Objectives Advancements in medical endoscopy and techniques of rigid bronchoscopy for foreign body removal have enabled higher diagnostic accuracy, reduced morbidity and precise manipulation. However, in pediatric patients, endoscope-combined forceps may be too big to fit into the small sized airway. Here we present our method of endoscope assisted rigid bronchoscopy in pediatric patients and compare the clinical benefits with conventional naked-eye rigid bronchoscopy. Methods We used a 2.7 mm, 0° straight endoscope and small caliber grasping forceps with 3.0 to 4.5 mm sized rigid bronchoscopy for very young (<3 years of age) patients of foreign body aspiration. As an assistant held the rigid bronchoscope in situ, the operator could manipulate the endoscope and forceps bimanually. With endoscopic guidance, the foreign body retrieval was performed carefully. The clinical advantages were compared between our endoscope-assisted method (n=29) and the conventional bronchoscopy method (n=33) in terms of operation time and recovery (hospital stay). Results Bimanual endoscope-assisted rigid bronchoscopy method was technically feasible and safe. The operation time was less, compared to the conventional technique and the patients recovered more quickly. In all cases, our method completely removed the foreign body without need of a second bronchoscopy procedure. Conclusion Bimanual endoscope-assisted retrieval of airway foreign body in very young age pediatric patients was superior to the conventional naked-eye method concerning accurate manipulation and safety. Keywords: Bronchoscopy; Endoscopes; Foreign bodies; Airway obstruction; Preschool child
Background: maxillary bone invasion (MBI) is not uncommon in hard palate or upper alveolus (HP/UA) cancer; however, there have been relatively few reports about the MBI of HP/UA cancer. Patients and Methods: this was a multi-center retrospective study, enrolling 144 cases of HP/UA cancer. MBI was defined by surgical pathology or radiology follow-up. The multiple prediction models for MBI were developed in total cases and in cases having primary bone resection, using clinical and radiological variables. Results: computerized tomography (CT) alone predicted MBI, with an area under receiver operating curve (AUC) of 0.779 (95% confidence interval (CI) = 0.712–0.847). The AUC was increased in a model that combined tumor dimensions and clinical factors (male sex and nodal metastasis) (0.854 (95%CI = 0.790–0.918)). In patients who underwent 18fluorodeoxyglucose positron emission tomography/CT (PET/CT), the discrimination performance of a model including the maximal standardized uptake value (SUVmax) had an AUC of 0.911 (95%CI = 0.847–0.975). The scoring system using CT finding, tumor dimension, and clinical factors, with/without PET/CT SUVmax clearly distinguished low-, intermediate-, and high-risk groups for MBI. Conclusion: using information from CT, tumor dimension, clinical factors, and the SUVmax value, the MBI of HP/UA cancer can be predicted with a relatively high discrimination performance.
Surgery has long been a cornerstone of cancer treatment in many types of cancer. Traditionally, intraoperative assessment of the resection margin is largely dependent on visual inspection and palpation of tumors, with the aid of frozen section analysis. Although preoperative imaging can provide gross anatomical information, in situ translation of these images to the operation field is challenging. With the advancement of molecular imaging technology and its clinical application, the gap between preoperative radiologic images and surgical findings has been reduced through image-guided surgery. However, the imaging probes for intraoperative visualization of tumors are not individual tumor-specific. As conventional oncology has moved toward precision oncology with genomic and biological information specific to each tumor, image-guided surgery should also shift toward tumor biology-based image-guided surgery, so-called precision surgery for cancer. In precision cancer surgery, tumors should be analyzed molecularly and genetically to select the optimal imaging probes for individual tumors before surgical resection, beyond the use of predetermined imaging probes for certain types of cancer. This will raise the likelihood of meeting the surgical goals of cancer treatment. In summary, precision cancer surgery can be defined as individual tumor biology-based image-guided surgery. Keywords: Molecular imaging; Neoplasms; Precision oncology; Surgery; Surgery, computer-assisted
6061 Background: The cytotoxic effect of cisplatin is based on the DNA cross linking. Nucleotide excision repair is associated with resistant to platinum-based chemotherapy. The excision repair cross-complementation group 1 (ERCC1) enzyme plays a rate-limiting role in nucleotide excision repair pathway. We evaluated the expression of ERCC1 as a predictive factor for survival in patients of squamous cell carcinoma of the head and neck (SCCHN) treated with cisplatin-based concurrent chemoradiotherapy (CCRT). Methods: We reviewed the clinical records and pathologic specimens of locally advanced SCCHN patients who had been treated with cisplatin-based definitive CCRT between 1995 and 2005. ERCC1 expression of the biopsy specimen was assessed by immunohistochemical (IHC) staining and a semi- quantitative grading system (H-score) was used for the evaluation. The median value of the H-score was chosen as the cutoff point for positive ERCC1 expression. Results: A total of 44 specimens and clinical data of the patients were reviewed. The median age was 59 years (range; 27–75), and 81.8% were male; 94.2% had ECOG performance status 0–1. The positive ERCC1 expression rate was 54.5% of all specimens (N=24/44). Overall tumor response rate for CCRT was 90.9% (CR=65.9%; PR=25.0%). With a median follow-up of 45.9 months (range; 5.4–133.0), 5-year progression free survival (PFS) rate was 58.0% and 5-year overall survival (OS) rate was 57.2%. Patients in group of positive ERCC1 expression showed poor survival in terms of PFS and OS (p=0.04; p=0.05), compared with negative ERCC1 expression group. Conclusions: The positive ERCC1 expression might be a predictive factor for poor survival and early progression in patients with locally advanced SCCHN treated with cisplatin-based CCRT. No significant financial relationships to disclose.
Purpose This study aimed to investigate the oncologic outcomes and prognostic factors of salvage treatments in patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after radiotherapy (RT)-based treatment.Materials and Methods A cancer registry was used to retrieve the records of 337 patients treated with definitive RT or concurrent chemoradiotherapy (CRT) from 2008 to 2018 at a single institution. The poor-responder group (PRG) was defined as patients with residual or recurrent disease after primary treatment, and the oncologic outcomes for each salvage treatment method were analyzed. In addition, prognostic indicators of recurrence-free survival (RFS) and overall survival (OS) were identified in patients who underwent salvage treatment.Results After initial (C)RT, the PRG comprised 71 of the 337 patients (21.1%): 18 patients had residual disease, and 53 had recurrence after primary treatment (mean time to recurrence 19.5 months). Of these, 63 patients received salvage treatment (surgery 57.2%, re-(C)RT 23.8%, and chemotherapy 19.0%), and the salvage success rate was 47.6% at the last follow-up. The overall 2-year OS for salvage treatments was 56.4% (60.8% for the salvage surgery group and 46.2% for the salvage re-(C)RT). Salvage surgery patients with negative resection margins had better oncologic outcomes than those with close/positive resection margins. Using multivariate analyses, locoregional recurrence and residual disease after primary surgery were associated with poor outcome after salvage treatment. In Kaplan-Meier analyses, p16 status was significantly associated with OS in the initial treatment setting but not in the salvage setting.Conclusion In recurrent OPSCC after RT-based treatment, successful salvage was achieved in 56.4% patients who had undergone salvage surgery and radiation treatment. Salvage treatment methods should be selected carefully, given recurrence site as a prognostic factor for RFS.
OBJECTIVE To investigate whether preserving the external jugular vein (EJV) in neck dissection reduces postoperative edema of the face and neck. STUDY DESIGN A prospective, randomized controlled trial. SETTING A tertiary hospital. SUBJECTS AND METHODS Thirty‐eight subjects were randomly assigned to two groups: EJV preservation versus sacrifice during neck dissection after stratification according to the neck dissection extent and type, the previous treatment, the primary site, and the reconstruction type. The relative soft‐tissue thickness was evaluated by follow‐up computed tomography (CT) scans at one week and four to five weeks postoperatively and compared with preoperative findings. The preserved EJV patency was also determined by contrast enhancement of EJV on follow‐up CT scans. In addition, the scores for pain/discomfort on the upper neck/face and laryngeal edema were recorded at each time point. RESULTS Relative soft‐tissue thickness reached up to 160 percent of preoperative status at the hyoid and cricoid levels at one week postoperatively but resolved at four to five weeks. EJV preservation reduced the soft‐tissue thickness significantly compared with EJV sacrifice ( P < 0.05) at one week postoperatively, particularly at the mandible and hyoid level. All preserved EJVs remained patent at one week, and 18 of 19 remained patent at four to five weeks. In addition, EJV preservation diminished the discomfort/pain of the upper neck/face compared with EJV sacrifice at one week ( P = 0.036). The extent of laryngeal edema did not differ between the two groups. CONCLUSION EJV preservation may reduce immediate postoperative neck edema and pain/discomfort related to neck dissection.
Conclusions. For extracranial arteriovenous malformations of the head and neck (HNAVMs), in which the nidus was accessible via the percutaneous route, ethanol sclerotherapy was a feasible and safe first-line treatment, although successful outcomes were obtained for only about half of the subjects. For other HNAVMs, surgical excision with embolization may be the best choice of treatment. Objective. To suggest a treatment protocol for patients with HNAVMs by comparing the treatment outcomes and complications of ethanol sclerotherapy with those of surgical excision combined with embolization. Material and methods. Twenty patients who had been diagnosed with HNAVM and treated between 1995 and 2002 were retrospectively reviewed. Ethanol sclerotherapy, surgical excision and embolization were used as treatments, either alone or in various combinations. The treatment outcomes and complications with the different modalities were analyzed. Results. Ethanol sclerotherapy was used for 12 cases, with a success rate of 50.0% and a permanent complication rate of 8.3%. Surgical excision combined with embolization was used for 13 patients. Although all patients achieved successful resolution of their HNAVM after surgical excision, 15.4% suffered from permanent complications. In total, 16/20 patients (80.0%) eventually achieved a ≥75% reduction in the size of their lesions.
Abstract Background: Dendritic cells (DCs) can effectively mediate the prevention and regression of a variety of solid tumors. However, not much has been determined about their efficacy for the prevention of squamous cell carcinoma (SCC), partly because there are no known tumor‐specific antigens or low immunogenicity for this tumor. The authors aimed to determine the preventive effect of DC‐based immunotherapy in a SCC animal model. Methods: Bone marrow derived DCs of C3H/He mice were pulsed with ultraviolet–B‐irradiated apoptotic SCCVII cells, which are known as a poorly immunogenic SCC cell line. After the animals were vaccinated with these DCs, a tumorigenic dosage of SCCVII cells was subcutaneously injected and the tumor growth assessed. Results: Animals pretreated with apoptotic SCCVII cell‐pulsed DCs showed tumor extinction within 2 weeks after forming a small tumor, or there was no tumor formation at all, as seen in 81% of the mice; in the remaining 19% of the mice, tumor growth was significantly retarded compared with the control groups ( P = .0029). The SCCVII cell‐specific T‐cell response was observed in the immunized mice. Conclusion: The adoptive transfer of DCs primed with apoptotic tumor cells can hopefully serve as an effective preventive vaccine, even in poorly immunogenic SCC.
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