Head and Neck Tumors (HNT)
ISSN / EISSN : 2222-1468 / 2411-4634
Current Publisher: Publishing House ABV Press (10.17650)
Total articles ≅ 229
Latest articles in this journal
Head and neck tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-97-100
Esophageal cancer spreads locally via the circulatory and lymphatic systems and can, extremely rarely, form brain metastases. The development of intracranial metastases is a long-term adverse event indicating poor prognosis. In this paper, we present a case of esophageal cancer with a brain metastasis in a patient who received combination therapy and demonstrated long-term progression-free survival.
Head and neck tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-54-60
This review analyzes the research data concerning the problem of antibiotic prophylaxis (ABP) of wound infections after various surgeries for head and neck tumors. In patients with clean wounds, ABP should be used in exceptional cases only (for example, if the patient has any risk factors), otherwise it should be avoided. A short ABP course is recommended for patients with clean-contaminated wounds; however highrisk patients may require a prolonged course. There is some evidence of ABP efficacy in patients with non-contaminated wounds after cervical lymphadenectomy. When choosing a drug for ABP, a doctor should consider the site of surgery and the risk of wound contamination. The optimal drugs after head and neck surgeries include first- and second-generation cephalosporins, ampicillin in combination with sulbactam, metronidazole, and clindamycin. First- and second-generation cephalosporins in combination with metronidazole are preferable, but if the wound is infected with gram-positive bacteria, it is necessary to use clindamycin monotherapy. Reconstructive surgeries with a free flap require a short course of ABP with one of the following combinations: cefazolin + metronidazole, cefuroxime + metronidazole, or ampicillin + sulbactam; if the patient is allergic to beta-lactams, clindamycin can be used. Despite the availability of standard ABP regimens, a surgeon must apply a tailored approach when choosing an ABP regimen for each patient, taking into account risk factors and the volume of surgery.
Head and neck tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-30-37
Background. Multikinase inhibitors of angiogenesis are currently the most effective group of drugs in target therapy for cancer. They are associated with a high prevalence of a specific cutaneous adverse reaction, which manifests as a hand-foot skin reaction (HFSR). This side effect is quite prominent in the majority of patients, usually graded as II–III degree, which leads to the dose reduction and even discontinuation of the drug. The study objective is to evaluate clinical, histological and ultrasound characteristics of a HFSR associated with MKI treatment, and to assess the influence of a HFSR on patient’s quality of life. Materials and methods. The study included 46 patients with HFSR, who were previously treated with sorafenib or lenvatinib. Clinical characteristics of HFSR, including severity grading, were evaluated. We also performed ultrasound and histological examinations and assess the Dermatology Life Quality Index. Results. Grade III HFSR was in 5 (10.86 %) patients, grade II – in 25 (54.35 %), and grade I – in 16 (34.79 %). Dermatology Life Quality Index depended on the HFSR severity, with the mean value 24.5 ± 2.4. Pathomorphological examination revealed irregular epidermal proliferation with hypertrophic psoriasiform acanthosis, minimal keratinocyte vacuolization, few apoptotic figures, dyskeratosis, hyperkeratosis and microvessel dilation in the papillary dermis. Ultrasound examination showed increased vascularization in papillary and reticular dermis in affected skin areas, which was more prominent in patients with severe degrees of HFSR. The pronounced enhancement of vascularization was detected in fragmented hypoechogenic sites along the border of papillary and reticular dermis and in similar sites along the border of dermis and hypodermis. Conclusion. The use of multikinase inhibitors leads to pronounced changes not only in the surface layers of the skin, but also in the dermis and subcutaneous fat, which significantly worsens the quality of life of patients. This indicates the need to search for pathogenetically based methods of treatment of HFSR and create practical guidelines for supportive treatment of patients with HFSR taking multikinase inhibitors.
Head and neck tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-61-68
This review covers the issues related to the application of radial free forearm flaps for the reconstruction of defects after surgeries for oral squamous cell carcinoma. The advantages of this method include optimal match of the flap to the tissues of the oral cavity, good adaptation to defect edges, and possibility to replace defects of almost any size and locations. Flap survival rate reaches 92.0–98.4 %. The method demonstrated good functional and aesthetic results when used for the repair of extensive defects of the tongue, oral floor, cheeks, as well as total defects of the lips, hard and soft palates. The main disadvantages of the method include aesthetic defects of the donor site and possible forearm dysfunction, but most patients are quite comfortable with these inconveniences. The death rate is 0.09 %; the incidence of complications is 15–24 %. The main cause of graft failure in this case is venous thrombosis. Advanced age is not currently considered as a contraindication for this method. Further studies evaluating free radial flaps are highly relevant, particularly those comparing this method with other ones and determining strict indications for it (such as size and location of the defect, tumor characteristics, and previous treatment).
Head and neck tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-85-89
The objective is to report a rare case of laryngeal cancer in spouses. Case report. A 59-year-old female patient was admitted to the Department of Head and Neck Tumors in December 2019 with complaints of hoarseness. In 1997, she had radiotherapy for T1N0M0 laryngeal cancer. After comprehensive examination, she was diagnosed with recurrent laryngeal cancer. The patient has undergone frontolateral laryngeal resection. A 67-year-old male patient was admitted to the Department of Head and Neck Tumors in November 2019 with T3N0M0 laryngeal cancer (diagnosed 2 months before). He has undergone extended frontolateral laryngeal resection followed by radiotherapy in the postoperative period. Discussion. Both patients had no risk factors, such as occupational hazards or smoking. However, both spouses had close relatives with cancer, what indicates their genetic predisposition to malignant tumors. The female patient was found to have human papilloma virus (HPV) in the tumor cells, whereas her spouse was HPV-negative, although rapid histology showed indirect signs of HPV, which does not exclude the elimination of HPV. Conclusion. In this rare case of laryngeal cancer diagnosed in two non-consanguineous spouses, the disease is likely to be caused by their hereditary predisposition, HPV infection, and the fact that they lived in the same socioeconomic conditions.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-46-53
The study objective is to perform retrospective analysis of the efficacy and safety of vandetanib for metastatic and non-resectable medullary thyroid cancer in routine clinical practice. Materials and methods. We analyzed treatment outcomes in 46 patients treated with vandetanib. We also evaluated progression-free survival, overall survival, time to progression, and frequency of adverse events. Results. At a median follow-up time of 27.4 months (range: 2.5–106.5 months) and median duration of vandetanib therapy of 21 months, disease progression was registered in 32.6 % of cases, whereas stable disease was observed in 28.3 % of cases and 8.7 % of study participants demonstrated partial response. One patient had complete response to treatment. Almost one-third of patients (28.2 %) died, including 2 individuals whose death was not associated with cancer. The one-year and three-year progression-free survival rates were 67.3 % and 33.3 %, respectively; the two-year and five-year overall survival rates were 82.4 % and 29.4 %, respectively. The efficacy of therapy was confirmed by a 79.4 % decrease in the serum level of calcitonin after treatment initiation. Side effects were observed in 33.9 % of patients (primarily skin and gastrointestinal toxic reactions) and were easily managed in most of the cases. Eight individuals (17.4 %) required cessation of vandetanib due to adverse events. Conclusion. Our findings suggest high efficacy and acceptable safety profile of vandetanib in the treatment of progressive locally advanced non-resectable and disseminated medullary thyroid cancer
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-69-78
Mammary analogue secretory carcinoma (MASC) of the salivary gland is a rare salivary cancer, histologically resembling to secretory carcinoma of the breast. In 2017 World Health Organization reported MASC is a new salivary cancer subtype. The aim of this article is to collect and analyze data about MASC, particularly clinical, histological and molecular profile, to evaluate targeted therapy effects. We discuss a case report of dramatic and durable response with entrectinib and the development of acquired resistance in an NTRK3-fusion positive salivary cancer, detected by next-generation sequencing. Next-generation sequencing as a comprehensive molecular profiling, that helps to investigate molecular profile of rare tumors and gives an opportunity to use an effective therapeutic options. Identifying ETV6-NTRK3 positive MASC provides a better prognosis for metastatic disease by using a novel effective targeted therapy with tyrosine kinase inhibitors (entrectinib, larotrectinib). Despite a durable and dramatic response, we showed an interesting case of the development of acquired resistance to tyrosine kinase inhibitors mediated by the appearance of a novel NTRK3 G623R mutation. Finally, we believe in great perspectives of comprehensive molecular profiling and targeted therapy for rare malignancies with NTRK gene fusions, including second-generation tyrosine kinase inhibitors.
Head and neck tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-22-29
The study objective is to analyze the results of the use of free osteomyofascial flaps in the reconstruction of combined post-resection facial defects with an intraoral component. Materials and methods. Fifty-three patients were operated by the proposed method. The muscle portions which were used with free flaps were: m. flexor hallucis longus with the free fibula flap (n = 27), m. vastus lateralis with anterolateral thigh flap (n = 11), m. subscapularis with the scapula free flap (n = 15). An analysis of postoperative complications was performed, as well as an analysis of the timing of dental implantation. Results. The average hospital stay was 15 days. The main complications from the recipient area were: local inflammation in the reconstruction area – 2 (3.8 %) cases, hematoma on the neck – 2 (3.8 %), fistula formation – 1 (1.9 %), full flap necrosis was noted in 1 (3.7 %) case, hypertrophic growths of granulation tissue on the muscle portions of the flaps in 3 (5.7 %). The main complications from the donor zone: hematomas – 0 cases. In 2 (13.3 %) patients after using a chimeric scapular flap, lymphorrea up to 50–70 ml was noted. Dental implantation was performed in 4 (9.5 %) cases. There were no complications or difficulties in performing dental implantation. The average time taken to form the soft tissue contour in the area of implants after installing the gingiva formers in our study was 2.5 weeks, which is 2 weeks faster than using flaps that include a skin paddle. Conclusion. This reconstruction method could be used as a main for the plastic elimination of combined facial defects with an intraoral component.
Head and neck tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-38-45
The study objective is to assess the possibilities of magnetic resonance imaging (MRI) in SWI (susceptibility weighted imaging) in the differential diagnosis of glial brain tumors and primary brain lymphomas. Materials and methods. Fifty-four patients with brain tumors were studied (men – 27 (50 %), women – 27 (50 %)). Average age 57.9 years. Histological examination of the surgical material revealed the glial nature of tumors in 41 patients (26 of them with glioblastoma, anaplastic astrocytomas – 15), primary brain lymphomas – in 13 patients. Brain MRI was performed using tomographs with a magnetic field of 3 and 1.5 T. A semi-quantitative assessment of the data obtained in the SWI mode based on the classification of ITSS (intratumoral susceptibility signals), reflecting the severity of interstitial vascular architectonics and microbleeding. Results. The degree of ITSS was 3 in glioblastomas (G4 ) in 26 (100 %) cases, in the structure of gliomas (G3 ) the ITSS values were 3 in 3 (20 %) cases, in the remaining 12 (80 %) cases – ITSS 2. In the group of primary brain lymphomas, the ITSS 1 was in 4 (30.7 %) cases, ITSS 0 was in 9 (69.3 %) cases. Conclusion. MRI in SWI mode is a promising technique that allows one to quantify the degree of pathological changes in tumor vascular architectonics and intratumoral hemorrhages and has shown high specificity in the differential diagnosis of malignant gliomas and lymphomas of the brain, accompanied by active accumulation of contrast medium.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-2-79-84
The objective of the scientific report is to describe a rare clinical case of a combination of Forestier’s disease (diffuse idiopathic skeletal hyperostosis) and laryngeal cancer that have common symptoms. Case report. A 68-year-old male patient presented with hoarseness lasting for a year. Indirect laryngoscopy revealed a vocal fold tumor. Histological examination confirmed well-differentiated keratinizing squamous cell carcinoma of the larynx. A 6-cm tumor was located in the projection of the right vocal fold and had no signs of invasion into the supraglottis, subglottis, and anterior commissure. No other focal disorders were detected. The patient has undergone endolaryngeal laser resection of the larynx and tracheostomy. After probe removal, the patient had swallowing difficulties with esophageal content passing to the trachea mainly due to organic changes in the cervical spine at the СЗ–С4 level, where there was a massive local calcification of the anterior longitudinal ligament. We also noticed severe movement restriction in the cervical spine: the amplitude of movements did not exceed 10°. The formation of the C3–C4 segment was removed via ventrolateral approach. Conclusion. Dysphagia, dysphonia, and dyspnea may indicate both malignant tumor and large osteophyte causing compression of the trachea and esophagus. In this case, no symptom resolution after tumor removal led to the suspicion of a second disease, namely Forestier’s disease.