Outcomes of the modern management approach for locally advanced (T3-T4) laryngeal cancer: a retrospective cohort study

\ua9 The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) Limited. Background: Our centre has favoured primary surgery over chemoradiotherapy(CRT) for specific advanced laryngeal cancer patients (e.g. large volume tumours, airway compromise, significant dysphagia, T4 disease). This study reports the survival outcomes for a modern, high-volume head and neck centre favouring surgical management to determine whether this approach improves survival. Methods: Retrospective analysis of patient data over a 7-year period from a tertiary cancer centre. Results: 121 patients were identified with T3(n=76) or T4 (n=45) laryngeal cancer (mean follow-up 2.9 years). In the cohort treated with curative intent(n=104;86.0%), the 2-year and 5-year estimated disease-specific survival (DSS) was 77.9% and 64.1%. CRT had the highest 2-year DSS (92.5%), followed by surgery with adjuvant therapy (81.8%), radiotherapy alone (75%), and surgery alone (72.4%). Conclusion: For a centre favouring primary surgery for certain advanced laryngeal cancers, the DSS appears no higher than published literature. To enhance survival, future research should focus on precision medicine to define treatment pathways in this disease

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment

The Application of Radiomics in Vestibular Schwannomas

\ua9 The Author(s), 2025.Objectives: Radiomics refers to converting medical images into high-quality quantitative data. This review examines applications of radiomics in vestibular schwannomas and future considerations for translation into clinical practice. Methods: The review was pre-registered on PROSPERO (ID: CRD42024579319). A comprehensive systematic review-informed search of OVID MEDLINE, EMBASE and Global Health online databases was undertaken. Keywords "acoustic neuroma"OR "vestibular schwannoma"OR "cerebellopontine angle tumour"OR "cerebellopontine tumour"OR "head and neck cancer"were combined with "radiomic"OR "signature"OR "machine learning"OR "artificial intelligence". Results: The studies (n=6) are categorised into two groups: Radiomics for Preoperative Decision-making (n=1) and Radiomics for Treatment Outcomes (n=5). Radiomic features are significantly associated with clinical outcomes. Radiomics-based predictive models are superior to expert vision. Conclusion: Radiomics has potential for improving multiple aspects of vestibular schwannoma care; however, lack of studies inhibits firm conclusions. Prospective studies are required to progress this field