Browsing by Subject "head and neck"

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  • Mascitti, Marco; Zhurakivska, Khrystyna; Togni, Lucrezia; Caponio, Vito C. A.; Almangush, Alhadi; Balercia, Paolo; Balercia, Andrea; Rubini, Corrado; Lo Muzio, Lorenzo; Santarelli, Andrea; Troiano, Giuseppe (2020)
    Aims One of the objectives of current research is to customise the treatment of cancer patients. The achievement of this objective requires stratification of patients based on the most significant prognostic factors. The aims of this study were to evaluate the prognostic value of the tumour-stroma ratio (TSR), defined as the proportion of tumour cells relative to surrounding stroma, in patients with oral tongue squamous cell carcinoma (OTSCC), and to develop a prognostic nomogram based on the most significant clinicopathological features. Methods and results Clinicopathological data of 211 patients treated at 'Ospedali Riuniti' General Hospital (Ancona, Italy) for OTSCC were collected. One hundred and thirty-nine patients were restaged according to the 8th edition American Joint Committee on Cancer (AJCC) staging system. Evaluation of the TSR was performed on haematoxylin and eosin-stained slides, and correlation with survival outcomes was evaluated. In addition, with the aim of integrating the independent value of the TSR with the 8th edition AJCC staging system, a prognostic nomogram for OTSCC has been developed. OTSCC with a low TSR (i.e. a high proportion of stroma and a low proportion of tumour cells) was shown to have negative prognostic value in terms of disease-specific survival, with a hazard ratio (HR) of 1.883 and a 95% confidence interval (CI) of 1.033-3.432 (P = 0.039), and overall survival (HR = 1.747, 95% CI 0.967-3.154;P = 0.044), independently of other histological and clinical parameters. For the cohort of 139 patients restaged according to the 8th edition AJCC staging system, variables correlating with a poor prognosis were: the TSR, perineural invasion, and sex. The nomogram built on these parameters showed good predictive capacity, outperforming the 8th edition AJCC staging system in stratifying disease-specific survival in OTSCC patients. Conclusions Including the TSR in the predictive model could improve risk stratification of OTSCC patients and aid in making treatment decisions.
  • Lopez, Fernando; Mäkitie, Antti; de Bree, Remco; Franchi, Alessandro; de Graaf, Pim; Hernandez-Prera, Juan C.; Strojan, Primoz; Zidar, Nina; Flezar, Margareta Strojan; Rodrigo, Juan P.; Rinaldo, Alessandra; Centeno, Barbara A.; Ferlito, Alfio (2021)
    The diagnosis is the art of determining the nature of a disease, and an accurate diagnosis is the true cornerstone on which rational treatment should be built. Within the workflow in the management of head and neck tumours, there are different types of diagnosis. The purpose of this work is to point out the differences and the aims of the different types of diagnoses and to highlight their importance in the management of patients with head and neck tumours. Qualitative diagnosis is performed by a pathologist and is essential in determining the management and can provide guidance on prognosis. The evolution of immunohistochemistry and molecular biology techniques has made it possible to obtain more precise diagnoses and to identify prognostic markers and precision factors. Quantitative diagnosis is made by the radiologist and consists of identifying a mass lesion and the estimation of the tumour volume and extent using imaging techniques, such as CT, MRI, and PET. The distinction between the two types of diagnosis is clear, as the methodology is different. The accurate establishment of both diagnoses plays an essential role in treatment planning. Getting the right diagnosis is a key aspect of health care, and it provides an explanation of a patient's health problem and informs subsequent decision. Deep learning and radiomics approaches hold promise for improving diagnosis.
  • Peuraharju, Elin (Helsingin yliopisto, 2019)
    Kronisk skleroserande sialadenit (KSS) anses vara en manifestation av IgG4-associerad sjukdom (IgG4-AS). Kohorter i tidigare publikationer är små och omfattar sällan västerländsk befolkning. KSS kliniska beteende samt behovet av uppföljning i denna patientpopulation bör studeras. Studiens mål var att utreda ifall KSS alltid är en manifestation av IgG4-AS eller förknippas med andra autoimmuna sjukdomar, samt att utreda vilka ytterligare undersökningar denna patientpopulation kräver. Materialet bestod av patienter som mellan åren 2000 - 2017 inom HUCS sjukvårdsdistrikt fått diagnosen KSS efter submandibulektomi (n=51). Vi omvärderade patienternas histologiska vävnadsprover och utförde immunohistokemisk färgning för IgG4. IgG4 positiva vävnadsprover (≥70 IgG4-positiva plasmaceller/ high power field (HPF)) färgades för IgG och CD31. Diagnosen IgG4-AS tillskrevs ifall ‘Boston consensus statement’- kriterierna för IgG4-AS uppfylldes. Vi granskade patientjournaler och skickade en uppföljningsblankett angående symptom av IgG4-AS eller autoimmuna sjukdomar. Trettiofyra vävnadsprover uppfyllde kriterierna för KSS, 17 vävnadsprover tillskrevs diagnosen icke-skleroserande kronisk sialadenit (KS). I 19 fall associerades en spottkörtelsten till organskadan. Tolv vävnadsprover var IgG4-positiva, varav två uppfyllde kriterierna för IgG4-AS. Båda fallen tillhörde KS-gruppen och hade manifestationer av IgG4-AS i andra organ. Histopatologiska drag hos KSS och KS sammanföll delvis. I finländsk befolkning verkar KSS inte tillhöra IgG4-AS. Däremot kan KS vara associerat med IgG4-AS. Att histologiskt urskilja KSS från KS är utmanande. Således bör IgG4-färgning utföras när lymfoplasmacytära infiltrat påträffas i KS och KSS.
  • Mäkitie, Antti A.; Keski-Säntti, Harri; Markkanen-Leppänen, Mari; Bäck, Leif; Koivunen, Petri; Ekberg, Tomas; Sandström, Karl; Laurell, Göran; von Beckerath, Mathias; Nilsson, Johan S.; Wahlberg, Peter; Greiff, Lennart; Spaak, Lena Norberg; Kjaergaard, Thomas; Godballe, Christian; Rikardsen, Oddveig; Channir, Hani Ibrahim; Rubek, Niclas; von Buchwald, Christian (2018)
    Background: The five Nordic countries with a population of 27 M people form a rather homogenous region in terms of health care. The management of head and neck cancer is centralized to the 21 university hospitals in these countries. Our aim was to gain an overview of the volume and role of transoral robotic surgery (TORS) and to evaluate the need to centralize it in this area as the field is rapidly developing. Materials and Methods: A structured questionnaire was sent to all 10 Departments of Otorhinolaryngology-Head and Neck Surgery in the Nordic countries having an active programme for TORS in December 2017. Results: The total cumulative number of performed robotic surgeries at these 10 Nordic centers was 528 and varied between 5 and 240 per center. The median annual number of robotic surgeries was 38 (range, 5-60). The observed number of annually operated cases remained fairly low ( Conclusions: The present results showing a limited volume of performed surgeries call for considerations to further centralize TORS in the Nordic countries.
  • Suarez, Carlos; Lopez, Fernando; Mendenhall, William M.; Andreasen, Simon; Mikkelsen, Lauge Hjorth; Langendijk, Johannes A.; Bondi, Stefano; Rodrigo, Juan P.; Bäck, Leif; Mäkitie, Antti A.; Fernandez-Alvarez, Veronica; Coca-Pelaz, Andres; Smee, Robert; Rinaldo, Alessandra; Ferlito, Alfio (2021)
    The aim of this review is to analyze the latest trends in the management of nonvestibular skull base and intracranial schwannomas in order to optimize tumor control and quality of life. Non-vestibular cranial nerve schwannomas are rare lesions, representing 5-10% of cranial nerve schwannomas. Management decisions should be individualized depending on tumor size, location and associated functional deficits. Generally, large sized schwannomas exerting significant mass effect with increased intracranial pressure are treated surgically. In some cases, even after optimal skull base resection, it is not possible to achieve a gross total resection because tumor location and extent and/or to reduce morbidity. Thus, subtotal resection followed by stereotactic radiosurgery or fractioned radiotherapy offers an alternative approach. In certain cases, stereotactic radiosurgery or radiotherapy alone achieves good tumor control rates and less morbidity to gross total resection. Finally, given the slow growth rate of most of these tumors, observation with periodic radiographic follow-up approach is also a reasonable alternative for small tumors with few, if any, symptoms.