Deepa Nair

Purpose of review: Ewing's sarcoma is a small round-cell tumour typically arising in the bones, and only rarely affecting soft tissues. These are rarely seen in the head and neck comprising 1–9% of all cases, making management of these tumours a challenge. This review aims to review the current literature to update the current diagnostic and treatment options in head and neck Ewing's sarcoma Recent findings: The tumour is characterized in most cases by recurrent balanced translocations between the EWSR1 gene on chromosome 22 and genes belonging to the ETS family of transcription factors. Its main driver is the reciprocal translocation between the EWSR1 and FLI1 genes (EWSR1:FLI1). Molecular techniques for the detection of FET/ETS fusions are widely used to confirm the diagnosis. Newer entities like adamantinoma-like Ewing sarcoma have been recently described. The chemotherapy protocols also have changed following Euro Ewing 2012 study. Reclassification of margin status may help standardize treatment in these cases. Summary: Head and neck Ewings sarcoma is an uncommon tumour, mainly affecting paediatric/adolescent male individuals. Histopathological diagnosis is often challenging and immunohistochemical markers and/or molecular tests are generally used. Several molecular techniques for the detection of FET/ETS fusions are widely used to confirm the diagnosis. Management of Ewing's consists of a multimodal treatment regimen, including surgical resection and/or local radiotherapy, as well as intensive multiagent chemotherapy. Increase in age and the presence of distant metastasis are associated with shorter survival times.

Revision thyroid surgery for residual/recurrent disease is known to have higher complication rates because of parathyroid injury and recurrent laryngeal nerve (RLN) damage. The aim of this study is to evaluate the accuracy of USG in predicting recurrent disease and disease outcomes in patients undergoing reoperation for recurrent/residual thyroid cancer. We performed a retrospective analysis of all thyroid reoperations from 2015 to 2017. Preoperative USG findings were categorized as per prespecified disease stations in the neck and compared with histopathology to calculate sensitivity, specificity, positive predictive value, and negative predictive value of USG. Survival analysis was performed using Kaplan–Meier curves. Two hundred fifty patients were included in the analysis. In a reoperative setting, USG had an overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 89%, 77%, 89%, 94%, and 60%, respectively. We found a significantly lower disease-free survival in patients who had radiologically detected recurrent disease as compared to disease detected only on histopathology. USG has a reasonable accuracy in determining status of lesions in patients undergoing revision thyroid surgeries.

Background: Advanced head and neck cancers are known to cause swallowing dysfunction due to anatomical and post-treatment changes. Literature is sparse on post-surgical and/or multi-modality therapy-associated swallowing function in advanced oral cancers. We conducted this study to longitudinally assess and compare the pre- and post-therapy swallowing dysfunction associated with locally advanced oral cancers. Methods and Material: A prospective observational longitudinal study was conducted at a tertiary cancer center from 2017 to 2018 including treatment-naive cT4a oral cancer patients (AJCC 7 ^th edition). The assessment was done pre-surgery, post-surgery, and post-adjuvant setting as per the scales (Dysphagia score, Penetration aspiration scale, and Yale pharyngeal residue (vallecular and pyriform fossa). Results: Of the 30 patients in the study, 47.4%, 47.4%, 52.6%, and 47.4% experienced deterioration of Dysphagia score, Penetration-Aspiration Scale (PAS), vallecula residue, and pyriform residue scores in the postoperative period. And 52.6%, 47.4%, 68.4%, and 57.9% had inferior dysphagia score, PAS, vallecula, and pyriform residue scores even 6 months after completion of adjuvant therapy. The dysphagia score correlated well with other objective assessment scores at different time points. Conclusion: Swallowing functions are significantly affected by surgery and adjuvant therapy and continue to be affected even 6 months after completion of treatment. Appropriate rehabilitation and intervention must be offered to patients to reduce this problem. Dysphagia scores can predict the swallowing status similar to other objective assessments.

BackgroundTo assess the efficacy of prophylactic versus reactive feeding strategy in oral cavity squamous cell carcinoma (OCSCC) patients receiving adjuvant radiation therapy (RT). MethodsThis was a post hoc analysis of patients of OCSCC enrolled in a randomized trial comparing three adjuvant strategies. In this trial, till 2010, a prophylactic feeding approach was followed for all patients. Since January 2011, a reactive feeding approach was followed. ResultsTwo hundred and sixty-eight in each cohort (total n = 526) were eligible for analysis after propensity score matching. At 6 weeks post-RT completion, the median weight loss in the prophylactic versus reactive cohort was 5 versus 3 kg, p = 0.002. At all other time points until 1 year, the median weight loss was lesser in reactive than in the prophylactic cohort. ConclusionsA reactive feeding tube approach should be preferred for OCSCC receiving adjuvant RT.

Background: Surgery and radiotherapy are well-established standards of care for unilateral stage 0 and I early-stage glottic cancer (ESGC). Based on comparative studies and meta-analyses, functional and oncological outcomes after both treatment modalities are similar. Historically, radiotherapy (RT) has been performed by irradiation of the whole larynx. However, only the involved vocal cord is being treated with recently introduced hypofractionated concepts that result in 8 to 10-fold smaller target volumes. Retrospective data argues for an improvement in voice quality with non-inferior local control. Based on these findings, single vocal cord irradiation (SVCI) has been implemented as a routine approach in some institutions for ESGC in recent years. However, prospective data directly comparing SVCI with surgery is lacking. The aim of VoiceS is to fill this gap. Methods: In this prospective randomized multi-center open-label phase III study with a superiority design, 34 patients with histopathologically confirmed, untreated, unilateral stage 0-I ESGC (unilateral cTis or cT1a) will be randomized to SVCI or transoral CO₂-laser microsurgical cordectomy (TLM). Average difference in voice quality, measured by using the voice handicap index (VHI) will be modeled over four time points (6, 12, 18, and 24 months). Primary endpoint of this study will be the patient-reported subjective voice quality between 6 to 24 months after randomization. Secondary endpoints will include perceptual impression of the voice via roughness – breathiness – hoarseness (RBH) assessment at the above-mentioned time points. Additionally, quantitative characteristics of voice, loco-regional tumor control at 2 and 5 years, and treatment toxicity at 2 and 5 years based on CTCAE v.5.0 will be reported. Discussion: To our knowledge, VoiceS is the first randomized phase III trial comparing SVCI with TLM. Results of this study may lead to improved decision-making in the treatment of ESGC. Trial registration: ClinicalTrials.gov NCT04057209. Registered on 15 August 2019. Cantonal Ethics Committee KEK-BE 2019-01506