Abnormal cortical brain integration of somatosensory afferents in ALS

Publication date: Available online 24 December 2017
Source:Clinical Neurophysiology
Author(s): Sina Sangari, Alain Giron, Guillaume Marrelec, Pierre-François Pradat, Véronique Marchand-Pauvert
ObjectivesInfraclinical sensory alterations have been reported at early stages of amyotrophic lateral sclerosis (ALS). While previous studies mainly focused on early somatosensory evoked potentials (SEPs), late SEPs, which reflect on cortical pathways involved in cognitive-motor functions, are relatively underinvestigated. Early and late SEPs were compared to assess their alterations in ALS.MethodsMedian and ulnar nerves were electrically stimulated at the wrist, at 9 times the perceptual threshold, in 21 ALS patients without clinical evidence of sensory deficits, and 21 age- and gender-matched controls. SEPs were recorded at the Erb point using surface electrodes and using a needle inserted in the scalp, in front of the primary somatosensory area (with reference electrode on the ear lobe).ResultsCompared to controls, ALS patients showed comparable peripheral (N9) and early cortical component (N20, P25, N30) reductions, while the late cortical components (N60, P100) were more depressed than the early ones.ConclusionsThe peripheral sensory alteration likely contributed to late SEP depression to a lesser extent than that of early SEPs.SignificanceLate SEPs may provide new insights on abnormal cortical excitability affecting brain areas involved in cognitive-motor functions.



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Editorial Board

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86





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Superior Reproducibility of the Leading to Leading Edge and Inner to Inner Edge Methods in the Ultrasound Assessment of Maximum Abdominal Aortic Diameter

Publication date: Available online 23 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Jens Borgbjerg, Martin Bøgsted, Jes S. Lindholt, Carsten Behr-Rasmussen, Arne Hørlyck, Jens B. Frøkjær
ObjectivesControversy exists regarding optimal caliper placement in ultrasound assessment of maximum abdominal aortic diameter. This study aimed primarily to determine reproducibility of caliper placement in relation to the aortic wall with the three principal methods: leading to leading edge (LTL), inner to inner edge (ITI), and outer to outer edge (OTO). The secondary aim was to assess the mean difference between the OTO, ITI, and LTL diameters and estimate the impact of using either of these methods on abdominal aortic aneurysm (AAA) prevalence in a screening program.MethodsRadiologists (n=18) assessed the maximum antero-posterior abdominal aortic diameter by completing repeated caliper placements with the OTO, LTL, and ITI methods on 50 still abdominal aortic images obtained from an AAA screening program. Inter-observer reproducibility was calculated as the limit of agreement with the mean (LoA), which represents expected deviation of a single observer from the mean of all observers. Intra-observer reproducibility was assessed averaging the LoA for each observer with their repeated measurements. Based on data from an AAA screening trial and the estimated mean differences between the three principal methods, AAA prevalence was estimated using each of the methods.ResultsThe inter-observer LoA of the OTO, ITI, and LTL was 2.6, 1.9, and 1.9 mm, whereas the intra-observer LoA was 2.0, 1.6, and 1.5 mm, respectively. Mean differences of 5.0 mm were found between OTO and ITI measurements, 2.6 mm between OTO and LTL measurements, and 2.4 mm between LTL and ITI measurements. The prevalence of AAA almost doubled using OTO instead of ITI, while the difference between ITI and LTL was minor (3.3% vs. 4.0% AAA).ConclusionsThe study shows superior reproducibility of LTL and ITI compared with the OTO method of caliper placement in ultrasound determination of maximum abdominal aortic diameter, and the choice of caliper placement method significantly affects the prevalence of AAAs in screening programs.



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Local Control and Toxicity of External Beam Reirradiation with Pulsed Low-Dose-Rate Technique

Publication date: Available online 23 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Charles T. Lee, Yanqun Dong, Tianyu Li, Samuel Freedman, Jordan Anaokar, Thomas J. Galloway, Mark A. Hallman, Stephanie E. Weiss, Shelly B. Hayes, Robert A. Price, C-M Charlie Ma, Joshua E. Meyer
PurposeTo evaluate the efficacy and toxicity of external beam reirradiation using pulsed low-dose-rate (PLDR) technique.Methods/MaterialsWe evaluated patients treated with PLDR reirradiation between 2009-2016 at a single institution. Toxicity was graded based on CTCAE4.0 and local control was assessed using RECIST1.1. In the univariate analysis (UVA), Chi-square, and Fisher's Exact test were used to assess toxicity outcomes; competing risk analysis via cumulative incidence function estimates were used to assess local progression.ResultsThirty-nine patients were treated to 41 disease sites with PLDR reirradiation, with a median follow-up of 8.8 months (range 0.5-64.7 months). Targets were thoracic, abdominal and pelvic, including 36 symptomatic sites. The median time between the first radiation course and reirradiation was 26.2 months; the median doses of the first and second courses of radiation were 50.4 Gy and 50 Gy, respectively. Five patients (13%) received concurrent systemic therapy.Out of 39 patients, 9 (23%) developed grade 2+ acute toxicity, most commonly radiation dermatitis (5/9). None developed grade 4+ acute/subacute toxicity. The only grade 2+ late toxicity was 1 patient with grade 2 late skin toxicity. In UVA, toxicity was not significantly associated with dose of the first course of radiation or reirradiation, time interval to reirradiation, or reirradiation site.Of the 41 disease sites treated with PLDR, 32 had pre and post-PLDR scans to evaluate for local control. Local progression was 16.5% at 6 months and 23.8% at 12 months, and was not associated with the dose of reirradiation, reirradiation site, or concurrent systemic therapy in UVA. Of 36 symptomatic disease sites, 25 (69%) sites achieved symptomatic response after PLDR, including 6 (17%) with complete symptomatic relief.ConclusionReirradiation with PLDR is effective and well-tolerated. Risk of late toxicity and durability of local control was limited by the relatively short follow up in this cohort.



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The transcription factors GATA2 and MITF regulate Hdc gene expression in mast cells and are required for IgE/mast cell-mediated anaphylaxis

Publication date: Available online 24 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Yapeng Li, Bing Liu, Laura Harmacek, Zijie Long, Jinyi Liang, Kara Lukin, Sonia M. Leach, Brian O'Connor, Anthony N. Gerber, James Hagman, Axel Roers, Fred D. Finkelman, Hua Huang
BackgroundHistamine is a critical mediator of IgE/mast cell-mediated anaphylaxis. Histamine is synthesized by decarboxylating the amino acid histidine, a reaction catalyzed by the Hdc-gene encoded enzyme histidine decarboxylase. However, regulation of the Hdc gene in mast cells is poorly understood.ObjectiveWe sought to investigate the in vivo regulation of IgE/mast cell mediated anaphylaxis by transcription factors GATA2 and MITF and the mechanisms by which GATA2 and MITF regulate Hdc gene expression in mouse and human mast cells.Methodsmice deficient in the transcription factors Gata2, Ahr, Ahrr, or Bhlhe40 were assessed for anaphylactic reactions. Chromatin immunoprecipitation sequencing analysis identified putative Hdc enhancers. Luciferase reporter transcription assay confirmed enhancer activities of putative enhancers in the Hdc gene. The shRNA knock down approach was used to determine the role of MITF in regulating mouse and human HDC gene expression.ResultsConnective tissue mast cell (CTMC)-specific Gata2 deficient mice failed to develop IgE/mast cell-mediated anaphylaxis. GATA2 induced the expression of Mitf, Ahr, Ahrr and Bhlhe40 in mast cells. MITF, but not AHR, AHRR or BHLHE40, was required for anaphylaxis. MITF bound to an enhancer located 8.8 kb upstream of the transcription start site of the Hdc gene and directed enhancer activity. MITF overexpression largely restored Hdc gene expression in the Gata2 deficient-mast cells. In human mast cell line LAD2, MITF was required for the HDC gene expression and histamine synthesis.ConclusionThe transcription factors GATA2 and MITF regulate Hdc gene expression in mast cells and are required for IgE/mast cell-mediated anaphylaxis.

Graphical abstract

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Quality of Prostate Cancer Screening Information on the Websites of Nationally-Recognized Cancer Centers and Health Organizations

Publication date: Available online 24 December 2017
Source:Practical Radiation Oncology
Author(s): Bogdan-Alexandru Manole, Daniel V. Wakefield, Austin Dove, Caleb R. Dulaney, Samuel R. Marcrom, David L. Schwartz, Michael R. Farmer




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Chest wall toxicity after hypofractionated proton beam therapy for liver malignancies

Publication date: Available online 24 December 2017
Source:Practical Radiation Oncology
Author(s): Rosanna Yeung, Stephen R. Bowen, Tobias R. Chapman, Grayden T. MacLennan, Smith Apisarnthanarax
PurposeNormal liver-sparing with proton beam therapy (PBT) allows for dose escalation in the treatment of liver malignancies, but may result in high doses to the chest wall (CW). CW toxicity (CWT) data after PBT for liver malignancies are limited, with most published reports describing toxicity after a combination of hypofractionated proton and photon radiotherapy. We examined the incidence and associated factors for CWT after hypofractionated PBT for liver malignancies.Methods and MaterialsWe retrospectively reviewed the charts of 37 consecutive patients with liver malignancies (30 hepatocellular carcinoma, 6 intrahepatic cholangiocarcinoma and 1 metastasis) treated with hypofractionated PBT. CWT was scored using CTCAEv4. Receiver-operating characteristic (ROC) curves were used to identify patient and dosimetric factors associated with CWT and to determine optimal DVH parameters/cut-offs. Cox regression univariate analysis was used to associate factors to time-dependent onset of CWT.ResultsThirty-nine liver lesions were treated with a median dose of 60 GyE (range, 35–67.5 GyE) in 15 fractions (range, 13–20 fractions). Median follow-up was 11months (range, 2–44months). Grade≥2 and 3 CW pain occurred in 7 (19%) and 4 (11%) patients, respectively. Median time to onset of pain was 6months (range, 1–14months). No patients had radiographic rib fracture. On univariate analysis, CW EQD2α/β=3V57>20cm³ (HR 2.7, p=0.004), V63>17cm³ (HR 2.7, p=0.003), and V78>8cm³ (HR 2.6, p=0.003) had the strongest association with grade≥2 CW pain as did tumor dose of >75Gy EQD2α/β=10 (HR 8.7, p=0.03). No other patient factors were associated with CWT.ConclusionsCWT after hypofractionated PBT for liver malignancies is clinically relevant. For a 15-fraction regimen, V47>20cm³, V50>17cm³, and V58>8cm³ were associated with higher rates of CWT. Further investigation of PBT techniques to reduce CW dose are warranted.



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Urolift as a surrogate for fiducial markers in IGRT planning of prostate cancer in BPH patients

Publication date: Available online 24 December 2017
Source:Practical Radiation Oncology
Author(s): Nrusingh C. Biswal, Beth Swann, Michael McKenna, Rachana Singh




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Five Years Experience with a Customized Electronic Checklist for Radiotherapy Planning Quality Assurance in a Multi-campus Institution

Publication date: Available online 24 December 2017
Source:Practical Radiation Oncology
Author(s): Sean L Berry, Kevin Tierney, Sharif Elguindi, James Mechalakos
IntroductionAn electronic checklist has been designed with the intention of reducing errors while minimizing the user effort in completing the checklist. We analyze the clinical use and evolution of the checklist over the past 5years and review data in an incident learning system (ILS) to investigate whether it has contributed to an improvement in patient safety.Methods and MaterialsThe checklist is written as a standalone HTML application utilizing VBScript. User selection of pertinent demographic details limits the display of checklist items only to those necessary for the particular clinical scenario. Ten common clinical scenarios were used to illustrate the difference between the maximum possible number of checklist items available in the code versus the number displayed to the user at any one time. An ILS database of errors and near misses was reviewed to evaluate whether the checklist influenced the occurrence of reported events.ResultsOver five years, the number of checklist items available in the code nearly doubled, while the number displayed to the user at any one time stayed constant. Events reported in our ILS related to the beam energy used with pacemakers, projection of anatomy on digitally reconstructed radiographs, orthogonality of setup fields, and field extension beyond matchlines, did not recur after the items were added to the checklist. Other events related to bolus documentation and breakpoints continued to be reported.ConclusionOur checklist is adaptable to the introduction of new technologies, transitions between planning systems, and to errors and near misses recorded in the ILS. The electronic format allows us to restrict user display to a small, relevant, subset of possible checklist items, limiting the planner effort needed to review and complete the checklist.SummaryAn electronic safety checklist for radiotherapy treatment planning has been in use at our institution for more than five years. We demonstrate that the electronic format allows the user display to be restricted to a small, relevant, subset of possible checklist items. The electronic checklist can be modified to adapt to the introduction of new technologies, transitions between planning systems, and in response to errors and near misses in the clinic.



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Intra-patient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy

Publication date: Available online 24 December 2017
Source:Practical Radiation Oncology
Author(s): James L. Robar, Kathryn Moran, James Allan, James Clancey, Tami Joseph, Krista Chytyk-Praznik, R. Lee MacDonald, John Lincoln, Parisa Sadeghi, Robert Rutledge
PurposeThis patient study evaluated the use of 3D printed bolus for chest wall radiotherapy, with comparison to standard sheet bolus with regard to accuracy of fit, surface dose measured in vivo and efficiency of patient setup. By alternating bolus type over the course of therapy, each patient served as her own control.Methods and materialsFor sixteen patients undergoing chest wall radiotherapy, custom 5.0mm thick bolus was designed based on the treatment planning CT and 3D printed using polylactic acid (PLA). Cone beam CT was used to image and quantify the accuracy of fit of the two bolus types with regard to air gaps between the bolus and skin. As a QA measure for the 3D printed bolus, Optically Stimulated Luminescent Dosimetry provided in vivo comparison of surface dose at seven points on the chest wall. Durations of patient setup and image guidance were recorded and compared.ResultsIn 13 of 16 patients the bolus was printed without user intervention and the median print time was 12.6hours. The accuracy of fit of the bolus to the chest wall was improved significantly relative to standard sheet bolus with the frequency of air gaps 5mm or greater reduced from 30% to 13% (p<0.001), and maximum air gap dimension diminished from 0.5 +/− 0.3mm to 0.3 +/− 0.3mm, on average. Surface dose was within 3% for both standard sheet and 3D printed bolus. On average, the use of 3D printed bolus reduced the setup time from 104 to 76seconds.ConclusionsThis study demonstrates 3D printed bolus in post-mastectomy radiation therapy improves fit of the bolus and reduces patient setup time marginally compared with standard vinyl gel sheet bolus. The time savings on patient setup must be weighed against the considerable time for the 3D printing process.



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Inferring Stance in News Broadcasts from Prosodic-Feature Configurations

Publication date: Available online 24 December 2017
Source:Computer Speech & Language
Author(s): Nigel G. Ward, Jason C. Carlson, Olac Fuentes
Speech conveys many things beyond content, including aspects of appraisal, feeling, and attitude that have not been much studied. In this work we identify 14 aspects of stance that occur frequently in radio news stories and that could be useful for information retrieval, including indications of subjectivity, immediacy, local relevance, and newness. We observe that newsreaders often mark their stance with prosody. To model this, we treat each news story as a collection of overlapping 6-second patches, each of which may convey one or more aspects of stance by its prosody. The stance of a story is then estimated from the information in its patches. Experiments with English, Mandarin, and Turkish show that this technique enables automatic identification of many aspects of stance in news broadcasts.



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A complete rethink is needed on how greenhouse gas emissions are quantified for national reporting

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): Adrian Leip, Ute Skiba, Alex Vermeulen, Rona L. Thompson




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Editorial Board

Publication date: February 2018
Source:Atmospheric Environment, Volume 174





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Intercomparison of OH and OH reactivity measurements in a high isoprene and low NO environment during the Southern Oxidant and Aerosol Study (SOAS)

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): Dianne Sanchez, Daun Jeong, Roger Seco, Ian Wrangham, Jeong-Hoo Park, William H. Brune, Abigail Koss, Jessica Gilman, Joost de Gouw, Pawel Misztal, Allen Goldstein, Karsten Baumann, Paul O. Wennberg, Frank N. Keutsch, Alex Guenther, Saewung Kim
We intercompare OH and OH reactivity datasets from two different techniques, chemical ionization mass spectrometry (CIMS) and laser-induced fluorescence (LIF) in a high isoprene and low NO environment in a southeastern US forest during the Southern Oxidant and Aerosol Study (SOAS). An LIF instrument measured OH and OH reactivity at the top of a tower, a CIMS instrument measured OH at the top of the tower, and a CIMS based comparative reactivity method (CRM-CIMS) instrument deployed at the base of the tower measured OH reactivity. Averaged diel variations of OH and OH reactivity from these datasets agree within analytical uncertainty and correlations of LIF versus CIMS for OH and OH reactivity have slopes of 0.65 and 0.97, respectively. However, there are systematic differences between the measurement datasets. The CRM-CIMS measurements of OH reactivity were ∼16% lower than those by the LIF technique in the late afternoon. We speculate that it is caused by losses in the sampling line down to the CRM-CIMS instrument. On the other hand, we could not come up with a reasonable explanation for the difference in the LIF and CIMS OH datasets for early morning and late afternoon when OH is below 1 × 10⁶ molecules cm⁻³. Nonetheless, results of this intercomparison exercise strengthen previous publications from the field site on OH concentrations and atmospheric reactivity.



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Corrigendum to “Risk assessment of bioaccessible trace elements in smoke haze aerosols versus urban aerosols using simulated lung fluids” [Atmos. Environ. 125PB (2016) 505–511]

Publication date: February 2018
Source:Atmospheric Environment, Volume 174
Author(s): Xian Huang, Raghu Betha, Li Yun Tan, Rajasekhar Balasubramanian




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Exertional Tolerance Assessments after Mild Traumatic Brain Injury: A Systematic Review

Publication date: Available online 23 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Catherine Quatman-Yates, Anna Bailes, Sara Constand, Mary Claire Sroka, Katharine Nissen, Brad Kurowski, Jason Hugentobler
ObjectiveThe objective of this study was to review the literature to identify and summarize strategies for evaluating responses to physical exertion after mild traumatic brain injury (mTBI) for clinical and research purposes.Data sourcesPubMed and EBSCOHost through December 31, 2016.Study SelectionTwo independent reviewers selected studies based on the following criteria: 1) inclusion of participants with mTBI/concussion, 2) use of a measurement of physiological or psychosomatic response to exertion, 3) a repeatable description of the exertion protocol was provided, 4) a sample of at least 10 participants with a mean age between 8-65 years, and 5) the article was in English. The search process yielded 2,685 articles, of which 14 studies met the eligibility requirements.Data ExtractionA quality assessment using a checklist was conducted for each study by two independent study team members and verified by a third team member. Data were extracted by a one team member and verified by a second team member.Data SynthesisA qualitative synthesis of the studies revealed that most protocols employed a treadmill or cycle ergometer as the exercise modality. Protocol methods varied across studies including differences in initial intensity determination, progression parameters, and exertion duration. Common outcome measures were self-reported symptoms, heart rate, and blood pressure.Summary/conclusionsThe strongest evidence indicates that exertional assessments can provide important insight about mTBI recovery and should be administered using symptoms as a guide. Additional studies are needed to verify an optimal modes and protocols for post-mTBI exertional assessments.



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Quantification of surfactant proteins in tears of patients suffering from dry eye disease compared to healthy subjects

Publication date: Available online 24 December 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Andreas Posa, Friedrich Paulsen, Richard Dietz, Fabian Garreis, Ralph Sander, Martin Schicht, Saadettin Sel, Michael Scholz, Christian M. Hammer, Lars Bräuer
PurposeTo quantify and compare the amounts of surfactant proteins SP-A, SP-B, SP-C and SP-D in the tear fluid collected from patients with dry eye syndrome and from individuals with a healthy ocular surface.MethodsSchirmer strips were used to collect tear fluid from both eyes of 241 volunteers (99 men, 142 women; age range: 18-87 years). Dry eye syndrome was diagnosed by ophthalmologists in 125 patients, whereas the healthy control group comprised 116 individuals. The total protein concentration was determined via Bradford assay. The relative concentration of surfactant proteins SP-A through −D was measured by enzyme-linked immuno-sorbent assay (ELISA).ResultsThe mean relative concentrations of SP-A, SP-C and SP-D were significantly higher in the dry eye group as compared to the healthy controls (p<0.05, one-way ANOVA). SP-B was also detected at a higher concentration in the dry eye group, but the difference to the control group was not statistically significant.ConclusionsThe upregulation of SP-A and SP-D in the dry eye group is probably related to these proteins' known antimicrobial and immunomodulatory effects at the ocular surface. It may represent a pathophysiological response to the inflammatory condition of the ocular surface in dry eye. The upregulation of SP-B and SP-C may represent an effort of the lacrimal system to reduce surface tension and thus to counteract the increased tendency of the tear film to tear in dry eye.



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Secretory carcinoma of the parotid with adenoid cystic carcinoma cytological pattern: A cytological-pathological correlation with literature review

Publication date: Available online 24 December 2017
Source:Annals of Diagnostic Pathology
Author(s): Oleksandr Kravtsov, Bryan Hunt, Jess Peterson, Luis Carrillo, Peter Bonneau, Tamara Giorgadze
Secretory carcinoma (SC) is a rare low-grade malignant tumor, defined by ETV6-NTRK3 fusion, identifiable by FISH. We describe a case in a 58-year-old male with a painless slowly growing 16mm palpable mass within left superficial parotid. FNA of the mass showed highly cellular specimen with moderate to large pleomorphic cells with round to ovoid nuclei with vesicular chromatin and distinct nucleoli. Cells had moderate to large amounts of vacuolated cytoplasm. Abundant globular metachromatic material, resembling that of adenoid cystic carcinoma, was noted. This material was seen extracellularly and intracytoplasmic, and stained magenta on Diff-Quik and blue-green on Papanicolaou-stained slides. The tumor cells on a cell block preparation were positive for Mammaglobin and S-100. PAS stain highlighted extracellular and intracytoplasmic secretions. FNA diagnosis was "Positive for Malignancy. Morphologic features most compatible with Mammary Analogue Secretory Carcinoma". ETV6 FISH studies as well as histologic examination of excised tumor confirmed the diagnosis. Finding the globular metachromatic material in SC, that is generally seen in adenoid cystic carcinoma, broadens a cytological differential diagnosis of both entities. Cytological differential diagnosis, clinical, histological, immunohistochemical, and molecular features of secretory carcinomas are discussed in this study.



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Understanding the direction of the relationship between white matter hyperintensities of vascular origin, sleep quality, and chronic kidney disease. Results from the Atahualpa Project

Publication date: Available online 24 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Oscar H. Del Brutto, Robertino M. Mera
ObjectiveThe burden of cerebral small vessel disease, sleep disorders, and chronic kidney disease is on the rise in remote rural settings. However, information on potential links between these conditions is limited. We aimed to assess the relationships between these conditions in community-dwelling older adults living in rural Ecuador.Patients and MethodsAtahualpa residents aged ≥60 years were offered a brain MRI. A venous blood sample was obtained for serum creatinine determination. Baseline interviews and procedures were directed to assess demographics, cardiovascular risk factors, and sleep quality. Using generalized structural equation modeling (GSEM), we assessed the associations between white matter hyperintensities (WMH) of vascular origin, sleep quality and kidney function, as well as the directions of the relationships between these variables.ResultsOf 423 candidates, 314 (74%) were enrolled. Moderate-to-severe WMH were noticed in 74 (24%) individuals, poor sleep quality in 101 (31%), and moderate-to-severe chronic kidney disease in 28 (9%). GSEM showed that the direction of the effect was from kidney function to WMH and from the latter to sleep quality. Of independent variables investigated, worse kidney function was associated with age, high glucose levels and male sex. WMH was associated with cholesterol blood levels, blood pressure, level of education and severe edentulism. Poor sleep quality was associated with poor physical activity.ConclusionThis population based study shows that chronic kidney disease is associated with increased severity of WMH, which, in turn, is associated with a poor sleep quality.



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Lymph-node metastasis following total laryngectomy and total pharyngolaryngectomy for laryngeal and hypopharyngeal squamous cell carcinoma: Frequency, distribution and risk factors

Publication date: Available online 23 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): D. Rivière, J. Mancini, L. Santini, A. Giovanni, P. Dessi, N. Fakhry
ObjectivesTo evaluate the prevalence and distribution of lymph-node metastasis after total laryngectomy or total pharyngolaryngectomy.Material and methodsRetrospective single-center series of 136 successive patients undergoing total laryngectomy or total pharyngolaryngectomy with neck dissection for squamous cell carcinoma of the larynx or hypopharynx.ResultsThe primary site was laryngeal in 110 cases and hypopharyngeal in 26. In 63 patients, surgery was first-line treatment; 73 were operated on for recurrence. The lymph-node metastasis rate, confirmed on histology, was 44.8% regardless of primary site. Hypopharyngeal location was a risk factor for lymph-node metastasis (73.1%, P=0.002) as was the supraglottic subsite (64.3%, P=0.039). Levels IIa and III were invaded in 28.7% and 25.7% of cases, respectively. Level VIb lymph-node involvement was 23.8% in patients who underwent level VIb neck dissection. Lymph-node recurrence rate was 10.3% in levels II to IV and 13.2% in VIb.ConclusionsWhatever the tumor site, levels IIa and III were most frequently invaded. The high rate of histological involvement of level VIb and of recurrence argues for systematic elective bilateral neck dissection of these territories in some primary sites.



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