Introduction: Adenoid cystic carcinoma (AdCC) is a rare tumor whose clinical course is burdened by local recurrence and distant dissemination. Lymph node metastasis is not believed to be common and ...its clinical impact is controversial. The aim of this study was to determine: (1) the prevalence of occult metastasis at diagnosis in cN0 head and neck AdCC, (2) its prognostic role, and (3) the consequent need to perform elective neck dissection (END). Material and Methods: A systematic review and meta-analyses following PRISMA guidelines was performed. PubMed, Embase, and Central databases were questioned up to July 2021 to identify studies reporting on the prevalence of occult neck metastases in head and neck AdCC. A single-arm meta-analysis was then performed to determine the pooled prevalence of occult lymph node metastases among the retained studies. Results: Of the initial 6317 studies identified, 16 fulfilled the inclusion criteria, and they were included in the meta-analysis. Of a population of 7534 patients, 2530 cN0 patients were treated with END, which revealed 290/2530 cases of occult metastases (pN+/cN0). Meta-analysis of the results of END in the 16 studies estimated an overall prevalence of occult metastases at diagnosis of 17%. No further subgroup analysis was possible to identify factors influencing lymph node involvement and the prognostic role of END. Conclusions: Taking 20% as an historically proposed cut off, a 17% prevalence of occult metastases represents a borderline percentage to get a definitive conclusion about the indication to END for head and neck AdCC. A more advanced UICC stage, an oropharyngeal minor salivary glands origin, and a high-grade transformation are factors to be considered in a comprehensive patient’s tailored therapeutic strategy. Multicenter prospective studies are the key to finding stronger recommendations on this topic.
•After treatment, MDADI scores were not significantly different between TORS and RT.•After treatment, MDADI scores demonstrated an impairment in both groups.•Personal nutritional plan may improve ...oncological and functional outcomes.
To answer an important question regarding the long-term morbidity of two oncological equivalent treatment for oropharyngeal squamous cell carcinoma (OPSCC), namely a comparison of swallowing function results between patients treated with trans-oral robotic surgery (TORS) versus patients treated with radiotherapy (RT).
Studies included patients with OPSCC treated with TORS or RT. Articles reporting complete data on MD Anderson Dysphagia Inventory (MDADI) and comparing the two treatments (TORS vs RT) were included in the meta-analysis. Swallowing assessed with MDADI was the primary outcome, the evaluation with instrumental methods was the secondary aim.
Included studies provided a total of 196 OPSCC primarily treated with TORS vs 283 OPSCC primarily treated with RT.
The mean difference in MDADI score at the longest follow-up was not significantly different between TORS and RT group (mean difference MD −0.52; 95% CI −4.53–3.48; p = 0.80). After treatment, mean composite MDADI scores demonstrated a slight impairment in both groups without reaching a statistical difference compared to the baseline status. DIGEST score and Yale score showed a significantly worse function in both treatment groups at 12-month follow-up compared to baseline status.
The meta-analysis demonstrates that up-front TORS (+- adjuvant therapy) and up-front RT (+- CT) appear to be equivalent treatments in functional outcomes in T1-T2, N0-2 OPSCC, however, both treatments cause impaired swallowing ability.
Clinicians should have a holistic approach and work with patients to develop an individualized nutrition plan and swallowing rehabilitation protocol from diagnosis to post-treatment surveillance.
We assessed the immunogenicity and safety of the BNT162b2 vaccine in a large cohort of patients with cancer (CP).
From March 1, 2021 to March 20, 2021, this prospective cohort study included 816 CP ...afferent to our institution and eligible for the vaccination. A cohort of 274 health care workers (HCW) was used as age- and sex-matched control group. BNT162b2 was administered as a two-dose regimen given 21 days apart. Blood samples to analyze anti-Spike (S) IgG antibodies (Ab) were collected prevaccination timepoint (TP) 0, and at 3 weeks (TP1) and 7 weeks (TP2) after the first dose.
Patients characteristics: median age 62 (range, 21-97); breast/lung cancer/others (31/21/48%); active treatment/follow-up (90/10%). In the whole CP cohort, the serologic response rate (RR) and the titre of anti-S IgG significantly increased across the TPs; at TP2, the responders (IgG >15 AU/mL) were 94.2%. Active chemotherapy and chronic use of steroids were independent predictors of lower RR. Adverse events (AE) after the booster predicted higher likelihood of response (OR, 4.04; 95% confidence interval, 1.63-9.99;
= 0.003). Comparing the matched cohorts, the responders were significantly lower in CP than in HCW at TP1 (61.2% vs. 93.2%) and TP2 (93.3% vs. 100%), while the geometric mean concentration of IgG did not significantly differ at TP2 being significantly lower in CP (23.3) than in HCW (52.1) at TP1. BNT162b2 was well tolerated in CP; severe-grade AEs were 3.5% and 1.3% after the first and second doses, respectively.
BNT162b2 assures serologic immunization without clinically significant toxicity in CP. The second dose is needed to reach a satisfactory humoral response.
Objective
Current guidelines indicate postoperative radiotherapy (PORT) in oral squamous cell carcinoma (OSCC) with perineural invasion (PNI), however, its real benefit has never been proven. The aim ...of our study is to investigate the benefit of PORT in OSCC patients with PNI in terms of survival and disease control.
Data Sources
The Pubmed/MEDLINE, Cochrane Library, and Scopus databases.
Review Methods
Patients with PNI + OSCC treated with primary surgery were extracted from the included studies. The pooled logHR was calculated by comparing patients who underwent PORT to those who underwent only observation for overall survival (OS), disease‐specific survival (DSS), disease‐free survival (DFS), and locoregional control (LRC).
Results
About 690 patients with primary OSCC and PNI were included from nine studies. 374 (54.2%) patients underwent PORT, while 316 (45.8%) underwent observation. Analyses showed non‐significant difference between the two groups for OS (HR: 1.01; 95% CI: 0.38–2.69), DSS (HR: 2.03; 95% CI: 0.54–7.56), and LRC (HR: 0.89; 95% CI: 0.53–1.50). They showed a significant difference in terms of DFS (HR: 0.86; 95% CI: 0.77–0.97).
Conclusion
The real benefit of PORT in OSCC patients with PNI is still unclear, although it may have a positive impact on DFS. Clinicians should consider individual patient's characteristics, tumor factors, and treatment goals when deciding whether to recommend PORT. Further studies are needed to clarify which entity of PNI really benefits from PORT.
Level of Evidence
NA Laryngoscope, 134:2019–2027, 2024
Our study showed that adjuvant radiotherapy may improve the outcomes of patients affected by oral cavity cancer with perineural invasion by reducing the risk of disease recurrence or progression. Other patient and tumor characteristics, other than treatment objectives, should be considered in the decision‐making.
Objective
To determine the oncological outcomes of salvage transoral laser microsurgery (TLM) in the treatment of patients suffering from recurrent laryngeal cancer.
Methods
PubMed/MEDLINE, Cochrane ...Library, and Scopus databases were searched. English language, original studies investigating oncological outcomes of TLM in adult patients with recurrent laryngeal cancer were included. Data were pooled using a distribution‐free approach for estimating summary local control (LC), disease‐specific survival (DSS), and overall survival (OS) curves with random effects.
Results
Two hundred and thirty‐five patients underwent salvage TLM after primary (chemo)radiotherapy. The mean follow‐up time was 60.8 months (95% CI: 32.7–88.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 74.2% (61.7–89.4), 53.9% (38.5–75.3), and 39.1% (25.2–60.8). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 88.4% (82.0–95.3), 67.8% (50.9–90.3), and 58.9% (42.7–81.1). Two hundred and seventy‐one patients underwent TLM after primary laser treatment. The mean follow‐up time was 70.9 months (95% CI: 36.9–104.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 72.2% (64.7–80.6), 53.2% (42.2–66.9), and 40.4% (29.6–55.2). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 92.1% (85.5–99.1), 77.0% (64.4–92.0), and 67.1% (51.6–87.3).
Conclusions
TLM is a valuable treatment option for the management of locally recurrent laryngeal carcinoma if performed by experienced surgeons and following rigorous patients' selection criteria. Further studies should be conducted to define stage‐based clinical guidelines.
Level of Evidence
NA Laryngoscope, 133:1425–1433, 2023
The aim of this systematic review and meta‐analysis was to determine the oncological outcomes of salvage transoral laser microsurgery (TLM) in the treatment of patients suffering from recurrent laryngeal cancer. We demonstrated that TLM is a valuable treatment option for the management of locally recurrent laryngeal carcinoma if performed by experienced surgeons and following rigorous patients' selection criteria. Further studies should be conducted to define stage‐based clinical guidelines.
We previously reported on the immunogenicity and safety of BNT162b2 in a large cohort of patients with cancer after the first and second doses (Di Noia et al., 2021) 1. Herein, we present result ...after six months of follow-up.
This prospective study included patients affected by solid tumors and afferent to our institution who received two doses of BNT162b2 vaccine. A cohort of vaccinated healthcare workers (HCW) was used as control-group. Both cohorts were evaluated for the titer of anti-Spike (S) IgG at prefixed time-points (TPs). Time-point 4 was scheduled at 24–26 weeks after the second dose.
In the current analysis, 400 patients and 232 healthcare workers were evaluated. Responders (IgG > 15 AU/mL) in patients group were 86.5% compared with 94.4% among healthcare workers. Also the IgG titer at TP4 was significantly inferior in patients than in healthcare workers (70.81 vs 134.64 AU/ml, p < 0.001). There was a more rapid decline of the antibody level from TP3 to TP4 in patients than in healthcare workers (1.78 vs 1.3 fold). The estimated IgG half-life was significantly shorter for patients (73 days) than in healthcare workers (118 days) as well as the time to reach negative serological status (340 vs 532 days).
The decline of humoral response to the vaccine observed in patients with solid cancer after six months from the first dose support the urgent need of an early additional dose.
•In the sixth month after the first dose, patients with a positive serological status were 86.3%.•IgG titer was inferior in patients than in healthcare workers due to a more rapid decline.•The estimated time to reach negative serological status was 11.3 months for patients.
Objectives/Hypothesis
The aim of this study was to assess the value of cell‐free human papillomavirus‐DNA (cfHPV‐DNA) as a diagnostic test for the post‐treatment surveillance of patients with ...HPV‐positive head and neck squamous cell carcinoma (HNSCC) through a systematic review and meta‐analysis.
Study Design
Systematic review and meta‐analysis.
Methods
A literature search was conducted in three databases (MEDLINE, Embase, and Scopus) in January 2021. The population included patients with HPV‐positive HNSCC. The intervention was the use of the repeated liquid biopsy with circulating HPV‐DNA detection during follow‐up. The outcome was to establish the value of cfHPV‐DNA as a diagnostic test for the post‐treatment surveillance of patients with HPV‐positive HNSCC.
Results
Ten studies included in the meta‐analysis provided a total of 457 patients with HPV‐positive HNSCC. The meta‐analytic study estimated the diagnostic performance of cfHPV‐DNA as follows: pooled sensitivity and specificity of 0.65 (95% confidence interval CI: 0.40–0.84) and 0.99 (99% CI: 0.96–0.99), respectively; positive and negative likelihood ratios of 62.5 (99% CI: 22.9–170.2) and 0.05 (99% CI: 0.013–0.24), respectively; and pooled diagnostic odds ratio of 371.66 (99% CI: 60.4–2286.7).
Conclusion
Currently, the follow‐up protocol for HNSCC patients includes routine clinical evaluation and radiological imaging. Biomarkers to monitor this disease are not established. Considering its high specificity, cfHPV‐DNA represents a potential confirmatory test in the case of positive positron emission tomography and computed tomography. In the near future, cfHPV‐DNA could be used as a biomarker for monitoring the treatment response during the clinical trials of de‐escalation therapy or immunotherapy. Larger sample sizes and the homologation of study protocols and methodology are needed to better establish its utility in the clinical practice. Laryngoscope, 132:560–568, 2022
