Head and Neck-Journal for the Sciences and Specialties of the Head and Neck最新文献

{"title":"EC-IC Bypass for Skull Base Necrosis and ICA Rupture Hemorrhage After Radiotherapy for Nasopharyngeal Carcinoma.","authors":"Yu Huang, Qiang Liu, Ye Gu, Kai Xue, Quan Liu, Shixing Zheng, Huankang Zhang, Wanpeng Li, Xiaole Song, Han Li, Jingjing Wang, Weidong Zhao, Yuzhen Wang, Bo Peng, Liang Zeng, Huimin Xu, Lei Wang, Xicai Sun, Hongmeng Yu","doi":"10.1002/hed.28107","DOIUrl":"https://doi.org/10.1002/hed.28107","url":null,"abstract":"<p><strong>Background: </strong>Skull base necrosis can cause life-threatening massive bleeding in patients following radiotherapy and chemotherapy for nasopharyngeal carcinoma. Patients with bilateral internal carotid artery rupture and hemorrhage are especially susceptible, which is a major challenge for clinicians.</p><p><strong>Methods: </strong>A team at the Eye and ENT Hospital affiliated with Fudan University recently successfully treated a patient with skull base necrosis after radiotherapy and chemotherapy for nasopharyngeal carcinoma. The patient experienced bilateral internal carotid artery rupture with massive nasopharyngeal hemorrhage and was treated with extracranial-intracranial bypass surgery, resection of the nasal skull base necrotic lesions, and bilateral internal carotid artery occlusion.</p><p><strong>Results: </strong>One week after the last surgery, the patient recovered well, and normal activity was restored.</p><p><strong>Conclusions: </strong>Simultaneous EC-IC bypass and TMF repair increase intracranial blood flow compensation without the need for an additional incision, saving the patient's life and improving their quality of life. These results highlight a promising surgical practice for rescuing patients suffering from skull base necrosis and ICA rupture hemorrhage.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Proximal Liquid Biopsy Approaches for Detecting Residual Disease and Predicting Recurrence in Head and Neck Cancer: A Review and Proposal of Novel Liquid Staging.","authors":"Vanessa Helou, Joshua D Smith, Micah Harris, Noah Earland, Kevin J Contrera, Aadel A Chaudhuri, Jose P Zevallos","doi":"10.1002/hed.28138","DOIUrl":"https://doi.org/10.1002/hed.28138","url":null,"abstract":"<p><strong>Background: </strong>Head and neck squamous cell carcinoma remains challenging due to high recurrence rates and poor survival outcomes. Developing precise technologies for disease burden assessment, treatment response, and minimal residual disease (MRD) surveillance is crucial for improving prognosis.</p><p><strong>Methods: </strong>This review explores the potential of liquid biopsy for MRD and recurrence detection. A novel liquid TNM (LiTNM) staging system is introduced, integrating biomarkers from saliva, surgical drain lymphatic fluid (SLF), and peripheral blood.</p><p><strong>Results: </strong>Proximal liquid biopsies, particularly saliva and SLF, offer advantages due to their proximity to the tumor microenvironment. Saliva demonstrates high sensitivity in HPV-associated oropharyngeal cancers, while SLF holds potential in identifying early postoperative recurrence. Despite these advancements, standardization and validation remain challenges.</p><p><strong>Conclusions: </strong>Liquid biopsy approaches show promise for postoperative disease monitoring, yet their clinical implementation remains in the early stages. The proposed LiTNM staging system could complement TNM staging by providing a molecular framework for risk stratification. However, rigorous prospective studies are necessary to validate its clinical utility and facilitate adoption.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Experience With Indocyanine Green (ICG) Fluorescent Guided Transoral Robotic Surgery With the Da Vinci SP.","authors":"Omar A Karadaghy, Michael P Wu, Edward S Sim, Charles D Meyer, Anand T N Kumar, Jeremy D Richmon","doi":"10.1002/hed.28135","DOIUrl":"10.1002/hed.28135","url":null,"abstract":"<p><strong>Importance: </strong>Carcinoma of Unknown Primary (CUP) presents a clinical challenge for practitioners. The current diagnostic approach often involves extensive imaging and examinations, with variable success. We aimed to evaluate the effectiveness of Indocyanine Green (ICG) injection using the Da Vinci robot to aid in intraoperative decision making.</p><p><strong>Objectives: </strong>To evaluate the diagnostic utility of ICG use during robotic surgery to aid in either the identification of the primary tumor or to delineate the extent of disease to guide excision.</p><p><strong>Methods: </strong>This study involved a retrospective review of patients treated at the Massachusetts Eye and Ear who underwent robotic surgery with the utilization of Indocyanine Green (ICG) from October 1, 2022. All patients in the study were operated on using the SP model of the Da Vinci robot. Basic demographic and pathologic data were recorded. Intraoperative data points included assessing the presence of an identifiable primary tumor using white light only and documenting the confidence level of ICG localization.</p><p><strong>Results: </strong>In total, 28 patients who underwent robotic surgery using ICG were identified for this study. The mean age of the cohort was 62 years. Twenty-six patients were male, and the primary diagnosis was HPV-related squamous cell carcinoma (SCCa) in 22 patients, HPV-negative SCC in 5 patients, atypia in 1 patient, and metastatic papillary thyroid carcinoma in 1 patient. Nine patients had either PET-localizing or visually identified primary tumors, and ICG was used to guide the surgical extent of resection. The remaining 19 patients had CUP. Within the patients with CUP, the primary was ultimately identified in 16 of the 19 (84.2%) patients. In regard to ICG localization, this resulted in a True Positive detection in 10 patients (52.6%), False Positive detection in 6 patients (31.6%), False Negative detection in 0 patients (0%), and True Negative detection in 3 patients (15.8%). Based on a confusion matrix of the aforementioned values, the calculated sensitivity, specificity, PPV, and NPV were 100%, 33.3%, 62.5%, and 100%, respectively. The discriminatory index of ICG in the detection of unknown primary disease was found to be 66.6%.</p><p><strong>Conclusion: </strong>The integration of systemic ICG injection with the Da Vinci SP robot's real-time imaging capabilities offers a potential option for enhancing primary tumor identification in CUP patients that adds little to no cost, time, and morbidity to the patient. This preliminary analysis suggests that the use of ICG in robotic surgery for CUP holds promise and warrants further investigation to refine surgical techniques and enhance clinical outcomes.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Outcomes in Adenoid Cystic Carcinoma of the Head and Neck: A Systematic Review of 17 497 Cases and Meta-Analysis.","authors":"Luccas Lavareze, Talita de Carvalho Kimura, Nádia Cacita, Reydson Alcides de Lima-Souza, Marcelo Elias Schempf Cattan, Erika Said Abu Egal, Albina Altemani, Fernanda Viviane Mariano","doi":"10.1002/hed.28132","DOIUrl":"https://doi.org/10.1002/hed.28132","url":null,"abstract":"<p><strong>Background: </strong>Adenoid cystic carcinoma (ACC) is a slow-growing tumor with variable outcomes, making follow-up protocols challenging. This review analyzed outcomes in ACC, focusing on patterns and factors related to adverse prognoses.</p><p><strong>Methods: </strong>A search was conducted on March 25, 2024, in MEDLINE, PubMed, Scopus, and EMBASE. Studies analyzing ACC survival were included, while those lacking these data or focusing on a single ACC site were excluded. The Joanna Briggs Institute's Critical Appraisal tool was used to assess the risk of bias, and the metanalysis was performed using R software.</p><p><strong>Results: </strong>Among 57 studies (17 497 patients), ACC predominantly affected women (mean age: 52.69 years) and occurred mainly in minor salivary glands. Distant metastasis was the most frequent adverse outcome, occurring at 34.8 months on average. Locoregional metastasis and local recurrence occurred at 27.5 and 31.3 months, respectively. Five-, 10-, 15-, and 20-year survival rates were 73.8%, 48.5%, 42.3%, and 26.5%, respectively. Poor survival predictors included advanced T stage, positive lymph nodes, solid tumors, distant metastasis, and positive surgical margins.</p><p><strong>Conclusions: </strong>Distant metastasis is the most frequent adverse outcome in ACC, and prognostic factors are related to advanced and residual tumors.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Radial Forearm Butterfly Flap: A Novel Technique for Oral Cavity Reconstruction With Primary Healing of the Forearm Donor Area.","authors":"Haoyue Xu, Liyan Liu, Baoxing Pang, Yi Ren, Xiaodan Hu, Minghao Li, Yaling Wang, Lingxue Bu","doi":"10.1002/hed.28134","DOIUrl":"https://doi.org/10.1002/hed.28134","url":null,"abstract":"<p><strong>Background: </strong>The traditional radial forearm free flap (TRFFF) combined with split-thickness skin grafting (STSG) for repairing oral defects presents unavoidable donor area complications, such as delayed healing and scar hyperplasia. This study introduces a modified radial forearm free flap, known as the butterfly flap, which enables primary closure of the forearm donor area.</p><p><strong>Methods: </strong>The study included 35 patients who received the butterfly flap and 40 patients who received TRFFF combined with STSG between March 2022 and March 2024. We compared subjective evaluations of postoperative pain and scar degree in the donor area as well as objective assessments of preoperative and postoperative grip strength, key pinch strength, and postoperative donor area complications between the two groups.</p><p><strong>Results: </strong>The delayed wound healing rate was 5.7% (2/35) in the butterfly flap group and 25.0% (10/40) in the TRFFF group, with a significant difference between the two groups (p = 0.023). The postoperative scar score of the donor site in the butterfly flap group was significantly lower than that in the TRFFF group (5.57 ± 1.24 vs. 7.10 ± 1.24, p < 0.05). No significant differences were observed in pain severity scores, incidence of other donor complications, and changes in grip and key pinch strength.</p><p><strong>Conclusion: </strong>The radial forearm butterfly flap can directly close the donor area wound without skin grafting, reducing scar formation and the delayed healing rate of the donor area.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vision Changes After Head and Neck Cancer Treatment.","authors":"Hsiao-Lan Wang, Megan Heskett, Peng Li, Laura Dreer, David Vance, Susan McCammon, Kailei Yan, Amanda Elliott","doi":"10.1002/hed.28133","DOIUrl":"https://doi.org/10.1002/hed.28133","url":null,"abstract":"<p><strong>Background: </strong>Literature about ocular toxicity after head and neck cancer (HNC) treatment is scarce. This study aimed to describe visual function and ocular symptoms among HNC patients.</p><p><strong>Methods: </strong>The study used a cross-sectional design. Two surveys, The National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) and an Ocular Symptom Scale, were sent to participants via e-mail. Descriptive statistics were used to describe the sample in the vision change and non-vision change groups. Chi-square and t-tests were used to compare groups.</p><p><strong>Results: </strong>Of the 485 HNC patients emailed, 126 responded to the survey (26%). Of those, 114 completed the surveys. The scores of NEI-VFQ were significantly lower in the vision change group than in the non-vision change group (p < 0.001). Similarly, all ocular symptoms were significantly different between the two groups (p < 0.05).</p><p><strong>Conclusions: </strong>These findings and a scarcity of literature suggest that vision screening after HNC treatment is warranted.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of a Huge Left Common Carotid Artery Paraganglioma Resected With the Left Thyroid Gland.","authors":"Jiaxi Pu, Shaofei Yang, Minhao Lu, Bin Zhao","doi":"10.1002/hed.28108","DOIUrl":"https://doi.org/10.1002/hed.28108","url":null,"abstract":"<p><strong>Background: </strong>Paraganglioma (PGL) is a rare neuroendocrine tumor. In the head and neck region, surgical resection of PGL is extremely difficult due to its proximity to many vital blood vessels, nerves, and organs. There is still some controversy about whether preoperative embolization is salutary.</p><p><strong>Methods: </strong>We present a case of a giant left common carotid artery PGL with nodular goiter, which needs surgical resection combined with interventional and endovascular treatments.</p><p><strong>Results: </strong>The patient recovered well after the operation without vascular and nerve injury complications. His chest tightness and dysphagia also resolved after the surgery.</p><p><strong>Conclusions: </strong>This case highlights the importance and effectiveness of interventional and endovascular treatments in complex head and neck PGL (HNPGL), particularly in cases involving important blood vessels and organs.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis and Phenotypes of Advanced Head and Neck Carcinoma Associated With Hypercalcemia.","authors":"Elodie Mamou, Paul Gougis, Baptiste Abbar, Jean-Philippe Spano, Laetitia Morardet, Aurore Vozy","doi":"10.1002/hed.28126","DOIUrl":"https://doi.org/10.1002/hed.28126","url":null,"abstract":"<p><strong>Purpose: </strong>Hypercalcemia is the most common metabolic disorder in cancer, affecting 10%-20% of patients with advanced malignancies, including squamous cell carcinoma of the head and neck (HNSCC), though its prognostic significance remains poorly studied. This study aimed to evaluate the prognostic impact of hypercalcemia at diagnosis in patients with locally advanced or metastatic HNSCC and to explore underlying mechanisms and treatment options.</p><p><strong>Methods: </strong>We conducted a bicentric, retrospective analysis of patients diagnosed between 2015 and 2021, including those with locally advanced or metastatic HNSCC undergoing chemotherapy. Hypercalcemia at diagnosis was defined as an albumin-corrected serum calcium level > 2.6 mmol/L, equivalent to 10.4 mg/dL. The primary outcome was overall survival (OS), compared between hypercalcemic and non-hypercalcemic patients using multivariate analysis. Progression-free survival (PFS), along with clinical, biological, and therapeutic characteristics were also evaluated.</p><p><strong>Results: </strong>The study included 286 HNSCC patients, 225 (78.7%) of whom were male. Hypercalcemia incidence was 17.8%. The median OS for the cohort was 7.9 months (95% CI = 6.8-10.6). Hypercalcemic patients had a median OS of 5.9 months (95% CI = 3.8-7.9), compared to 9.1 months (95% CI = 7.3-11.7) in non-hypercalcemic patients (p = 0.002). In multivariate analysis, hypercalcemia was associated with worse OS (HR = 1.73, 95% CI = 1.17-2.56, p = 0.006). Median PFS was 4.3 months (95% CI = 3.6-5.5) for all patients. Hypercalcemic patients had a significantly shorter PFS of 2.4 months (95% CI = 1.9-4.8) compared to 4.7 months (95% CI = 3.8-5.9) in non-hypercalcemic patients (p = 0.0025). Multivariate analysis identified hypercalcemia and oral cavity tumors as negative prognostic factors, with HRs of 1.76 and 1.86, respectively. Bone metastasis rates were similar (17.6% vs. 16.2%), but local osteolysis was significantly higher in hypercalcemic patients (54.1% vs. 27.2%, p = 0.003). Bisphosphonates were administered to 38% of hypercalcemic patients.</p><p><strong>Conclusion: </strong>In this study, hypercalcemia was an independent negative prognostic factor of survival and rapid progression in patients with locally advanced or metastatic HNSCC.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of COVID-19 Vaccination on Treatment-Related Adverse Events and Oncologic Outcomes of Nonmetastatic Nasopharyngeal Carcinoma.","authors":"Minglong Liu, Bin Zhang, Yufei Pan, Xiaoping Lin, Guanhong Luo, Yuan Xie, Xiaolan Ruan, Yu Pan, Yi Liang, Defeng Wang, Yuejia Wei, Hengwei Chen, Guorong Tang, Wei Jiang","doi":"10.1002/hed.28130","DOIUrl":"https://doi.org/10.1002/hed.28130","url":null,"abstract":"<p><strong>Background: </strong>The influence of COVID-19 vaccination before chemoradiotherapy on nonmetastatic nasopharyngeal carcinoma (NPC) is not known.</p><p><strong>Methods: </strong>Propensity score matching was used to minimize potential selection bias between groups. Primary endpoints were treatment-related adverse events (TRAEs). The Kaplan-Meier method and Cox proportional hazards models were performed to conduct survival analysis. The Benjamini-Hochberg false discovery rate control procedure was used to adjust for multiple comparisons.</p><p><strong>Results: </strong>Eight hundred ninety-three patients with newly diagnosed nonmetastatic NPC were enrolled. On propensity score matching analysis, the vaccinated group exhibited a higher prevalence of neutropenia (p = 0.045) and fatigue (p = 0.010) during induction chemotherapy and a higher prevalence of fatigue (p = 0.015) during radiotherapy after adjustment for multiple comparisons. No significant differences were observed in 2-year OS, PFS, DMFS, and LRRFS in matched groups. Additionally, vaccinated patients exhibited a high and comparable absolute lymphocyte count.</p><p><strong>Conclusions: </strong>COVID-19 vaccination before chemoradiotherapy increases the prevalence of acute TRAEs, while no significant influence is observed on the oncologic outcomes of patients with nonmetastatic NPC.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Registry Trial of Adjuvant High-Dose Rate Brachytherapy in Unirradiated Head and Neck Cancer: 20-Year Data.","authors":"Alejandro García-Consuegra, Marta Gimeno-Morales, Mauricio Cambeiro, José María López-Picazo, Juan Alcalde, Luis I Ramos, Luca Tagliaferri, José Luis Guinot, Francesco Bussu, Marta Moreno-Jiménez, Rafael Martinez-Monge","doi":"10.1002/hed.28131","DOIUrl":"https://doi.org/10.1002/hed.28131","url":null,"abstract":"<p><strong>Background and purpose: </strong>Full-dose postoperative external beam radiation therapy (EBRT)/chemoradiation is the standard of care in patients with resected, unirradiated head and neck cancer (HNC). This study aims to determine the long-term results of adjuvant high-dose rate (HDR) brachytherapy ± intermediate-dose postoperative external beam radiation therapy (EBRT)/chemoradiation in this HNC patient population.</p><p><strong>Materials and methods: </strong>From 2000 to 2018, a total of 152 patients diagnosed with HNC were treated with surgery and adjuvant HDR brachytherapy alone (n = 32) or combined with EBRT ± chemotherapy (n = 120). Patients treated with brachytherapy alone received 32 or 40 Gy in 8 or 10 b.i.d. fractions. Combined modality patients received 16 or 24 Gy of HDR brachytherapy in 4-6 b.i.d. fractions followed by EBRT 45 Gy in 25 fractions ± chemotherapy.</p><p><strong>Results: </strong>Median follow-up was 8.1 years (range, 0.1-21.6). Forty patients (26.3%) developed RTOG grade ≥ 3 adverse events, mainly soft tissue necrosis (11.2%) and osteoradionecrosis (6.6%). The 5-year local and locoregional control rates were 85.5% and 74.9%, respectively. Five-year disease-free survival and overall survival rates were 54.9% and 62.2%, respectively.</p><p><strong>Conclusion: </strong>Adjuvant HDR brachytherapy alone or combined with EBRT is an adequate treatment option for HNC patients who are candidates to receive postoperative radiation/chemoradiation. The results obtained in terms of toxicity and locoregional control are comparable to standard chemoradiation. In addition, this study identifies a subset of patients that may benefit from adjuvant HDR in terms of reduced toxicity, provided that the high-risk CTV does not exceed 15 cm³ and is treated to EQD2-DVH TV₁₀₀ doses of less than 87 Gy, together with a mandible_2cm3 of less than 61 Gy.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}