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Tsang W, Meghji S, Masterson L, Fish B. Successful use of sclerotherapy in giant supraglottic vascular malformation. BMJ Case Rep 2024; 17:e256195. [PMID: 38359957 PMCID: PMC10875521 DOI: 10.1136/bcr-2023-256195] [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] [Indexed: 02/17/2024] Open
Abstract
A young male patient presented with an incidental finding of a large supraglottic vascular lesion. The lesion was initially noted during intubation 4 years ago. Although originally listed for elective excision, there was a significant delay and at the time of surgery, the lesion proved too large to remove and a significant threat to the patient's airway. An emergency tracheostomy was performed, followed by two consecutive treatments with sclerotherapy agents to reduce the size of the lesion. It was then successfully excised using a Thunderbeat ultrasound and bipolar dissection and cautery device.
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Affiliation(s)
- William Tsang
- ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sheneen Meghji
- ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Liam Masterson
- ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brian Fish
- ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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2
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Huynh KA, MacFarlane J, Newman C, Gillett D, Das T, Scoffings D, Cheow HK, Moyle P, Koulouri O, Harper I, Aloj L, Mendichovszky IA, Inchiappa D, Buch HN, Chung TT, Simpson HL, Powlson AS, Challis BG, Bashari WA, Stokes VJ, Masterson L, Jani P, Fish B, Gurnell M, Casey RT. Diagnostic utility of 11 C-methionine PET/CT in primary hyperparathyroidism in a UK cohort: A single-centre experience and literature review. Clin Endocrinol (Oxf) 2023. [PMID: 37272391 DOI: 10.1111/cen.14933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Primary hyperparathyroidism is a common endocrine disorder, with 80% of all cases usually caused by one single hyperfunctioning parathyroid adenoma. Conventional imaging modalities for the diagnostic work-up of primary hyperparathyroidism (PHPT) include ultrasound of the neck, 99mTc-sestamibi scintigraphy, and four-dimensional computed tomography (4D-CT). However, the role of other imaging modalities, such as 11C-methionine PET/CT, in the care pathway for PHPT is currently unclear. Here, we report our experience of the diagnostic utility of 11C-methionine PET/CT in a single-center patient cohort (n = 45). DESIGN Retrospective single-center cohort study. PATIENTS AND MEASUREMENTS The data of eligible patients that underwent 11C-methionine PET/CT between 2014 and 2022 at Addenbrooke's Hospital (Cambridge, UK) were collected and analyzed. The clinical utility of imaging modalities was determined by comparing the imaging result with histopathological and biochemical outcomes following surgery. RESULTS In patients with persistent primary hyperparathyroidism following previous surgery, 11C-methionine PET/CT identified a candidate lesion in 6 of 10 patients (60.0%), and histologically confirmed in 5 (50.0%). 11C-methionine PET/CT also correctly identified a parathyroid adenoma in 9 out of 12 patients (75.0%) that failed to be localized on other imaging modalities. 11C-methionine PET/CT had a sensitivity of 70.0% (95% CI 55.8 - 84.2%) for the detection of parathyroid adenomas. CONCLUSIONS This study highlights a diagnostic role for 11C-methionine PET/CT in patients that have undergone unsuccessful prior surgery or have equivocal or negative prior imaging results, aiding localization and a targeted surgical approach.
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Affiliation(s)
- Kevin A Huynh
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - James MacFarlane
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Christine Newman
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Daniel Gillett
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tilak Das
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Heok K Cheow
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Penelope Moyle
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Olympia Koulouri
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Ines Harper
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Luigi Aloj
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Iosif A Mendichovszky
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Danilo Inchiappa
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Harit N Buch
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Teng-Teng Chung
- Department of Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen L Simpson
- Department of Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew S Powlson
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Ben G Challis
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Waiel A Bashari
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Victoria J Stokes
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Liam Masterson
- Department of ENT/Head and Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Piyush Jani
- Department of ENT/Head and Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brian Fish
- Department of ENT/Head and Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Gurnell
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Ruth T Casey
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Medical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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3
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Gowrishankar SV, Bidaye R, Das T, Majcher V, Fish B, Casey R, Masterson L. Intrathyroidal parathyroid adenomas: Scoping review on clinical presentation, preoperative localization, and surgical treatment. Head Neck 2023; 45:706-720. [PMID: 36563301 PMCID: PMC10108101 DOI: 10.1002/hed.27287] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/03/2022] [Revised: 09/26/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Intrathyroidal parathyroid adenomas (IPAs) are a rare cause of primary hyperparathyroidism. They are often difficult to localize preoperatively and intraoperatively, making diagnosis and treatment challenging. Current data on IPAs are sparse and fragmented in the literature. This makes it difficult to compare the effectiveness of different imaging and surgical techniques. To address this issue, this scoping review maps the literature on IPAs, focusing on four domains: clinical presentation, current localization methods, different surgical techniques, and histopathological features. A search of MEDLINE, Embase, and the Cochrane Library was conducted, with 19 studies meeting the inclusion criteria. The characteristics of IPAs on ultrasound, fine-needle aspiration, CT, MRI, sestamibi-based techniques, and selective venous sampling are summarized. Emerging imaging modalities, including autofluorescence, are introduced. Surgical methods and intraoperative factors that correlate with high success rates for removal are highlighted. This review also identifies gaps in knowledge to guide further research into this area.
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Affiliation(s)
| | - Rohan Bidaye
- Department of Otolaryngology-Head & Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tilak Das
- Department of Neuroradiology and Head & Neck Imaging, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Veronika Majcher
- Department of Neuroradiology and Head & Neck Imaging, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brian Fish
- Department of Otolaryngology-Head & Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ruth Casey
- Department of Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Liam Masterson
- Department of Otolaryngology-Head & Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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4
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Basyuni S, Nugent G, Ferro A, Barker E, Reddin I, Jones O, Lechner M, O’Leary B, Jones T, Masterson L, Fenton T, Schache A. Value of p53 sequencing in the prognostication of head and neck cancer: a systematic review and meta-analysis. Sci Rep 2022; 12:20776. [PMID: 36456616 PMCID: PMC9715723 DOI: 10.1038/s41598-022-25291-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
This review aimed to examine the relationship between TP53 mutational status, as determined by genomic sequencing, and survival in squamous cell carcinoma of the head and neck. The databases Medline, Embase, Web of Science (core collection), Scopus and Cochrane Library were searched from inception to April 2021 for studies assessing P53 status and survival. Qualitative analysis was carried out using the REMARK criteria. A meta-analyses was performed and statistical analysis was carried out to test the stability and reliability of results. Twenty-five studies met the inclusion criteria, of which fifteen provided enough data for quantitative evaluation. TP53 mutation was associated with worse overall survival (HR 1.75 [95% CI 1.45-2.10], p < 0.001), disease-specific survival (HR 4.23 [95% CI 1.19-15.06], p = 0.03), and disease-free survival (HR 1.80 [95% CI 1.28-2.53], p < 0.001). Qualitative assessment identified room for improvement and the pooled analysis of all anatomical subsites leads to heterogeneity that may erode the validity of the observed overall effect and its subsequent extrapolation and application to individual patients. Our systematic review and meta-analysis supports the utility of TP53 mutational as a prognostic factor for survival in head and neck squamous cell carcinoma. A well designed prospective, multi-centre trial is needed to definitively answer this question.
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Affiliation(s)
- Shadi Basyuni
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.24029.3d0000 0004 0383 8386Department of Oral and Maxillo-Facial Surgery, Cambridge University Hospitals, Cambridge, CB2 0QQ UK
| | - Gareth Nugent
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.24029.3d0000 0004 0383 8386Department of Oral and Maxillo-Facial Surgery, Cambridge University Hospitals, Cambridge, CB2 0QQ UK
| | - Ashley Ferro
- grid.24029.3d0000 0004 0383 8386Department of Oral and Maxillo-Facial Surgery, Cambridge University Hospitals, Cambridge, CB2 0QQ UK
| | - Eleanor Barker
- grid.5335.00000000121885934Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ian Reddin
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.5491.90000 0004 1936 9297Faculty of Medicine, University of Southampton, Southampton, UK
| | - Oliver Jones
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.8250.f0000 0000 8700 0572University of Durham, Durham, UK
| | - Matt Lechner
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.83440.3b0000000121901201Cancer Institute, Faculty of Medical Sciences, University College London, London, UK
| | - Ben O’Leary
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.18886.3fThe Institute of Cancer Research, London, UK
| | - Terry Jones
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.10025.360000 0004 1936 8470Liverpool Head & Neck Centre, University of Liverpool, Liverpool, UK
| | - Liam Masterson
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.24029.3d0000 0004 0383 8386Department of Ear, Nose and Throat Surgery, Cambridge University Hospitals, Cambridge, UK
| | - Tim Fenton
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.5491.90000 0004 1936 9297Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew Schache
- grid.498322.6Genomics England Head and Neck Cancer Clinical Interpretation Partnership, England, UK ,grid.10025.360000 0004 1936 8470Liverpool Head & Neck Centre, University of Liverpool, Liverpool, UK
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5
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Glasgow C, Lau EYC, Aloj L, Harper I, Cheow H, Das T, Berman L, Powlson AS, Bashari WA, Challis BG, Marker A, Moyle P, Mohamed IA, Schoenmakers N, Broomfield J, Oddy S, Moran C, Gurnell M, Jani P, Masterson L, Fish B, Casey RT. An Approach to a Patient With Primary Hyperparathyroidism and a Suspected Ectopic Parathyroid Adenoma. J Clin Endocrinol Metab 2022; 107:1706-1713. [PMID: 35150267 DOI: 10.1210/clinem/dgac024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 11/19/2022]
Abstract
Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia driven by excess parathyroid hormone (PTH) secretion. PHPT is a common endocrine condition with a prevalence of 1 to 7 cases per 1000 adults. PHPT typically presents in the fifth or sixth decade and shows significant female preponderance. Solitary hyperfunctioning parathyroid adenomas account for 85% to 90% of PHPT cases. The remaining 10% to 15% include cases of multiglandular disease (multiple adenomas or hyperplasia) and, rarely, parathyroid carcinoma (1%). Ectopic parathyroid adenomas may arise due to abnormal embryological migration of the parathyroid glands and can be difficult to localize preoperatively, making surgical cure challenging on the first attempt. The potential existence of multiglandular disease should be considered in all patients in whom preoperative localization fails to identify a target adenoma or following unsuccessful parathyroidectomy. Risk factors for multiglandular disease include underlying genetic syndromes (eg, MEN1/2A), lithium therapy, or previous radiotherapy. In addition to multifocal disease, the possibility of an ectopic parathyroid gland should also be considered in patients requiring repeat parathyroid surgery. In this article, we use illustrative clinical vignettes to discuss the approach to a patient with primary hyperparathyroidism (PHPT) and a suspected ectopic parathyroid adenoma.
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Affiliation(s)
- Clark Glasgow
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - Eunice Y C Lau
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - Luigi Aloj
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Ines Harper
- Department of Nuclear Medicine, Cambridge University Hospitals, Cambridge, UK
| | - Heok Cheow
- Department of Nuclear Medicine, Cambridge University Hospitals, Cambridge, UK
| | - Tilak Das
- Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Laurence Berman
- Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Andrew S Powlson
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - Waiel A Bashari
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - Benjamin G Challis
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - Alison Marker
- Department of Histopathology, Cambridge University Hospitals, Cambridge, UK
| | - Penelope Moyle
- Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - Isra Ahmed Mohamed
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - Nadia Schoenmakers
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | | | - Sue Oddy
- Department of Biochemistry, Cambridge University Hospitals, Cambridge, UK
| | - Carla Moran
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
- Endocrinology & Diabetes Section, Beacon Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Ireland
| | - Mark Gurnell
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
| | - Piyush Jani
- Department of ENT/Head and Neck Surgery, Cambridge University Hospitals, Cambridge, UK
| | - Liam Masterson
- Department of ENT/Head and Neck Surgery, Cambridge University Hospitals, Cambridge, UK
| | - Brian Fish
- Department of ENT/Head and Neck Surgery, Cambridge University Hospitals, Cambridge, UK
| | - Ruth T Casey
- Department of Endocrinology, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
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6
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Lechner M, Liu J, Masterson L, Fenton TR. Reply to ‘HPV-associated oropharyngeal cancer — discussion points’. Nat Rev Clin Oncol 2022; 19:422-423. [DOI: 10.1038/s41571-022-00627-z] [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: 11/09/2022]
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Karamali K, Salau E, Das T, Scoffings D, Casey R, Masterson L, Fish B. 4DCT as first line imaging during Covid pandeminc. Br J Surg 2022. [PMCID: PMC9383505 DOI: 10.1093/bjs/znac057.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim The Covid-19 pandemic encouraged prompt modification to clinical practice to minimise hospital attendances in an aim to minimize exposure and protection of the NHS whilst maintaining the standards of patient care. Current literature advocates that Four-Dimensional Computerised Tomography (4DCT) has equal diagnostic value as ultrasound alone or a combination of ultrasound and Sestamibi scan in the identification of abnormal parathyroid glands in the work up for surgical management of hyperparathyroidism. In response to the evolving pandemic at Addenbrookes we modified our practice and escalated 4DCT as our first line imaging. In light of this we had a unique opportunity to evaluate the diagnostic value of the currently used imaging modalities. Methods This is a retrospective study of 270 parathyroidectomies who underwent pre-operative 4DCT (n=270), ultrasound (n= 254) and sestamibi scan (n=253). Subsequently, we assessed the accuracy of these three modalities with the of intra-operative findings, histology, post-operative calcium and PTH. Results The sensitivity of the 4DCT was 77% in comparison to 43% sensitivity of the ultrasound alone. (p>0.05). The combined sensitivity of ultrasound and Sestamibi scan was found to be 69%. Conclusion The implementation of 4DCT as a single modality diagnostic imaging can be considered equally effective and accurate in the diagnosis of parathyroid abnormality. Implementing this would reduce the number of diagnostic tests improving the likelihood of successful operative planning and reduce financial cost.
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Affiliation(s)
| | - Eniola Salau
- Cambridge University Hospital NHS Foundation trust, Cambridge, UK
| | - Tilak Das
- Cambridge University Hospital NHS Foundation trust, Cambridge, UK
| | - Daniel Scoffings
- Cambridge University Hospital NHS Foundation trust, Cambridge, UK
| | - Ruth Casey
- Cambridge University Hospital NHS Foundation trust, Cambridge, UK
| | - Liam Masterson
- Cambridge University Hospital NHS Foundation trust, Cambridge, UK
| | - Brian Fish
- Cambridge University Hospital NHS Foundation trust, Cambridge, UK
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8
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Emanuel O, Liu J, Schartinger VH, Nei WL, Chan YY, Tsang CM, Riechelmann H, Masterson L, Haybaeck J, Oppermann U, Willems SM, Ooft ML, Wollmann G, Howard D, Vanhaesebroeck B, Lund VJ, Royle G, Chua MLK, Lo KW, Busson P, Lechner M. SSTR2 in Nasopharyngeal Carcinoma: Relationship with Latent EBV Infection and Potential as a Therapeutic Target. Cancers (Basel) 2021; 13:4944. [PMID: 34638429 PMCID: PMC8508244 DOI: 10.3390/cancers13194944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 01/04/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor, most commonly located in the pharyngeal recess and endemic to parts of Asia. It is often detected at a late stage which is associated with poor prognosis (5-year survival rate of 63%). Treatment for this malignancy relies predominantly on radiotherapy and/or systemic chemotherapy, which can be associated with significant morbidity and impaired quality of life. In endemic regions NPC is associated with infection by Epstein-Barr virus (EBV) which was shown to upregulate the somatostatin receptor 2 (SSTR2) cell surface receptor. With recent advances in molecular techniques allowing for an improved understanding of the molecular aetiology of this disease and its relation to SSTR2 expression, we provide a comprehensive and up-to-date overview of this disease and highlight the emergence of SSTR2 as a key tumor biomarker and promising target for imaging and therapy.
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Affiliation(s)
- Oscar Emanuel
- UCL Cancer Institute, University College London, London WC1E 6BT, UK; (O.E.); (J.L.); (B.V.); (V.J.L.); (G.R.)
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, London WC1E 6BT, UK; (O.E.); (J.L.); (B.V.); (V.J.L.); (G.R.)
| | - Volker H. Schartinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (V.H.S.); (H.R.)
| | - Wen Long Nei
- National Cancer Centre, Divisions of Radiation Oncology and Medical Sciences, Singapore 169610, Singapore; (W.L.N.); (M.L.K.C.)
- Oncology Academic Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Yuk Yu Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong 999077, China; (Y.Y.C.); (C.M.T.); (K.W.L.)
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Chi Man Tsang
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong 999077, China; (Y.Y.C.); (C.M.T.); (K.W.L.)
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (V.H.S.); (H.R.)
| | - Liam Masterson
- Department of Otolaryngology, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK;
| | - Johannes Haybaeck
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Udo Oppermann
- Botnar Research Centre, University of Oxford, Oxford OX1 2JD, UK;
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, 79085 Freiburg, Germany
| | - Stefan M. Willems
- Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.M.W.); (M.L.O.)
- Department of Pathology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Marc L. Ooft
- Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.M.W.); (M.L.O.)
- King’s College Hospitals, NHS Foundation Trust, London SE5 9RS, UK
| | - Guido Wollmann
- Institute of Virology and Christian Doppler Laboratory for Viral Immunotherapy of Cancer, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - David Howard
- ENT Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 9EP, UK;
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London WC1E 6DG, UK
| | - Bart Vanhaesebroeck
- UCL Cancer Institute, University College London, London WC1E 6BT, UK; (O.E.); (J.L.); (B.V.); (V.J.L.); (G.R.)
| | - Valerie J. Lund
- UCL Cancer Institute, University College London, London WC1E 6BT, UK; (O.E.); (J.L.); (B.V.); (V.J.L.); (G.R.)
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London WC1E 6DG, UK
| | - Gary Royle
- UCL Cancer Institute, University College London, London WC1E 6BT, UK; (O.E.); (J.L.); (B.V.); (V.J.L.); (G.R.)
| | - Melvin L. K. Chua
- National Cancer Centre, Divisions of Radiation Oncology and Medical Sciences, Singapore 169610, Singapore; (W.L.N.); (M.L.K.C.)
- Oncology Academic Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Kwok Wai Lo
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong 999077, China; (Y.Y.C.); (C.M.T.); (K.W.L.)
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Pierre Busson
- CNRS-UMR 9018-Metsy, Gustave Roussy and Université Paris-Saclay, 94805 Villejuif, France
| | - Matt Lechner
- UCL Cancer Institute, University College London, London WC1E 6BT, UK; (O.E.); (J.L.); (B.V.); (V.J.L.); (G.R.)
- Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
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9
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Lechner M, Schartinger VH, Steele CD, Nei WL, Ooft ML, Schreiber LM, Pipinikas CP, Chung GTY, Chan YY, Wu F, To KF, Tsang CM, Pearce W, Morelli D, Philpott M, Masterson L, Nibhani R, Wells G, Bell CG, Koller J, Delecluse S, Yip YL, Liu J, Forde CT, Forster MD, Jay A, Dudás J, Krapp A, Wan S, Uprimny C, Sprung S, Haybaeck J, Fenton TR, Chester K, Thirlwell C, Royle G, Marafioti T, Gupta R, Indrasari SR, Herdini C, Slim MAM, Indrawati I, Sutton L, Fles R, Tan B, Yeong J, Jain A, Han S, Wang H, Loke KSH, He W, Xu R, Jin H, Cheng Z, Howard D, Hwang PH, Le QT, Tay JK, West RB, Tsao SW, Meyer T, Riechelmann H, Oppermann U, Delecluse HJ, Willems SM, Chua MLK, Busson P, Lo KW, Wollmann G, Pillay N, Vanhaesebroeck B, Lund VJ. Somatostatin receptor 2 expression in nasopharyngeal cancer is induced by Epstein Barr virus infection: impact on prognosis, imaging and therapy. Nat Commun 2021; 12:117. [PMID: 33402692 PMCID: PMC7785735 DOI: 10.1038/s41467-020-20308-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 01/09/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
Nasopharyngeal cancer (NPC), endemic in Southeast Asia, lacks effective diagnostic and therapeutic strategies. Even in high-income countries the 5-year survival rate for stage IV NPC is less than 40%. Here we report high somatostatin receptor 2 (SSTR2) expression in multiple clinical cohorts comprising 402 primary, locally recurrent and metastatic NPCs. We show that SSTR2 expression is induced by the Epstein-Barr virus (EBV) latent membrane protein 1 (LMP1) via the NF-κB pathway. Using cell-based and preclinical rodent models, we demonstrate the therapeutic potential of SSTR2 targeting using a cytotoxic drug conjugate, PEN-221, which is found to be superior to FDA-approved SSTR2-binding cytostatic agents. Furthermore, we reveal significant correlation of SSTR expression with increased rates of survival and report in vivo uptake of the SSTR2-binding 68Ga-DOTA-peptide radioconjugate in PET-CT scanning in a clinical trial of NPC patients (NCT03670342). These findings reveal a key role in EBV-associated NPC for SSTR2 in infection, imaging, targeted therapy and survival.
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MESH Headings
- Animals
- Female
- Humans
- Male
- Mice
- Antineoplastic Agents/pharmacology
- Cell Line, Tumor
- Epstein-Barr Virus Infections/drug therapy
- Epstein-Barr Virus Infections/genetics
- Epstein-Barr Virus Infections/mortality
- Epstein-Barr Virus Infections/virology
- Gene Expression Regulation, Neoplastic
- Herpesvirus 4, Human/drug effects
- Herpesvirus 4, Human/growth & development
- Herpesvirus 4, Human/pathogenicity
- Host-Pathogen Interactions/genetics
- Lymphatic Metastasis
- Mice, Nude
- Molecular Targeted Therapy
- Nasopharyngeal Carcinoma/drug therapy
- Nasopharyngeal Carcinoma/genetics
- Nasopharyngeal Carcinoma/mortality
- Nasopharyngeal Carcinoma/virology
- Nasopharyngeal Neoplasms/drug therapy
- Nasopharyngeal Neoplasms/genetics
- Nasopharyngeal Neoplasms/mortality
- Nasopharyngeal Neoplasms/virology
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/virology
- NF-kappa B/genetics
- NF-kappa B/metabolism
- Octreotide/pharmacology
- Positron Emission Tomography Computed Tomography
- Receptors, Somatostatin/antagonists & inhibitors
- Receptors, Somatostatin/genetics
- Receptors, Somatostatin/metabolism
- Signal Transduction
- Survival Analysis
- Viral Matrix Proteins/antagonists & inhibitors
- Viral Matrix Proteins/genetics
- Viral Matrix Proteins/metabolism
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, London, UK.
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
- Barts Health NHS Trust, London, UK.
- Royal National Throat, Nose and Ear Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK.
| | - Volker H Schartinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Wen Long Nei
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre, Singapore, Singapore
- Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Marc Lucas Ooft
- King´s College Hospitals, NHS Foundation Trust, London, UK
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Liesa-Marie Schreiber
- Institute of Virology and Christian Doppler Laboratory for Viral Immunotherapy of Cancer, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Grace Tin-Yun Chung
- Department of Anatomical and Cellular Pathology and State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuk Yu Chan
- Department of Anatomical and Cellular Pathology and State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Feng Wu
- Department of Anatomical and Cellular Pathology and State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Fai To
- Department of Anatomical and Cellular Pathology and State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Man Tsang
- Department of Anatomical and Cellular Pathology and State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wayne Pearce
- UCL Cancer Institute, University College London, London, UK
| | | | | | - Liam Masterson
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
| | - Reshma Nibhani
- Botnar Research Centre, University of Oxford, Oxford, UK
| | - Graham Wells
- Botnar Research Centre, University of Oxford, Oxford, UK
| | - Christopher G Bell
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julia Koller
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
- Botnar Research Centre, University of Oxford, Oxford, UK
| | - Susanne Delecluse
- German Cancer Research Centre (DKFZ) and Inserm, Unit F100/U1074, Heidelberg, Germany
| | - Yim Ling Yip
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, London, UK
| | - Cillian T Forde
- Royal National Throat, Nose and Ear Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Martin D Forster
- UCL Cancer Institute, University College London, London, UK
- Royal National Throat, Nose and Ear Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Amrita Jay
- Department of Histopathology, University College London Hospitals NHS Trust, Euston Road, London, UK
| | - József Dudás
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Annika Krapp
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Wan
- Institute of Nuclear Medicine, University College Hospital, Euston Road, London, UK
| | - Christian Uprimny
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Susanne Sprung
- Department of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Haybaeck
- Department of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
- Diagnostic & Research Center for Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Tim R Fenton
- School of Biosciences, University of Kent, Canterbury, UK
| | - Kerry Chester
- UCL Cancer Institute, University College London, London, UK
| | - Christina Thirlwell
- UCL Cancer Institute, University College London, London, UK
- University of Exeter College of Medicine and Health, Exeter, UK
| | - Gary Royle
- UCL Cancer Institute, University College London, London, UK
| | | | - Rajeev Gupta
- UCL Cancer Institute, University College London, London, UK
| | - Sagung Rai Indrasari
- ENT Head and Neck Surgery Department, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Camelia Herdini
- ENT Head and Neck Surgery Department, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Mohd Afiq Mohd Slim
- Department of Ear, Nose and Throat, University Hospital Crosshouse, Crosshouse, Kilmarnock, UK
| | - I Indrawati
- Department of Anatomical Pathology, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Renske Fles
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bing Tan
- ENT Head and Neck Surgery Department, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
- Department of ENT/Head and Neck Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Joe Yeong
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - Amit Jain
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Shuting Han
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Haitao Wang
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre, Singapore, Singapore
| | - Kelvin S H Loke
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Wan He
- Department of Oncology, The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Ruilian Xu
- Department of Oncology, The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Hongtao Jin
- Department of Pathology, The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Zhiqiang Cheng
- Department of Pathology, The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - David Howard
- Royal National Throat, Nose and Ear Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
- ENT Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Joshua K Tay
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Robert B West
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sai Wah Tsao
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Tim Meyer
- UCL Cancer Institute, University College London, London, UK
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Udo Oppermann
- Botnar Research Centre, University of Oxford, Oxford, UK
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, 79085, Freiburg, Germany
| | | | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands
| | - Melvin L K Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre, Singapore, Singapore
- Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Pierre Busson
- CNRS-UMR 9018-METSY, Gustave Roussy and Université Paris-Saclay, Villejuif, France
| | - Kwok Wai Lo
- Department of Anatomical and Cellular Pathology and State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Guido Wollmann
- Institute of Virology and Christian Doppler Laboratory for Viral Immunotherapy of Cancer, Medical University of Innsbruck, Innsbruck, Austria
| | - Nischalan Pillay
- UCL Cancer Institute, University College London, London, UK
- Department of Cellular and Molecular Pathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - Valerie J Lund
- UCL Cancer Institute, University College London, London, UK.
- Royal National Throat, Nose and Ear Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK.
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10
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Lechner M, Sutton L, Murkin C, Masterson L, O'Flynn P, Wareing MJ, Tatla T, Saeed S. Squamous cell cancer of the temporal bone: a review of the literature. Eur Arch Otorhinolaryngol 2020; 278:2225-2228. [PMID: 32869160 PMCID: PMC8165064 DOI: 10.1007/s00405-020-06281-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
Background and aims Squamous cell carcinoma (SCC) of the temporal bone is a rare malignancy accounting for only 0.2% of head and neck cancers. There is currently no clear consensus on staging or common approach to management. It is the aim of this work to provide the readers with a review of the current literature on this malignancy. Methods A literature review was performed identifying 16 case series with patient numbers ranging from 12 to 124. A total of 708 patients were included in this review, 67% presented with advanced disease. 578 cases were managed operatively with lateral temporal bone resection, some underwent local resection alone in early stage disease. In all studies radiation therapy was used as an adjunct to some degree. Results More than half of studies reported 100% either 2-, 3- or 5-year survival for T1 and T2 disease with no nodal involvement. Survival correlated with disease stage and in five studies SCC differentiation was found to be a significant prognostic factor. Post-operative radiotherapy was found to improve survival in only one study. Conclusions Temporal bone SCC is a readily treatable malignancy in early stage disease, however late stage disease has a poor prognosis. Differentiation of the SCC and stage of disease at presentation appear to have the greatest influence on 5-year survival rates. Further work is required in both the identification of early stage disease and in the treatment of later T3 and T4 lesions. Electronic supplementary material The online version of this article (10.1007/s00405-020-06281-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matt Lechner
- Royal London Hospital, Barts Health NHS Trust, London, UK. .,UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK.
| | - Liam Sutton
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Paul O'Flynn
- Department of ENT, Adenbrooke's Hospital, Cambridge, UK.,Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK
| | | | - Taranjit Tatla
- Department of Otolaryngology-Head and Neck Surgery, Northwick Park Hospital, Harrow Road, Harrow, London, UK
| | - Shakeel Saeed
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, 330 Grays Inn Road, London, WC1X 8DA, UK.,UCL Ear Institute, 332 Gray's Inn Road, London, UK
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11
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Masterson L, Howard J, Gonzalez‐Cruz J, Jackson C, Barnett C, Overton L, Liu H, Ladwa R, Simpson F, McGrath M, Wallwork B, Jones T, Ottensmeier C, Chua ML, Perry C, Khanna R, Panizza B, Porceddu S, Lechner M. Immune checkpoint inhibitors in advanced nasopharyngeal carcinoma: Beyond an era of chemoradiation? Int J Cancer 2020; 146:2305-2314. [DOI: 10.1002/ijc.32869] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Liam Masterson
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
- Department of ENTUniversity of Cambridge Cambridge United Kingdom
| | | | | | - Christopher Jackson
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
| | - Catherine Barnett
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
| | - Lewis Overton
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
| | - Howard Liu
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
| | - Rahul Ladwa
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
| | - Fiona Simpson
- Diamantina Institute, University of Queensland Woolloongabba QLD Australia
| | - Margie McGrath
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
| | - Ben Wallwork
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
- Faculty of MedicineUniversity of Queensland St. Lucia Australia
| | - Terry Jones
- Liverpool Head & Neck CentreUniversity of Liverpool Liverpool United Kingdom
| | | | - Melvin L.K. Chua
- Divisions of Radiation Oncology & Medical Science, National Cancer Centre Singapore Singapore
| | - Chris Perry
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
- Faculty of MedicineUniversity of Queensland St. Lucia Australia
| | - Rajiv Khanna
- QIMR Berghofer Medical Research Institute Brisbane City QLD Australia
| | - Benedict Panizza
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
- Faculty of MedicineUniversity of Queensland St. Lucia Australia
| | - Sandro Porceddu
- Department of Head & Neck OncologyPrincess Alexandra Hospital Brisbane Australia
- Faculty of MedicineUniversity of Queensland St. Lucia Australia
| | - Matt Lechner
- UCL Cancer InstituteUniversity College London London United Kingdom
- Barts Health NHS Trust London United Kingdom
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12
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Masterson L, Lechner M, Jones TM. Targeting mTOR in Head and Neck Cancer—Letter. Clin Cancer Res 2019; 25:6554. [DOI: 10.1158/1078-0432.ccr-19-1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/02/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Liam Masterson
- 1Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Matt Lechner
- 2UCL Cancer Institute, University College London, London, United Kingdom
| | - Terry M. Jones
- 3Liverpool Head and Neck Centre, University of Liverpool, United Kingdom
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13
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Lechner M, Sutton L, Fishman JM, Kaylie DM, Moon RE, Masterson L, Klingmann C, Birchall MA, Lund VJ, Rubin JS. Otorhinolaryngology and Diving-Part 2: Otorhinolaryngological Fitness for Compressed Gas Scuba Diving: A Review. JAMA Otolaryngol Head Neck Surg 2019; 144:259-263. [PMID: 29450499 DOI: 10.1001/jamaoto.2017.2616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Self-contained underwater breathing apparatus (scuba) diving has become increasingly popular with millions of people diving each year. Otorhinolaryngologists are often consulted either by patients or diving physicians regarding fitness to dive, and at present, the guidelines do not provide comprehensive information regarding the evaluation of this patient cohort. The aim of this review is to provide a comprehensive overview of existing otorhinolaryngological guidelines for fitness to dive recreationally. Observations There is a paucity of guidelines for assessing otorhinolaryngological fitness to dive in the recreational diver. Comprehensive guidelines exist from US, European, and UK regulatory bodies regarding fitness for commercial diving; however, not all of these can be directly extrapolated to the recreational diver. There are also a variety of conditions that are not covered either by the existing fitness for recreational diving guidelines or the commercial regulatory bodies. Conclusions and Relevance With the paucity of recreational fitness to dive guidelines we must draw on information from the commercial diving regulatory bodies. We have provided our own recommendations on the conditions that are not covered by either of the above, to provide otorhinolaryngologists with the information they require to assess fitness for recreational diving.
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Affiliation(s)
- Matt Lechner
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Liam Sutton
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Jonathan M Fishman
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - David M Kaylie
- Duke Skull Base Center, Duke University School of Medicine, Durham, North Carolina.,Departments of Anesthesiology and Medicine, and Center for Hyperbaric Medicine and Environmental Physiology, Duke University School of Medicine, Durham, North Carolina
| | - Richard E Moon
- Departments of Anesthesiology and Medicine, and Center for Hyperbaric Medicine and Environmental Physiology, Duke University School of Medicine, Durham, North Carolina
| | - Liam Masterson
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, England
| | | | - Martin A Birchall
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - John S Rubin
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England.,City, University of London, London, England
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14
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Lechner M, Sutton L, Fishman JM, Kaylie DM, Moon RE, Masterson L, Klingmann C, Birchall MA, Lund VJ, Rubin JS. Otorhinolaryngology and Diving-Part 1: Otorhinolaryngological Hazards Related to Compressed Gas Scuba Diving: A Review. JAMA Otolaryngol Head Neck Surg 2019; 144:252-258. [PMID: 29450472 DOI: 10.1001/jamaoto.2017.2617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Scuba diving is becoming increasingly popular. However, scuba diving is associated with specific risks; 80% of adults and 85% of juvenile divers (aged 6-17 years) have been reputed to have an ear, nose, or throat complaint related to diving at some point during their diving career. Divers frequently seek advice from primary care physicians, diving physicians, and otorhinolaryngologists, not only in the acute setting, but also related to the long-term effects of diving. Observations The principles underpinning diving-related injuries that may present to the otorhinolaryngologist rely on gas volume and gas saturation laws, and the prevention of these injuries requires both that the diver is skilled and that their anatomy allows for pressure equalization between the various anatomical compartments. The overlapping symptoms of middle ear barotrauma, inner ear barotrauma, and inner ear decompression sickness can cause a diagnostic conundrum, and a thorough history of both the diver's symptoms and the dive itself are required to elucidate the diagnosis. Correct diagnosis and appropriate treatment result in a more timely return to safe diving. Conclusions and Relevance The aim of this review is to provide a comprehensive overview of otorhinolaryngological complications during diving. With the increasing popularity of diving and the frequency of ear, nose, or throat-related injuries, it could be expected that these injuries will become more common and this review provides a resource for otorhinolaryngologists to diagnose and treat these conditions.
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Affiliation(s)
- Matt Lechner
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Liam Sutton
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Jonathan M Fishman
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - David M Kaylie
- Duke Skull Base Center, Duke University School of Medicine, Durham, North Carolina.,Departments of Anesthesiology and Medicine, and Center for Hyperbaric Medicine and Environmental Physiology, Duke University School of Medicine, Durham, North Carolina
| | - Richard E Moon
- Departments of Anesthesiology and Medicine, and Center for Hyperbaric Medicine and Environmental Physiology, Duke University School of Medicine, Durham, North Carolina
| | - Liam Masterson
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, England
| | | | - Martin A Birchall
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - John S Rubin
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England.,City, University of London, London, England
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15
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Banerjee I, McNulty JP, Catania D, Maccagni D, Masterson L, Portelli JL, Rainford L. An Investigation of Procedural Radiation Dose Level Awareness and Personal Training Experience in Communicating Ionizing Radiation Examinations Benefits and Risks to Patients in Two European Cardiac Centers. Health Phys 2019; 117:76-83. [PMID: 31136364 DOI: 10.1097/hp.0000000000001049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Cardiac interventional practitioners need to be appropriately informed regarding radiation dose quantities and risks. Communicating benefit-risk information to patients requires attention as specified in Basic Safety Standards Directive 2013/59/Eurotom. This study investigated the awareness of procedural radiation dose levels and the impact of personal training experience in communicating ionizing radiation benefit-risks to patients. METHODOLOGY A questionnaire, consisting of 28 questions, was distributed directly to adult and pediatric interventional cardiology specialists at specialized cardiovascular imaging centers in Dublin, Ireland and Milan, Italy. RESULTS A total of 18 interventional cardiologists (senior registrar to consultant grades with between 2 y to over 21 y experience in cardiac imaging) participated. The majority of participants (n = 17) stated that parents of pediatric and adult patients should be informed of the potential benefits and risk. All participants indicated they had radiation safety training; however, 50% had not received training in radiation examination benefit-risk communication. Despite this, 77.8% (n = 14) participants indicated a high confidence level in successfully explaining risks and/or benefits of cardiac imaging procedures. When asked to estimate effective dose (ED) values for common cardiac imaging procedures less than 50% identified appropriate dose ranges. All participants underestimated procedural dose values based on recent European data. 50% (n = 9) participants answered all questions correctly for a number of true or false radiation risk statements. CONCLUSION Benefit-risk communication training deficits and inaccurate understanding of radiation dose levels was identified. Further research and training to support clinicians using radiation on a daily basis is required.
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Affiliation(s)
- I Banerjee
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
| | - J P McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
| | - D Catania
- AITRI, Association of Italian Interventional Radiographers, Milan, Italy
| | | | - L Masterson
- Our Lady's University Children's Hospital, Crumlin, Dublin, Ireland
| | - J L Portelli
- Department of Radiography, Faculty of Health Sciences, University of Malta
| | - L Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
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16
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, London WC1E 6AG, UK; Head and Neck Centre, University College London Hospitals NHS Trust and Barts Health NHS Trust, London, UK.
| | - Charles E Breeze
- UCL Cancer Institute, University College London, London WC1E 6AG, UK
| | - James F O'Mahony
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
| | - Liam Masterson
- Department of ENT, Cambridge University Hospitals NHS Trust, Cambridge, UK
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Howard J, Dwivedi RC, Masterson L, Kothari P, Quon H, Holsinger FC. De-intensified adjuvant (chemo)radiotherapy versus standard adjuvant chemoradiotherapy post transoral minimally invasive surgery for resectable HPV-positive oropharyngeal carcinoma. Cochrane Database Syst Rev 2018; 12:CD012939. [PMID: 30550641 PMCID: PMC6517188 DOI: 10.1002/14651858.cd012939.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND More than 400,000 cases of oropharyngeal squamous cell cancer (OPSCC) are diagnosed every year worldwide and this is rising. Much of the increase has been attributed to human papillomavirus (HPV). HPV-positive OPSCC patients are often younger and have significantly improved survival relative to HPV-negative patients. Traditional management of OPSCC has been with radiotherapy with or without chemotherapy, as this was shown to have similar survival to open surgery but with significantly lower morbidity. Techniques have evolved, however, with the development of computerised planning and intensity-modulated radiotherapy, and of minimally invasive surgical techniques. Acute and late toxicities associated with chemoradiotherapy are a significant burden for OPSCC patients and with an ever-younger cohort, any strategies that could decrease treatment-associated morbidity should be investigated. OBJECTIVES To assess the effects of de-intensified adjuvant (chemo)radiotherapy in comparison to standard adjuvant (chemo)radiotherapy in patients treated with minimally invasive transoral surgery (transoral robotic surgery or transoral laser microsurgery) for resectable HPV-positive oropharyngeal squamous cell carcinoma. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 26 April 2018. SELECTION CRITERIA Randomised controlled trials (RCTs) in patients with carcinoma of the oropharynx (as defined by the World Health Organization classification C09, C10). Cancers included were primary HPV-positive squamous cell tumours originating from the oropharyngeal mucosa. Tumours were classified as T1-4a with or without nodal spread and with no evidence of distant metastatic spread. The intervention was minimally invasive transoral surgery followed by de-intensified adjuvant therapy (either omission of chemotherapy or reduced-dose radiotherapy). The comparator was minimally invasive transoral surgery followed by standard concurrent chemoradiotherapy or standard-dose radiotherapy. The treatments received were of curative intent and patients had not undergone any prior intervention, other than diagnostic biopsy. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related survival was to be studied where possible) and disease-free survival, measured at one, two, three and five years. Our secondary outcomes included assessment of swallowing ability and voice, measured at one, six, 12 and 24 months. We planned to use GRADE to assess the quality of evidence for each outcome. MAIN RESULTS We did not identify any completed RCTs that met our inclusion criteria. However, three eligible studies are in progress:ADEPT is a phase III trial comparing postoperative radiotherapy with or without cisplatin in HPV-positive T1-4a OPSCC patients. Included patients must have received minimally invasive surgery and demonstrated extra-capsular spread from disease in the neck.ECOG-E3311 is a phase II trial of treatment for HPV-positive locally advanced OPSCC (stages III-IVa + IVb without distant metastasis). Patients are stratified after minimally invasive surgery. Medium-risk patients are randomised to either standard or reduced-dose radiotherapy.PATHOS is a phase III trial of treatment for HPV-positive OPSCC (T1-3, N0-2b). Patients are stratified after minimally invasive surgery. Medium-risk patients are randomised to either standard or reduced-dose radiotherapy. High-risk patients are randomised to radiotherapy with or without concurrent cisplatin. AUTHORS' CONCLUSIONS This review highlights the current lack of high-quality randomised controlled trials studying treatment de-escalation after minimally invasive surgery in patients with HPV-positive OPSCC. However, trials that will meet the inclusion criteria for this review are in progress with results expected between 2021 and 2023.
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Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | | | - Harry Quon
- Sidney Kimmel Comprehensive Cancer CenterDepartment of Radiation Oncology and Molecular Radiation Sciences401 North Broadway‐Suite 1440BaltimoreUSA
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Mohammed H, Del Pero M, Coates M, Masterson L, Tassone P, Burrows S, Nassif R. Office-based transnasal esophagoscopy biopsies for histological diagnosis of head and neck patients. Laryngoscope 2018; 129:2721-2726. [PMID: 30548865 DOI: 10.1002/lary.27714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 09/11/2018] [Revised: 10/12/2018] [Accepted: 11/01/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present yield of transnasal esophagoscopy (TNE) biopsies of upper aerodigestive tract (UADT) lesions and define the role of TNE as a safe alternative to rigid endoscopy. STUDY DESIGN Retrospective case series. METHODS All patients who underwent TNE-guided biopsies attempted over a 2-year period were included. Patients were identified using coding records and outpatient diaries. Demographic data were recorded as well as the histological diagnosis and additional histological diagnostic procedures. RESULTS During the observation period, 134 TNE-guided procedures were attempted. The procedure could not be completed in 19 patients. There were 102/115 (89%) patients who did not require further interventions for histological diagnosis of the tumor. The most common biopsied area was the larynx (53), followed by the tongue base (29). The most common malignancy was invasive squamous cell carcinoma in 42/115 (36.5%). CONCLUSIONS The work presented in this article strongly suggests that TNE-guided biopsy is a valuable diagnostic tool for patients suspected of having carcinoma of the UADT. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2721-2726, 2019.
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Affiliation(s)
- Hassan Mohammed
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Marcus Del Pero
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Matthew Coates
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Liam Masterson
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Peter Tassone
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Stuart Burrows
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Ramez Nassif
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
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Affiliation(s)
- Liam Masterson
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK and the Department of Otorhinolaryngology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Matt Lechner
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK and at the Royal National Throat, Nose and Ear Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London NW1 2PG, UK
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Lechner M, Chakravarthy AR, Walter V, Masterson L, Feber A, Jay A, Weinberger PM, McIndoe RA, Forde CT, Chester K, Kalavrezos N, O'Flynn P, Forster M, Jones TM, Vaz FM, Hayes DN, Fenton TR. Frequent HPV-independent p16/INK4A overexpression in head and neck cancer. Oral Oncol 2018; 83:32-37. [DOI: 10.1016/j.oraloncology.2018.06.006] [Citation(s) in RCA: 28] [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: 02/03/2018] [Revised: 05/13/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
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Haywood M, Masterson L, Cronin A, Vijendren A, Iyngkaran T, Kothari P, Chan C, Camilleri A. Improving the efficacy of
PET
‐
CT
imaging in head and neck cancer management and surveillance through the multidisciplinary team: A multicentre, retrospective cohort analysis of 51 patients. Clin Otolaryngol 2018; 43:1131-1135. [DOI: 10.1111/coa.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M. Haywood
- Luton and Dunstable University Hospital Luton UK
| | - L. Masterson
- Luton and Dunstable University Hospital Luton UK
| | | | - A. Vijendren
- Luton and Dunstable University Hospital Luton UK
| | - T. Iyngkaran
- Luton and Dunstable University Hospital Luton UK
| | - P. Kothari
- Luton and Dunstable University Hospital Luton UK
| | - C.‐H. Chan
- Luton and Dunstable University Hospital Luton UK
| | - A. Camilleri
- Luton and Dunstable University Hospital Luton UK
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22
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Lechner M, Vassie C, Kavasogullari C, Jones O, Howard J, Masterson L, Fenton T, Yarbrough W, Waller J, Gilson R. A cross-sectional survey of awareness of human papillomavirus-associated oropharyngeal cancers among general practitioners in the UK. BMJ Open 2018; 8:e023339. [PMID: 30056394 PMCID: PMC6067376 DOI: 10.1136/bmjopen-2018-023339] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To examine the level of awareness of the link between human papillomavirus (HPV) and oropharyngeal cancer (OPC) and epidemiological trends in HPV-related OPC among general practitioners (GPs) in the UK. DESIGN Cross-sectional survey. PARTICIPANTS 384 GPs from England, Scotland, Wales and Northern Ireland. SETTING The survey was administered at GP training courses and via email to lists of training course attendees. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of respondents aware of the link between HPV and OPC; respondents' self-rated knowledge of OPC; proportion of participants aware of the epidemiological trends in HPV-associated OPC. RESULTS 384 questionnaires were completed with an overall response rate of 72.9%. 74.0% of participants recognised HPV as a risk factor for OPC, which was lower than knowledge about the role of smoking, chewing tobacco and alcohol consumption (all >90% recognition). Overall, 19.4% rated their knowledge of OPC as very good or good, 62.7% as average and 17.7% as poor or very poor. The majority (71.9%) were aware that rates of HPV-associated OPC have increased over the last two decades. Fewer than half (41.5%) of the participants correctly identified being male as a risk factor of HPV-associated OPC, while 58.8% were aware that patients with HPV-associated OPC tend to be younger than those with non-HPV-associated disease. CONCLUSIONS The association of HPV infection with OPC is a relatively recent discovery. Although the level of awareness of HPV and OPC among GPs was high, the characteristics of HPV-associated OPC were less well recognised, indicating the need for further education.
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, London, UK
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Claire Vassie
- UCL Cancer Institute, University College London, London, UK
- Institute for Global Health, University College London, London, London, UK
| | | | - Oliver Jones
- UCL Cancer Institute, University College London, London, UK
| | - James Howard
- ENT Department, Wrexham Maelor Hospital, Wrexham, UK
| | - Liam Masterson
- Department of Otolaryngology, Lister Hospital, Stevenage, UK
| | - Tim Fenton
- UCL Cancer Institute, University College London, London, UK
| | - Wendell Yarbrough
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, London, UK
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Howard J, Dwivedi RC, Masterson L, Kothari P, Quon H, Holsinger FC. De-intensified adjuvant (chemo)radiotherapy versus standard adjuvant chemoradiotherapy post transoral minimally invasive surgery for resectable HPV-positive oropharyngeal carcinoma. Hippokratia 2018. [DOI: 10.1002/14651858.cd012939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation Trust; ENT Department; Hills Road Cambridge UK CB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation Trust; ENT Department; Hills Road Cambridge UK CB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation Trust; ENT Department; Hills Road Cambridge UK CB2 0QQ
| | | | - Harry Quon
- Sidney Kimmel Comprehensive Cancer Center; Department of Radiation Oncology and Molecular Radiation Sciences; 401 North Broadway-Suite 1440 Baltimore USA
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Mohammed H, Coates M, Masterson L, Nassif R. Indications for transnasal flexible laryngooesophagoscopy in a head and neck clinic, our experience in one hundred and ninety-four patients. Clin Otolaryngol 2018; 43:924-928. [PMID: 29316307 DOI: 10.1111/coa.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
- H Mohammed
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - M Coates
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - L Masterson
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - R Nassif
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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Mohammed H, Chrastek D, Masterson L, Nassif R. Coding proforma in TNFLO clinic from a UK centre, an audit of 85 procedures. Clin Otolaryngol 2017. [PMID: 28637097 DOI: 10.1111/coa.12927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Mohammed
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - D Chrastek
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - L Masterson
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - R Nassif
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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26
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Mohammed H, Coates M, Masterson L, Chan W, Hassan Y, Nassif R. Role of transnasal flexible laryngo-oesophagoscopy (TNFLO) in investigating patients with globus symptoms. Clin Otolaryngol 2017; 42:1311-1318. [DOI: 10.1111/coa.12872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/11/2022]
Affiliation(s)
- H. Mohammed
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - M. Coates
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - L. Masterson
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - W.Y. Chan
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - Y. Hassan
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - R. Nassif
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
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Vijendren A, Lee C, Moualed D, Masterson L, McFerran D. Improving the aetiological investigations of congenital hearing loss: our experience in an audit of 56 patients. Clin Otolaryngol 2017; 42:180-184. [DOI: 10.1111/coa.12589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2015] [Indexed: 11/27/2022]
Affiliation(s)
- A. Vijendren
- Colchester Hospital University NHS Foundation Trust; Colchester UK
| | - C. Lee
- Colchester Hospital University NHS Foundation Trust; Colchester UK
| | - D. Moualed
- Milton Keynes University Hospital; Milton Keynes UK
| | - L. Masterson
- Cambridge University Hospitals NHS Trust; Cambridge UK
| | - D. McFerran
- Colchester Hospital University NHS Foundation Trust; Colchester UK
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Masterson L, Egro FM, Bewick J, Erskine SE, Clark A, Javer AR, Philpott CM. Quality-of-life outcomes after sinus surgery in allergic fungal rhinosinusitis versus nonfungal chronic rhinosinusitis. Am J Rhinol Allergy 2016; 30:e30-5. [PMID: 26980383 DOI: 10.2500/ajra.2016.30.4280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Given the differences in pathophysiology between allergic fungal rhinosinusitis (AFRS) and other chronic rhinosinusitis (CRS) subgroups, it remains unclear about whether these patients respond differently to a combination of surgical and medical treatments. OBJECTIVE To evaluate differences in quality-of-life (QoL) outcomes for a cohort of patients who underwent endoscopic sinus surgery (ESS) for CRS. METHODS This retrospective review included patients with CRS who underwent ESS between 2010 and 2013. QoL was measured by using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, SNOT-22 scores before ESS and at 1, 3, 6, 9, and 12 months after ESS. Groups tested were CRS with nasal polyposis, CRS without nasal polyposis (CRSsNP), and patients with AFRS. A linear mixed- effects regression model was used to calculate the adjusted mean QoL differences. RESULTS Among the 250 patients included, 61.6% had CRS with nasal polyposis (n = 154), 28.8% had CRSsNP (n = 72), and 9.6% had AFRS (n = 24). Significant differences were seen in SNOT-22 scores between pre- and postoperative visits and between the etiologic subgroups (p < 0.001). Multivariate analysis revealed significantly greater improvement in QoL for patients with AFRS in comparison with those with CRSsNP at the 9-month follow-up (change in SNOT-22 score, 22.6 [95% confidence interval, 1.2-44.1]; p < 0.0) and the 12-month follow-up (change in SNOT-22 score, 20.2 [95% confidence interval, 0.5-39.9]; p < 0.04). CONCLUSIONS Patients with AFRS experienced a more-prolonged QoL benefit from surgical and targeted medical intervention compared with those with CRSsNP, which may reflect the severity of inflammation that they presented with compared with other CRS subtypes.
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Affiliation(s)
- Liam Masterson
- Department of Ear Nose and Throat, James Paget University Hospital, Lowestoft Road, Gorleston-on-Sea, UK
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Affiliation(s)
- Liam Masterson
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK; Department of Otorhinolaryngology, Cambridge University Hospitals NHS Trust, Cambridge, UK.
| | - James O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Republic of Ireland
| | - Matt Lechner
- UCL Cancer Institute, University College London, London, UK; Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
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Howard J, Masterson L, Dwivedi RC, Riffat F, Benson R, Jefferies S, Jani P, Tysome JR, Nutting C. Minimally invasive surgery versus radiotherapy/chemoradiotherapy for small-volume primary oropharyngeal carcinoma. Cochrane Database Syst Rev 2016; 12:CD010963. [PMID: 27943254 PMCID: PMC6463943 DOI: 10.1002/14651858.cd010963.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity. However, interventions have now evolved with computerised planning and intensity-modulated radiotherapy, and the advent of endoscopic head and neck surgery, which provide the potential for decreased treatment-associated morbidity.The oropharynx plays an essential role in swallowing, speech and protecting the airway as it is situated at the bifurcation of the respiratory and digestive tracts. Treatment modality recommendations are based on survival outcomes. Given the younger patient demographic, establishing the safety of modalities that potentially have better functional outcome is becoming increasingly important. OBJECTIVES To assess the efficacy of endoscopic head and neck surgery (transoral robotic surgery or transoral laser microsurgery) for small-volume, primary (T1-2, N0-2) oropharyngeal squamous cell carcinoma (OPSCC) in comparison to radiotherapy/chemoradiotherapy. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 November 2016. SELECTION CRITERIA Randomised controlled trials in patients with carcinoma in the oropharynx subsite (as defined by the World Health Organization classification C09, C10). Cancers included were primary squamous cell carcinomas arising from the oropharyngeal mucosa. The tumours were classified as T1-T2 with or without nodal disease and with no evidence of distant metastatic spread. The intervention was transoral, minimally invasive surgery with or without adjuvant radiotherapy or adjuvant chemoradiotherapy. The comparator was primary radiotherapy with or without induction or concurrent chemotherapy for the tumour. The treatments received and compared were of curative intent and patients had not undergone prior intervention, other than diagnostic biopsy. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related mortality was to be studied where possible), locoregional control, disease-free survival and progression-free survival or time to recurrence. All outcomes were to be measured at two, three and five years after diagnosis. Our secondary outcomes included quality of life, harms associated with treatment, patient satisfaction and xerostomia score. MAIN RESULTS No completed studies met the inclusion criteria for the review. Two ongoing trials fulfilled the selection criteria, however neither are complete.'Early-stage squamous cell carcinoma of the oropharynx: radiotherapy versus trans-oral robotic surgery (ORATOR)' is a phase II randomised controlled trial comparing primary radiation therapy with primary transoral robotic surgery for small-volume primary (T1-2, N0-2) OPSCC. It is currently in progress with an estimated completion date of June 2021.'European Organisation for Research and Treatment of Cancer 1420 (EORTC 1420-HNCG-ROG)' is a phase III, randomised study assessing the "best of" radiotherapy compared to transoral robotic surgery/transoral laser microsurgery in patients with T1-T2, N0 squamous cell carcinoma of the oropharynx and base of tongue. It was due to start accrual mid-2016. AUTHORS' CONCLUSIONS The role of endoscopic head and neck surgery in the management of OPSCC is clearly expanding as evidenced by its more overt incorporation into the current National Comprehensive Cancer Network guidelines. Data are mounting regarding its outcomes both in terms of survival and lower morbidity. As confidence increases, it is being used in the management of more advanced OPSCC.Based on this review, there is currently no high-quality evidence from randomised controlled trials regarding clinical outcomes for patients with oropharyngeal cancer receiving endoscopic head and neck surgery compared with primary chemoradiotherapy.
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Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | | | - Richard Benson
- Addenbrooke's HospitalOncology CentreBox 193CambridgeUKCB2 2QQ
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Piyush Jani
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - James R Tysome
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Chris Nutting
- Royal Marsden HospitalHead and Neck UnitFulham RoadLondonUKSW3 6JJ
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Mohammed H, Jin X, Masterson L, Wickstead M. Ambulant management of acute tonsillitis in adult patients, a study on 330 patients. Clin Otolaryngol 2016; 42:897-901. [PMID: 27662600 DOI: 10.1111/coa.12753] [Citation(s) in RCA: 4] [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] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
- H Mohammed
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - X Jin
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - L Masterson
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - M Wickstead
- Department of Otolaryngology-Head and Neck Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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Bewick J, Egro FM, Masterson L, Javer AR, Philpott CM. Anatomic findings in revision endoscopic sinus surgery: Case series and review of contributory factors. Allergy Rhinol (Providence) 2016; 7:151-157. [PMID: 28107148 PMCID: PMC5244272 DOI: 10.2500/ar.2016.7.0173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background: It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective: To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods: A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results: Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion: Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs.
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Masterson L, Winder DM, Ball SLR, Vaughan K, Lehmann M, Scholtz LU, Sterling JC, Sudhoff HH, Goon PKC. Molecular analyses of unselected head and neck cancer cases demonstrates that human papillomavirus transcriptional activity is positively associated with survival and prognosis. BMC Cancer 2016; 16:367. [PMID: 27296171 PMCID: PMC4906991 DOI: 10.1186/s12885-016-2398-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/03/2016] [Indexed: 12/16/2022] Open
Abstract
Background Human papillomavirus DNA detection in head and neck squamous cell carcinoma has been linked to improved patient prognosis. The main aims of the study was to test the hypotheses that HPV16 E6/E7 oncogene and p53 function within tumours were associated with the widely reported improved patient survival and prognosis in head and neck cancer. Methods HPV16 DNA, mRNA and p53 mRNA presence were analysed in a prospective study of 42 unselected HNSCC patients; correlating the data with patient age, tumour staging/grade, treatment response, disease recurrence and survival. Results HPV16 DNA and HPV16 mRNA were present in 45.2 % and 21.4 % of patients, respectively. There was a significant positive association between the detection of HPV16 E6/E7 mRNA and p53 mRNA (p = 0.032), but this was not replicated for HPV16 DNA. Five-year disease free survival for the whole cohort was 63 % (CI 52.5–73.5 %). Multivariable analysis revealed only HPV16 E6/E7 mRNA expression to have significant prognostic influence (p = 0.04). Conclusions Our study suggests that HPV16 oncogenic transcriptional activity within HNSCC tumours is associated with improved patient survival and better prognosis in a German population. Simple HPV DNA detection alone did not demonstrate this association. The significant association of full-length (wild-type) p53 with HPV16 E6/E7 mRNA is further evidence for a functional relationship, which could contribute to the widely reported improved survival and prognosis. Larger studies are required to validate the frequency of HPV16 mRNA expression in HNSCC.
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Affiliation(s)
- Liam Masterson
- Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Otorhinolaryngology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - David M Winder
- Department of Pathology, University of Cambridge, Cambridge, UK
| | | | - Katie Vaughan
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Martin Lehmann
- Department of Otorhinolaryngology, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| | - Lars-Uwe Scholtz
- Department of Otorhinolaryngology, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| | - Jane C Sterling
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Holger H Sudhoff
- Department of Otorhinolaryngology, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| | - Peter K C Goon
- Department of Pathology, University of Cambridge, Cambridge, UK.
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Vijendren A, Kothari P, Iyngkaran T, Masterson L, Silva S. Metastatic level V cervical nodes of unknown primary? Do not overlook the thyroid. Eur J Radiol 2016; 85:987-8. [DOI: 10.1016/j.ejrad.2016.02.029] [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] [Received: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 11/29/2022]
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Mohammed H, Masterson L, Gendy S, Nassif R. Outpatient-based injection laryngoplasty for the management of unilateral vocal fold paralysis - clinical outcomes from a UK centre. Clin Otolaryngol 2016; 41:341-6. [DOI: 10.1111/coa.12516] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 12/01/2022]
Affiliation(s)
- H. Mohammed
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - L. Masterson
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - S. Gendy
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
| | - R. Nassif
- Department of Otolaryngology-Head and Neck Surgery; Norfolk and Norwich University Hospital; Norwich UK
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Abstract
BACKGROUND Following middle ear ventilation tube (tympanostomy tube or grommet) insertion, most surgeons advise that a child's ears should be kept dry during the immediate postoperative period. Following the initial period some surgeons will permit swimming or bathing, whereas other surgeons will recommend ongoing water precautions. A large number of studies have been conducted to explore the association between water exposure and ear infections in children with ventilation tubes, however a range of differing conclusions exist regarding the need for water precautions and there is wide variation in clinical practice. OBJECTIVES To assess the effectiveness of water precautions for the prevention of ear infections in children with ventilation tubes (grommets), at any time while the tubes are in place. SEARCH METHODS The Cochrane ENT Trials Search Co-ordinator searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 8); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 1 September 2015. SELECTION CRITERIA Randomised controlled trials recruiting children (0 to 17 years) with ventilation tubes and assessing the effect of water precautions while the tubes are in place. We considered all forms of water precautions, including behavioural (i.e. avoidance or swimming/bathing restrictions) and mechanical (ear plugs/moulds or hats/bands). DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcome measures were episodes of otorrhoea and adverse effects; secondary outcomes were antimicrobial prescriptions for ear infections, ventilation tube extrusion, surgical intervention to remove ventilation tubes and hearing outcomes. MAIN RESULTS Two randomised controlled trials recruiting a total of 413 patients met the criteria for inclusion in our review; one study had a low risk of bias and the other study had a high risk of bias. Ear plugs versus control One study recruited 201 children (aged six months to six years) who underwent myringotomy and ventilation tube insertion. The study compared an intervention group who were instructed to swim and bathe with ear plugs with a control group; the participants were followed up at one-month intervals for one year. This study, with low risk of bias, showed that the use of ear plugs results in a small but statistically significant reduction in the rate of otorrhoea from 1.2 episodes to 0.84 episodes in the year of follow-up (mean difference (MD) -0.36 episodes per year, 95% confidence interval (CI) -0.45 to -0.27). There was no significant difference in ventilation tube extrusion or hearing outcomes between the two study arms. No child required surgical intervention to remove ventilation tubes and no adverse events were reported. Water avoidance versus control Another study recruited 212 children (aged three months to 12 years) who underwent myringotomy and ventilation tube insertion. The study compared an intervention group who were instructed not to swim or submerge their heads while bathing with a control group; the participants were followed up at three-month intervals for one year. This study, with high risk of bias, did not show any evidence of a reduction or increase in the rate of otorrhoea (1.17 episodes per year in both groups; MD 0 episodes, 95% CI -0.14 to 0.14). No other outcomes were reported for this study and no adverse events were reported. Quality of evidence The overall quality (GRADE) of the body of evidence for the effect of ear plugs on the rate of otorrhoea and the effect of water avoidance on the rate of otorrhoea are low and very low respectively. AUTHORS' CONCLUSIONS The baseline rate of ventilation tube otorrhoea and the morbidity associated with it is usually low and therefore careful prior consideration must be given to the efficacy, costs and burdens of any intervention aimed at reducing this rate.While there is some evidence to suggest that wearing ear plugs reduces the rate of otorrhoea in children with ventilation tubes, clinicians and parents should understand that the absolute reduction in the number of episodes of otorrhoea appears to be very small and is unlikely to be clinically significant. Based on the data available, an average child would have to wear ear plugs for 2.8 years to prevent one episode of otorrhoea.Some evidence suggests that advising children to avoid swimming or head immersion during bathing does not affect rates of otorrhoea, although good quality data are lacking in this area. Currently, consensus guidelines therefore recommend against the routine use of water precautions on the basis that the limited clinical benefit is outweighed by the associated cost, inconvenience and anxiety.Future high-quality studies could be undertaken but may not be thought necessary. It is uncertain whether further trials in this area would change the findings of this review or have an impact on practice. Any future high-quality research should focus on determining whether particular groups of children benefit more from water precautions than others, as well as on developing clinical guidelines and their implementation.
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Affiliation(s)
- Daniel Moualed
- Northampton General Hospital NHS TrustENT DepartmentNorthamptonUK
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Sanjiv Kumar
- University Hospital of North MidlandsENT DepartmentStoke‐on‐TrentUK
| | - Neil Donnelly
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
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Howard JEF, Masterson L, Dwivedi RC, Jani P. Langerhans cell sarcoma of the head and neck. Crit Rev Oncol Hematol 2016; 99:180-8. [PMID: 26777877 DOI: 10.1016/j.critrevonc.2015.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/23/2015] [Revised: 11/24/2015] [Accepted: 12/23/2015] [Indexed: 12/24/2022] Open
Abstract
Head and neck Langerhans cell sarcoma (HNLCS) is a rare malignant tumor carrying a poor prognosis. The aim of this work was to perform a systematic review of HNLCS cases, examine outcomes, and develop an evidence-based management algorithm. We performed a systematic literature search yielding 16 studies with 17 cases of HNLCS; 33 studies with 55 Non-HNLCS were used as a comparison. Mean disease-specific survival was 20.5 months (SE ± 5.1) for HNLCS versus 26.2 months (SE±4.2) for non-HNLCS. There was no significant difference in disease-specific (p = 0.768) or disease-free survival (p = 0.880) between the two cohorts. There was a significant difference in both disease-specific (p = 0.044) and disease-free survival (p = 0.001) between local, locoregional and disseminated disease favoring more limited disease. HNLCS appears to present later, with more disseminated disease. Surgery remains the mainstay of treatment of local disease, however clear margins do not guarantee clearance.
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Affiliation(s)
- James E F Howard
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Liam Masterson
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK; Department of Pathology, Tennis Court Road, University of Cambridge, CB1 1QP, UK
| | - Raghav C Dwivedi
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Piyush Jani
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Abstract
BACKGROUND Graves' disease is an autoimmune disease caused by the production of auto-antibodies against the thyroid-stimulating hormone receptor, which stimulates follicular cell production of thyroid hormone. It is the commonest cause of hyperthyroidism and may cause considerable morbidity with increased risk of cardiovascular and respiratory adverse events. Five per cent of people with Graves' disease develop moderate to severe Graves' ophthalmopathy. Thyroid surgery for Graves' disease commonly falls into one of three categories: 1) total thyroidectomy, which aims to achieve complete macroscopic removal of thyroid tissue; 2) bilateral subtotal thyroidectomy, in which bilateral thyroid remnants are left; and 3) unilateral total and contralateral subtotal thyroidectomy, or the Dunhill procedure. Recent American Thyroid Association guidelines on treatment of Graves' hyperthyroidism emphasised the role of surgery as one of the first-line treatments. Total thyroidectomy removes target tissue for the thyroid-stimulating hormone receptor antibody. It controls hyperthyroidism at the cost of lifelong thyroxine replacement. Subtotal thyroidectomy leaves a thyroid remnant and may be less likely to lead to complications, however a higher rate of recurrent hyperthyroidism is expected and revision surgery would be challenging. The choice of the thyroidectomy technique is currently largely a matter of surgeon preference, and a systematic review of the evidence base is required to determine which option offers the best outcomes for patients. OBJECTIVES To assess the optimal surgical technique for Graves' disease and Graves' ophthalmopathy. SEARCH METHODS We searched the Cochrane Library, MEDLINE and PubMed, EMBASE, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The date of the last search was June 2015 for all databases. We did not apply any language restrictions. SELECTION CRITERIA Only randomised controlled trials (RCTs) involving participants with a diagnosis of Graves' disease based on clinical features and biochemical findings of hyperthyroidism were eligible for inclusion. Trials had to directly compare at least two surgical techniques of thyroidectomy. There was no age limit to study inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently extracted and cross-checked the data for analysis, evaluation of risk of bias and establishment of 'Summary of findings' tables using the GRADE instrument. The senior review authors reviewed the data and reconciled disagreements. MAIN RESULTS We included five RCTs with a total of 886 participants; 172 were randomised to total thyroidectomy, 383 were randomised to bilateral subtotal thyroidectomy, 309 were randomised to the Dunhill procedure and 22 were randomised to either bilateral subtotal thyroidectomy or the Dunhill procedure. Follow-up ranged between six months and six years. One trial had three comparison arms. All five trials were conducted in university hospitals or tertiary referral centres for thyroid disease. All thyroidectomies were performed by experienced surgeons. The overall quality of the evidence ranged from low to moderate. In all trials, blinding procedures were insufficiently described. Outcome assessment for objective outcomes was blinded in one trial. Surgeons were not blinded in any of the trials. One trial blinded participants. Attrition bias was a substantial problem in one trial, with 35% losses to follow-up. In one trial the analysis was not carried out on an intention-to-treat basis.Total thyroidectomy was more effective than subtotal thyroidectomy techniques (both bilateral subtotal thyroidectomy and the Dunhill procedure) at preventing recurrent hyperthyroidism in 0/150 versus 11/200 participants (OR 0.14 (95% CI 0.04 to 0.46); P = 0.001; 2 trials; moderate quality evidence). Total thyroidectomy was also more effective than bilateral subtotal thyroidectomy at preventing recurrent hyperthyroidism in 0/150 versus 10/150 participants (odds ratio (OR) 0.13 (95% confidence interval (CI) 0.04 to 0.44); P = 0.001; 2 trials; moderate quality evidence). Compared to bilateral subtotal thyroidectomy, the Dunhill procedure was more likely to prevent recurrent hyperthyroidism in 20/283 versus 8/309 participants (OR 2.73 (95% CI 1.28 to 5.85); P = 0.01; 3 trials; low quality evidence). Total thyroidectomy compared with subtotal thyroidectomy conferred a greater risk of permanent hypocalcaemia/hypoparathyroidism in 8/172 versus 3/221 participants (OR 4.79 (95% CI 1.36 to 16.83); P = 0.01; 3 trials; low quality evidence). Effects of the various surgical techniques on permanent recurrent laryngeal nerve palsy and regression of Graves' ophthalmopathy were neutral. One death was reported in one study in year three of follow-up. No study investigated health-related quality of life or socioeconomic effects. AUTHORS' CONCLUSIONS Total thyroidectomy is more effective than subtotal thyroidectomy (both bilateral subtotal thyroidectomy and the Dunhill procedure) at preventing recurrent hyperthyroidism in Graves' disease. The type of surgery performed does not affect regression of Graves' ophthalmopathy. There was some evidence that total thyroidectomy compared with subtotal thyroidectomy conferred a greater risk of permanent hypocalcaemia/hypoparathyroidism, which however, was not seen in comparison with bilateral subtotal thyroidectomy. Permanent recurrent laryngeal nerve palsy did not seem to be affected by type of thyroidectomy. Health-related quality of life as a patient-important outcome measure should form a core determinant of any future trial on the effects of thyroid surgery for Graves' disease.
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Affiliation(s)
- Zi Wei Liu
- ENT Department, Whipps Cross University Hospital, Leytonstone, London, UK, E11 1NR
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Masterson L, Sorgeloos F, Winder D, Lechner M, Marker A, Malhotra S, Sudhoff H, Jani P, Goon P, Sterling J. Deregulation of SYCP2 predicts early stage human papillomavirus-positive oropharyngeal carcinoma: A prospective whole transcriptome analysis. Cancer Sci 2015; 106:1568-75. [PMID: 26334652 PMCID: PMC4714680 DOI: 10.1111/cas.12809] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/20/2015] [Accepted: 08/29/2015] [Indexed: 12/31/2022] Open
Abstract
This study was designed to identify significant differences in gene expression profiles of human papillomavirus (HPV)‐positive and HPV‐negative oropharyngeal squamous cell carcinomas (OPSCC) and to better understand the functional and biological effects of HPV infection in the premalignant pathway. Twenty‐four consecutive patients with locally advanced primary OPSCC were included in a prospective clinical trial. Fresh tissue samples (tumor vs. matched normal epithelium) were subjected to whole transcriptome analysis and the results validated on the same cohort with RT–quantitative real‐time PCR. In a separate retrospective cohort of 27 OPSCC patients, laser capture microdissection of formalin‐fixed, paraffin‐embedded tissue allowed RNA extraction from adjacent regions of normal epithelium, carcinoma in situ (premalignant) and invasive SCC tissue. The majority of patients showed evidence of high‐risk HPV16 positivity (80.4%). Predictable fold changes of RNA expression in HPV‐associated disease included multiple transcripts within the p53 oncogenic pathway (e.g. CDKN2A/CCND1). Other candidate transcripts found to have altered levels of expression in this study have not previously been established (SFRP1, CRCT1, DLG2, SYCP2, and CRNN). Of these, SYCP2 showed the most consistent fold change from baseline in premalignant tissue; aberrant expression of this protein may contribute to genetic instability during HPV‐associated cancer development. If further corroborated, this data may contribute to the development of a non‐invasive screening tool. This study is registered with the UK Clinical Research Network (ref.: 11945).
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Affiliation(s)
- Liam Masterson
- Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Otorhinolaryngology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | | | - David Winder
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Matt Lechner
- University College London Cancer Institute, London, UK
| | - Alison Marker
- Department of Histopathology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Shalini Malhotra
- Department of Histopathology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| | - Piyush Jani
- Department of Otorhinolaryngology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Peter Goon
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Jane Sterling
- Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Dermatology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
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Jin X, Masterson L, Patel A, Hook L, Nicholson J, Jefferies S, Gaze M, Nassif R, Eller R, Hulse T, Jani P. Conservative or radical surgery for pediatric papillary thyroid carcinoma: A systematic review of the literature. Int J Pediatr Otorhinolaryngol 2015; 79:1620-4. [PMID: 26300408 DOI: 10.1016/j.ijporl.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pediatric papillary thyroid carcinoma (PTC) is characterized by an aggressive clinical course. Early diagnosis is a challenge and treatment consists principally of partial or total thyroidectomy±neck dissection and radioactive iodine therapy. Due to the rarity of PTC in children, there is no consensus on optimal surgical treatment. METHODS AND RESULTS A literature search was carried out using PubMed, Embase, Medline, Cochrane and Web of Science. Seven studies (489 patients) investigating the outcome of surgically managed pediatric PTC were identified. No clear advantage in survival or recurrence rate was found for total thyroidectomy compared to other surgical approaches. CONCLUSION Despite the aggressive behavior of PTC, prognosis is good, with low mortality. After removal of disease and prevention of recurrence, reduction of iatrogenic complications are a priority in this age group. Due to the paucity of available evidence, this review cannot recommend conservative or radical surgery for pediatric papillary thyroid carcinoma. To answer this question, we recommend the establishment of a randomized controlled trial with adequately matched baseline variables.
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Affiliation(s)
- Xi Jin
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Liam Masterson
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Anant Patel
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Liz Hook
- Department of Pathology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - James Nicholson
- Department of Pediatric Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Sarah Jefferies
- Department of Clinical Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Mark Gaze
- Department of Oncology, University College Hospital, London NW1 2PG, UK
| | - Ramez Nassif
- Department of Head & Neck Oncology, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK
| | - Robert Eller
- US Air Force and Army Voice Center, San Antonio, TX, USA
| | - Tony Hulse
- Department of Paediatric Endocrinology, Guy's & St Thomas' Hospital, London SE1 7UH, UK
| | - Piyush Jani
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Affiliation(s)
- Liam Masterson
- Ear, Nose, and Throat Department, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK
| | - Martin Vallis
- Rosedale Surgery, NHS Great Yarmouth and Waveney Clinical Commissioning Group, Lowestoft, UK
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Peter Prinsley
- Ear, Nose, and Throat Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
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Patel AP, Masterson L, Deutsch CJ, Scoffings DJ, Fish BM. Management and outcomes in children with sinogenic intracranial abscesses. Int J Pediatr Otorhinolaryngol 2015; 79:868-873. [PMID: 25887135 DOI: 10.1016/j.ijporl.2015.03.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management. METHODS All children with sinogenic intracranial abscesses presenting to a large university teaching hospital over a five-year period were included in the study. Data on clinical presentation, radiological findings, microbiology, medical and surgical management and follow-up were recorded and analysed. RESULTS We identified 27 children aged 12.9 ± 3.4 years of which 56% were male. Fourteen (52%) children had extradural abscesses, nine (33%) subdural abscesses and four (15%) parenchymal abscesses. Early sinus drainage procedures were performed on 24 (89%) patients, and the same number required neurosurgical drainage. Streptococcus milleri was isolated in 18 (67%) cases. An initial conservative neurosurgical approach failed in 50% of cases where trialled, and was associated with longer length of stay (p = 0.025). In comparison to extradural abscesses, subdural abscesses were more likely to present with neurological deficits (p < 0.001) and reduced consciousness (p = 0.018), and required multiple neurosurgical procedures (p < 0.001), longer stays (p = 0.017), and had greater morbidity at six months (p = 0.017). A third of children had significant morbidity at six months, which included cognitive and behavioural problems (25%), residual hemiparesis (19%) and expressive dysphasia (7%). There were no mortalities. CONCLUSION Sinusitis complicated by intracranial abscess remains a contemporary problem. We demonstrate good outcomes with an early combined rhinological and neurosurgical approach. S. milleri is identified as the causative organism in the majority of cases, and empirical antimicrobial treatments should reflect this.
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Affiliation(s)
- Anant P Patel
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Liam Masterson
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christopher J Deutsch
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daniel J Scoffings
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brian M Fish
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Dwivedi R, Jani P, Masterson L, Riffat F, Marker A, Woodruff S, Hardy A. Inverted papilloma of lacrimal sac invading into the orbit: Case report and review of literature. J Cancer Res Ther 2015; 11:238-40. [DOI: 10.4103/0973-1482.155111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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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Kuet ML, Kasbekar AV, Masterson L, Jani P. Management of tumors arising from the parapharyngeal space: A systematic review of 1,293 cases reported over 25 years. Laryngoscope 2014; 125:1372-81. [DOI: 10.1002/lary.25077] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/28/2014] [Accepted: 10/31/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Mong-Loon Kuet
- Department of Otolaryngology-Head and Neck Surgery; Addenbrooke's Hospital, Cambridge University Hospitals; Cambridge United Kingdom
| | - Anand V. Kasbekar
- Department of Otolaryngology-Head and Neck Surgery; Aintree University Hospital; Liverpool United Kingdom
| | - Liam Masterson
- Department of Otolaryngology-Head and Neck Surgery; Addenbrooke's Hospital, Cambridge University Hospitals; Cambridge United Kingdom
| | - Piyush Jani
- Department of Otolaryngology-Head and Neck Surgery; Addenbrooke's Hospital, Cambridge University Hospitals; Cambridge United Kingdom
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Masterson L, Moualed D, Liu ZW, Howard JEF, Dwivedi RC, Tysome JR, Benson R, Sterling JC, Sudhoff H, Jani P, Goon PKC. De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of current clinical trials. Eur J Cancer 2014; 50:2636-48. [PMID: 25091798 DOI: 10.1016/j.ejca.2014.07.001] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [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: 05/27/2014] [Revised: 06/27/2014] [Accepted: 07/01/2014] [Indexed: 11/26/2022]
Abstract
Iatrogenic complications associated with current treatment protocols for oropharyngeal squamous cell carcinoma are noted to cause high rates of acute and chronic morbidity. The aims of this study are to provide an overview of the current de-escalation trials for human papillomavirus positive (HPV+) oropharyngeal carcinoma and to evaluate the evidence supporting improved response to treatment of patients within this viral cohort. This study reviewed all completed or in progress randomised controlled trials (RCTs) assessing clinical interventions for human papillomavirus-associated locally advanced oropharyngeal squamous cell carcinoma. We utilised a validated 'risk of bias' tool to assess study quality. We identified nine RCTs that met the full inclusion criteria for this review (all of which are currently on-going and will report from 2015 onwards). Five RCTs performed a post hoc analysis by HPV status, which allowed meta-analysis of 1130 patients. The data reveal a significant difference in overall survival (hazard ratio (HR) 0.49 [95% confidence interval (CI) 0.35-0.69]), loco-regional failure (HR 0.43 [95% CI 0.17-1.11]) and disease specific survival (0.41 [95% 0.3-0.56]) in favour of the HPV+ category. In considering de-escalation treatment protocols, nine studies are currently ongoing. Our meta-analysis provides strong evidence for an improved prognosis in the viral associated cohort when treated by platinum based chemotherapy in combination with radiotherapy or primary radiotherapy. So far, one trial (with moderate to high risk of bias) suggests a reduced survival outcome for the HPV+ population when using the epidermal growth factor receptor (EGFR) inhibitor cetuximab.
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Affiliation(s)
- Liam Masterson
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Pathology, University of Cambridge, UK.
| | - Daniel Moualed
- ENT Department, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Zi Wei Liu
- ENT Department, Barts Health NHS Trust, London, UK
| | - James E F Howard
- Oncology Centre, University College Hospital NHS Trust, London, UK
| | - Raghav C Dwivedi
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James R Tysome
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| | - Piyush Jani
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Wong BLK, Dwivedi RC, Masterson L, Riffat F, Marker A, Jani P. Kaposiform hemangioendothelioma of paranasal sinus. Laryngoscope 2014; 124:2103-6. [PMID: 24619771 DOI: 10.1002/lary.24669] [Citation(s) in RCA: 5] [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] [Accepted: 03/07/2014] [Indexed: 11/10/2022]
Abstract
Kapossiform hemangioendothelioma (KHE) of the paranasal sins (PNS) is a rare cause of recurrent epistaxis. To date, only two cases of PNS KHE have been reported in the literature, both occurring in the pediatric population. The case presented here appears to be the first case of PNS KHE occurring in an adult. A 46-year-old white female presented with progressively worsening unilateral recurrent epistaxis. Diagnostic histopathology confirmed it to be KHE. After a detailed workup, the tumor was completely excised en bloc (medial maxillectomy; anterior and posterior ethmoidectomy) via a lateral-rhinotomy approach. Complete excision of the tumor with clear margins offers the best results.
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Affiliation(s)
- Billy L K Wong
- Department of Otolaryngology, Head and Neck Surgery, Addenbrookes Hospital, Cambridge, United Kingdom
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Masterson L, Rouhani M, Donnelly N, Tysome J, Patel P, Axon P, Moffatt D. Squamous Carcinoma of the Temporal Bone: Lessons Learned Over the Past Thirty Years. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1370545] [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: 10/25/2022]
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Masterson L, Moualed D, Masood A, Dwivedi RC, Benson R, Sterling JC, Rhodes KM, Sudhoff H, Jani P, Goon P. De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma. Cochrane Database Syst Rev 2014; 2014:CD010271. [PMID: 24532092 PMCID: PMC10654373 DOI: 10.1002/14651858.cd010271.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Human papillomavirus-associated oropharyngeal squamous cell carcinomas are a distinct subgroup of tumours that may have a better prognosis than traditional tobacco/alcohol-related disease. Iatrogenic complications, associated with conventional practice, are estimated to cause mortality of approximately 2% and high morbidity. As a result, clinicians are actively investigating the de-escalation of treatment protocols for disease with a proven viral aetiology. OBJECTIVES To summarise the available evidence regarding de-escalation treatment protocols for human papillomavirus-associated, locally advanced oropharyngeal squamous cell carcinoma. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 25 June 2013. SELECTION CRITERIA Randomised controlled trials investigating de-escalation treatment protocols for human papillomavirus-associated, locally advanced oropharyngeal carcinoma. Specific de-escalation categories were: 1) bioradiotherapy (experimental) versus chemoradiotherapy (control); 2) radiotherapy (experimental) versus chemoradiotherapy (control); and 3) low-dose (experimental) versus standard-dose radiotherapy (control). The outcomes of interest were overall and disease-specific survival, treatment-related morbidity, quality of life and cost. DATA COLLECTION AND ANALYSIS Three authors independently selected studies from the search results and extracted data. We planned to use the Cochrane 'Risk of bias' tool to assess study quality. MAIN RESULTS We did not identify any completed randomised controlled trials that could be included in the current version of this systematic review. We did, however, identify seven ongoing trials that will meet our inclusion criteria. These studies will report from 2014 onwards. We excluded 30 studies on methodological grounds (seven randomised trials with post hoc analysis by human papillomavirus status, 11 prospective trials and 12 ongoing studies). AUTHORS' CONCLUSIONS There is currently insufficient high-quality evidence for, or against, de-escalation of treatment for human papillomavirus-associated oropharyngeal carcinoma. Future trials should be multicentre to ensure adequate power. Adverse events, morbidity associated with treatment, quality of life outcomes and cost analyses should be reported in a standard format to facilitate comparison with other studies.
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Affiliation(s)
- Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Daniel Moualed
- Great Western Hospitals NHS Foundation TrustENT DepartmentSwindonUK
| | - Ajmal Masood
- Norfolk and Norwich University HospitalENT DepartmentNorwichUK
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Richard Benson
- Addenbrooke's HospitalOncology CentreBox 193CambridgeUKCB2 2QQ
| | - Jane C Sterling
- Addenbrooke's HospitalDepartment of DermatologyBox 46CambridgeUKCB2 2QQ
| | - Kirsty M Rhodes
- University of CambridgeMRC Biostatistics UnitNewnham CollegeSidgwick AvenueCambridgeCambridgeshireUKCB3 DF
| | - Holger Sudhoff
- Bielefeld Academic Teaching HospitalDepartment of Otolaryngology, Head and Neck SurgeryTeutoburger Str. 50BielefeldGermany33604
| | - Piyush Jani
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Peter Goon
- University of CambridgeDepartment of PathologyCambridgeUK
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Abstract
A 40 year old man presents with a 1 cm tender soft swelling in the lateral neck region. This developed seven days after the onset of a tonsillitis episode that has now resolved. He has a 20 pack-year smoking history and consumes minimal alcohol. Examination is otherwise normal.
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Affiliation(s)
- Raghav C Dwivedi
- Department of Otolaryngology and Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK
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Abstract
AIMS Ballistic cervical injury has become a significant source of both morbidity and mortality for the deployed UK soldier. The aim of this paper was to document a case series of ballistic cervical wounds to describe the pattern of these injuries and relate them to outcome. METHODS The records of all UK service personnel sustaining wounds to the neck in Iraq or Afghanistan between 01 August 2004 and 01 January 2008 were analysed following identification by the Joint Theatre Trauma Registry. Blunt or thermal injuries were excluded. RESULTS The records of 75/76 service personnel sustaining penetrating cervical injury during this period were available for analysis. 56/75 (75%) were due to explosive fragmentation and the remainder due to gunshot wounds (GSW). 33/75 (44%) of soldiers sustained vascular injury, 32/75 (43%) injury to the spine or spinal cord, 29/75 (39%) injury to the larynx or trachea and 11/75 (15%) injury to the pharynx or oesophagus. 14/75 (19%) patients in this series underwent surgery in a hospital facility for treatment of potentially life threatening cervical injuries, with a survival rate after surgery of 12/14 (86%). The overall mortality from this series of battlefield penetrating neck injury was 63%. CONCLUSIONS Penetrating cervical ballistic injury is a significant source of injury to deployed UK service personnel, predominantly due to neurovascular damage. Neck collars if worn would likely prevent many of the injuries in this case series but such protection is uncomfortable and may interfere with common military tasks. Newer methods of protecting the neck should be investigated that will be acceptable to the deployed UK soldier.
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Affiliation(s)
- J Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine
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