Head and Neck Tumors (HNT)
ISSN / EISSN : 2222-1468 / 2411-4634
Current Publisher: Publishing House ABV Press (10.17650)
Total articles ≅ 251
Latest articles in this journal
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-50-59
Introduction. The main method of preoperative diagnosis of thyroid tumors and the identification of possible metastasis is a cytological examination of smears obtained by fine-needle aspiration biopsy. However, the cytological material of the lymph nodes may not be adequate, and the detection of metastases faces a number of difficulties. In our recent study, we described a variant of the molecular classifier that allows the detection and typing of malignant thyroid tumors by analyzing several molecular markers in cytological preparations.The study objective was to assess the applicability of the developed method for the preoperative detection of metastases of papillary and medullary thyroid cancer in the lymph nodes of the neck lateral cellular tissue.Materials and methods. A total of 86 cytological samples were used, obtained from individual lymph nodes of 62 patients who had a diagnosis – thyroid cancer. Samples were analyzed by real-time polymerase chain reaction regarding the preselected set of molecular markers: the BRAF V600E mutation, the normalized concentration of HMGA2, FN1 and SERPINA1 mRNA, 5 miRNAs and the mitochondrial/nuclear DNA ratio. The decision tree-based classifier was used to discriminate between benign and malignant samples.Results. The previously described classifier, based on the analysis of the BRAF V600E mutation, the content of HMGA2 mRNA, 3 miRNAs and the mitochondrial/nuclear DNA ratio, revealed metastases of thyroid cancer with good specificity (98 %) but less sensitivity (83 %). Therefore, a new classifier was built, including three markers – HMGA2 and FN1 mRNA, and miRNA-375, which, with regard to the detection of metastases, showed good sensitivity – 93 % with a slight decrease in specificity (up to 96 %).Conclusion. Thus, we demonstrated the possibility of preoperative detection of thyroid cancer metastases in the lymph nodes of the neck lateral cellular tissue by analyzing several molecular markers in cytological material.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-25-31
Background. The main aims of hard palate reconstruction include separation of the nasal and oral cavities, restoration of chewing, swallowing, speech, ensuring good aesthetic results, and preparation for dental rehabilitation. The choice of reconstruction method is determined by such factors as the nature and location of the defect, surgeon’s experience in certain reconstruction methods, cancer prognosis, and patient’s preference. The study objective is to analyze the results of microsurgical reconstruction of hard palate defects using different types of flaps. Materials and methods. Forty-one (41) patients underwent microsurgical reconstruction of defects of the hard palate, soft palate, and alveolar process between 2014 and 2020. Defects of the anterior portion of the hard palate (grade I, IIc, IId according to the classification of J.S. Brown; grade IB, II, III according to the classification of D.J. Okay) were formed in 13 cases; all of them involved the alveolar margin of the maxilla to some extent. To repair these defects, we used flaps containing revascularized bone (n = 10; scapular tip flaps in 8 patients and fibular flaps in 2 patients) and fasciocutaneous or musculocutaneous flaps (n = 3; radial fasciocutaneous flaps in 2 patients and musculocutaneous flap from the anterior surface of the thigh in 1 patient). Defects of the posterior portion of the hard palate (grade Ib according to the classification of J.S. Brown; grade Ib according to the classification of D.J. Okay) were formed in 18 patients. To repair these defects, we used radial fasciocutaneous flaps (n = 17) and fibular autologous graft containing skin, muscles, and bone (n = 1). Soft palate resection was performed in 10 patients; all surgeries were combination, since the lateral oropharyngeal wall was included in the block of removed tissues. None of the patients had the opposite side affected. These defects were repaired using radial fasciocutaneous flaps.Results. Six patients (15 %) developed total flap necrosis due to venous thrombosis on days 2, 3, and 6 postoperatively; two patients developed flap necrosis due to arterial thrombosis 2 days postoperatively. Good speech quality was achieved in 33 patients (80 %), while 6 patients (15 %) had satisfactory speech; rhinolalia was observed in 2 patients (5 %). All patients with defects of the posterior hard palate and of the soft palate had excellent aesthetic results. Among participants with defects of the anterior hard palate and alveolar process, 10 patients had excellent aesthetic results, while 5 individuals had good results. Three patients had unsatisfactory results due to scarring in the middle portion of the face.Conclusion. Patients with subtotal defects of the hard palate and defects of its anterior portion (grade I, IIb, IIc according to the classification of J.S. Brown; grade II, III according to the classification of D.J. Okay) require repair of the alveolar margin of the maxilla; flaps containing revascularized bone are preferable in this case. The method of choice is defect repair using musculoskeletal scapular tip flap. In patients with short defects, defects located posteriorly, minimal or no defect of the alveolar margin of the maxilla (grade Ia, IB according to the classification of J.S. Brown; grade Ia, Ib according to the classification of D.J. Okay; grade V according to the classification of M.A. Aramany), soft palate defects, radial fasciocutaneous flaps should be used.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-10-15
Background. The detection of primary tumor in patients with cervical lymph node metastases without the primary tumor found is very important, because its location often determines the treatment strategy. The study objective is to analyze the capabilities of upper respiratory tract fibroscopy for the detection of primary tumor in patients with cervical lymph node metastases from squamous-cell carcinoma without the primary tumor found.Materials in methods. A total of 70 patients with cervical lymph node metastases without the primary tumor found, in whom cytological examination of biopsy specimens collected from cervical lymph nodes revealed squamous-cell carcinoma, underwent upper respiratory tract fibroscopy in N.N. Blokhin National Medical Research Center of Oncology between January 2017 and May 2020.Results. In 24 out of 70 patients, fibroscopy helped to identify the primary tumor and collect biomaterial for morphological examination. Twelve patients were found to have oropharyngeal cancer; ten patients were diagnosed with nasopharyngeal cancer; and 2 patients had laryngopharyngeal cancer. Fifteen out of 24 patients had tumors less than 1.2 cm.Conclusion. Upper respiratory tract fibroscopy is a highly effective method for detecting small asymptomatic tumors. It can be recommended for the examination of patients with metastases from squamous-cell carcinoma without the primary tumor found, if the primary tumor is believed to be located in the upper respiratory tract
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-16-24
The study objective is to evaluate value of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET-CT) and whole-body scintigraphy (131I-WBS) performed during the first course of radioiodine therapy for its ability to detect persistence metastatic foci and for its role in the management of differentiated thyroid cancer patients.Materials and methods. Forty patients with DTC underwent both post-therapeutic 131I-WBS and PET-CT. PET-CT performed on a positron emission tomograph combined with a 16-slice computer tomograph. Post-therapeutic 131I-WBS performed during radioiodine therapy on the single-detector gamma camera.Results. Sensitivity in detecting of the tumor persistence for PET-CT was 84 %, for post-therapeutic 131I-WBS 66 % (р >0.05). In 17 (42.5 %) patients additional PET-CT foci were found that negative on 131I-WBS, including 11 (27.5 %) cases of distant metastases. Fifteen percent of patients had metastatic foci visualized only on 131I-WBS, including 4 (10 %) cases of distant metastases. In 17 (44 %) patients tumor foci were identified by both methods. A high pre-ablative level of stimulated thyroglobulin was the only independent predictor of the presence of PET-CTpositive metastatic foci (p = 0.001).Conclusion. 18F-fluorodeoxyglucose PET-CT can be recommended during the first radioiodine therapy in differentiated thyroid cancer patients with a high risk progression group, as well as with suspected the tumor persistence in case of a high pre-ablation thyroglobulin level, to complete staging, improve the quality of management and ongoing risk stratification.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-32-43
The study objective is to assess functional and oncologic results of transhyoid approach used for surgical treatment of oropharyngeal carcinoma.Materials and methods. Operative records, hospital charts and data from out-patient department of 55 patients (T1 – 6, T2 – 16, T3 – 19, T4 – 14) with oropharyngeal carcinoma operated via a transhyoid approach were reviewed. Postoperative period was reviewed for complications. All oncologic adverse events were registered with special emphasis on the rate of local recurrence. A univariate analysis with chisquare and Fisher’s exact test was used to check the correlation between tumor factors and surgical variables (complications, mode of reconstruction). The influence of tumor- and treatment-related variables (T stage, differentiation, perineural invasion, p16 status, depth of invasion, extension to the oral cavity, adjuvant treatment) on the rate of local recurrence was studied in the same way. The log-rank test was used to assess differences in survival curves. The data was compared with other series of patients treated with the same technique.Results. Seventeen (30,9 %) patients developed 29 complications. There was 1 postoperative death. Five (9,1 %) patients required repeated operation. The mode of reconstruction (primary closure vs flaps) was a major factor influencing the rate of complications. Fifty (92,6 %) patients were able to resume oral diet with a duration of nasogastric tube feeding of 7–35 days. Three-year overall/disease-specific survival for the whole cohort were 47 and 51,1 %, for p16-positive (22 %) cohort – 65,6 and 87,5 %, for p16-negative (78 %) cohort – 40,6 and 46,8 %. Thirteen (24 %) patients developed a local recurrence. The rate of local recurrence was negatively affected by p16 negativity (p = 0,048), depth of invasion >10 mm (p = 0,044) and depth of invasion >15 mm (p = 0,003).Conclusion. Transhyoid approach may be considered as a surgical option for treatment of oropharyngeal carcinoma with acceptable rate of complications.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-91-97
Introduction. Surgery is frequently preferable to therapy as it yields longer overall and recurrence-free survival. But surgery of locally advanced tumors of the oral cavity can not always guarantee preservation of oral functions. In the EORTC 24971 and RTOG 90-03 trials, effectiveness of conventional radiotherapy was demonstrated. Addition of brachytherapy allowed to double recurrence-free and overall survival. Implementation of proton therapy increased treatment safety. However, high cost of modern technology for radiotherapy limits its accessibility. Intra-arterial chemotherapy is characterized by lower toxicity. Additionally, it allows to create a pool for the 1st cycle of systemic circulation directly in the tumor and neighboring tissues, and a significant portion of the drug enters the draining lymph node replicating lymphogenic metastasis.The objective was to present a clinical case of successful treatment of inoperable squamous-cell carcinoma of the oropharynx using intra-arterial chemoradiotherapy.Clinical case. A patient sought medical help at the multidisciplinary clinical medical center “Medical City” where combination treatment was chosen: a course of chemoradiation therapy using an original approach combining external beam 3D-conformal radiotherapy and intraarterial chemotherapy. According to control computed tomography data, dynamics was described as partial response: 30 % reduction in marker lesions. The patient did not have any complaints and evaluated their quality of life as high which corresponded to the testing results.Conclusion. We have demonstrated benefits of intra-arterial chemoradiation therapy: low toxicity allows patients to receive a full course of radiotherapy without breaks and achieve high functional results. Considering palliative status of the patient, we did not aim to increase recurrence-free period but the objective of ensuring satisfactory quality of life was achieved. New, more physiological regimens of intra-arterial infusion will improve pharmacokinetic profile of chemotherapeutic drugs and will allow to achieve positive results.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-86-90
Skin cancer of external ear is a very aggressive type of cancer with spread to the parotid gland, bone structures of the lateral skull base, meninges and brain tissue. At the same time, malignant tumors of the external ear are very rare disease, accounting for 0.2 % of all malignant head and neck tumors. This fact explains the small amount of investigation in this scientific field. Now, does not exist unanimous opinion about the treatment tactics for patient with locally advanced ear cancer. Surgical tactics for volumes of block resections of the temporal bone are different. Controversial issues relate to the appropriateness of surgical treatment in general in the case of advanced tumor process. In this article we performed publication analysis devoted to selection of optimal treatment tactics for patient with locally advanced ear cancer.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-60-73
The study objective is to improve quality of life in patients with oropharyngeal squamous-cell carcinoma during chemo/bioradiation therapy and at early stages after its completion which allows to perform the full extent of radiation within optimal treatment period.Materials and methods. A retrospective analysis of data on 196 patients who underwent chemoradiation therapy between 2005 and 2016 was performed. The results were used to develop and implement a program of support for chemo/bioradiotherapy. The program was characterized by: 1. use of Russian hydrogel materials for local delivery of antibiotics and wound-healing, anesthetizing, anti-inflammatory medications; 2. new regimens of pain relief with differentiated pathogenetic approach and use of modern transdermal long-acting forms; 3. nutritional support at every treatment stage; 4. assurance of compliancy. To evaluate the program, prospective randomized controlled study was performed between January of 2017 and March of 2019 including 60 patients.Results. Mucositis and dermatitis severity and changes in physical state associated with them, progression and duration of radiation did not significantly differ in the two groups. Use of the support program allowed to control adverse effects and to perform chemoradiotherapy to the full extent, at optimal time and with satisfactory quality of life.Conclusion. The program of support of chemo/bioradiotherapy in combination with psychological support is effective both form the point of view of optimization of treatment and rehabilitation times and from the point of view of maintenance of high quality of life in patients.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-44-49
Dermal toxicity of anti-cancer drugs apparent in patients with thyroid cancer. This side effect appears, in particular, in relation to increased administration of targeted anti-cancer treatment, especially tyrosinkinase inhibitors, towards various receptors of growth factors which are applied in the ethiopathogenesis of a tumor cell. Our article focuses on the dermatotoxity, designated also as skin reaction, which most frequently occurs in patients treated by tyrosinkinase inhibitors – sorafenib, vandetonib, cabozantinib and lenvantinib. High prevalence of dermatotoxity, reported by patients, treated with these drugs underscores the need for greater understanding of the pathogenesis and management of this syndrome.
Head and Neck Tumors (HNT), Volume 10; doi:10.17650/2222-1468-2020-10-4-74-85
The study objective is to evaluate the effect of periodontal microorganisms on development of squamous-cell carcinoma of the oral mucosa and the risk of its recurrence.Materials and methods. Microbiological study of biomaterials from 150 patients was performed. The study group included 100 patients with T3–T4 squamous-cell carcinoma of the oral mucosa and was subdivided into two subgroups with 50 patients in each. The control group included 50 patients.Results. Analysis of the results obtained in the subgroup of primary patients showed the following trends: in 2 (50 %) of 4 patients with Fusobacterium spp., recurrence of the main disease was observed as well as a case of distant metastasis into the bones. Among 35 patients with Prevotella spp. in the biomaterials, in 16 (45.7 %) recurrence of the tumor was observed. Among 10 patients with Veillonella spp., recurrence was observed in 20 %. The most common aerobic microorganism was Streptococcus spр. Among patients who underwent treatment at the N.N. Blokhin National Medical Research Center of Oncology, recurrence was diagnosed in 28.5 %, distant metastases in 4.7 %. In the subgroup of repeat patients, the following trends were observed: among 27 patients with Fusobacterium spp., recurrence of the main disease was observed in 63 %. Among 26 patients with Prevotella spp. in the biomaterial, in 11 (42.3 %) local recurrence was observed. Among 24 patients with Veillonella spp., recurrence developed in 33.3 %. The most common aerobic microorganism was Streptococcus spр., recurrences developed in 21 % of cases.