Publications by authors named "Mehanna H"

Cancer care is evolving, and digital resources are being introduced to support cancer patients throughout the cancer journey. Logistical concerns, such as health literacy and the emotional experience of cancer, need to be considered. Fear of cancer recurrence (FCR) and fear of cancer progression (FOP) are relevant emotional constructs that should be investigated.

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Background: The limitations of the traditional TNM system have spurred interest in multivariable models for personalized prognostication in laryngeal and hypopharyngeal cancers (LSCC/HPSCC). However, the performance of these models depends on the quality of data and modelling methodology, affecting their potential for clinical adoption. This systematic review and meta-analysis (SR-MA) evaluated clinical predictive models (CPMs) for recurrence and survival in treated LSCC/HPSCC.

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Objectives: This systematic review aims to evaluate externally validated models for individualised prediction of recurrence or survival in adults treated with curative intent for oropharyngeal cancer.

Design: Systematic review.

Setting: Hospital care.

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Background: Head and neck squamous cell carcinomas (HNSCCs) are heterogeneous in terms of origin and aetiology. In addition, there is uncertainty about the genetic evolution from initial diagnosis to recurrence after primary treatments and further disease progression following systemic treatment. Changes in the genetic profile have implications on the selection of appropriate treatments for patients, especially in the era of targeted therapies and immunotherapies.

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  • The study focused on establishing minimal important change (MIC) estimates for quality of life (QoL) in head and neck cancer patients using the EORTC QLQ-HN43 questionnaire.
  • A total of 503 patients from 15 countries completed the questionnaire at three different time points during treatment, and results indicated varying MICs for different QoL domains such as swallowing, speech, and dry mouth.
  • Findings revealed that MIC values for deterioration were generally higher than those for improvement, implying that a universal MIC or minimal detectable change (MDC) cannot be uniformly applied across all scales of the EORTC QLQ-HN43.
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  • - The study aimed to compare the effectiveness of ultrasound (US) elastography-guided fine-needle aspiration cytology (FNAC) versus conventional US-guided FNAC in diagnosing thyroid nodules, focusing on reducing nondiagnostic results.
  • - Conducted across 18 hospitals in England, the trial involved 982 participants who were randomized to either the elastography (493 patients) or conventional method (489 patients), finding no significant differences in the nondiagnostic rates or time to diagnosis between the two methods.
  • - The results showed similar rates of malignancy and benign findings in both groups, indicating that US elastography-guided FNAC may not provide additional benefits compared to standard US-guided FNAC for thyroid nodules. *
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Introduction: ElaTION is a large multi-centre pragmatic randomised controlled trial, performed in 18 secondary/tertiary hospitals across England, comparing elastography ultrasound-guided fine needle aspiration cytology (EUS-FNAC) with ultrasound-guided FNAC (US-FNAC) alone in the diagnostic assessment of thyroid nodules. Secondary trial outcomes, reported here, assessed the accuracy of ultrasound-alone (US) compared with US-guided FNAC to inform and update current practice guidelines.

Methods: Adults with single or multiple thyroid nodules who had not undergone previous FNAC were eligible.

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  • Oropharyngeal cancer (OPC) cases are rising, especially HPV-related ones, which generally have a better prognosis; however, the detection methods currently in use do not effectively differentiate between HPV-positive and HPV-negative cases, potentially leading to inappropriate treatment decisions.
  • Researchers utilized GeoMx digital spatial profiling to analyze gene expression in three OPC subtypes (p16+/HPV+, p16+/HPV-, and p16-/HPV-) from tumor samples to uncover these discrepancies.
  • The study found that certain genes associated with survival and proliferation were more active in p16-/HPV- tumors, while genes linked to immune response were elevated in p16+/HPV+ tumors, highlighting the need to further explore the implications of
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Purpose: The assessment of p16INK4a (p16) in oropharyngeal squamous cell carcinoma (OPSCC) has been incorporated into tumor classification, as p16 has been shown to impact survival probability. However, a recent study demonstrated that human papillomavirus (HPV) status in addition to p16 may have a better discriminatory effect on survival probability. This study aims to determine the impact of combined evaluation of p16 and HPV on prognosis.

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Background: Strain and shear wave elastography which is commonly used with concurrent real-time imaging known as real-time ultrasound shear/strain wave elastography is a new diagnostic technique that has been reported to be useful in the diagnosis of nodules in several organs. There is conflicting evidence regarding its benefit over ultrasound-guided fine-needle aspiration cytology alone in thyroid nodules.

Objectives: To determine if ultrasound strain and shear wave elastography in conjunction with fine-needle aspiration cytology will reduce the number of patients who have a non-diagnostic first fine-needle aspiration cytology results as compared to conventional ultrasound-only guided fine-needle aspiration cytology.

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Liquid biopsy profiling is gaining increasing promise towards biomarker-led identification and disease stratification of tumours, particularly for tumours displaying significant intra-tumoural heterogeneity (ITH). For head and neck squamous cell carcinoma (HNSCC), which display high levels of genetic ITH, identification of epigenetic modifications and methylation signatures has shown multiple uses in stratification of HNSCC for prognosis, treatment, and HPV status. In this study, we investigated the potential of liquid biopsy methylomics and genomic copy number to profile HNSCC.

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Background: Pre-clinical studies suggest AZD1775, a WEE1 kinase inhibitor, potentiates the activity of various chemotherapeutic agents.

Methods: WISTERIA was a prospective, parallel two-group, open-label, dose-finding, phase I clinical trial. Eligible patients had histologically confirmed oral, laryngeal, or hypopharyngeal squamous cell carcinoma, ECOG performance status 0/1, and aged ≥18-to-≤70 years.

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Article Synopsis
  • About 40% of head and neck cancer patients face recurrence after treatment, prompting a need for modified follow-up strategies beyond current guidelines, which lack strong evidence for effectiveness.
  • PETNECK2 is a UK-based study that is testing a new follow-up approach using PET-CT scans and allowing patients to manage their own follow-up based on symptoms.
  • The study aims to improve overall survival rates and gather insights on patient experiences and anxiety regarding cancer recurrence through a randomized controlled trial and embedded feasibility study.
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Oral epithelial dysplasia (OED) is a premalignant histopathological diagnosis given to lesions of the oral cavity. Its grading suffers from significant inter-/intra-observer variability, and does not reliably predict malignancy progression, potentially leading to suboptimal treatment decisions. To address this, we developed an artificial intelligence (AI) algorithm, that assigns an Oral Malignant Transformation (OMT) risk score based on the Haematoxylin and Eosin (H&E) stained whole slide images (WSIs).

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  • Robust definitions of time-to-event endpoints are essential for evaluating treatment effects and the clinical value of interventions in trials.
  • The Head and Neck Cancer International Group reviewed 92 phase 3 trials from 2008 to 2021 focused on curative treatments for mucosal head and neck squamous cell carcinoma.
  • The study found significant variability in how core endpoint components, like overall survival and progression-free survival, were reported, emphasizing the need for standardization and collaboration among stakeholders for clearer endpoint reporting.
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Transparent and precise endpoint definitions are a crucial aspect of clinical trial conduct and reporting, and are used to communicate the benefit of an intervention. Previous studies have identified inconsistencies in endpoint definitions across oncological clinical trials. Here, the Head and Neck Cancer International Group assessed endpoint definitions from phase 3 trials or trials considered practice-changing for patients with recurrent or metastatic mucosal head and neck squamous cell carcinoma, published between 2008 and 2021.

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Extranodal extension of tumour on histopathology is known to be a negative prognostic factor in head and neck cancer. Compelling evidence suggests that extranodal extension detected on radiological imaging is also a negative prognostic factor. Furthermore, if imaging detected extranodal extension could be identified reliably before the start of treatment, it could be used to guide treatment selection, as patients might be better managed with non-surgical approaches to avoid the toxicity and cost of trimodality therapy (surgery, chemotherapy, and radiotherapy together).

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  • Detection of extranodal extension (ENE) in head and neck squamous cell carcinoma indicates a poor prognosis, but there's currently a lack of standardized diagnostic criteria and reporting methods in the literature.
  • The Head and Neck Cancer International Group organized a modified Delphi process involving 19 pathology experts to establish consensus recommendations for diagnosing and reporting ENE.
  • The resulting guidelines, supported by 19 organizations from 34 countries, aim to standardize the diagnosis and improve accuracy in data collection regarding histology detected extranodal extension.
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  • * The study involved over 1,100 patients across 19 hospitals, revealing that men made up 82% of diagnoses, with an upward trend in HPV-driven oropharyngeal cancers increasing from 44.2% to 51.7% over the decade.
  • * HPV genotypes linked to the 9-valent HPV vaccine accounted for 95.2% of HPV-driven H
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Background: As circulating tumour DNA (ctDNA) liquid biopsy analysis is increasingly incorporated into modern oncological practice, establishing the impact of genomic intra-tumoural heterogeneity (ITH) upon data output is paramount. Despite advances in other cancer types the evidence base in head and neck squamous cell carcinoma (HNSCC) remains poor. We sought to investigate the utility of ctDNA to detect ITH in HNSCC.

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Introduction: HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) shows distinct biological and clinical behaviour when compared to HPV-negative OPSCC. The overall role of the tumour microenvironment (TME) in head and neck cancer progression and metastasis has been studied intensively, but differences in HPV-negative and HPV-positive OPSCCs are less understood.

Objective: To investigate the role of cancer-associated fibroblasts (CAFs) and the functional interactions of normal tonsil fibroblasts (NTFs) and OP CAFs with HPV+ and HPV- OPSCC cells and explore novel candidates in tumour-fibroblast crosstalk.

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  • A new way of following up with cancer patients called patient-initiated follow-up (PIFU) is being looked at because the old methods are not working well anymore.
  • Studies show that most women with breast and endometrial cancer, as well as healthcare professionals, like PIFU because it gives them more control and can reduce stress from clinic visits.
  • However, some worry about not having regular check-ups for reassurance and that not everyone might be able to handle managing their health on their own, so more research is needed.
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The MD Anderson Dysphagia Inventory (MDADI), a measure of swallowing-related quality of life, has become the preferred patient-reported outcome measure (PROM) in contemporary clinical trials evaluating the experience of human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPVOPSCC) survivors. With many potentially practice-changing studies using the MDADI composite score as either a primary or coprimary endpoint, or as a key secondary endpoint, it is important to understand its psychometric properties as judged by contemporary PROM standards, with a particular focus on its application to contemporary HPVOPSCC populations. In this critical review, we evaluate contemporary HPVOPSCC studies reporting MDADI outcomes, followed by a detailed evaluation of the psychometric properties of the MDADI.

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Oral epithelial dysplasia (OED) is a premalignant condition that carries an appreciable risk of malignant progression. The current grading system for severity, as defined by the World Health Organization, is a valuable clinical tool, but further work is required to improve the accuracy of predicting OED malignant progression. This systematic review aimed to assess progress in prognostic biomarker discovery in OED over the past 16 years.

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