head and neck squamous cell carcinoma (HNSCC) was proposed using the pre-RT maximum standardized uptake value (SUVmax) of18F-fluorodeoxyglucose (FDG) and tumor structural changes during RT as evaluated using computed tomography (CT). In addition, we evaluated the predictive performance of BM-driven imaging biomarkers for the treatment response of patients with HNSCC who underwent concurrent chemoradiotherapy (CCRT).Approach. Patients with histologically confirmed HNSCC treated with definitive CCRT were enrolled in this study. All patients underwent CT two times as follows: before the start of RT (pre-RT) and 3 weeks after the start of RT (mid-RT). Among these patients, 67 patients who underwent positron emission tomography/CT during the pre-RT period were included in the final analysis. The locoregional control (LC), progression-free survival (PFS), and overall survival (OS) prediction performances of whole tumor stress change (TS) between pre- and mid-RT computed using BM were assessed using univariate, multivariate, and Kaplan-Meier survival curve analyses, respectively. Furthermore, performance was compared with the pre and post-RT SUVmax, tumor volume reduction rate (TVRR) during RT, and other clinical prognostic factors.Main results. For both univariate, multivariate, and survival curve analyses, the significant prognostic factors were as follows (p< 0.05): TS and TVRR for LC; TS and pre-RT FDG-SUVmaxfor PFS; and TS only for OS. In addition, for 2 year LC, PFS, and OS prediction, TS showed a comparable predictive performance to post-RT FDG-SUVmax.Significance. BM-driven TS is an effective prognostic factor for tumor treatment response after CCRT. The proposed method can be a feasible functional imaging biomarker that can be acquired during RT using only routine clinical data and may provide useful information for decision-making during R-ART.

Molecular subtype identification and prognosis stratification based on golgi apparatus-related genes in head and neck squamous cell carcinoma

BACKGROUND

Abnormal dynamics of the Golgi apparatus reshape the tumor microenvironment and immune landscape, playing a crucial role in the prognosis and treatment response of cancer. This study aims to investigate the potential role of Golgi apparatus-related genes (GARGs) in the heterogeneity and prognosis of head and neck squamous cell carcinoma (HNSCC).

METHODS

Transcriptional data and corresponding clinical information of HNSCC were obtained from public databases for differential expression analysis, consensus clustering, survival analysis, immune infiltration analysis, immune therapy response assessment, gene set enrichment analysis, and drug sensitivity analysis. Multiple machine learning algorithms were employed to construct a prognostic model based on GARGs. A nomogram was used to integrate and visualize the multi-gene model with clinical pathological features.

RESULTS

A total of 321 GARGs that were differentially expressed were identified, out of which 69 were associated with the prognosis of HNSCC. Based on these prognostic genes, two molecular subtypes of HNSCC were identified, which showed significant differences in prognosis. Additionally, a risk signature consisting of 28 GARGs was constructed and demonstrated good performance for assessing the prognosis of HNSCC. This signature divided HNSCC into the high-risk and low-risk groups with significant differences in multiple clinicopathological characteristics, including survival outcome, grade, T stage, chemotherapy. Immune response-related pathways were significantly activated in the high-risk group with better prognosis. There were significant differences in chemotherapy drug sensitivity and immune therapy response between the high-risk and low-risk groups, with the low-risk group being more suitable for receiving immunotherapy. Riskscore, age, grade, and radiotherapy were independent prognostic factors for HNSCC and were used to construct a nomogram, which had good clinical applicability.

CONCLUSIONS

We successfully identified molecular subtypes and prognostic signature of HNSCC that are derived from GARGs, which can be used for the assessment of HNSCC prognosis and treatment responses.

A radiobiological perspective on radioresistance or/and radiosensitivity of head and neck squamous cell carcinoma

Background

This article aimed to compile and summarize clinically relevant literature in radiation therapy, and to discuss the potential in radioresistant and radiosensitive head and neck cancer.

Study Design

Narrative review.

Materials and methods

Google Scholar, PubMed and the Cochrane Library were retrieved using combined key words such as "radiotherapy" and "head and neck cancer". Search strings additionally queried were "radioresistant", "radiosensitive", "head and neck region", "squamous cell carcinoma", in combination with Boolean Operators 'AND' and 'OR'. Subsequently, the resulting publications were included for review of the full text.

Results

Radiotherapeutic response currently in clinical observation referred to HNSCC scoping were selected into this review. The compiled mechanisms were then detailed concerning on the clinical significance, biological characteristics, and molecular function.

Conclusions

Brachytherapy or/and external-beam radiotherapy are crucial for treating HNSCC, especially the early stage patients, but in patients with locally advanced tumors, their outcome with radiation therapy is poor due to obvious radioresistance. The curative effects mainly depend on the response of radiation therapy, so an updated review is needed to optimize further applications in HNSCC radiotherapy.

Dual anti-HER2/EGFR inhibition synergistically increases therapeutic effects and alters tumor oxygenation in HNSCC

Epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), and hypoxia are associated with radioresistance. The goal of this study is to study the synergy of anti-HER2, trastuzumab, and anti-EGFR, cetuximab, and characterize the tumor microenvironment components that may lead to increased radiation sensitivity with dual anti-HER2/EGFR therapy in head and neck squamous cell carcinoma (HNSCC). Positron emission tomography (PET) imaging ([89Zr]-panitumumab and [89Zr]-pertuzumab) was used to characterize EGFR and HER2 in HNSCC cell line tumors. HNSCC cells were treated with trastuzumab, cetuximab, or combination followed by radiation to assess for viability and radiosensitivity (colony forming assay, immunofluorescence, and flow cytometry). In vivo, [18F]-FMISO-PET imaging was used to quantify changes in oxygenation during treatment. Bliss Test of Synergy was used to identify combination treatment synergy. Quantifying EGFR and HER2 receptor expression revealed a 50% increase in heterogeneity of HER2 relative to EGFR. In vitro, dual trastuzumab-cetuximab therapy shows significant decreases in DNA damage response and increased response to radiation therapy (p < 0.05). In vivo, tumors treated with dual anti-HER2/EGFR demonstrated decreased tumor hypoxia, when compared to single agent therapies. Dual trastuzumab-cetuximab demonstrates synergy and can affect tumor oxygenation in HNSCC. Combination trastuzumab-cetuximab modulates the tumor microenvironment through reductions in tumor hypoxia and induces sustained treatment synergy.

Extending deterministic transport capabilities for very-high and ultra-high energy electron beams

Focused Very-High Energy Electron (VHEE, 50-300 MeV) and Ultra-High Energy Electron (UHEE, > 300 MeV) beams can accurately target both large and deeply seated human tumors with high sparing properties, while avoiding the spatial requirements and cost of proton and heavy ion facilities. Advanced testing phases are underway at the CLEAR facilities at CERN (Switzerland), NLCTA at Stanford (USA), and SPARC at INFN (Italy), aiming to accelerate the transition to clinical application. Currently, Monte Carlo (MC) transport is the sole paradigm supporting preclinical trials and imminent clinical deployment. In this paper, we propose an alternative: the first extension of the nuclear-reactor deterministic chain NJOY-DRAGON for VHEE and UHEE applications. We have extended the Boltzmann-Fokker-Planck (BFP) multigroup formalism and validated it using standard radio-oncology benchmarks, complex assemblies with a wide range of atomic numbers, and comprehensive irradiation of the entire periodic table. We report that [Formula: see text] of water voxels exhibit a BFP-MC deviation below [Formula: see text] for electron energies under [Formula: see text]. Additionally, we demonstrate that at least [Formula: see text] of voxels of bone, lung, adipose tissue, muscle, soft tissue, tumor, steel, and aluminum meet the same criterion between [Formula: see text] and [Formula: see text]. For water, the thorax, and the breast intra-operative benchmark, typical average BFP-MC deviations of [Formula: see text] and [Formula: see text] were observed at [Formula: see text] and [Formula: see text], respectively. By irradiating the entire periodic table, we observed similar performance between lithium ([Formula: see text]) and cerium ([Formula: see text]). Deficiencies observed between praseodymium ([Formula: see text]) and einsteinium ([Formula: see text]) have been reported, analyzed, and quantified, offering critical insights for the ongoing development of the Evaluated Nuclear Data File mode in NJOY.

Clinical predictors of premature radiotherapy terminations in senior adults with oral cavity and laryngeal carcinoma

INTRODUCTION

The underlying factors that contribute to early radiotherapy (RT) termination are understudied, especially in the era of hypofractionated treatment regimens. In this retrospective investigation, we examined the characteristics and causes of premature RT terminations in senior adults (>70 years old) with oral cavity (OC) and laryngeal carcinomas.

METHODS

Hundred and eighty-eight patients treated with RT ± systemic therapy for OC and laryngeal cancer from 2017 to 2022 were identified. Premature termination was defined as completion of less than 95% of the prescribed RT. Logistic regression analysis was performed to examine factors predictive of premature termination, and survival was determined using the Kaplan-Meier method.

RESULTS

Twenty patients (10.6%) experienced premature RT terminations. On regression analysis, ECOG score at initiation of RT was the only covariate studied to be independently associated with premature termination (OR 2.00, 95%CI: [1.21, 3.30], p = 0.007). Three-year overall survival (49.1% vs. 77.3%) was significantly reduced in the termination cohort (p < 0.0001).

CONCLUSIONS

This analysis demonstrated over 1 in 10 patients had premature RT termination, which prognosticated inferior survival outcomes. Poor performance status may highlight patients at risk for premature termination and thus identify good candidates for hypofractionated protocols.

Emergence and impact of theranostic-nanoformulation of triple therapeutics for combination cancer therapy

Cancer remains a major global health threat necessitating the multipronged approaches for its prevention and management. Traditional approaches in the form of chemotherapy, surgery, and radiotherapy are often encountered with poor patient outcomes evidenced by high mortality and morbidity, compelling the need for precision medicine for cancer patients to enable personalized and targeted cancer treatment. There has been an emergence of smart multimodal theranostic nanoformulation for triple combination cancer therapy in the last few years, which dramatically enhances the overall safety of the nanoformulation for in vivo and potential clinical applications with minimal toxicity. However, it is imperative to gain insight into the limitations of this system in terms of clinical translation, cost-effectiveness, accessibility, and multidisciplinary collaboration. This review paper aims to highlight and compare the impact of the recent theranostic nanoformulations of triple therapeutics in a single nanocarrier for effective management of cancer and provide a new dimension for diagnostic and treatment simultaneously.

Comparison of da Vinci Single Port vs Si Systems for Transoral Robotic-Assisted Surgery: A Review With Technical Insights

Importance

Transoral robot-assisted surgery (TORS) continues to have a major role in the treatment of oropharyngeal cancer. As new iterations of robotic technology are increasingly utilized, it is important to share learning experiences and clinical outcomes data, to optimize technical efficiency and clinical care.

Observations

This was a retrospective review of a large academic institution's initial clinical use of the da Vinci Single Port (SP) compared with the da Vinci Si (Si) system. A total of 205 TORS cases were reviewed: 109 in the SP group (November 22, 2018, through September 30, 2020), and 96 in the Si group (January 1, 2016, through November 12, 2018). Both groups had comparable operative times, rates of postoperative pharyngeal hemorrhage, length of hospital stay, and duration of nasogastric feeding tube use. There was no difference in pathological characteristics, rates of positive margins, or indications for or time to initiation of adjuvant therapy between the groups. The collective experience of 6 faculty members-who have trained 139 TORS surgeons for the SP system rollout-was compiled to provide a summary of learning experiences and technical notes on safe and efficient operation of the SP system.

Conclusions and Relevance

This Review found that the functional and oncologic outcomes were comparable between TORS cases performed with the Si and SP systems, and they had similar complication rates. Recognized advantages of the SP over the Si system include the availability of bipolar-energized instruments, a usable third surgical arm, and improved camera image quality.