Head and Neck Tumors (HNT)
ISSN / EISSN : 2222-1468 / 2411-4634
Published by: Publishing House ABV Press (10.17650)
Total articles ≅ 272
Latest articles in this journal
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2222-1468-2021-11-2-41-49
The study objective – to evaluate the feasibility of correcting eating disorders in patients undergoing surgery for oral and oropharyngeal cancers using various reconstructive techniques to restore postoperative defects. Materials and methods. Between 2012 and 2019, a total of 56 patients with stage II–IV oral and oropharyngeal cancer underwent reconstructive surgery after either hemiglossectomy or glossectomy. The patients ranged in age from 26 to 70 years. The patients were divided into two groups. Group I consisted of 36 (64.3 %) patients who underwent tongue reconstruction using rotation flaps. For reconstruction of hemiglossectomy defects, a chin flap was used, and for reconstruction of glossectomy defects, a pectoral flap was used. Group II comprised 20 (35.7 %) patients who underwent tongue reconstruction using free revascularized flaps. For the tongue reconstruction after hemiglossectomy, the radial flap, medial sural perforator flap and fasciocutaneous anterolateral thigh flap were used. For the tongue reconstruction after glossectomy, the fasciocutaneous anterolateral thigh flap was used. The acts of chewing and swallowing were restored during speech rehabilitation due to the activation and coordination of the work of the muscles of the cheeks, lips, soft palate, pharynx, and the reconstructed tongue. Eating disorders were assessed by interviewing patients. A comparative analysis of eating disorders included mobility and coordination of facial muscles and reconstructed tongue, increased sensitive in the oral cavity, the presence of aspiration and nasal regurgitation, and subjective difficulties of patients. The time before the start of rehabilitation and its duration were taken into account. Patients were interviewed before the start of the combined treatment, at the beginning and after the completion of rehabilitation. Results. After the completion of rehabilitation, all patients received food by the oral route. The best outcomes were achieved in group 2a patients, who underwent tongue reconstruction with free revascularized flaps. This group of patients had a lower percentage of the asymmetry of facial muscles and limited mobility of the tongue compared to other groups of patients. In the subgroups of patients undergoing glosssectomy, most of the studied parameters did not have statistically significant differences in values. However, it should be noted that in group 2b, the period from the date of surgical treatment to the beginning of rehabilitation was significantly longer than in group 1b. Conclusion. The use of the microvascular surgical techniques using various donor flaps creates the basis for a more complete functional recovery and expands the rehabilitation potential of patients after surgical treatment of oral and oropharyngeal cancer.
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2313-805x-2021-11-2-31-40
Currently, the role of human papillomavirus (HPV) in carcinogenesis is well known: more than 90 % of HPV-positive oropharyngeal squamous cell carcinomas are caused by HPV type 16 (HPV-16). HPV E6 and E7 oncoproteins play a significant role in the development of this tumor. The E6- mediated degradation of suppressor protein p53 results in G2/M-phase checkpoint dysregulation and inhibition of apoptosis. HPV oncoprotein E7 binds to pRb, promoting its degradation and the release of E2F transcription factor. Diagnostic assays for HPV detection include immunohistochemical staining for p16, polymerase chain reaction, in situ hybridization, and next-generation sequencing. Immunohistochemical examination (determination of p16 protein expression) is an economical and very specific way to detect a viral infection. Patients with HPV-positive oropharyngeal squamous cell carcinoma demonstrate significantly better response to treatment and overall survival rates than those with HPV-negative oropharyngeal squamous cell carcinoma. Despite the fact that five-year overall survival rate in patients with HPV-positive oropharyngeal squamous cell carcinoma after treatment exceeds 80 %, some patients have poor survival. Unfortunately, currently available methods of risk stratification still do not endure their timely identification. Further research is needed to address these problems.
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2222-1468-2021-11-2-57-63
Introduction. Juvenile nasopharyngeal angiofibroma is a rare, benign, well-vascularized tumor of the skull base characterized by destructive growth. The development of endoscopic techniques and experience of surgeons have enabled the removal of this tumor both at early stages and late stages (advanced disease). Patients may develop various complications in the intraoperative and postoperative periods, including massive bleeding, nasal liquorrhea, facial paresthesia, lacrimal hyposecretion, etc. Air penetration into the subcutaneous fat and mediastinum during endoscopic surgery on the paranasal sinuses is rare. Such complication as subcutaneous emphysema and pneumomediastinum after endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma has not been reported in the literature. Case report. A 19-year-old male patient has undergone endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma. The tamponade was removed within the first 24 h postoperatively. Ten hours after it, the patient developed subcutaneous emphysema and pneumomediastinum triggered by sneezing. The diagnosis was confirmed by computed tomography of the neck and chest. The patient was transferred to the intensive care unit and received conservative treatment (including infusion, antibacterial, and antiinflammatory therapy). The symptoms of subcutaneous emphysema and pneumomediastinum subsided in response to treatment. Follow-up examinations (computed tomography and magnetic resonance imaging) confirmed that the tumor had been completely removed. The patient was discharged in a satisfactory condition. Conclusion. Subcutaneous emphysema and pneumomediastinum are exceedingly rare complications of endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma and are caused by anatomical connection between the parapharyngeal / retropharyngeal spaces and mediastinum. To prevent such complications, it is necessary to keep tampons in the nasal cavity for at least 2 days, as well as to instruct patients after surgery (avoid sneezing with their mouth closed, lifting weights, coughing, and vomiting). The nasoseptal flap used to repair the nasopharyngeal defect after tumor removal also ensures its sealing. Patients with complications should undergo computed tomography of the neck and chest (in case of emergency) and should be transferred to an intensive care unit. Conservative treatment (antibacterial and antiinflammatory therapy) will ensure good results in most patients.
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2222-1468-2021-11-2-18-24
Introduction. Partial maxillectomy involves resection of 1 or 2 walls of the upper jaw, usually medial and anterior ones. The main purposes of reconstruction include the formation of an adequate support for the eyeball; isolation of the orbit from the nasal cavity, nasopharynx, and anterior skull base; normal symmetry; good aesthetic result. Materials and methods. Between 2014 and 2020, we followed up 13 patients. Nine of them (69 %) had combined defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010), as well as skin on the buccal and zygomatic areas; 1 patient also had lower eyelid affected. Four individuals (31 %) had isolated defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010). Twelve patients have undergone preoperative 3D-computer simulation. We divided patients into 2 groups according to the size of their defects and resection areas in the anterior wall of the maxillary sinus. Group 1 included 5 patients with partial maxillary defects (involving 25–40 % of the total area), whereas Group 2 comprised 7 patients with limited maxillary defects (involving 25–40 % of the total area). Five patients have undergone reconstructive surgeries with fasciocutaneous flaps, including anterolateral thigh flaps used in 4 individuals (31 %) and thoracodorsal flap used in 1 individual (8 %). Eight patients had their defects repaired using radial fasciocutaneous flaps. The inferior orbital wall was reconstructed using an individual titanium mesh implant. Results. All patients from Group 1 after defect repair with anterolateral thigh flaps and thoracodorsal flaps (4 individuals) had satisfactory aesthetic result. One patient had an unsatisfactory aesthetic result after reconstruction with a radial fasciocutaneous flap due to mesh implant protrusion and formation of an opening in the nasal cavity. The assessment of the eyeball position demonstrated that symmetry was achieved in 4 patients (80 %) after reconstruction using anterolateral thigh flaps (3 patients) and thoracodorsal flap (1 patient). Five patients from Group 2 (72 %) had excellent results, while 2 patients (28 %) had satisfactory results. The assessment of the eyeball position demonstrated that symmetry was achieved in 5 patients (70 %); two participants (28 %) had lower eyelid ectropion. Conclusion. Patients with large maxillary defects (involving 41–60 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) should undergo reconstructive surgeries with fasciocutaneous anterolateral thigh flaps. In case of relatively small defects (involving 25–40 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) the best option is defect repair with radial fasciocutaneous flaps. Such strategy ensures excellent aesthetic and functional results in 75 % of patients.
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2222-1468-2021-11-2-50-56
Melanoma is a malignant skin tumor associated with a poor clinical prognosis. The incidence of melanoma is constantly rising. Several studies demonstrated that overall and relapse-free survival rates in patients with head and neck melanoma were lower than those in patients with skin melanoma of other locations. Some authors showed that patients with scalp melanoma had the worst prognosis. Surgery is currently the main treatment option for resectable skin melanoma. It has a number of specific characteristics, such as the need for a smaller resection margin at primary tumor removal in some cases, lower accuracy of sentinel lymph node identification due to the complexity of lymph flow from the scalp and neck, and changes in the standard volumes of lymphadenectomy considering lymph flow from the scalp and neck. Oncologists should have reconstructive surgery skills, because their aim is not only to ensure complete tumor excision, but also to achieve a satisfactory appearance of the patient, especially if the tumor is located in the face, open areas of the head and neck and ears, since this is of functional and aesthetic importance. The administration of adjuvant therapy still causes some controversy in cases where both radiation therapy and pharmacotherapy are indicated. In this article, we describe the main characteristics of the current treatment strategy for resectable scalp and neck melanoma and cover the main problems in this area that have not been addressed so far.
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2222-1468-2021-11-2-10-17
Introduction. Сomputed tomography (СТ) and magnetic resonance imaging (MRI) are the main methods of radiological diagnostics, which makes it possible to objectively assess the local advancement of malignant tumors of the hearing organ and decide on the possibility of surgical intervention. The objective of this scientific research – to determine the main indications for surgical intervention, taking into account the radiological criteria for the lesion of the temporal bone (CT, MRI) in locally advanced outer ear skin cancer. Materials and methods. This research work based on a retrospective and prospective analysis case history for patients with locally advanced external ear skin cancer. These are 45 patients, who received treatment in surgical department of head and neck tumors in N. N. Blokhin National Medical Research Center of Oncology between 1994 and 2020. Patient observation time averaged 30.0 ± 32.3 months (from 0.7 to 117.4 months, median – 12.0 months). Results. The prevalence of the tumor process in cancer of the skin of the external auditory canal in accordance with the staging system for lesions of the temporal bone structures (University of Pittsburgh, 1990), which takes into account CT and MRI signs of damage to the temporal bone and adjacent anatomical structures, is a factor that significantly affects the long-term results of treatment (for disease-free survival: hazard ratio (HR) 4.76, 95 % confidence interval (CI) 1.93–11.73, р = 0.00069; for tumor-specific survival: HR 4.25, 95 % CI 1.74–10.39, р = 0.0015; for overall survival: HR 1.96, 95 % CI 1.07–3.58, р = 0.029). Conclusion. CT and MRI are mandatory methods of radiological diagnosis of patients with skin cancer of the external auditory canal.
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2222-1468-2021-11-2-64-71
Thyroid carcinoma with thymus-like differentiation (Carcinoma Showing Thymus-Like Differentiation, CASTLE) is an extremely rare disease. It arises from the thymus tissue ectopic into the tissue of the thyroid gland, usually in patients 40–50 years old. In this work, we present an observation of the development of CASTLE in a patient at a young age. A 21-year-old woman was admitted to our clinic with a volumetric education in the projection of the left lobe of the thyroid gland. Ultrasound revealed a 5-centimeter thyroid tumor. Surgery was performed in the scope of thyroidectomy, selective cervical dissection (level VI). Morphological and immunohistochemical studies showed that cancer has a thymus-like differentiation (CASTLE). After 32 months, she recurred to the lymph nodes of the neck (level IV on the left). She underwent repeated surgery, after which she was observed without signs of relapse for 120 months. The rarity of the pathology leads to difficulties in establishing a diagnosis at the preoperative stage and in choosing the optimal treatment tactics during treatment and further follow-up.
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2222-1468-2021-11-2-25-30
During 1996–2015 years, 53 patients with stage locally-advanced squamous cell carcinoma of the pharynx with stage N3 were treated in N. N. Blokhin National Research Center of Oncology. Depending on the treatment method, patients were divided into 2 groups: concurrent (n = 26) and induction (n = 27) chemoradiotherapy. Concurrent chemoradiotherapy (option 1) was given using: cisplatin 100 mg/m2 – every 3 weeks, or carboplatin 1.5 AUC weekly, or cisplatin 100 mg/m2 with 5-fluorouracil 1000 mg/m2 every 24 hours, in continuous infusion for 96 hours (PF). Induction chemotherapy (option 2) was performed in 2 modes: TPF (docetaxel, cisplatin, 5-fluorouracil) or PF (cisplatin, 5-fluorouracil). Radiation therapy was performed on a linear accelerator for 2 Gy daily up to SD 68–70 Gy for the primary tumor and 66 Gy for the affected lymph nodes. According to the results of our retrospective study, the 3 year overall and relapse-free survival rate depending on the chemoradiotherapy option was 37 and 32 % (option 1), 62 and 56 % (option 2). A promising option for chemoradiotherapy of locally advanced squamous cell carcinoma of the pharynx is induction chemoradiotherapy.
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2222-1468-2021-11-1-101-108
Glioblastoma multiform^ is one of the most aggressive malignancies, wich standard of treatment not changed over the past decade, and the average life expectancy from diagnosis to death does not exceed two years in the most optimistic trials. The review examines the features of the glioblastoma microenvironment, its genetic heterogeneity, the development of recurrent glioblastoma, the formation of drug resistance, the influence of the blood-brain barrier and the brain lymphatic system on the development of immunotherapy and targeted therapy. Molecular subgroups of glioblastomas with an assumed prognostic value were analyzed. It was determined that numerous relationships between glioblastoma cells and the microenvironment are aimed at ensuring tumor progression, and also cause a state of reduced effector function of T cells. Data on the development of future molecular-targeted therapies for four types of cancer cells based on their different properties and response to therapy are summarized: primary GSC, RISC cells, and proliferating and postmitotic non-GSC fractions. The penetration of blood-brain barrier with chemotherapeutic drugs and antibodies currently remains the main limitation in the treatment of glioblastoma. The resulting analysis of the causes is reduced to the following conclusions. A detailed understanding of the evolutionary dynamics of tumor progression can provide insight into the related molecular and genetic mechanisms underlying glioblastoma recurrence. The most promising methods of treatment for glioblastoma are combined therapy using immune checkpoint inhibitors in combination with new treatment methods -vaccine therapy, CAR-T-cell therapy and viral therapy. A deeper study of the mechanisms of drug resistance and acquisition resistance, biology and subcloning clonal populations of glioblastoma and its microenvironment, with active consideration of combined trips to the treatment will increase the survival rate of patients, and may lead to stable remission of the disease.
Head and Neck Tumors (HNT), Volume 11; https://doi.org/10.17650/2222-1468-2021-11-1-41-50
The study objective is to evaluate the results of organ-preserving treatment of locally advanced larynx squamous cell carcinoma. Materials and methods. Analysis of 28 patients with locally advanced larynx squamous cell carcinoma (stages III-IV) who underwent treatment at the N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia between 2017 and 2020 was performed. At the first stage, 2-3 courses of combined inductive polychemotherapy per the DCF scheme with 21-day interval were performed (docetaxel 60 mg/m2, cisplatin 60 mg/m2 intraarterially bolus with detoxication with sodium thiosulfate, 5-fluorouracil 1000 mg/m2/day as 96-hour infusion). The second stage included external beam radiotherapy (60-70 Gy, 2 Gy per day 5 days a week) as monotreatment if complete clinical response after chemotherapy was achieved or with regional administration of cisplatin (60 mg/m2 once per 3 weeks) if after inductive stage full clinical response wasn»t observed. Results. In 20 (71.5 %) patients, complete clinical response was observed after inductive treatment; in 7 (25 %) patients, partial response was observed. Tumor stabilization was detected in 1 (3.5 %) patient. Two-year overall survival was 95.8 ± 4.1 %, progression-free survival was 90.1 ± 6.8 %. Conclusion. The proposed strategy of organ-preserving treatment of stage III-IV larynx cancer with substitution of systemic chemotherapy with regional intraarterial chemotherapy prior to radiotherapy is highly effective from the point of view of direct anti-tumor effect and recurrence-free and overall survival.