Treatment outcomes with whole‐field versus split‐field intensity‐modulated radiotherapy for patients with nasopharyngeal carcinoma

Abstract

Background

The purpose of this study was to present our comparison of the clinical outcome of patients with nasopharyngeal carcinoma (NPC) treated with whole‐field intensity‐modulated radiotherapy (whole‐field‐IMRT) or split‐field‐IMRT.

Methods

We retrospectively studied 388 patients with M0 NPC. The median lower neck doses were 50 Gy in 1.35 Gy/fractions for the 240 whole‐field‐IMRT patients, and 50.4 Gy in 1.8 to 2.0 Gy/fractions for the 148 split‐field‐IMRT patients.

Results

The IMRT technique did not affect the overall survival (OS; P = .077) and locoregional control (P = .231) rates. However, the split‐field‐IMRT group had more locoregional recurrences at the whole neck (P = .005) but not at the nasopharynx (P = .968) or the lower neck (P = .485). The patients treated with split‐field‐IMRT (43.2%) had more grade III neck fibrosis than the patients who received whole‐field‐IMRT (18.3%; P < .001). Only 1 patient had temporal lobe necrosis in our study.

Conclusion

Our study shows that whole‐field‐IMRT using a lower dose/fraction for the lower neck results in at least comparable locoregional control and less fibrosis compared to conventional fraction with split‐field‐IMRT.

http://bit.ly/2Sx9rXY

AHNS Series – Do you know your guidelines?: Assessment and management of malnutrition in patients with head and neck cancer: A review of the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines®)

Abstract

This article is a part of the "Do you know your guidelines" series by the Education Committee of the American Head and Neck Society. The aim is to summarize the core principles outlined by the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines^®) on management of malnutrition in patients with head and neck cancer. We outline the current recommendations from the National Comprehensive Cancer Network^® (NCCN^®) for the screening and management of malnutrition, including indications for nutritional supplementation and placement of a nasogastric or gastrostomy tube. We also include a brief review of the available literature on additional screening tools, alternative guidelines, as well as an update on the emerging data surrounding the use of immune‐enhancing nutrition.

http://bit.ly/2Aqpi3z

Respiratory Epithelial Adenomatoid Hamartoma (REAH) in the Olfactory Cleft: Often Masked by Bilateral Nasal Polyps

Abstract

Respiratory epithelial adenomatoid hamartoma (REAH) is a distinct non-neoplastic entity originating from anterior olfactory cleft in the nasal cavity, often going unnoticed. Clinically, REAH presents as unilateral or bilateral nasal polyps. Our aim is to expand the understanding of bilateral REAH associated with nasal polyposis with respect to clinical, radiological and histopathological features for better clinical outcomes. Our analysis includes patients presenting as bilateral nasal polyps, whose CT-PNS showed opacity in olfactory clefts. During endoscopic sinus surgery, the lesions in the olfactory cleft (medial-to-middle turbinate) were identified and the specimens from olfactory cleft and ethmoid sinus cavity were subjected separately to histopathological analysis. Six patients (average age 50 years, 83% male) of bilateral REAH with nasal obstruction of > 3 years were analysed. On nasal endoscopy, the polypoid masses in the olfactory cleft and in the ethmoids did not show any gross differences. However, polypoidal masses from the olfactory cleft bled more during biopsy and excision. Histopathological study of these masses revealed the closely arranged round to oval glands (with few dilated glands) lined by ciliated columnar epithelium in mildly edematous stroma, confirming the presence of REAH. REAH is an often overlooked lesion in the nasal cavity, arising from olfactory cleft. The presence of nasal polyposis obscures this lesion, resulting in under diagnosis. The prompt identification with high index of suspicion by the otorhinolaryngologists helps in accurate histopathological diagnosis thereby improving clinical outcomes.

http://bit.ly/2SwQlRu

A Sizeable Solitary Pedunculated Peripheral Osteoma of the Hard Palate: A Case Report

Abstract

Osteomas are benign, slow growing, usually sessile osteogenic tumors of unknown etiology. They arise from proliferation of either cancellous or compact bone. They can be central, peripheral or extra-skeletal based on their origin from endosteum, periosteum or extra-skeletal soft tissue respectively. They are commonly found in the skull and facial bones, the most common site in the maxillofacial region being paranasal sinuses. Among the jaw bones the most common site is the mandible. The hard palate is a rare site for such osteomas with a very few cases reported in literature. We report a case of large pedunculated peripheral osteoma of the hard palate in a 38 year old male. The tumor was excised with no recurrence after 3 years followup.

http://bit.ly/2ArRvXx

Health literacy – a new piece of the puzzle in psoriasis care?

Summary

Background

Health literacy (HL), the ability to seek, understand and utilize health information, is important for good health. Suboptimal HL has been associated with poorer health outcomes in other chronic conditions, although this has not previously been studied in patients with psoriasis.

Objectives

The aim of this study was to investigate the HL strengths and weaknesses of a cohort of patients with moderate to severe psoriasis. Another aim was to examine possible associations between patients' quality of life, their demographic, clinical and self‐management characteristics and dimensions of HL.

Methods

A cross‐sectional study was conducted. Data were collected from a cohort of patients with psoriasis who had participated in climate helio therapy from 2011‐2016 (N= 825). HL was assessed by the Health Literacy Questionnaire (HLQ). The association between HL domains, demographic, clinical and self‐management variables was analysed using bivariate correlation and a four‐step linear multiple regression model.

Results

The scores on all HLQ dimensions indicate lower health literacy compared to other populations. The linear regression models showed a significant association between HL, quality of life and self‐management variables, with higher HL predicting higher quality of life, self‐efficacy, and psoriasis knowledge. Sex, educational attainment, age and disease severity had less influence on health literacy.

Conclusions

Improving HL may be a useful strategy for reducing disparities in self‐management skills for patients with psoriasis. Interventions that aim to reduce disease severity and increase psoriasis knowledge, self‐ efficacy and quality of life may positively increase HL.

This article is protected by copyright. All rights reserved.

http://bit.ly/2GMEtta

Health literacy – a new piece of the puzzle in psoriasis care?

Summary

Background

Health literacy (HL), the ability to seek, understand and utilize health information, is important for good health. Suboptimal HL has been associated with poorer health outcomes in other chronic conditions, although this has not previously been studied in patients with psoriasis.

Objectives

The aim of this study was to investigate the HL strengths and weaknesses of a cohort of patients with moderate to severe psoriasis. Another aim was to examine possible associations between patients' quality of life, their demographic, clinical and self‐management characteristics and dimensions of HL.

Methods

A cross‐sectional study was conducted. Data were collected from a cohort of patients with psoriasis who had participated in climate helio therapy from 2011‐2016 (N= 825). HL was assessed by the Health Literacy Questionnaire (HLQ). The association between HL domains, demographic, clinical and self‐management variables was analysed using bivariate correlation and a four‐step linear multiple regression model.

Results

The scores on all HLQ dimensions indicate lower health literacy compared to other populations. The linear regression models showed a significant association between HL, quality of life and self‐management variables, with higher HL predicting higher quality of life, self‐efficacy, and psoriasis knowledge. Sex, educational attainment, age and disease severity had less influence on health literacy.

Conclusions

Improving HL may be a useful strategy for reducing disparities in self‐management skills for patients with psoriasis. Interventions that aim to reduce disease severity and increase psoriasis knowledge, self‐ efficacy and quality of life may positively increase HL.

This article is protected by copyright. All rights reserved.

http://bit.ly/2GMEtta

Prevalence Ratio of Otitis Media with Effusion in Laryngopharyngeal Reflux

Background. Otitis media with effusion (OME) in adults is less prevalent than in the pediatric population but still causes considerable morbidity. It has been suggested that laryngopharyngeal reflux (LPR) may have a role in the aetiology of adult OME. Reflux advances to the laryngopharynx and, subsequently, to other regions of the head and neck such as oral cavity, nasopharynx, nasal cavity, paranasal sinuses, and even middle ear with clinical manifestations being asthma, sinusitis, and otitis media. Objective. To determine the prevalence ratio of otitis media with effusion in laryngopharyngeal reflux. Methods. Observational analytic with cross sectional design. Result. 9 of 28 subjects experienced OME in LPR group, and 2 of 28 subjects in non-LPR group. Statistically there was significant difference between the two groups with p-value 0.02 and with 95% confidence interval range of 1.066-18.990. Conclusion. The prevalence ratio of otitis media with effusion in laryngopharyngeal reflux group is 4.5 times that in non-laryngopharyngeal reflux group.

http://bit.ly/2Aoluzu