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Song JS, Smith SP, Stucken CL. Implications of Malignancy, Radiation, and Timing of Major Nasal Reconstruction. Facial Plast Surg Clin North Am 2024; 32:189-198. [PMID: 38575277 DOI: 10.1016/j.fsc.2023.12.001] [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] [Indexed: 04/06/2024]
Abstract
Owing to the complex, multilayered anatomy of the nose in the central face, major nasal reconstruction can pose a significant challenge for reconstructive surgeons. It is the responsibility of reconstructive surgeons to have an understanding of the most common cutaneous malignancies and excisional techniques that may lead to complex nasal defects. The purpose of this article is to discuss these malignancies, excisional techniques, and impacts of radiation on tissue that has implications for reconstructive surgeons.
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Affiliation(s)
- Jin Soo Song
- Smith Facial Plastics, Columbus Ohio, 725 Buckles Court North #210, Gahanna, OH 43230, USA
| | - Stephen P Smith
- Smith Facial Plastics, Columbus Ohio, 725 Buckles Court North #210, Gahanna, OH 43230, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Kinj R, Gaide O, Jeanneret-Sozzi W, Dafni U, Viguet-Carrin S, Sagittario E, Kypriotou M, Chenal J, Duclos F, Hebeisen M, Falco T, Geyer R, Gonçalves Jorge P, Moeckli R, Bourhis J. Randomized phase II selection trial of FLASH and conventional radiotherapy for patients with localized cutaneous squamous cell carcinoma or basal cell carcinoma: A study protocol. Clin Transl Radiat Oncol 2024; 45:100743. [PMID: 38362466 PMCID: PMC10867306 DOI: 10.1016/j.ctro.2024.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/03/2024] [Accepted: 02/03/2024] [Indexed: 02/17/2024] Open
Abstract
Background Cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most prevalent skin cancers in western countries. Surgery is the standard of care for these cancers and conventional external radiotherapy (CONV-RT) with conventional dose rate (0.03-0.06 Gy/sec) represents a good alternative when the patients or tumors are not amenable to surgery but routinely generates skin side effects. Low energy electron FLASH radiotherapy (FLASH-RT) is a new form of radiotherapy exploiting the biological advantage of the FLASH effect, which consists in delivering radiation dose in milliseconds instead of minutes in CONV-RT. In pre-clinical studies, when compared to CONV-RT, FLASH-RT induced a robust, reproducible and remarkable sparing of the normal healthy tissues, while the efficacy on tumors was preserved. In this context, we aim to prospectively evaluate FLASH-RT versus CONV-RT with regards to toxicity and oncological outcome in localized cutaneous BCC and SCC. Methods This is a randomized selection, non-comparative, phase II study of curative FLASH-RT versus CONV-RT in patients with T1-T2 N0 M0 cutaneous BCC and SCC. Patients will be randomly allocated to low energy electron FLASH-RT (dose rate: 220-270 Gy/s) or to CONV-RT arm. Small lesions (T1) will receive a single dose of 22 Gy and large lesions (T2) will receive 30 Gy in 5 fractions of 6 Gy over two weeks.The primary endpoint evaluates safety at 6 weeks after RT through grade ≥ 3 toxicity and efficacy through local control rate at 12 months. Approximately 60 patients in total will be randomized, considering on average 1-2 lesions and a maximum of 3 lesions per patients corresponding to the total of 96 lesions required. FLASH-RT will be performed using the Mobetron® (IntraOp, USA) with high dose rate functionality.LANCE (NCT05724875) is the first randomized trial evaluating FLASH-RT and CONV-RT in a curative setting.
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Affiliation(s)
- Rémy Kinj
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Olivier Gaide
- Service of Dermatology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Wendy Jeanneret-Sozzi
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Urania Dafni
- Laboratory of Biostatistics School of Health Sciences University of Athens, Greece
| | - Stéphanie Viguet-Carrin
- Center of Experimental Therapeutics (CTE), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Enea Sagittario
- Center of Experimental Therapeutics (CTE), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Magdalini Kypriotou
- Center of Experimental Therapeutics (CTE), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julie Chenal
- Center of Experimental Therapeutics (CTE), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Duclos
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Marine Hebeisen
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Teresa Falco
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Reiner Geyer
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrik Gonçalves Jorge
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raphaël Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
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Fang Q, Yuan J, Zhang X, Dai L, Luo R, Xu C. Neck management in cutaneous squamous cell carcinoma with parotid metastasis. Head Neck 2024. [PMID: 38334480 DOI: 10.1002/hed.27676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE Our objective is to assess the oncologic outcomes of observation, elective neck dissection (END), and elective neck irradiation (ENI) in the neck management of head and neck cutaneous squamous cell carcinoma (HNcSCC) with parotid metastasis (P+) and to evaluate the quality of life (QoL) of patients who received END or ENI. METHODS Patients with P+ HNcSCC were retrospectively enrolled. The impact of observation, END, and ENI on regional control (RC) and overall survival (OS) was analyzed using Cox proportional hazards model with presentation via hazard ratio (HR) with a 95% confidence interval (CI). QoL was evaluated using the University of Washington Quality of Life questionnaire. RESULTS A total of 134 patients were included in our analysis. In the Cox model for RC, both END and ENI had decreased HRs of 0.27 (95% CI: 0.15-0.69) and 0.34 (95% CI: 0.18-0.86), respectively, in comparison with observation. In the Cox model for OS, both END (p = 0.001, HR: 0.22, 95% CI: 0.10-0.72) and ENI (p = 0.006, HR: 0.30, 95% CI: 0.17-0.83) were superior to observation. In patients with three or more positive parotid lymph nodes, END resulted in significantly better RC (p < 0.001) and OS (p = 0.001) compared with ENI. The two groups were found to be comparable in all 12 domains of the University of Washington Quality of Life questionnaire. CONCLUSION In the neck management of P+ HNcSCC, observation is not recommended. END is the preferred option, but ENI is an alternative method without compromise to survival or QoL, except in cases with three or more metastatic parotid lymph nodes.
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Affiliation(s)
- Qigen Fang
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Junhui Yuan
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Xu Zhang
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Liyuan Dai
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Ruihua Luo
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Chunmiao Xu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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