Proton re-irradiation of Sinonasal Esthesioneuroblastoma: a Case Report

2021 ◽  
Vol 1 (1) ◽  
pp. 75-81
Author(s):  
Konstantin Gordon ◽  
Igor Gulidov ◽  
Danil Gogolin ◽  
Olga Lepilina ◽  
Olga Golovanova ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Head And Neck ◽  
Local Control ◽  
Proton Therapy ◽  
Locally Advanced ◽  
Comprehensive Treatment ◽  
Sinonasal Tumor ◽  
Advanced Stages ◽  
Novel Approaches

"Head and neck (H&N) cancers are in the 7-8th place among all types of cancer. Despite novel approaches in cancer treatment, most of the patients have a high risk of loco-regional recurrence. Esthesioneuroblastoma (ENB) is a very rare H&N neoplasm, accounting for only 3-6% of all intranasal tumors. These tumors usually are presented with locally advanced stages and required radiotherapy as a part of the comprehensive treatment. Loco-regional failures represent a challenge, and re-irradiation can be effective for some groups of patients. We present a case of re-irradiation with protons of sinonasal tumor in a 49-years old patient with recurrent ENB, involving visual structures. We achieved a 5-year positive local control after the proton therapy (PT), without significant toxicity.The case shows an example of re-irradiation as an essential area for PT application,given the need to maximize the treatment's efficacy and minimize the risk of severetoxicity."

scholarly journals Neoadjuvant and Adjuvant Pembrolizumab in Resectable Locally Advanced, Human Papillomavirus-Unrelated Head and Neck Cancer: A Multicenter, Phase 2 Trial

2020 ◽  
Author(s):  
Ravindra Uppaluri ◽  
Katie M. Campbell ◽  
Ann Marie Egloff ◽  
Paul Zolkind ◽  
Zachary L. Skidmore ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
High Risk ◽  
Head And Neck ◽  
Relapse Rate ◽  
Locally Advanced ◽  
Giant Cells ◽  
Phase 2 ◽  
Phase 2 Trial ◽  
One Year ◽  
The One

SUMMARYBackgroundPembrolizumab improved survival of patients with recurrent or metastatic head and neck squamous-cell carcinoma (HNSCC). The aims of this phase 2 trial were to determine if pembrolizumab administered to patients with resectable locally advanced, human papillomavirus (HPV)-unrelated HNSCC would be safe, result in pathologic tumor response (pTR), and lower the relapse rate.MethodsNeoadjuvant pembrolizumab (200 mg) was administered 2-3 weeks before surgery. Resection of the primary tumor and involved/at-risk nodes was performed. Post-operative (chemo) radiation was planned. Patients with high-risk pathology (positive margins and/or extranodal extension) were to receive adjuvant pembrolizumab. pTR was quantified as the proportion of the resection bed with tumor necrosis, keratinous debris, and giant cells/histiocytes: pTR-0 (<10%), pTR-1 (10-49%), and pTR-2 (≥50%). Co-primary endpoints were pTR-2 among all patients, and one-year relapse rate in patients with high-risk pathology (historical: 35%). Correlations of baseline PD-L1 expression and T-cell infiltration with pTR were assessed, and tumor clonal dynamics were evaluated. Analyses were done per protocol. This trial is registered with ClinicalTrials.gov(NCT02296684), and is ongoing but closed to accrual.FindingsBetween June 30, 2015, and March 30, 2018, 36 patients enrolled. After neoadjuvant pembrolizumab, serious (grades 3-4) adverse events and unexpected surgical delays/complications did not occur. pTR-2 occurred in eight patients (22%), and pTR-1 in eight other patients (22%). pTR ≥10% correlated with baseline tumor PD-L1 expression, immune infiltrate, and IFN-γ pathway activity. Matched sample analysis showed compensatory upregulation of multiple immune inhibitory checkpoints in patients with pTR-0, and confirmed that clonal loss occurred in some patients. The one-year relapse rate among the eighteen patients with high-risk pathology was 16.7% (95%CI: 3.6-41.4%).ConclusionsAmong patients with locally advanced, HPV-unrelated HNSCC, neoadjuvant pembrolizumab was safe, and resulted in pTR-1 or pTR-2 in 44% of patients. The one-year relapse rate in patients with high-risk-pathology was lower than historical.FundingMerck, NCI, NIDCR, NHGRI and The V Foundation.

scholarly journals Giant locally advanced and metastatic squamous cell skin carcinoma of head and neck region: case report

2020 ◽  
Vol 25 (1) ◽  
pp. 20-22
Author(s):  
Jan Stuk ◽  
Jaroslav Vanasek ◽  
Karel Odrazka ◽  
Martin Dolezel ◽  
Iveta Kolarova ◽  
...  
Keyword(s):  
Case Report ◽  
Head And Neck ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Neck Region ◽  
Skin Carcinoma ◽  
Head And Neck Region ◽  
Squamous Cell Skin Carcinoma

A Challenging Case of Multiply Recurrent Nasal Basal Cell Carcinoma

2011 ◽  
Vol 15 (5) ◽  
pp. 285-289
Author(s):  
Fazilat Mohammed ◽  
Nowell Solish ◽  
Christian A. Murray
Keyword(s):  
High Risk ◽  
Basal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Basal Cell ◽  
Locally Advanced ◽  
Complex Case ◽  
Definitive Treatment ◽  
Management Options ◽  
Risk Scale

Background: Basal cell carcinoma (BCC) is the most common human malignancy worldwide and represents a significant cost to health care systems. Most cases occur on the head and neck, and many are successfully treated with relatively simple measures. However, if high-risk or complicated cases are not treated effectively, they may result in considerable disfigurement or morbidity. We report on a patient with a complex nasal basal cell carcinoma (BCC) that failed multiple treatments by electrodesiccation and curettage (EDC). Management strategies for primary and recurrent BCC, including EDC, standard excision, Mohs micrographic surgery (MMS), and radiation therapy, are discussed. This case required extensive resection, and we review the literature for predictive factors of significant subclinical spread. Objective: To present a complex case that illustrates the management options of high-risk, recurrent BCC of the head and neck. Materials and Methods: Case report and review of the literature. Results: MMS offers the lowest recurrence rate in the treatment of recurrent BCC in surgical candidates. A validated risk scale may predict subclinical spread in patients with BCC of the head and neck. Conclusions: BCC can progress to locally advanced disease, necessitating definitive treatment. EDC performed by an experienced dermatologist may offer cure rates comparable to those of surgery in lower-risk BCC. However, in higher-risk tumors, such as recurrent or larger lesions, methods that ensure clear margins should be considered first line, especially in sensitive locations. The routine use of a validated risk scale can better prepare patients and dermatologists for potentially extensive resections. In cases with risk of extensive involvement, strategies to clearly communicate options and progress at all stages of the process should be available.

scholarly journals Parotid mucoepidermoid carcinoma with extensive intravenous metastasis: a case report

2021 ◽  
Vol 4 (1) ◽  
pp. 71-74
Author(s):  
Alice Flavell-Birch ◽  
Helen D Brasch ◽  
Swee T Tan
Keyword(s):  
Case Report ◽  
High Risk ◽  
Head And Neck ◽  
Adjuvant Radiotherapy ◽  
Mucoepidermoid Carcinoma ◽  
Resection Margins ◽  
Tumour Stage ◽  
Histological Grading ◽  
Adults And Children ◽  
Positive Resection Margins

Salivary tumours are uncommon, comprising only 2–5 per cent of head and neck neoplasms,1 with mucoepidermoid carcinoma (MEC) being the most common salivary cancer in both adults and children.1–4 Clinically, head and neck MEC can present variably from being asymptomatic to locally or metastatically aggressive.5,6 Treatment is primary surgical resection with neck dissection. The use of adjuvant radiotherapy is indicated for patients at high risk of recurrence, such as those with a high tumour stage, positive resection margins and high histological grading.6–8 

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