Long-term control of melanoma adrenal metastasis treated with radiotherapy

xlomafota13 shared this article with you from Inoreader Long-term control of melanoma adrenal metastasis treated with radiotherapy Via Melanoma Research - Published Ahead-of-Print Introduction Melanoma remains a large global burden with a significant proportion of patients succumbing to metastatic disease. The adrenal gland is a common area for metastasis with surgical treatment as the main modality. Radiotherapy is less utilised in this setting with uncertainty over deliverability and efficacy. Here, we present the details and outcomes of 20 patients treated with radiotherapy, with or without systemic therapy, for melanoma adrenal metastasis in a single institute. Methods Twenty patients were identified from radiation treatment and medical records from between 2015 and 2019 at our institution. Three patients had bilateral radiotherapy treatments and therefore 23 adrenal lesions were analysed. Demographics, indications for treatment, radiotherapy methodology and outcomes were recorded. Outcomes were based on serial 18F FDG PET/computerized tomography scans reporting using the PERCIST criteria. Results The most common indication for radiotherapy was oligo-progressive disease (70%) followed by symptom palliation. Eight (35%) of the treatments were delivered by stereotactic ablative body radiotherapy. Twelve (60%) patients had concurrent immunotherapy. Twenty of twenty-three (87%) adrenal lesions had an initial response to treatment with 12 (60%) maintaining local control until death or end of follow-up. Median adrenal-specific progression-free survival was 13 months. Four patients (17%) required salvage adrenalectomy. Symptom palliation was achieved in the majority of patients for which it was indicated and there were no grade three toxicities. The median time from radiotherapy to change of immunotherapy treatment was 4 months. Conclusions Radiotherapy for melanoma adrenal metastasis is effective and deliverable. With the majority of patients achieving a palliative and clinically relevant durable response, adrenalectomy can be reserved as a salvage option. Received 2 August 2021 Accepted 13 February 2022 Correspondence to Brendan McCann, MbChB, Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Tel: +44 7505398515; e-mail: brendanmccann85@gmail.comBrendan.mccann@ggc.scot.nhs.uk Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of Nebulization on Laryngeal Parameters: Analysis Using High-Speed Digital Videolaryngoscopy

xlomafota13 shared this article with you from Inoreader Effect of Nebulization on Laryngeal Parameters: Analysis Using High-Speed Digital Videolaryngoscopy Via Journal of Voice Superficial laryngeal hydration, obtained through nebulization, is related to the moisture level on the epithelial surfaces of the vocal folds, modifying their biomechanical and aerodynamic properties. Through high-speed videolaryngoscopy it is possible to obtain objective data for laryngeal analysis after nebulization and a better understanding of this phenomenon View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Radiomics and deep learning approach to the differential diagnosis of parotid gland tumors

xlomafota13 shared this article with you from Inoreader Radiomics and deep learning approach to the differential diagnosis of parotid gland tumors Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Advances in computer technology and growing expectations from computer-aided systems have led to the evolution of artificial intelligence into subsets, such as deep learning and radiomics, and the use of these systems is revolutionizing modern radiological diagnosis. In this review, artificial intelligence applications developed with radiomics and deep learning methods in the differential diagnosis of parotid gland tumors (PGTs) will be overviewed. Recent findings The development of artificial intelligence models has opened new scenarios owing to the possibility of assessing features of medical images that usually are not evaluated by physicians. Radiomics and deep learning models come to the forefront in computer-aided diagnosis of medical images, even though their applications in the differential diagnosis of PGTs have been limited because of the scarcity of data sets related to these rare neoplasms. Nevertheless, recent studies have shown that artificial intelligence tools can classify common PGTs with reasonable accuracy. Summary All studies aimed at the differential diagnosis of benign vs. malignant PGTs or the identification of the commonest PGT subtypes were identified, and five studies were found that focused on deep learning-based differential diagnosis of PGTs. Data sets were created in three of these studies with MRI and in two with computed tomography (CT). Additional seven studies were related to radiomics. Of these, four were on MRI-based radiomics, two on CT-based radiomics, and one compared MRI and CT-based radiomics in the same patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of lateral neck nodes in common and aggressive variants of thyroid cancer

xlomafota13 shared this article with you from Inoreader Management of lateral neck nodes in common and aggressive variants of thyroid cancer Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Although nodal metastasis in thyroid cancer does not have a major impact on outcome, it does have some prognostic implication in adverse metastasis and aggressive histology. The purpose of this review is to discuss evaluation and management of lateral neck nodes in thyroid cancer. Recent findings There is a high incidence of central and lateral neck node metastasis in thyroid cancer. Appropriate preoperative evaluation is key prior to first surgical procedure. The distribution of nodal metastasis is well recognized and so generally a modified neck dissection is recommended from levels II through V. The risk of nodal metastasis at level IIb is rare. The complications of lateral neck dissection, though rare, are of significant importance to the quality of life. Summary Appropriate preoperative evaluation, including good ultrasound and CT scan with contrast, is recommended. Preoperative FNA of the lateral neck node will be helpful, along with thyroglobulin management if indicated. The neck dissection should include significant levels of neck, avoiding neural injury. Nonsurgical therapies may be recommended in selected patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Limits and potential implementation of the present pN classification for oral squamous cell carcinoma

xlomafota13 shared this article with you from Inoreader Limits and potential implementation of the present pN classification for oral squamous cell carcinoma Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review The purpose of this review is to highlight the most important changes in the eighth TNM classification system for oral squamous cell carcinomas compared with the seventh edition with focus on lymph node staging (pN). Nodal involvement is crucial when addressing prediction of survival, and staging must mirror the disease extension. pN classification will be evaluated with respect to lymph node yield (LNY), lymph node density (LND), and a recently proposed classification: pN-N+ reflecting positive regional lymph nodes (metastatic burden) and extra nodal extension. Recent findings TNM8 was introduced in 2018, and the most noteworthy changes were depth of invasion (DOI) and extranodal extension (ENE). Recent studies indicate, that TNM8-related pN is not superior to TNM7 with respect to predicting survival. LNY and LND are biased with ecological interference fallacy, and currently not recommended in future iterations of TNM. In contrast, the pN-N+ classification has demonstrated improved survival prediction compared with TNM8. Summary The recent findings support the inclusion of pN-N+, that is, metastatic burden and extranodal extension in future iterations of TNM. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sarcopenia and its impact in head and neck cancer treatment

xlomafota13 shared this article with you from Inoreader Sarcopenia and its impact in head and neck cancer treatment Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review The aim of this review is to discuss recent studies on the assessment of sarcopenia and its predictive and prognostic value in head and neck cancer (HNC) patients. Recent findings There is increasing evidence that low skeletal muscle mass (SMM), often named sarcopenia, can easily be assessed on cross-sectional imaging of the head and neck and is associated with chemotherapy (dose limiting) and radiotherapy toxicity and survival. Summary SMM measurement at the level of the third cervical vertebra (C3) on routine computed tomography and magnetic resonance imaging is easy and robust to perform. Several studies have shown a significantly higher incidence of cisplatin dose limiting toxicity in HNC patients with a low SMM. In HNC patients pretreatment low SMM is associated with acute and late toxicity and adverse events of radiotherapy, complications of major head and neck surgery and decreased disease-specific and overall survival. This information can be used for individualized treatment planning in HNC patients with low SMM. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Conservative management of orbital involvement in malignant tumors: is the paradigm evolving? A critical review

xlomafota13 shared this article with you from Inoreader Conservative management of orbital involvement in malignant tumors: is the paradigm evolving? A critical review Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Review the recent literature regarding conservative management of orbital invasion in sinonasal cancers. Recent findings Recent data seem to confirm the possibility to preserve the orbital content in a significant number of patients. MRI is the best available imaging tool for evaluating orbital invasion. Limited periorbital and extraconal fat invasion should not be considered an indication for orbital cleaning. Histology-driven neoadjuvant chemotherapy should be attempted whenever possible, and could act as a prognosticator. Summary Orbital preservation strategy can be attempted even in case of limited extraconal fat invasion. When extraocular muscles, massive extraconal fat, lateral wall of the lacrimal sac, eyelids or even optic nerve/globe are invaded, a conservative procedure cannot be offered. Induction chemotherapy and postoperative radiotherapy are invaluable tools for maintaining oncological outcome while preserving ocular function. Frozen section should be used for guiding surgical procedures in borderline situations. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Indications of external beams radiation for thyroid cancer

xlomafota13 shared this article with you from Inoreader Indications of external beams radiation for thyroid cancer Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review The use of external beam radiation therapy (EBRT) for the treatment of the different histologic subtypes of thyroid cancer is a matter of debate. This article provides an up-to-date review on the current evidence concerning the benefits of EBRT in thyroid cancer in specific indications. Recent findings Based on retrospective studies, adjuvant EBRT lessens the risk of locoregional recurrence in locally advanced differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC) with high-risk features. The effect of EBRT on overall survival remains uncertain. EBRT should also be part of the multimodality treatment in anaplastic thyroid cancer (ATC), as it improves survival rates in incompletely resected ATC. Summary The role of EBRT in thyroid cancer remains unclear. To date, no randomized control studies are available. Retrospective data showed improved outcomes in patients with high-risk features for locoregional recurrence. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Subjective Fatigue in Children With Unaided and Aided Unilateral Hearing Loss

xlomafota13 shared this article with you from Inoreader Subjective Fatigue in Children With Unaided and Aided Unilateral Hearing Loss Via The Laryngoscope Objectives Fatigue is frequently observed in children with chronic diseases and can affect the quality of life (QoL). However, research in children with unilateral hearing loss (UHL) is scarce. Subsequently, no studies investigated the effects of hearing aids on fatigue in children. This study investigates subjective fatigue and hearing-related QoL in children with UHL. Furthermore, it evaluates the influence of hearing aids, subject-specific factors, and respondent-type on subjective fatigue. Study Design A cross-sectional study was conducted from June 2020 until September 2020 at the department of otorhinolaryngology in a tertiary referral center. Methods The primary outcome was the difference in subjective fatigue and hearing-related QoL between children with unaided UHL, aided UHL, and normal hearing. Subjective fatigue and hearing-related QoL were measured using the Pediatric Quality of Life Inventory™ Multidimensional Fatigue Scale (PedsQL™-MFS) and Hearing Environments and Reflection on Quality of Life (HEAR-QL™) questionnaires. Results Along with 36 aided children with UHL, 34 unaided and 36 normal-hearing children were included. Child reports revealed significantly more cognitive fatigue in children with aided UHL than children with normal hearing (median difference 12.5, P = .013). Parents reported more fatigue in children with UHL compared to normal-hearing siblings. Especially children with aided UHL seemed at increased risk for fatigue. Children with UHL scored lower on hearing-related QoL than children with normal hearing. No apparent differences were found in fatigue and QoL between children with unaided and aided UHL. Conclusion Children with unaided and even aided UHL seem to experience more subjective fatigue and lower hearing-related QoL than children with normal hearing. Prospective longitudinal studies are required to investigate the influence of hearing aids on fatigue and QoL in individual patients. Level of Evidence Level 3 Laryngoscope, 2021 Laryngoscope, 2022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ultrasound Guided Biopsy in Patients With HPV‐Associated Oropharyngeal Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader Ultrasound Guided Biopsy in Patients With HPV‐Associated Oropharyngeal Squamous Cell Carcinoma Via The Laryngoscope Objectives To identify the differences in sensitivity and accuracy between ultrasound-guided and palpation-guided fine needle aspirations (FNA) of suspicious lymph nodes in patients with human papillomavirus (HPV) (+) oropharyngeal squamous cell carcinoma (OPSCC). Additional objectives included identifying patient specific factors affecting biopsy accuracy and evaluating potential differences in accuracy between fine and core needle biopsies. Study Design Retrospective chart review. Materials and Methods A retrospective study of diagnostic sensitivity was completed at a single tertiary care center between 1/1/2006–12/31/2016. Participants included patients who underwent pretreatment FNA biopsy with HPV(+)OPSCC confirmed pathologically following neck dissection or excisional lymph node biopsy. A true positive (TP) on FNA biopsy was defined as an FNA biopsy concerning for squamous cell carcinoma (SCC) that was confirmed on excisional biopsy or neck dissection. A false negative (FN) was defined as a negative FNA but metastatic disease identified on excisional biopsy or neck dissection. Sensitivity was calculated as TPs/(TPs + FNs). Sensitivity was compared among techniques using chi-square and Fisher exact tests. Results A total of 209 FNA biopsies among 198 patients were included in the study, including 31 (15%) palpation-guided FNAs, 160 (77%) ultrasound-guided FNAs, and 18 (9%) ultrasound-guided FNA + core biopsies. Sensitivity was significantly different among palpation-guided FNA, ultrasound-guided FNA, and ultrasound-guided FNA + core biopsies (48% vs. 83% vs. 94%, respectively; P < .001) but there was no significant difference in sensitivity between ultrasound-guided FNA versus ultrasound-guided FNA + core biopsies (P = .31). Conclusion The use of ultrasound guidance in FNA biopsies of nodal metastases in HPV(+)OPSCC improves sensitivity compared to palpation guidance alone. Ultrasound guided biopsies are preferred in patients with suspected nodal metastasis from HPV(+)OPSCC. Level of Evidence 3 Laryngoscope, 2022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pathogenic DST sequence variants result in either epidermolysis bullosa simplex (EBS) or hereditary sensory and autonomic neuropathy type 6 (HSAN‐VI)

xlomafota13 shared this article with you from Inoreader Pathogenic DST sequence variants result in either epidermolysis bullosa simplex (EBS) or hereditary sensory and autonomic neuropathy type 6 (HSAN‐VI) Via Experimental Dermatology Abstract DST encodes bullous pemphigoid antigen-1 (BPAG1), a protein with eight tissue-specific isoforms expressed in the skin, muscle, brain, and nerves. Accordingly, mutations in this gene are associated with epidermolysis bullosa simplex (EBS) and hereditary sensory and autonomic neuropathy type 6 (HSAN-VI). The genotypic spectrum is attested to by 19 distinct mutations but genotype-phenotype correlation for both disorders is not well established. In this study, we performed next-generation sequencing (NGS) on two families with different phenotypic presentations, one fetus (P1) with musculoskeletal and neurological malformations established by prenatal ultrasound and family history, and a 15-year-old female (P2) with skin blistering. P1 had a novel homozygous nonsense mutation, DST: NM_001144769, c.3805C>T, p.R1269* within a region of homozygosity (ROH). This mutation resides within the plakin domain of BPAG1 and ablates all isoforms of this protein, leading to novel ex tracutaneous phenotypes consistent with HSAN-VI in P1. P2 had a recurrent homozygous mutation DST: NM_001723.7, c.3370C>T, p.Gln1124* that presented with giant, trauma-induced skin blisters without extracutaneous involvement. This mutation is located within the coiled-coil domain present on the skin isoform of DST, BPGA1-e, associated with EBS. In summary, we report two families with pathogenic DST variants and expand the spectrum of DST genotype and phenotypes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Autologous lipoaspirate as a new treatment of vulvar lichen sclerosus: a review on literature

xlomafota13 shared this article with you from Inoreader Autologous lipoaspirate as a new treatment of vulvar lichen sclerosus: a review on literature Via Experimental Dermatology Abstract Lichen sclerosus (LS) is a chronic inflammatory dermatosis that mostly affects the genital and anal skin areas. Symptoms may vary from pruritis and pain to sexual dysfunction, however, LS can also be asymptomatic. LS occurs at all ages and in both sexes. Approximately 5% of all women affected by vulvar LS will develop vulvar squamous cell carcinoma. Topical treatment is safe but less effective resulting in chronic course in most patients, who suffer from persistent itching and pain. In severe cases of therapy-resistant LS, there is no adequate treatment. Fat grafting is a novel regenerative therapy to reduce dermal fibrosis. The therapeutic effect of adipose tissue grafts for LS is already investigated in various pioneering studies. This review provides an overview of these studies and the putative mechanisms-of-action of fat grafting to treat LS. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.