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Asarkar AA, Chang BA, de Bree R, Kowalski LP, Guntinas-Lichius O, Bradley PJ, de Graaf P, Strojan P, Rao KN, Mäkitie AA, López F, Rinaldo A, Palme C, Genden EM, Sanabria A, Rodrigo JP, Ferlito A. Primary Management of Operable Locally Advanced Oral Cavity Squamous Cell Carcinoma: Current Concepts and Strategies. Adv Ther 2024:10.1007/s12325-024-02861-6. [PMID: 38642199 DOI: 10.1007/s12325-024-02861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy. METHODS A review of literature using PubMED was performed for studies reporting the management of LAOCSCC. Based on the reviewed literature and opinions of experts in the field, recommendations were made. RESULTS Studies have shown that outcomes following resection of T4a and infranotch (inferior to mandibular notch) T4b are comparable. We discuss the concept of compartmental resection of LAOCSCC and issues concerning the management of the neck. Further, patients who refuse or are unable to undergo surgery can be treated with chemoradiotherapy with uncertain outcomes. The role of neoadjuvant chemotherapy has shown promise for organ (mandibular) preservation in a select subset of patients. CONCLUSION The management strategy for LAOCSCC should be determined in a multidisciplinary setting with emphasis on tumor control, functional preservation, and quality of life of the patient.
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Affiliation(s)
- Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, Louisiana Health Sciences Center, Shreveport, LA, 71103, USA.
| | - Brent A Chang
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luiz P Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Patrick J Bradley
- Department of ORLHNS, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK
| | - Pim de Graaf
- Amsterdam UMC Location Vrije Universiteit, Radiology and Nuclear Medicine, de Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, 1000, Ljubljana, Slovenia
| | - Karthik N Rao
- Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Center, Bangalore, India
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fernando López
- ENT and Head and Neck Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Carsten Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY, 10029, USA
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Universidad de Antioquia, Medellin, Colombia
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, CIBERONC, 33011, Oviedo, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35030, Padua, Italy
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Bradley PJ. Extranodal extension in head and neck squamous cell carcinoma: need for accurate pretherapeutic staging to select optimum treatment and minimize toxicity. Curr Opin Otolaryngol Head Neck Surg 2024; 32:71-80. [PMID: 38116845 DOI: 10.1097/moo.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW In 2017, the American Joint Committee on Cancer (AJCC) introduced the inclusion of extracapsular nodal extension (ENE) into the N staging of nonviral head and neck squamous cell carcinoma (HNSCC), while retaining the traditional N classification based on the number and sizes of metastatic nodes. The extent of ENE was further defined as microscopic ENE (ENEmi) and major ENE (ENEma) based on extent of disease beyond the nodal capsule (≤ or > 2 mm). This article reviews the evidence and progress made since these changes were introduced. RECENT FINDINGS The 'gold standard' for evaluation ENE is histopathologic examination, the current preferred primary treatment of patients with HNSCC is by radiation-based therapy ± chemotherapy or biotherapy. The current pretreatment staging is by imaging, which needs improved reliability of radiologic rENE assessment with reporting needs to consider both sensitivity and specificity (currently computed tomography images have high-specificity but low-sensitivity). Adjuvant chemotherapy is indicated for patients with ENEma to enhance disease control, whereas for patients with ENEmi, there is a need to assess the benefit of adjuvant chemotherapy. Evidence that the presence of pENE in HPV-positive oropharyngeal carcinoma is an independent prognostic factor and should be considered for inclusion in future AJCC editions has recently emerged. SUMMARY There remains a paucity of data on the reliability of imaging in the staging of rENE, more so the for the accurate assessment of ENEmi. Optimistic early results from use of artificial intelligence/deep learning demonstrate progress and may pave the way for better capabilities in tumor staging, treatment outcome prediction, resulting in improved survival outcomes.
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Affiliation(s)
- Patrick J Bradley
- Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
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Guntinas-Lichius O, Geißler K, Mäkitie AA, Ronen O, Bradley PJ, Rinaldo A, Takes RP, Ferlito A. Treatment of recurrent acute tonsillitis-a systematic review and clinical practice recommendations. Front Surg 2023; 10:1221932. [PMID: 37881239 PMCID: PMC10597714 DOI: 10.3389/fsurg.2023.1221932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023] Open
Abstract
Background There is an ongoing debate on the indications for tonsil surgery in both children and adults with recurrent acute tonsillitis. The aim is to provide practical recommendations for diagnostics and treatment for recurrent acute tonsillitis including evidence-based decision making for tonsillectomy. Methods A systematic literature search in PubMed, Embase, Web of Science, and ScienceDirect from 2014 until April 2023 resulted in 68 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostics and indications for both non-surgical and surgical therapy. A consensus paper was circulated among the authors and members of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations. Results The differentiation between sore throat and tonsillitis patient episodes is mostly not feasible and hence is not relevant for diagnostic decision making. Diagnostics of a tonsillitis/sore throat episode should always include a classification with a scoring system (Centor, McIssac, FeverPAIN score) to estimate the probability of a bacterial tonsillitis, mainly due to group A streptococcus (GAS). In ambiguous cases, a point-of-care test GAS swab test is helpful. Consecutive counting of the tonsillitis/sore throat episodes is important. In addition, a specific quality of life score (Tonsillectomy Outcome Inventory 14 or Tonsil and Adenoid Health Status Instrument) should be used for each episode. Conservative treatment includes a combination of paracetamol and/or non-steroidal anti-inflammatory drugs. In case of high probability of bacterial tonsillitis, and only in such cases, especially in patients at risk, standard antibiotic treatment is initiated directly or by delayed prescription. Tonsillectomy is indicated and is highly effective if the patient has had ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years. An essential part of surgery is standardized pain management because severe postoperative pain can be expected in most patients. Conclusion It is necessary to follow a stringent treatment algorithm for an optimal and evidence-based treatment for patients with recurrent acute tonsillitis. This will help decrease worldwide treatment variability, antibiotic overuse, and avoid ineffective tonsillectomy.
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Affiliation(s)
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Patrick J. Bradley
- Department Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, United Kingdom
| | | | - Robert P. Takes
- Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Civantos F, Helmen ZM, Bradley PJ, Coca-Pelaz A, De Bree R, Guntinas-Lichius O, Kowalski LP, López F, Mäkitie AA, Rinaldo A, Robbins KT, Rodrigo JP, Takes RP, Ferlito A. Lymph Node Metastases from Non-Melanoma Skin Cancer of the Head and Neck. Cancers (Basel) 2023; 15:4201. [PMID: 37686478 PMCID: PMC10486745 DOI: 10.3390/cancers15174201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Non-melanoma skin cancer (NMSC) represents the most common malignancy in the world, comprising exceedingly common lesions such as basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) and rare lesions such as Merkel cell carcinoma. Risk factors are widely recognized and include ultraviolet (UV) light exposure, radiation exposure, immunosuppression, and many others. As a whole, survival and functional outcomes are favorable, but each histopathological subtype of NMSC behaves differently. Treatment regimens for the primary site usually include wide surgical excision and neck dissection in cases of clinically involved metastatic lymph nodes. The elective management of draining nodal basins, however, is a contested topic. Nearly all subtypes, excluding BCC, have a significant risk of lymphatic metastases, and have been studied with regard to sentinel lymph node biopsy (SLNB) and elective neck dissection. To date, no studies have definitively established a true single standard of care, as exists for melanoma, for any of the NMSCs. As a result, the authors have sought to summarize the current literature and identify indications and management options for the management of the cervical lymphatics for each major subtype of NMSC. Further research remains critically necessary in order to develop complete treatment algorithms.
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Affiliation(s)
- Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.C.); (Z.M.H.)
| | - Zachary M. Helmen
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.C.); (Z.M.H.)
| | - Patrick J. Bradley
- Department of Otorhinolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, 07747 Jena, Germany
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paolo 01509-900, Brazil
- Head and Neck Surgery Department, University of São Paulo Medical School, Sao Paulo 05403-000, Brazil
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-00029 HUS Helsinki, Finland;
| | | | - K. Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Southern Illinois University Carbondale, Carbondale, IL 62901, USA
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Robert P. Takes
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
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Fernández-Alvarez V, Linares-Sánchez M, Suárez C, López F, Guntinas-Lichius O, Mäkitie AA, Bradley PJ, Ferlito A. Novel Imaging-Based Biomarkers for Identifying Carotid Plaque Vulnerability. Biomolecules 2023; 13:1236. [PMID: 37627301 PMCID: PMC10452902 DOI: 10.3390/biom13081236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Carotid artery disease has traditionally been assessed based on the degree of luminal narrowing. However, this approach, which solely relies on carotid stenosis, is currently being questioned with regard to modern risk stratification approaches. Recent guidelines have introduced the concept of the "vulnerable plaque," emphasizing specific features such as thin fibrous caps, large lipid cores, intraplaque hemorrhage, plaque rupture, macrophage infiltration, and neovascularization. In this context, imaging-based biomarkers have emerged as valuable tools for identifying higher-risk patients. Non-invasive imaging modalities and intravascular techniques, including ultrasound, computed tomography, magnetic resonance imaging, intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy, have played pivotal roles in characterizing and detecting unstable carotid plaques. The aim of this review is to provide an overview of the evolving understanding of carotid artery disease and highlight the significance of imaging techniques in assessing plaque vulnerability and informing clinical decision-making.
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Affiliation(s)
- Verónica Fernández-Alvarez
- Department of Vascular and Endovascular Surgery, Hospital Universitario de Cabueñes, 33394 Gijón, Spain;
| | - Miriam Linares-Sánchez
- Department of Vascular and Endovascular Surgery, Hospital Universitario de Cabueñes, 33394 Gijón, Spain;
| | - Carlos Suárez
- Instituto de Investigacion Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (C.S.); (F.L.)
| | - Fernando López
- Instituto de Investigacion Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (C.S.); (F.L.)
- Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncologia del Principado de Asturias, University of Oviedo, CIBERONC, 33011 Oviedo, Spain
| | | | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, P.O. Box 263, 00029 Helsinki, Finland;
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Patrick J. Bradley
- Department of ORLHNS, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham NG7 2UH, UK;
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy;
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Mäkitie AA, Alabi RO, Ng SP, Takes RP, Robbins KT, Ronen O, Shaha AR, Bradley PJ, Saba NF, Nuyts S, Triantafyllou A, Piazza C, Rinaldo A, Ferlito A. Artificial Intelligence in Head and Neck Cancer: A Systematic Review of Systematic Reviews. Adv Ther 2023; 40:3360-3380. [PMID: 37291378 PMCID: PMC10329964 DOI: 10.1007/s12325-023-02527-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/20/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Several studies have emphasized the potential of artificial intelligence (AI) and its subfields, such as machine learning (ML), as emerging and feasible approaches to optimize patient care in oncology. As a result, clinicians and decision-makers are faced with a plethora of reviews regarding the state of the art of applications of AI for head and neck cancer (HNC) management. This article provides an analysis of systematic reviews on the current status, and of the limitations of the application of AI/ML as adjunctive decision-making tools in HNC management. METHODS Electronic databases (PubMed, Medline via Ovid, Scopus, and Web of Science) were searched from inception until November 30, 2022. The study selection, searching and screening processes, inclusion, and exclusion criteria followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A risk of bias assessment was conducted using a tailored and modified version of the Assessment of Systematic Review (AMSTAR-2) tool and quality assessment using the Risk of Bias in Systematic Reviews (ROBIS) guidelines. RESULTS Of the 137 search hits retrieved, 17 fulfilled the inclusion criteria. This analysis of systematic reviews revealed that the application of AI/ML as a decision aid in HNC management can be thematized as follows: (1) detection of precancerous and cancerous lesions within histopathologic slides; (2) prediction of the histopathologic nature of a given lesion from various sources of medical imaging; (3) prognostication; (4) extraction of pathological findings from imaging; and (5) different applications in radiation oncology. In addition, the challenges in implementation of AI/ML models for clinical evaluations include the lack of standardized methodological guidelines for the collection of clinical images, development of these models, reporting of their performance, external validation procedures, and regulatory frameworks. CONCLUSION At present, there is a paucity of evidence to suggest the adoption of these models in clinical practice due to the aforementioned limitations. Therefore, this manuscript highlights the need for development of standardized guidelines to facilitate the adoption and implementation of these models in the daily clinical practice. In addition, adequately powered, prospective, randomized controlled trials are urgently needed to further assess the potential of AI/ML models in real-world clinical settings for the management of HNC.
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Affiliation(s)
- Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, P.O. Box 263, 00029, HUS, Helsinki, Finland.
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
| | - Rasheed Omobolaji Alabi
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Australia
- School of Imaging and Radiation Sciences, Monash University, Melbourne, Australia
| | - Robert P Takes
- Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Thomas Robbins
- Department of Otolaryngology Head Neck Surgery, SIU School of Medicine, Southern Illinois University, Springfield, IL, USA
| | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center Affiliated with Azrieil Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patrick J Bradley
- The University of Nottingham, Department of ORLHNS, Queens Medical Centre Campus, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, 3000, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Asterios Triantafyllou
- Department of Pathology, Liverpool Clinical Laboratories, School of Dentistry, University of Liverpool, Liverpool, UK
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Bradley PJ. Peristomal recurrence following primary total laryngectomy: the enigma of the central compartment neck lymph nodes. Curr Opin Otolaryngol Head Neck Surg 2023; 31:94-104. [PMID: 36730566 DOI: 10.1097/moo.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The practice of primary total laryngectomy (TL) for advanced laryngo-hypopharyngeal cancer has significantly declined in the developed countries. The treatment options most frequently adopted have changed from open surgery to transoral laser or robotic approaches or nonsurgical (bio-chemo-) radiotherapy. Primary TL remains the treatment of choice in the developing world where healthcare resources are limited, especially for the treatment of cancer. RECENT FINDINGS Peristomal recurrence (PSR) is quite a serious complication, with an incidence of 6.6% from the published literature (mainly concerning the developed world), most diagnosed within 2 years, and associated with >80% mortality. The major risk factors include pretreatment tracheostomy, specific primary tumor subsites, positive surgical margins, and presence of nodal metastasis. The treatment options are limited and most success has been observed with surgery, especially when PSR is diagnosed at an early-stage, which is uncommon. Treatment of advanced-stage disease is usually palliative. Reduction and/or prevention of the known risk factors for PSR remain the goal when performing TL. In particular, central compartment (para- and pretracheal) lymph nodes dissection in case of large tumors with extra-laryngeal and/or subglottic extension or pretreatment tracheotomy plays a paramount role in PSR prevention. SUMMARY Research is required to conclude the formulation of guidelines for proper dissection of the central compartment (level VI) lymph nodes as indicated either prophylactically or therapeutically during TL for preventing PSR.
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Affiliation(s)
- Patrick J Bradley
- Department Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
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Li WX, Dong YB, Lu C, Bradley PJ, Liu LF. Efficacy of Larynx Preservation Surgery and Multimodal Adjuvant Therapy for Hypopharyngeal Cancer: A Case Series Study. Ear Nose Throat J 2022:1455613221098784. [PMID: 35537143 DOI: 10.1177/01455613221098784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Larynx preservation surgery (LPS) combined with multimodal adjuvant therapy (MAT) is re-emerging as treatment option for hypopharyngeal cancer (HPC). This study aims to explore the survival and functional outcome of this combined approach. Methods: This is a retrospective cohort study. Selected patients with primary HPC treated by LPS and MAT at two large Beijing medical centers between 2005 and 2019 were included. In addition to LPS, patients received one or more of the following treatments: preoperative induction chemotherapy, postoperative intensity-modulated radiotherapy, chemotherapy, or targeted therapy. Results: In total, 64 patients were included (62 were men, and median age was 57.5 years). The disease in most patients was in stage III (28.1%) or IV (56.3%), or in stage T2 (34.4%) or T3 (45.3%), based on the TNM scale. Across all patients, the rate of overall survival (OS) was 60.7% at 3 yr and 47.3% at 5 yr. OS was significantly higher for patients with stage I or II disease than for those with stage III or IV disease (HR 8.64, 95% CI 3.69-20.2, log-rank P = .010). Decannulation was successful in 55 patients (85.9%), and swallowing function was satisfactory (stage 0-III, on Functional Outcome Swallowing Scale) for 50 (78.1%). Median Voice Handicap Index-10 score on voice performance was 19 (range 4-40), and median Functional Assessment of Cancer Therapy-General Questionnaire score for QoL was 75 (range 16-105). Conclusions: LPS and MAT can provide satisfactory oncologic control and good functional outcomes for selected patients with HPC, especially those with stage I or II disease.
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Affiliation(s)
- Wan-Xin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Yan-Bo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Patrick J Bradley
- Head and Neck Oncological Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
| | - Liang-Fa Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China.,Department of Otolaryngology, Head & Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, China
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Bradley PJ. Parotid lymph nodes in primary malignant salivary neoplasms. Curr Opin Otolaryngol Head Neck Surg 2021; 30:99-106. [DOI: 10.1097/moo.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Li WX, Dong YB, Lu C, Bradley PJ, Liu ALF. Survival and swallowing function outcome impact factors analysis of surgery-oriented comprehensive treatment for hypopharyngeal cancer in a series of 122 patients. Ear Nose Throat J 2021; 101:532-541. [PMID: 34792398 DOI: 10.1177/01455613211058108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Under current standards of treating highly aggressive hypopharyngeal cancer (HPC), oncological control and functional outcome are still unsatisfactory worldwide. This study explored the surgery-oriented comprehensive treatment approach based on 15 years of practice. METHODS A retrospective cohort of HPC patients treated by the senior author at Chinese PLA General Hospital between Nov 2005 and Aug 2012 and Capital Medical University Beijing Friendship Hospital between May 2014 and Nov 2019 was studied. Oncological control, swallowing function, and quality of life (QoL) were assessed. RESULTS In total, 122 patients were included in this study, with 11 (9.0%) cases in the early stage and 111 (91.0%) cases in the advanced stage. Five-year overall survival (OS) and disease-free survival (DFS) were 40.0% and 36.1%, respectively. The swallowing outcome was satisfactory in 90 (73.8%) patients. Tracheostomy-free survival was achieved in 55 (45.1%) patients. Multivariate cox regression analysis showed that the size of the surgical defect, local-regional recurrence, and distant metastasis were independent impact factors for OS and DFS (P < .05). Multivariate analysis showed that the logistic regression coefficients (standard error) of pharyngo-cutaneous fistula and local-regional recurrence on swallowing function were 1.274 (.532) and 1.283 (.496), respectively (P < .05). In addition, the logistic regression coefficients (standard error) of the clinical stage, local-regional recurrence, decannulation, and feeding tube on QoL were -7.803 (3.593), -7.699 (3.151), 13.853 (3.494), and -20.243 (3.696), respectively (P < .05). CONCLUSIONS Surgery-oriented comprehensive treatment can give rise to good swallowing function without jeopardizing oncological control. The size of the surgical defect, local-regional recurrence, and distant metastasis were independent factors impacting OS and DFS. Pharyngo-cutaneous fistula and local-regional recurrence were independent factors impacting swallowing function. Clinical stage, local-regional recurrence, decannulation, and feeding tube were independent factors impacting QoL.
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Affiliation(s)
- Wan-Xin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Yan-Bo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Patrick J Bradley
- Head and Neck Oncological Surgeon, Queens Medical Centre Campus, Nottingham University Hospitals, Nottingham, UK
| | - And Liang-Fa Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China.,Department of Otolaryngology, Head & Neck Surgery, Chinese PLA General Hospital, Institute of Otolaryngology, Beijing, China
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11
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12
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Bier-Laning C, Cramer JD, Roy S, Palmieri PA, Amin A, Añon JM, Bonilla-Asalde CA, Bradley PJ, Chaturvedi P, Cognetti DM, Dias F, Di Stadio A, Fagan JJ, Feller-Kopman DJ, Hao SP, Kim KH, Koivunen P, Loh WS, Mansour J, Naunheim MR, Schultz MJ, Shang Y, Sirjani DB, St John MA, Tay JK, Vergez S, Weinreich HM, Wong EWY, Zenk J, Rassekh CH, Brenner MJ. Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries. Otolaryngol Head Neck Surg 2020; 164:1136-1147. [PMID: 33138722 DOI: 10.1177/0194599820961985] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. DATA SOURCES Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. REVIEW METHODS The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. CONCLUSIONS Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. IMPLICATIONS FOR PRACTICE Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.
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Affiliation(s)
- Carol Bier-Laning
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John D Cramer
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Soham Roy
- Department of Otorhinolaryngology-Head and Neck Surgery, Children's Memorial Hermann Hospital, University of Texas Medical School, Houston, Texas, USA
| | - Patrick A Palmieri
- Office of the Vice Chancellor for Research, Universidad Norbert Wiener, Lima, Peru.,EBHC South America: A Joanna Briggs Affiliated Group, Lima, Peru
| | - Ayman Amin
- Head and Neck Department, National Cancer Institute, Cairo University, Egypt
| | - José Manuel Añon
- La Paz-Carlos III University Hospital, IdiPAZ, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Cesar A Bonilla-Asalde
- Hospital Nacional Daniel Alcides Carrión, Lima, Perú.,Universidad Privada San Juan Bautista, Lima, Perú
| | - Patrick J Bradley
- Department of Otolaryngology, Head and Neck Oncologic Surgery, University of Nottingham, Nottingham, UK
| | - Pankaj Chaturvedi
- Department of Head & Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - David M Cognetti
- Department of Otolaryngology-Head & Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Philadelphia, USA
| | - Fernando Dias
- Head and Neck Surgery Service, Brazilian National Cancer Institute, Chairman, Department of Head and Neck Surgery, Post-Graduation School of Medicine, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Johannes J Fagan
- Division of Otorhinolaryngology (ENT), University of Cape Town, Cape Town, South Africa
| | - David J Feller-Kopman
- Departments of Medicine, Anesthesiology and Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheng-Po Hao
- Department of Otorhinolaryngology-Head & Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei.,Department of Otorhinolaryngology-Head & Neck Surgery, Fu Jen Catholic University School of Medicine, New Taipei City
| | - Kwang Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery and Cancer Research Institute, Bundang Jesaeng Hospital Seoul National University College of Medicine, Seoul, Korea
| | - Petri Koivunen
- Department of Otolaryngology, Oulu University Hospital, Oulu, Finland
| | - Woei Shyang Loh
- Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jobran Mansour
- Department of Otorhinolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Marcus J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·CA), Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Davud B Sirjani
- Department of Otorhinolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California, USA.,UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California, USA
| | - Joshua K Tay
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore
| | - Sébastien Vergez
- Department of Otolaryngology-Head & Neck Surgery, University Hospital Rangueil-Larrey, Toulouse, France
| | - Heather M Weinreich
- Department of Otolaryngology, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Eddy W Y Wong
- Department of Otorhinolaryngology, Head & Neck Surgery, Chinese University of Hong Kong, Hong Kong
| | - Johannes Zenk
- Universitätsklinikum Augsburg Klinik für HNO-Heilkunde, Augsburg, Germany
| | - Christopher H Rassekh
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Global Tracheostomy Collaborative, Raleigh, North Carolina, USA
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Abstract
In the coming years, further developments can be expected in the field of diagnosis and management of tumors involving the anterior skull base, and especially malignant tumors of the sinonasal tract, which account for the majority of lesions affecting this anatomic area. Advances in genomics and radiomics will undoubtedly lead to better profiling of tumor biology, with consequent refinement of treatment according to the principles of precision medicine. Similarly, the continuous evolution of morphologic and metabolic imaging will improve the accuracy of pretreatment staging and posttreatment surveillance. Finally, the relentless development of technology in complementary fields (i.e., bioengineering, regenerative medicine, robotics, navigation systems, optical imaging) will refine the safety and accuracy of surgery. As a consequence of these innovations, all healthcare professionals involved in the management of anterior skull base tumors need to consolidate their multidisciplinary efforts for improving the patient's quality of life and survival outcomes. In tandem, hospital administrators and politicians should understand the essential importance of limiting the treatment of these pathologies to "centers of excellence," ensuring an adequate workload and appropriate human and technological resources.
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Affiliation(s)
- Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Patrick J Bradley
- Department of Otorhinolaryngology - Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, United Kingdom
| | - Paolo Bossi
- Unit of Oncology, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy,
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14
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Nicolai P, Bradley PJ. Preface. Adv Otorhinolaryngol 2020; 84:VII-VIII. [PMID: 32731243 DOI: 10.1159/000505104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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15
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Bradley PJ. The Oto-rhino-laryngological Research Society (ORS). Clin Otolaryngol 2020; 45:445-449. [PMID: 32100922 DOI: 10.1111/coa.13517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 11/26/2022]
Abstract
AIM To report the activity of the Otorhinolaryngology Research Society (ORS) from its' founding in 1978 until dissolution in 2017. METHOD Data were obtained, (Minutes of Council Meetings, and Correspondence) from the Societies website (now closed and archived), and relevant documents and e-mails that pervious secretaries and treasurers of ORS and The British Society of Academics in Otolaryngology (BSAO) had available. The secretarial documents of the ORS, the first 20 years, had been reported "lost," and the data retained on website were incomplete. ETHICAL CONSIDERATION No patient data have been used in this publication. RESULTS The first constitution of ORS was based on that of the Surgical Research Society and was brief and simple, with two meetings per year, awarding prizes and bursaries for the best presentations. The Society initially limited to 250 members. The constitution of ORS was revised in 1988 and modified again in 2006, which expanded the council and disbanded the need for membership. CONCLUSION The changing priorities of trainees and commercialisation of the National Health Service had resulted in running any society costly. The amalgamation of the ORL Research Societies as a Specialty Group within ENT UK to organise and run the national research agenda is likely to result in a more cohesive group with financial stability and a secure and stable environment.
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Affiliation(s)
- Patrick J Bradley
- School of Medicine, University of Nottingham, Nottingham, UK.,Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Campus, Nottingham, UK
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16
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Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G, Beamishaj, Bashashati M, Millham FH, Orgill DP, Noureldin A, Nixon IJ, Alsawadi A, Bradley PJ, Giordano S, Laskin DM, Basu S, Johnston M, Muensterer OJ, Mukherjee I, Ngu JCY, Valmasoni M, Pagano D, Vasudevan B, Rosin RD, McCaul JA, Albrecht J, Hoffman JR, Thorat MA, Massarut S, Thoma A, Kirshtein B, Afifi RY, Farooq N, Challacombe B, Pai PS, Perakath B, Kadioglu H, Aronson JK, Raveendran K, Machado-Aranda D, Klappenbach R, Healy D, Miguel D, Leles CR, Ather MH. STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg 2019; 72:156-165. [DOI: 10.1016/j.ijsu.2019.11.002] [Citation(s) in RCA: 806] [Impact Index Per Article: 161.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 12/31/2022]
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17
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Bradley PJ. Thomas Burnett Hogarth. Assoc Med J 2019. [DOI: 10.1136/bmj.l2300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Abstract
Early throat symptoms are common and a diagnosis of hypopharyngeal cancer rare; therefore, confirming or excluding a serious diagnosis is missed or overlooked by both the patient and the practitioner - however, symptoms such as throat clearing and food sticking, which persist in adult patients who have the social habit of tobacco usage and/or drink excessive alcohol should be examined by a specialist to exclude the presence of hypopharyngeal cancer. Late symptoms/signs include neck swelling (uni- or bilateral), dysphagia, odynophagia, otalgia, dysphonia, dyspnoea and stridor. Associated with advancing age and social habits, many patients have co-morbidities such as diabetes mellitus, respiratory, cardiovascular disease and behavioural health disorders that play a major role in selecting the optimal treatment and thus a likely worse long-term outcome. The majority of cases when diagnosed are at an advanced stage including evidence of local cervical nodal metastasis and distant metastasis. The TNM staging system continues to be the "gold standard" for reporting and evaluation of treatment outcomes, but more recent reports show that the use of "tumour volume" obtained from disease stage scanning of both the T and N stage are better predictors of a successful disease response outcome for the selection of a non-surgical option. Patients at presentation and those that survive curative treatment are associated with the highest risk of developing a second primary tu mour - synchronous or metachronous, involving the lung and/or the oesophagus.
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Affiliation(s)
- Patrick J Bradley
- Department of Otolaryngology, Head and Neck Surgery, Nottingham University Hospital NHS Trust, Queens Medical Centre Campus, Nottingham, United Kingdom,
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19
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Abstract
Recent advances in minimal access surgery have shown promise in the treatment of limited hypopharyngeal lesions. In spite of their functionally excellent results in individual patients, it currently remains unlikely that these approaches will gain a more major universal impact on hypopharyngeal cancer care. In advanced stage hypopharyngeal cancer, the use of the traditional radical surgery, such as laryngo-pharyngectomy, is no longer accepted by many patients. In recent years, most would rather opt for less mutilating treatment, preferring a non-surgical option. Patients, families and medical practitioners frequently ignore or misunderstand the associated mortality and morbidity consequence of such an approach. Although synergy between chemotherapy and radiotherapy enhances the efficacy of the treatment, chemo-radiation as currently used achieves a tumour response in < 80%, with relapses of the tumour during the follow-up period, indicating that surgery is the only effective treatment option as salvage. Advances in molecular research have improved our understanding of oncogenesis, tumour spread and the mechanisms of metastases. Innovative strategies have become available that manipulating tumours or the host to favour conditions receptive for disease eradication. These advances have gone through pre-clinical testing and are currently being used in early clinical trials using approaches such as replacement of defective genes, suicide gene therapy, and immunologic gene therapy. Precision oncology may eventually be able to predict which patients are more likely to respond to specific cancer therapies based on increasingly accurate, high-resolution biomarkers based on molecular diagnostics of individual tumours. Currently concentrating cancer treatment at specialised head and neck cancer institutions is likely to contribute faster and more sustained results at improving patient outcomes for hypopharyngeal cancer care than any individual innovation in surgery, radiation oncology or systemic treatment. Preventative work should continue by governments with the elimination of the preventable risk factors (abusive use of alcohol, tobacco and betel nut chewing) may reduce the incidence of the disease.
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Affiliation(s)
- Hans E Eckel
- Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Klagenfurt, Austria,
| | - Patrick J Bradley
- Department of Otolaryngology, Head and Neck Surgery, Nottingham University Hospital NHS Trust, Queens Medical Centre Campus, Nottingham, United Kingdom
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20
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Abstract
Patients with hypopharyngeal cancer are difficult to treat because they typically present with advanced disease, poor general health status and severe nutritional problems. Currently, treatment options for previously untreated and newly diagnosed hypopharyngeal cancer patients include surgery of the primary tumour and lymph nodes metastasis, radiotherapy, systemic medical treatment, including traditional chemotherapy and immunotherapy. Currently, a multimodal treatment approach is preferred using surgery, radiotherapy and systemic therapy with curative intent and best supportive care in patients considered unfit for curative treatment or patients presenting with distant metastatic spread. More detailed topics regarding the choice of treatment include biological and immunological host factors and their use for defining individualised cancer care, integration of novel therapies, integration of patient autonomy into clinical reasoning and dealing with patients' trade-offs between oncological outcome and individual quality of life, local availability of diagnostic therapeutic procedures and volume-outcome relationships for head and neck cancer surgery, radiotherapy and specialised supportive care. They also include considerations regarding potential delay between diagnosis and treatment, and between different treatment modalities within the frame of multimodal therapy. To date only one randomised trial comparing surgical versus non-surgical approaches has been published. Most randomised trials dealing with hypopharyngeal cancer compare different chemo- and radiotherapy regimen, but do not compare with a surgical approach. On the other hand, most studies on the results of surgery are best considered to be of low-quality case series. At the same time, many of the chemotherapy and radiation oncology studies in head and neck cancer include patients with different primary sites, where hypopharyngeal cancer patients when included usually account for a minority of the study population. Therefore, choosing the best treatment for an individual patient with hypopharyngeal cancer relies on personal experience and local expertise of the multidisciplinary team involved in the therapeutic process.
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Affiliation(s)
- Hans E Eckel
- Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Klagenfurt, Austria,
| | - Patrick J Bradley
- Department of Otolaryngology, Head and Neck Surgery, Nottingham University Hospital NHS Trust, Queens Medical Centre Campus, Nottingham, United Kingdom
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21
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Eckel HE, Bradley PJ. Natural History of Treated and Untreated Hypopharyngeal Cancer. Adv Otorhinolaryngol 2019; 83:27-34. [PMID: 30943503 DOI: 10.1159/000492305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/01/2018] [Indexed: 01/04/2023]
Abstract
Patients with hypopharyngeal cancers frequently present at advanced stage and in poor general health status. Their natural history is characterised by diffuse local primary disease, mucosal and submucosal spread, early cervical nodal metastasis, and a relatively high rate of distant spread. By the time of initial diagnosis, some 60% of all hypopharyngeal cancer patients will be with stage IV disease, some 5% will present with distant metastases, and almost 40% will have a significant reduction in performance status. Less than 20% are diagnosed with a localised early stage disease. A long-standing social habit of excess of alcohol and tobacco usage leads to cancerisation and accounts for the multiple, synchronous primary malignant lesions that occur in many hypopharyngeal cancer patients. The natural history of untreated head and neck squamous cell carcinoma has infrequently been documented in the medical literature. However, without understanding the natural history of hypopharyngeal cancer, patient counselling and clinical management are difficult. Less than 20% of untreated patients survive for > 12 months and only a small proportion of patients will survive for more than 2 years after initial diagnosis. The natural course of the disease in patients treated for cure or, at least, for the relief of symptoms, is certainly more favourable than that of those who are not suited for, or not willing to accept the adverse effects of treatment. However, treatment results are still considerably less encouraging than those that are being reported for other sub-sites of the head and neck region. Among all head and neck cancer sites, 5-year age-standardised relative survival is currently the poorest for cancer of the hypopharynx and the highest for larynx cancers, 25 and 59%, respectively. Among the head and neck cancers, only hypopharynx showed a low outcome (25% at 5 years), with survival figures ranging between ≤30 (North Ireland and Italy) and 8% (Bulgaria). Recent studies from the United States indicate that overall 5-year survival rates for hypopharyngeal cancer have improved significantly in recent years, with the average survival being ≥40%.
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Affiliation(s)
- Hans E Eckel
- Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Klagenfurt, Austria,
| | - Patrick J Bradley
- Department of Otolaryngology, Head and Neck Surgery, Nottingham University Hospital NHS Trust, Queens Medical Centre Campus, Nottingham, United Kingdom
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22
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Abstract
Hypopharyngeal cancer is uncommon in the developed world; it is mostly diagnosed in men who smoke tobacco and consume excessive alcohol and uncommon in women. However, recent trends in the developed world show that there has been an annual increase in the percentage of women with hypopharyngeal cancer. In France, there has been a significant annual percentage change in the incidence of this form of cancer - a decrease in men and a greater increase in women since the 1980s. In the developing world, India, Taiwan and other countries, the incidence of hypopharyngeal cancer has increased in both men and women. These populations indulge widely in the social habit of tobacco usage at an earlier age, both smoking and chewing, excessive alcohol drinking, along with the chewing of the areca nut. Recent research has proven that areca nut alone is carcinogenic. The combination of tobacco and alcohol has a greater multiplicative impact on increasing the risk of cancer, while the involvement of areca nut remains to be proven. The World Health Organisation has commenced a Global Mission on the cessation of smoking and reduction of alcohol intake. The effect of this work has been credited with a reduction of hypopharyngeal and other head and neck cancers. While the younger aged should be the targeted population to avoid tobacco usage, the middle and older age of the population must be targeted for quitting smoking tobacco.
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Affiliation(s)
- Patrick J Bradley
- Department of Otolaryngology, Head and Neck Surgery, Nottingham University Hospital NHS Trust, Queens Medical Centre Campus, Nottingham, United Kingdom,
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23
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Abstract
The phase interplay between overlapping electric and magnetic dipoles of equal amplitude generated by exclusively alldielectric structures presents an intriguing paradigm in the manipulation of electromagnetic energy. Here, we offer a holistic implementation by proposing an additive manufacturing route and associated design principles that enable the programming and fabrication of synthetic multi-material microstructures. In turn, we compose, manufacture and experimentally validate the first demonstrable 3d printed all-dielectric electromagnetic broadband absorbers that point the way to circumventing the technical limitations of conventional metal-dielectric absorber configurations. One of the key innovations is to judicially distribute a dispersive soft matter with a high-dielectric constant, such as water, in a low-dielectric matrix to enhance wave absorption at a reduced length scale. In part, these results extend the promise of additive manufacturing and illustrate the power of topology optimisation to create carefully crafted magnetic and electric responses that are sure to find new applications across the electromagnetic spectrum.
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Affiliation(s)
- Patrick J Bradley
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, E1 4NS, UK. .,School of Electronic Engineering, Dublin City University, Dublin, D09 W6Y4, Ireland.
| | - Max O Munoz Torrico
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, E1 4NS, UK
| | - Conor Brennan
- School of Electronic Engineering, Dublin City University, Dublin, D09 W6Y4, Ireland
| | - Yang Hao
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, E1 4NS, UK.
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Bradley PJ. Guidelines to authors publishing a case report: the need for quality improvement. AME Case Rep 2018; 2:10. [PMID: 30264006 DOI: 10.21037/acr.2018.04.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Patrick J Bradley
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Nottingham, Nottingham, UK
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25
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Bradley PJ. Special section “Case Reports in Otolaryngology”. AME Case Rep 2018; 2:1. [DOI: 10.21037/acr.2018.01.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Abstract
Malignant sublingual gland neoplasms are rare, early-stage neoplasms presenting as painless non-ulcerated masses in the antero-lateral floor of the mouth. The majority of patients present with advanced disease, with symptoms of pain or anaesthesia of the tongue. Malignant minor salivary gland neoplasms are more common, the majority (>80%) of which present in the oral cavity, most frequently in the palatal area, as painless masses or as obstructive symptoms in the head and neck region. The most frequent pathologies are adenoid cystic carcinoma and mucoepidermoid carcinoma (>85%), with the majority presenting at an advanced stage (III/IV). Wide tumour-free surgical margin excision is the treatment of choice, followed by radiotherapy, after discussion of the multidisciplinary head and neck cancer tumour board. Improvements in survival and quality of life have been achieved since the introduction of endoscopic and robotic surgeries for many minor salivary gland malignancies.
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27
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Abstract
Metastases from salivary gland carcinomas to the cervical lymph nodes are relatively uncommon. However, their impact on prognosis is significant and, thus, it is important to manage them appropriately. Treatment of clinically evident metastases consists primarily of surgery, frequently followed by radiation. Management of the N0 neck, on the other hand, remains controversial. While there seems to be agreement regarding the tumor and patient factors that make it more likely for a patient to harbor subclinical metastases in the lymph nodes, some clinicians prefer to treat those patients with surgery, i.e. a neck dissection, and others prefer to use elective radiation. These different approaches and their rationale will be discussed in detail.
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28
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Abstract
For many decades, surgery has been the primary treatment for malignant submandibular gland neoplasms. Nonetheless, due to the heterogeneity and rarity of submandibular gland malignant tumors and the high frequency of chronic benign processes in this region, management can be complex. Preoperative investigations, such as fine-needle aspiration and imaging, are critical to achieve the correct diagnosis so that appropriate surgery can be planned. In general, for malignant submandibular gland neoplasms, the minimal treatment necessary is excision of the submandibular gland with level I lymph node dissection. Salivary gland cancer in the submandibular gland is generally more aggressive than the same histologic type in the parotid gland. Neck dissection may be required and primarily depends on the stage and histological grade. Adjuvant therapy most frequently consists of radiation and can improve overall survival. Some factors that influence prognosis after surgical treatment include the histologic grade, stage at presentation, and positive surgical margins.
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29
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Abstract
The frequency distribution of salivary gland neoplasms (SGNs) is, in decreasing order, parotid neoplasms, submandibular gland neoplasms, minor SGNs, and sublingual gland neoplasms. The larger the salivary gland (e.g. parotid), the more likely a neoplasm is benign, and the smaller the gland (e.g. minor salivary gland), the more likely the neoplasm is malignant. The majority of SGNs, benign and/or malignant, irrespective of site, present as a painless swelling or mass. Definitive symptoms and signs of salivary gland malignancy are the presence of named nerve palsy in anatomical proximity to the gland and/or the presence of cervical lymphadenopathy. All discrete major salivary gland masses and non-ulcerated submucosal masses presenting in the head and neck region, irrespective of age, should be investigated, with the aim of excluding an SGN.
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Affiliation(s)
- Patrick J Bradley
- School of Medicine, The University of Nottingham, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
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Abstract
Presently, there is no universal 'working' classification system acceptable to all clinicians involved in the diagnosis and management of patients with salivary gland neoplasms. The most recent World Health Organization Classification of Tumours: Head and Neck Tumours (Salivary Glands) (2005) for benign and malignant neoplasms represents the consensus of current knowledge and is considered the standard pathological classification based on which series should be reported. The TNM classification of salivary gland malignancies has stood the test of time, and using the stage groupings remains the current standard for reporting treated patients' outcomes. Many developments in molecular and genetic methods in the meantime have identified a number of new entities, and new findings for several of the well-established salivary malignancies need to be considered for inclusion in any new classification system. All clinicians involved in the diagnosis, assessment and treatment of patients with salivary gland neoplasms must understand and respect the need for the various classification systems, enabling them to work within a multidisciplinary clinical team environment.
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Affiliation(s)
- Patrick J Bradley
- School of Medicine, The University of Nottingham, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
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Eisele DW, Bradley PJ. Salivary Gland Neoplasms: Future Perspectives. Adv Otorhinolaryngol 2016; 78:198-199. [PMID: 27092948 DOI: 10.1159/000442141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Suárez C, Barnes L, Silver CE, Rodrigo JP, Shah JP, Triantafyllou A, Rinaldo A, Cardesa A, Pitman KT, Kowalski LP, Robbins KT, Hellquist H, Medina JE, de Bree R, Takes RP, Coca-Pelaz A, Bradley PJ, Gnepp DR, Teymoortash A, Strojan P, Mendenhall WM, Eloy JA, Bishop JA, Devaney KO, Thompson LDR, Hamoir M, Slootweg PJ, Vander Poorten V, Williams MD, Wenig BM, Skálová A, Ferlito A. Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review. Auris Nasus Larynx 2016; 43:477-84. [PMID: 27017314 DOI: 10.1016/j.anl.2016.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/08/2016] [Accepted: 02/19/2016] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to suggest general guidelines in the management of the N0 neck of oral cavity and oropharyngeal adenoid cystic carcinoma (AdCC) in order to improve the survival of these patients and/or reduce the risk of neck recurrences. The incidence of cervical node metastasis at diagnosis of head and neck AdCC is variable, and ranges between 3% and 16%. Metastasis to the cervical lymph nodes of intraoral and oropharyngeal AdCC varies from 2% to 43%, with the lower rates pertaining to palatal AdCC and the higher rates to base of the tongue. Neck node recurrence may happen after treatment in 0-14% of AdCC, is highly dependent on the extent of the treatment and is very rare in patients who have been treated with therapeutic or elective neck dissections, or elective neck irradiation. Lymph node involvement with or without extracapsular extension in AdCC has been shown in most reports to be independently associated with decreased overall and cause-specific survival, probably because lymph node involvement is a risk factor for subsequent distant metastasis. The overall rate of occult neck metastasis in patients with head and neck AdCC ranges from 15% to 44%, but occult neck metastasis from oral cavity and/or oropharynx seems to occur more frequently than from other locations, such as the sinonasal tract and major salivary glands. Nevertheless, the benefit of elective neck dissection (END) in AdCC is not comparable to that of squamous cell carcinoma, because the main cause of failure is not related to neck or local recurrence, but rather, to distant failure. Therefore, END should be considered in patients with a cN0 neck with AdCC in some high risk oral and oropharyngeal locations when postoperative RT is not planned, or the rare AdCC-high grade transformation.
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Affiliation(s)
- Carlos Suárez
- Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain; Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
| | - Leon Barnes
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Carl E Silver
- Departments of Surgery and Otolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Juan P Rodrigo
- Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain; Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jatin P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Asterios Triantafyllou
- Oral and Maxillofacial Pathology, School of Dentistry, University of Liverpool and Cellular Pathology, Liverpool Clinical Laboratories, Liverpool, UK
| | | | - Antonio Cardesa
- Department of Anatomic Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Karen T Pitman
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Henrik Hellquist
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Jesus E Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Patrick J Bradley
- Department of Otolaryngology - Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK; European Salivary Gland Society, Geneva, Switzerland
| | - Douglas R Gnepp
- University Pathologists, Providence, RI, USA; University Pathologists, Fall River, MA, USA
| | - Afshin Teymoortash
- Department of Otolaryngology-Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | | | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Justin A Bishop
- Departments of Pathology and Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Lester D R Thompson
- Consultant Pathologist, Southern California Permanente Medical Group, Woodland Hills, CA, USA
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Pieter J Slootweg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent Vander Poorten
- European Salivary Gland Society, Geneva, Switzerland; Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and KU Leuven, Department of Oncology, Section Head and Neck Oncology, Leuven, Belgium
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruce M Wenig
- Department of Pathology, Beth Israel Medical Center, New York, NY, USA
| | - Alena Skálová
- Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group.
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Hellquist H, Skálová A, Barnes L, Cardesa A, Thompson LDR, Triantafyllou A, Williams MD, Devaney KO, Gnepp DR, Bishop JA, Wenig BM, Suárez C, Rodrigo JP, Coca-Pelaz A, Strojan P, Shah JP, Hamoir M, Bradley PJ, Silver CE, Slootweg PJ, Vander Poorten V, Teymoortash A, Medina JE, Robbins KT, Pitman KT, Kowalski LP, de Bree R, Mendenhall WM, Eloy JA, Takes RP, Rinaldo A, Ferlito A. Cervical Lymph Node Metastasis in High-Grade Transformation of Head and Neck Adenoid Cystic Carcinoma: A Collective International Review. Adv Ther 2016; 33:357-68. [PMID: 26895332 PMCID: PMC4833802 DOI: 10.1007/s12325-016-0298-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Indexed: 12/11/2022]
Abstract
Adenoid cystic carcinoma (AdCC) is among the most common malignant tumors of the salivary glands. It is characterized by a prolonged clinical course, with frequent local recurrences, late onset of metastases and fatal outcome. High-grade transformation (HGT) is an uncommon phenomenon among salivary carcinomas and is associated with increased tumor aggressiveness. In AdCC with high-grade transformation (AdCC–HGT), the clinical course deviates from the natural history of AdCC. It tends to be accelerated, with a high propensity for lymph node metastasis. In order to shed light on this rare event and, in particular, on treatment implications, we undertook this review: searching for all published cases of AdCC-HGT. We conclude that it is mandatory to perform elective neck dissection in patients with AdCC-HGT, due to the high risk of lymph node metastases associated with transformation.
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Affiliation(s)
- Henrik Hellquist
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Alena Skálová
- Department of Pathology, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic
| | - Leon Barnes
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Antonio Cardesa
- Department of Anatomic Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Asterios Triantafyllou
- Oral and Maxillofacial Pathology, School of Dentistry, University of Liverpool and Cellular Pathology, Liverpool Clinical Laboratories, Liverpool, UK
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Douglas R Gnepp
- University Pathologists, Providence, RI, USA
- University Pathologists, Fall River, MA, USA
| | - Justin A Bishop
- Departments of Pathology and Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bruce M Wenig
- Department of Pathology, Beth Israel Medical Center, New York, NY, USA
| | - Carlos Suárez
- Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Jatin P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Patrick J Bradley
- Department of Otolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
- European Salivary Gland Society, Geneva, Switzerland
| | - Carl E Silver
- Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Pieter J Slootweg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent Vander Poorten
- European Salivary Gland Society, Geneva, Switzerland
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Afshin Teymoortash
- Department of Otolaryngology-Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Jesus E Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Karen T Pitman
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
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Abstract
Salivary gland neoplasms (SGNs) in children are uncommon. Epithelial SGNs (ESGNs) comprise the majority (95%), with the remaining being mesenchymal SGNs (MeSGNs). Pleomorphic adenoma is the most frequently encountered benign neoplasm, mucoepidermoid carcinoma is the most frequent malignant ESGN, and rhabdomyosarcoma is the most frequent malignant MeSGN. ESGN presents in the second decade, whereas MeSGN presents in the first and second decades. Swelling without pain or neurological signs is the main presentation of both benign and malignant neoplasms. Making an accurate preoperative histological diagnosis is important, so a needle biopsy or a perioperative frozen section is useful when there is doubt about the disease status of the patient; the excised tumour margin is also important. Surgical excision should aim to achieve clear margin excision in benign and malignant ESGNs, minimising the need for adjuvant radiotherapy and maximising the long-term likelihood of patient cure. Benign ESGNs are uncommon, and excision is curative, whereas malignant ESGN and MeSGN should be managed by a multidisciplinary paediatric oncology team.
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López F, Rodrigo JP, Silver CE, Haigentz M, Bishop JA, Strojan P, Hartl DM, Bradley PJ, Mendenhall WM, Suárez C, Takes RP, Hamoir M, Robbins KT, Shaha AR, Werner JA, Rinaldo A, Ferlito A. Cervical lymph node metastases from remote primary tumor sites. Head Neck 2015; 38 Suppl 1:E2374-85. [PMID: 26713674 DOI: 10.1002/hed.24344] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/14/2015] [Accepted: 10/17/2015] [Indexed: 11/08/2022] Open
Abstract
Although most malignant lymphadenopathy in the neck represent lymphomas or metastases from head and neck primary tumors, occasionally, metastatic disease from remote, usually infraclavicular, sites presents as cervical lymphadenopathy with or without an obvious primary tumor. In general, these tumors metastasize to supraclavicular lymph nodes, but occasionally may present at an isolated higher neck level. A search for the primary tumor includes information gained by histology, immunohistochemistry, and evaluation of molecular markers that may be unique to the primary tumor site. In addition, 18F-fluoro-2-deoxyglocose positron emission tomography combined with CT (FDG-PET/CT) has greatly improved the ability to detect the location of an unknown primary tumor, particularly when in a remote location. Although cervical metastatic disease from a remote primary site is often incurable, there are situations in which meaningful survival can be achieved with appropriate local treatment. Management is quite complex and requires a truly multidisciplinary approach. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2374-E2385, 2016.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Carl E Silver
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Missak Haigentz
- Departments of Medicine (Oncology) and Otorhinolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Justin A Bishop
- Departments of Pathology, The Johns Hopkins University, Baltimore, Maryland
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Patrick J Bradley
- Department of Otolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, United Kingdom
| | | | - Carlos Suárez
- University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jochen A Werner
- Department of Otolaryngology, Head and Neck Surgery, Marburg, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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Coca-Pelaz A, Rodrigo JP, Bradley PJ, Vander Poorten V, Triantafyllou A, Hunt JL, Strojan P, Rinaldo A, Haigentz M, Takes RP, Mondin V, Teymoortash A, Thompson LDR, Ferlito A. Adenoid cystic carcinoma of the head and neck--An update. Oral Oncol 2015; 51:652-61. [PMID: 25943783 DOI: 10.1016/j.oraloncology.2015.04.005] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 01/20/2023]
Abstract
This article provides an update on the current understanding of adenoid cystic carcinoma of the head and neck, including a review of its epidemiology, clinical behavior, pathology, molecular biology, diagnostic workup, treatment and prognosis. Adenoid cystic carcinoma is an uncommon salivary gland tumor that may arise in a wide variety of anatomical sites in the head and neck, often with an advanced stage at diagnosis. The clinical course is characterized by very late recurrences; consequently, clinical follow-up should extend at least >15 years. The optimal treatment is generally considered to be surgery with postoperative radiotherapy to optimize local disease control. Much effort has been invested into understanding the tumor's molecular biological processes, aiming to identify patients at high risk of recurrence, in hopes that they could benefit from other, still unproven treatment modalities such as chemotherapy or biological therapy.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Spain
| | - Patrick J Bradley
- Department of Otorhinolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK; European Salivary Gland Society, Geneva, Switzerland
| | - Vincent Vander Poorten
- European Salivary Gland Society, Geneva, Switzerland; Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | | | - Missak Haigentz
- Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vanni Mondin
- University of Udine School of Medicine, Udine, Italy
| | - Afshin Teymoortash
- Department of Otolaryngology-Head and Neck Surgery, University of Marburg, Marburg, Germany
| | - Lester D R Thompson
- Department of Pathology, Woodland Hills Medical Center, Woodland Hills, CA, USA
| | - Alfio Ferlito
- University of Udine School of Medicine, Udine, Italy.
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Paleri V, Drinnan M, van den Brekel MWM, Hinni ML, Bradley PJ, Wolf GT, de Bree R, Fagan JJ, Hamoir M, Strojan P, Rodrigo JP, Olsen KD, Pellitteri PK, Shaha AR, Genden EM, Silver CE, Suárez C, Takes RP, Rinaldo A, Ferlito A. Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 2014; 124:1848-53. [PMID: 24474684 DOI: 10.1002/lary.24619] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/13/2013] [Accepted: 01/27/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVES/HYPOTHESIS Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs and quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularized tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis. DATA SOURCES English language literature from 2004 to 2013 REVIEW METHODS: We searched the English language literature for articles published on the subject from 2004 to 2013. RESULTS Adequate data was available to identify pooled incidence rates from seven articles. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by one-third. CONCLUSION This pooled analysis suggests that there is a clear advantage in using vascularized tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair.
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Affiliation(s)
- Vinidh Paleri
- Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Foundation Hospitals NHS Trust, Newcastle upon Tyne, Nottingham, U.K
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40
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Abstract
CONCLUSION The total lymph node yield in neck dissection is highly variable and depends on anatomical, surgical and pathological parameters. A minimum yield of six lymph nodes for a selective neck dissection (SND) as recommended in guidelines lies in the lower range of the reported clinical nodal yields. A future application of a lymph node ratio may improve the risk stratification of head and neck cancer patients. However, this will require a higher number of retrieved lymph nodes. OBJECTIVES To compare the clinical guideline recommendations for nodal yield in SND with the number of lymph nodes obtained from cadavers and the clinical nodal yield reported in the literature. METHODS Lymph nodes retrieved from SND specimens from nine fresh cadavers were quantified histopathologically. The literature on nodal yields reportedly obtained by clinicians performing neck dissections was reviewed. Finally, the discussion makes reference to the six lymph nodes currently recommended in international clinical guidelines. RESULTS For clinical SNDs (I-III) the lowest mean nodal yield was 19.4, for SNDs (II-IV) it was 26.4. The cadaver SNDs (I-III and II-IV) yielded 8.8 (range 1-15) and 10.4 nodes (range 1-19), respectively.
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Affiliation(s)
- Rikke Norling
- Department of Radiology, Copenhagen University Hospital, Denmark.
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Bradley PJ, Guntinas-Lichius O. Salivary gland disorders and diseases: diagnosis and management. Ann R Coll Surg Engl 2013. [DOI: 10.1308/rcsann.2013.95.6.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bradley PJ, McGurk M. Incidence of salivary gland neoplasms in a defined UK population. Br J Oral Maxillofac Surg 2013; 51:399-403. [DOI: 10.1016/j.bjoms.2012.10.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
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Poorten VV, Hunt J, Bradley PJ, Haigentz M, Rinaldo A, Mendenhall WM, Suarez C, Silver C, Takes RP, Ferlito A. Recent trends in the management of minor salivary gland carcinoma. Head Neck 2013; 36:444-55. [DOI: 10.1002/hed.23249] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Leuven Cancer Institute; Department of Oncology-Head and Neck Oncology; University Hospitals Leuven; KULeuven Belgium
- European Salivary Gland Society; Geneva Switzerland
| | - Jennifer Hunt
- Department of Pathology and Laboratory Services, College of Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Patrick J. Bradley
- European Salivary Gland Society; Geneva Switzerland
- Department of Otolaryngology-Head and Neck Surgery; Nottingham University Hospital; Queens Medical Centre Nottingham United Kingdom
| | - Missak Haigentz
- Division of Oncology; Department of Medicine; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx New York
| | - Alessandra Rinaldo
- Department of Surgical Sciences; ENT Clinic, University of Udine; Udine Italy
| | | | - Carlos Suarez
- Department of Otolaryngology; Hospital Universitario Central de Asturias; Oviedo Spain
| | - Carl Silver
- Departments of Surgery and Otolaryngology-Head and Neck Surgery; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
| | - Robert P. Takes
- Department of Otolaryngology-Head and Neck Surgery; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Alfio Ferlito
- Department of Surgical Sciences; ENT Clinic, University of Udine; Udine Italy
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Bradley PJ. Multidisciplinary clinical approach to the management of head and neck cancer. Eur Arch Otorhinolaryngol 2012; 269:2451-4. [DOI: 10.1007/s00405-012-2209-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 09/19/2012] [Indexed: 12/24/2022]
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Ferlito A, Devaney KO, Woolgar JA, Slootweg PJ, Paleri V, Takes RP, Strojan P, Bradley PJ, Rinaldo A. Squamous epithelial changes of the larynx: Diagnosis and therapy. Head Neck 2011; 34:1810-6. [DOI: 10.1002/hed.21862] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 04/28/2011] [Accepted: 05/20/2011] [Indexed: 11/11/2022] Open
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Bradley PJ. PD8. Complications of surgery of the oral cavity – How to avoid them! Oral Oncol 2011. [DOI: 10.1016/j.oraloncology.2011.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vander Poorten V, Bradley PJ, Takes RP, Rinaldo A, Woolgar JA, Ferlito A. Diagnosis and management of parotid carcinoma with a special focus on recent advances in molecular biology. Head Neck 2011; 34:429-40. [DOI: 10.1002/hed.21706] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 10/19/2010] [Accepted: 10/26/2010] [Indexed: 11/05/2022] Open
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Sanabria A, Kowalski LP, Bradley PJ, Hartl DM, Bradford CR, de Bree R, Rinaldo A, Ferlito A. Sternocleidomastoid muscle flap in preventing Frey's syndrome after parotidectomy: A systematic review. Head Neck 2011; 34:589-98. [DOI: 10.1002/hed.21722] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2010] [Indexed: 11/09/2022] Open
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Ferlito A, Robbins KT, Shah JP, Medina JE, Silver CE, Al-Tamimi S, Fagan JJ, Paleri V, Takes RP, Bradford CR, Devaney KO, Stoeckli SJ, Weber RS, Bradley PJ, Suárez C, Leemans CR, Coskun HH, Pitman KT, Shaha AR, de Bree R, Hartl DM, Haigentz M, Rodrigo JP, Hamoir M, Khafif A, Langendijk JA, Owen RP, Sanabria A, Strojan P, Vander Poorten V, Werner JA, Bień S, Woolgar JA, Zbären P, Betka J, Folz BJ, Genden EM, Talmi YP, Strome M, González Botas JH, Olofsson J, Kowalski LP, Holmes JD, Hisa Y, Rinaldo A. Proposal for a rational classification of neck dissections. Head Neck 2010; 33:445-50. [PMID: 21319256 DOI: 10.1002/hed.21614] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy.
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