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Carsuzaa F, Chabrillac E, Marcy PY, Mehanna H, Thariat J. Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary. Strahlenther Onkol 2024; 200:553-567. [PMID: 38600366 DOI: 10.1007/s00066-024-02228-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Substantial changes have been made in the neck management of patients with head and neck squamous cell carcinomas (HNSCC) in the past century. These have been fostered by changes in cancer epidemiology and technological progress in imaging, surgery, or radiotherapy, as well as disruptive concepts in oncology. We aimed to review changes in nodal management, with a focus on HNSCC patients with nodal involvement (cN+) undergoing (chemo)radiotherapy. METHODS A narrative review was conducted to review current advances and address knowledge gaps in the multidisciplinary management of the cN+ neck in the context of (chemo)radiotherapy. RESULTS Metastatic neck nodes are associated with poorer prognosis and poorer response to radiotherapy, and have therefore been systematically treated by surgery. Radical neck dissection (ND) has gradually evolved toward more personalized and less morbid approaches, i.e., from functional to selective ND. Omission of ND has been made feasible by use of positron-emission tomography/computed tomography to monitor the radiation response in cN+ patients. Human papillomavirus-driven oropharyngeal cancers and their cystic nodes have shown dramatically better prognosis than tobacco-related cancers, justifying a specific prognostic classification (AJCC) creation. Finally, considering the role of lymph nodes in anti-tumor immunity, de-escalation of ND and prophylactic nodal irradiation in combination are intense areas of investigation. However, the management of bulky cN3 disease remains an issue, as aggressive multidisciplinary strategies or innovative combined treatments have not yet significantly improved their prognosis. CONCLUSION Personalized neck management is an increasingly important aspect of the overall therapeutic strategies in cN+ HNSCC.
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Affiliation(s)
- Florent Carsuzaa
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, Poitiers University Hospital, Poitiers, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Pierre Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Juliette Thariat
- Department of radiotherapy, Centre François Baclesse, Caen, France.
- Laboratoire de physique Corpusculaire, IN2P3/ENSICAEN/CNRS, UMR 6534, Normandie Université, Caen, France.
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Wang L, Feng Q, Ge X, Chen F, Yu B, Chen B, Liao Z, Lin B, Lv Y, Ding Z. Textural features reflecting local activity of the hippocampus improve the diagnosis of Alzheimer’s disease and amnestic mild cognitive impairment: A radiomics study based on functional magnetic resonance imaging. Front Neurosci 2022; 16:970245. [PMID: 36003964 PMCID: PMC9393721 DOI: 10.3389/fnins.2022.970245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022] Open
Abstract
Background Textural features of the hippocampus in structural magnetic resonance imaging (sMRI) images can serve as potential diagnostic biomarkers for Alzheimer’s disease (AD), while exhibiting a relatively poor discriminant performance in detecting early AD, such as amnestic mild cognitive impairment (aMCI). In contrast to sMRI, functional magnetic resonance imaging (fMRI) can identify brain functional abnormalities in the early stages of cerebral disorders. However, whether the textural features reflecting local functional activity in the hippocampus can improve the diagnostic performance for AD and aMCI remains unclear. In this study, we combined the textural features of the amplitude of low frequency fluctuation (ALFF) in the slow-5 frequency band and structural images in the hippocampus to investigate their diagnostic performance for AD and aMCI using multimodal radiomics technique. Methods Totally, 84 AD, 50 aMCI, and 44 normal controls (NCs) were included in the current study. After feature extraction and feature selection, the radiomics models incorporating sMRI images, ALFF values and their combinations in the bilateral hippocampus were established for the diagnosis of AD and aMCI. The effectiveness of these models was evaluated by receiver operating characteristic (ROC) analysis. The radiomics models were further validated using the external data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Results The results of ROC analysis showed that the radiomics models based on structural images in the hippocampus had a better diagnostic performance for AD compared with the models using ALFF, while the ALFF-based model exhibited better discriminant performance for aMCI than the models with structural images. The radiomics models based on the combinations of structural images and ALFF were found to exhibit the highest accuracy for distinguishing AD from NCs and aMCI from NCs. Conclusion In this study, we found that the textural features reflecting local functional activity could improve the diagnostic performance of traditional structural models for both AD and aMCI. These findings may deepen our understanding of the pathogenesis of AD, contributing to the early diagnosis of AD.
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Affiliation(s)
- Luoyu Wang
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Feng
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiuhong Ge
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fenyang Chen
- The Fourth School of Medical, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bo Yu
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, China
| | - Bing Chen
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, China
| | - Zhengluan Liao
- Center for Rehabilitation Medicine, Department of Geriatric VIP No. 3, Department of Clinical Psychology, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Biying Lin
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yating Lv
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- *Correspondence: Yating Lv,
| | - Zhongxiang Ding
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhongxiang Ding,
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