Clinical and Radiological Evaluation of Hypopharyngeal Carcinoma.

Pre-treatment clinical and radiological evaluations represent a key step in the proper management of hypopharyngeal carcinoma. First, office-based endoscopy allows the assessment of superficial tumor extension, signs of laryngeal infiltration, and the overall residual function of the laryngo-hypopharyngeal complex. Different tools, maneuvers, and techniques can improve this essential diagnostic step and should be considered a prerequisite to direct subsequent investigations and give an initial indication for the most appropriate treatment.

Surgical margins in oral squamous cell cancer: intraoperative evaluation and prognostic impact.

Purpose Of Review: To summarize recent findings regarding surgical management of oral squamous cell cancer (OSCC) through analysis of different intraoperative techniques for assessment of margins, evaluate the pros and cons of each, and ensuing prognostic impact.

Recent Findings: 'En bloc' OSCC resection and histopathologic evaluation of margins on the formalin-fixed specimen remain the 'gold standard' for oral oncologic surgery, whereas assessment of intraoperative surgical margins and its overall clinical value are still questioned and debated in the literature. The commonly applied evaluation of frozen sections still raises concerns regarding its efficacy and reproducibility; therefore, several ancillary diagnostic methods have entered the field of head and neck oncology in the last decades, aiming to support the surgeon in achieving tumor-free margins during ablative procedures.

Open Partial Horizontal Laryngectomies for T3⁻T4 Laryngeal Cancer: Prognostic Impact of Anterior vs. Posterior Laryngeal Compartmentalization.

Open partial horizontal laryngectomies (OPHLs) are well-established and oncologically safe procedures for intermediate⁻advanced laryngeal cancers (LC). T⁻N categories are well-known prognosticators: herein we tested if "anterior" vs. "posterior" tumor location (as defined in respect to the paraglottic space divided according to a plane passing through the arytenoid vocal process, perpendicular to the ipsilateral thyroid lamina) may represent an additional prognostic factor.

Implementation of the European Laryngological Society classification for pediatric benign laryngotracheal stenosis: a multicentric study.

Purpose: The European Laryngological Society (ELS) has published a revised classification for benign laryngotracheal stenosis (LTS), based on their degree, longitudinal extension, and associated comorbidities. We retrospectively applied this classification to pediatric patients treated in four referral centers to assess its reliability in predicting surgical outcomes.

Methods: We included 191 pediatric LTS patients treated by segmental resection, restaged according to the degree of stenosis (I-IV according to Myer-Cotton grading system), number of subsites involved ("a" to "d" for 1-4 subsites among supraglottis, glottis, subglottis and trachea), and presence of systemic comorbidity ("+" sign).

A management system for randomized clinical trials: A novel way to supply medication.

Background: Randomized controlled clinical trials require management effort, involving huge organizational, economic and informatics investments. Information technology offers opportunities to approach clinical trial methodology in new ways. However, there are only a few reports of computerized data and drug management systems.

Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study.

Background: Ovarian tumours are usually surgically removed because of the presumed risk of complications. Few large prospective studies on long-term follow-up of adnexal masses exist. We aimed to estimate the cumulative incidence of cyst complications and malignancy during the first 2 years of follow-up after adnexal masses have been classified as benign by use of ultrasonography.

Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice.

Purpose Of Review: To summarize the most recent nuances in diagnosis, management, and prognostic stratification of carcinoma of unknown primary of the head and neck (CUPHN), in light of its recent re-assessment in the eighth edition of the TNM Classification Manual.

Recent Findings: At least in Western Countries, most CUPHN are expected to be Human Papilloma Virus (HPV)-positive with an oropharyngeal origin. Their appropriate diagnosis starts with fine needle aspiration cytology and/or core biopsy of pathologic lymph node(s) with staining for p16 by immunohistochemistry and subsequent HPV detection by PCR.

Radiation-induced papillary thyroid cancer: is it a distinct clinical entity?

Purpose Of Review: To present the current status of knowledge regarding radiation-induced papillary thyroid cancer (RIPTC), defining its epidemiologic, pathologic, and clinical characteristics, with ensuing possible therapeutic and prognostic consequences.

Recent Findings: Cumulative evidence shows that RIPTC resembles sporadic papillary thyroid cancer (PTC) of comparable age, both in terms of clinical-pathological features and prognosis. Therefore, more aggressive treatment does not seem to be required when managing RIPTC as its prognosis is comparable to that of never-irradiated patients.

Compartmental surgery for oral tongue and floor of the mouth cancer: Oncologic outcomes.

Background: Oral tongue/floor of mouth squamous cell carcinoma (OTFMSCC) with a depth of invasion (DOI) > 10 mm involves extrinsic muscles and lingual neurovascular/lymphatic bundles. "Compartmental" hemiglossopelvectomy (CHGP) was developed to improve loco-regional control by "en bloc" removal of tumor and its pathways of spread.

Methods: We conducted a retrospective observational study on 45 CHGPs performed at a single institution for OTFMSCC with a DOI > 10 mm at CT/MR.

Predictors of recurrence after surgical treatment of idiopathic progressive subglottic stenosis.

Idiopathic progressive subglottic stenosis is a rare cause of tracheal narrowing. Partial cricotracheal resection and anastomosis can cure idiopathic stenosis, even if some patients may require multiple interventions and experience voice and swallowing deterioration. We investigated risk factors for retreatment and assessed the impact of crico-tracheal resection on functional parameters.

Glottic exposure for transoral laser microsurgery: Proposal of a mini-version of the laryngoscore.

Objectives: Good laryngeal exposure (GLE) is typically regarded as an essential prerequisite for transoral laser microsurgery (TLM). The Laryngoscore is a preoperative scoring system aimed at predicting glottic visualization through the laryngoscope using easy patient-derived parameters. However, the presence of subjective variables may hamper its reliability and reproducibility.

Radiation-Induced Sarcoma of the Head and Neck: A Review of the Literature.

In the last decades, radiotherapy (RT) has become one of the cornerstones in the treatment of head and neck (HN) malignancies and has paralleled an increase in long-term patient survival. This lead to a concomitant increase in the incidence of radiation-induced sarcomas (RIS) of the irradiated field, with an annual rate up to 0.17%.

A national multicenter study on 1072 DCIS patients treated with breast-conserving surgery and whole breast radiotherapy (COBCG-01 study).

Background And Purpose: Breast-conserving surgery (BCS) and whole breast radiation (RT) with or without endocrine therapy (ET) represent the standard of care for ductal carcinoma in situ (DCIS). The use of adjuvant treatments after surgery is still controversial in this setting. We performed a retrospective multicenter analysis on a series of DCIS patients treated with BCS and adjuvant RT.

Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy.

Introduction: The Union for International Cancer Control-American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcategories according to tumor local extension and determine oncologic outcomes after treatment by transoral laser microsurgery (TLM) alone.

Methods: We retrospectively evaluated 410 patients affected by previously untreated pT1-pT3 glottic SCC treated by TLM alone from January 2005 to December 2015 at the Departments of Otorhinolaryngology-Head and Neck Surgery, Universities of Genoa and Brescia, Italy.

Anatomical Cadaver Study of Endolaryngeal Vascularization: Focus on the Glottis, Supraglottis, and Subglottis From the Transoral Microsurgical Point of View.

Introduction: Carbon dioxide laser coagulation during transoral laser microsurgery (TLM) for laryngeal cancer allows control of bleeding from vessels smaller than 0.5 mm. Therefore, larger arteries and veins must be carefully managed by clipping and/or monopolar cautery.

The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer.

Introduction: Trans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer.

Objective: The authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins.

Methods: Forty-four consecutive T1-T2 glottic cancers treated with trans-oral laser microsurgery Type I-VI cordectomy were presented.

Role of narrow-band imaging in detection of head and neck unknown primary squamous cell carcinoma.

Objectives/hypothesis: There is no general consensus on what kind of examination to include in an optimal detection strategy for head and neck squamous cell carcinomas of unknown primary (SCCUPs). This study investigates the role of narrow-band imaging (NBI) in their identification.

Study Design: Case series.

Synovial sarcomas of the upper aero-digestive tract: is there a role for conservative surgery?

Purpose Of Review: To present the current state of knowledge concerning the role of conservative surgery in the treatment of synovial sarcomas of the upper aero-digestive tract (UADT).

Recent Findings: The wider experience on synovial sarcomas involving the extremities and the results of retrospective reports focused on head and neck synovial sarcomas tend to justify a conservative surgical approach when dealing with tumors involving the UADT.

Summary: UADT synovial sarcomas is an extremely rare clinical entity (only around 50 cases reported in the literature, with four more herein presented from our own surgical series), with no clear guidelines concerning its treatment.

High Frequency Jet Ventilation during Transoral Laser Microsurgery for Tis-T2 Laryngeal Cancer.

Background: Transoral laser microsurgery (TLM) for early to intermediate laryngeal squamous cell cancer (SCC) can be technically challenging when adequate exposure of the posterior laryngeal compartment is required due to the presence of the orotracheal tube. The goal of our study was to analyze the efficacy of high frequency jet ventilation (HFJV) in achieving appropriate laryngeal exposure and safe oncologic resection of lesions located in such a position.

Methods: We reviewed the clinical records of 62 patients affected by Tis-T2 SCC of the posterior laryngeal compartment treated by TLM between 02/2012 and 12/2016.

Impact of Close and Positive Margins in Transoral Laser Microsurgery for Tis-T2 Glottic Cancer.

Introduction: Transoral laser microsurgery (TLM) represents one of the most effective treatment strategies for Tis-T2 glottic squamous cell carcinomas (SCC). The prognostic influence of close/positive margins is still debated, and the role of narrow band imaging (NBI) in their intraoperative definition is still to be validated on large cohort of patients. This study analyzed the influence of margin status on recurrence-free survival (RFS) and disease-specific survival (DSS).

Clinical implications for pro-GRP in small cell lung cancer. A single center experience.

Background: Recently, pro-gastrin-releasing peptide (pro-GRP) became available as an alternative sensitive, specific and reliable tumor marker for patients with small cell lung cancer (SCLC), both in limited (LD) and diffuse disease (DD).

Methods: We retrospectively analyzed pro-GRP, neuron-specific enolase (NSE) and CEA in patients with SCLC and non-small cell lung cancer (NSCLC). Serum pro-GRP level was measured with electrochemiluminescence at our laboratory (cutoff 77.

"Open mesh" or "strictly selected population" recruitment? The experience of the randomized controlled MeMeMe trial.

Among randomized controlled trials (RCTs), trials for primary prevention require large samples and long follow-up to obtain a high-quality outcome; therefore the recruitment process and the drop-out rates largely dictate the adequacy of the results. We are conducting a Phase III trial on persons with metabolic syndrome to test the hypothesis that comprehensive lifestyle changes and/or metformin treatment prevents age-related chronic diseases (the MeMeMe trial, EudraCT number: 2012-005427-32, also registered on ClinicalTrials.gov [NCT02960711]).

Cross-cultural validation of health literacy measurement tools in Italian oncology patients.

Background: The aim of this study was to assess the psychometric characteristics of four Health Literacy (HL) measurement tools, viz. Newest Vital Sign (NVS), Short Test of Functional Health Literacy in Adults (STOFHLA), Single Item Literacy Screener (SILS) and Single question on Self-rated Reading Ability (SrRA) among Italian oncology patients.

Methods: The original version of the tools were translated from the English language into Italian using a standard forward-backward procedure and according to internationally recognized good practices.