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A Multidisciplinary Approach in Head and Neck Malignancies
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A Multidisciplinary Approach in Head and Neck Malignancies

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 17814

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Marco Zeppieri

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Guest Editor
Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
Interests: glaucoma; general ophthalmology; intraocular pressure; tonometry; mesenchymal stem cell; eyes; visual fields; clinical ophthalmology
Special Issues, Collections and Topics in MDPI journals
Dr. Tamara Ius

E-Mail Website
Guest Editor
Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, 33100 Udine, Italy
Interests: neurosurgery; glioma; meningioma; glioblastoma; brain mapping; real-time neuropsychological testing; brain tractography
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Filippo Flavio Angileri

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Guest Editor
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgery Unit, University of Messina, Messina, Italy
Interests: brain tumor; skull base surgery; pituitary tumor; gliomas, meningiomas
Dr. Antonio Pontoriero

E-Mail Website
Guest Editor
Radiotherapy Unit, University of Messina, Messina, Italy
Interests: CyberKnife; radiosurgery; SBRT; FSRT; radiotherapy
Special Issues, Collections and Topics in MDPI journals
Dr. Alessandro Tel

E-Mail Website
Guest Editor
Department of Maxillofacial Surgery, University of Udine, Udine, Italy
Interests: maxillofacial surgery; computer-guided surgery; virtual reality; augmented reality; 3D printing; liquid biopsy; maxillofacial oncology; temporomandibular joint; orthognathic surgery

Special Issue Information

Dear Colleagues,

Head and malignancies involve a highly complex anatomical district, in which a multidisciplinary approach is of utmost importance when it comes to clinical management, surgical strategies and adjuvant therapies. Head and neck cancers account for a high number of diagnoses and deaths each year, being the 7th most frequent tumor worldwide. Local therapy with surgery and radiotherapy represent the most effective treatments for these tumors, while systemic chemotherapy tends to be mostly considered in tumor relapse. Current ongoing studies have been providing new insights into the stem cell and molecular mechanisms of these tumors, which may pave the way to novel treatment options in the near future. 

New strategies and approaches aim at less invasive techniques, increased radicality and simulation 3D technology. Modern methods tend to consider anatomic variability, virtual 3D reconstruction, and functional restoration. Virtual planning and 3D imaging and printing represent the most important advances in technology in diagnostic and surgical settings. Current literature has shown that these methods are being increasingly applied, providing postoperative clinical success. Computerized preoperative and perioperative planning with precise definition of resection areas and enhanced visualization can contribute to cleaner margins, more effective reconstruction, and greater extent of tumor resection, with the aim of preserving function.

Modern diagnostic approaches are showing substantial progresses, especially in the field of liquid biopsy, allowing to characterize neoplasms from a non-invasive sampling, directly performed on liquid matrices. Molecular and histopathology markers are becoming of great interest in grading severity and providing prognostic factors and scores that can be beneficial in the individual planning and management of patients. Real time continuous perioperative neurophysiological testing, novel staining markers, awake surgery and modern surgical tools have shown benefits in terms of greater extent of resection and survival.   

The primary goals of this Special Issue are to provide a collection of pertinent topics and highlight the importance of innovative and multidisciplinary approaches in head and neck malignancies, with regards to novel diagnostic tools, surgical strategies, and adjuvant therapies in managing patients with these lesions.

Dr. Marco Zeppieri
Dr. Tamara Ius
Prof. Dr. Filippo Flavio Angileri
Dr. Antonio Pontoriero
Dr. Alessandro Tel
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neurosurgery
  • maxillofacial surgery
  • radiotherapy
  • chemotherapy

Published Papers (13 papers)

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Research

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15 pages, 7565 KiB  
Article
The Prognostic Role of Volumetric MRI Evaluation in the Surgical Treatment of Glioblastoma
by Denis Aiudi, Alessio Iacoangeli, Mauro Dobran, Gabriele Polonara, Mario Chiapponi, Andrea Mattioli, Maurizio Gladi and Maurizio Iacoangeli
J. Clin. Med. 2024, 13(3), 849; https://doi.org/10.3390/jcm13030849 - 1 Feb 2024
Viewed by 549
Abstract
Background: Glioblastoma is the most common primary brain neoplasm in adults, with a poor prognosis despite a constant effort to improve patient survival. Some neuroradiological volumetric parameters seem to play a predictive role in overall survival (OS) and progression-free survival (PFS). The [...] Read more.
Background: Glioblastoma is the most common primary brain neoplasm in adults, with a poor prognosis despite a constant effort to improve patient survival. Some neuroradiological volumetric parameters seem to play a predictive role in overall survival (OS) and progression-free survival (PFS). The aim of this study was to analyze the impact of the volumetric areas of contrast-enhancing tumors and perineoplastic edema on the survival of patients treated for glioblastoma. Methods: A series of 87 patients who underwent surgery was retrospectively analyzed; OS and PFS were considered the end points of the study. For each patient, a multidisciplinary revision was conducted in collaboration with the Neuroradiology and Neuro-Oncology Board. Manual and semiautomatic measurements were adopted to perform the radiological evaluation, and the following quantitative parameters were retrospectively analyzed: contrast enhancement preoperative tumor volume (CE-PTV), contrast enhancement postoperative tumor volume (CE-RTV), edema/infiltration preoperative volume (T2/FLAIR-PV), edema/infiltration postoperative volume (T2/FLAIR-RV), necrosis volume inside the tumor (NV), and total tumor volume including necrosis (TV). Results: The median OS value was 9 months, and the median PFS value was 4 months; the mean values were 12.3 and 6.9 months, respectively. Multivariate analysis showed that the OS-related factors were adjuvant chemoradiotherapy (p < 0.0001), CE-PTV < 15 cm3 (p = 0.03), surgical resection > 95% (p = 0.004), and the presence of a “pseudocapsulated” radiological morphology (p = 0.04). Conclusions: Maximal safe resection is one of the most relevant predictive factors for patient survival. Semiautomatic preoperative MRI evaluation could play a key role in prognostically categorizing these tumors. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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20 pages, 7371 KiB  
Article
Quantitative Anatomical Comparison of Surgical Approaches to Meckel’s Cave
by Luca Zanin, Edoardo Agosti, Florian Ebner, Lucio de Maria, Francesco Belotti, Barbara Buffoli, Rita Rezzani, Bernard Hirt, Marco Ravanelli, Tamara Ius, Marco Zeppieri, Marcos Soares Tatagiba, Marco Maria Fontanella and Francesco Doglietto
J. Clin. Med. 2023, 12(21), 6847; https://doi.org/10.3390/jcm12216847 - 30 Oct 2023
Cited by 1 | Viewed by 1599
Abstract
Background: Meckel’s cave is a challenging surgical target due to its deep location and proximity to vital neurovascular structures. Surgeons have developed various microsurgical transcranial approaches (MTAs) to access it, but there is no consensus on the best method. Newer endoscopic approaches have [...] Read more.
Background: Meckel’s cave is a challenging surgical target due to its deep location and proximity to vital neurovascular structures. Surgeons have developed various microsurgical transcranial approaches (MTAs) to access it, but there is no consensus on the best method. Newer endoscopic approaches have also emerged. This study seeks to quantitatively compare these surgical approaches to Meckel’s cave, offering insights into surgical volumes and exposure areas. Methods: Fifteen surgical approaches were performed bilaterally in six specimens, including the pterional approach (PTA), fronto-temporal-orbito-zygomatic approach (FTOZA), subtemporal approach (STA), Kawase approach (KWA), retrosigmoid approach (RSA), retrosigmoid approach with suprameatal extension (RSAS), endoscopic endonasal transpterygoid approach (EETPA), inferolateral transorbital approach (ILTEA) and superior eyelid approach (SEYA). All the MTAs were performed both with 10 mm and 15 mm of brain retraction, to consider different percentages of surface exposure. A dedicated navigation system was used to quantify the surgical working volumes and exposure of different areas of Meckel’s cave (ApproachViewer, part of GTx-Eyes II, University Health Network, Toronto, Canada). Microsurgical transcranial approaches were quantified with two different degrees of brain retraction (10 mm and 15 mm). Statistical analysis was performed using a mixed linear model with bootstrap resampling. Results: The RSAS with 15 mm of retraction offered the maximum exposure of the trigeminal stem (TS). If compared to the KWA, the RSA exposed more of the TS (69% vs. 46%; p = 0.01). The EETPA and ILTEA exposed the Gasserian ganglion (GG) mainly in the anteromedial portion, but with a significant 20% gain in exposure provided by the EETPA compared to ILTEA (42% vs. 22%; p = 0.06). The STA with 15 mm of retraction offered the maximum exposure of the GG, with a significant gain in exposure compared to the STA with 10 mm of retraction (50% vs. 35%; p = 0.03). The medial part of the three trigeminal branches was mainly exposed by the EETPA, particularly for the ophthalmic (66%) and maxillary (83%) nerves. The EETPA offered the maximum exposure of the medial part of the mandibular nerve, with a significant gain in exposure compared to the ILTEA (42% vs. 11%; p = 0.01) and the SEY (42% vs. 2%; p = 0.01). The FTOZA offered the maximum exposure of the lateral part of the ophthalmic nerve, with a significant gain of 67% (p = 0.03) and 48% (p = 0.04) in exposure compared to the PTA and STA, respectively. The STA with 15 mm of retraction offered the maximum exposure of the lateral part of the maxillary nerve, with a significant gain in exposure compared to the STA with 10 mm of retraction (58% vs. 45%; p = 0.04). The STA with 15 mm of retraction provided a significant exposure gain of 23% for the lateral part of the mandibular nerve compared to FTOZA with 15 mm of retraction (p = 0.03). Conclusions: The endoscopic approaches, through the endonasal and transorbital routes, can provide adequate exposure of Meckel’s cave, especially for its more medial portions, bypassing the impediment of major neurovascular structures and significant brain retraction. As far as the most lateral portion of Meckel’s cave, MTA approaches still seem to be the gold standard in obtaining optimal exposure and adequate surgical volumes. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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15 pages, 31526 KiB  
Article
The Transorbital Approach, A Game-Changer in Neurosurgery: A Guide to Safe and Reliable Surgery Based on Anatomical Principles
by Matteo de Notaris, Matteo Sacco, Francesco Corrivetti, Michele Grasso, Sergio Corvino, Amedeo Piazza, Doo-Sik Kong and Giorgio Iaconetta
J. Clin. Med. 2023, 12(20), 6484; https://doi.org/10.3390/jcm12206484 - 12 Oct 2023
Cited by 5 | Viewed by 1440
Abstract
During the last few years, the superior eyelid endoscopic transorbital approach has been proposed as a new minimally invasive pathway to access skull base lesions, mostly in ophthalmologic, otolaryngologic, and maxillofacial surgeries. However, most neurosurgeons performing minimally invasive endoscopic neurosurgery do not usually [...] Read more.
During the last few years, the superior eyelid endoscopic transorbital approach has been proposed as a new minimally invasive pathway to access skull base lesions, mostly in ophthalmologic, otolaryngologic, and maxillofacial surgeries. However, most neurosurgeons performing minimally invasive endoscopic neurosurgery do not usually employ the orbit as a surgical corridor. The authors undertook this technical and anatomical study to contribute a neurosurgical perspective, exploring the different possibilities of this novel route. Ten dissections were performed on ten formalin-fixed specimens to further refine the transorbital technique. As part of the study, the authors also report an illustrative transorbital surgery case to further detail key surgical landmarks. Herein, we would like to discuss equipment, key anatomical landmarks, and surgical skills and stress the steps and details to ensure a safe and successful procedure. We believe it could be critical to promote and encourage the neurosurgical community to overcome difficulties and ensure a successful surgery by following these key recommendations. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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10 pages, 2643 KiB  
Article
Thalamopeduncular Tumors in Pediatric Age: Advanced Preoperative Imaging to Define Safe Surgical Planning: A Multicentric Experience
by Alberto D’Amico, Giulia Melinda Furlanis, Valentina Baro, Luca Sartori, Andrea Landi, Domenico d’Avella, Francesco Sala and Luca Denaro
J. Clin. Med. 2023, 12(17), 5521; https://doi.org/10.3390/jcm12175521 - 25 Aug 2023
Cited by 1 | Viewed by 657
Abstract
Background: Thalamopeduncular tumors are challenging lesions arising at the junction between the thalamus and the cerebral peduncle. They represent 1–5% of pediatric brain tumors, are mainly pilocytic astrocytoma and occur within the first two decades of life. To date, the optimal treatment [...] Read more.
Background: Thalamopeduncular tumors are challenging lesions arising at the junction between the thalamus and the cerebral peduncle. They represent 1–5% of pediatric brain tumors, are mainly pilocytic astrocytoma and occur within the first two decades of life. To date, the optimal treatment remains unclear. Methods: We retrospectively reviewed pediatric patients who underwent surgery for thalamopeduncular tumors in the Academic Pediatric Neurosurgery Unit of Padova and Verona from 2005 to 2022. We collected information on age, sex, symptoms, preoperative and postoperative neuroradiological studies, histological specimens, surgical approaches, and follow-up. Results: We identified eight patients with a mean age of 9 years. All lesions were pilocytic astrocytoma. The main symptoms were spastic hemiparesis, cranial nerve palsy, headache, and ataxia. The corticospinal tract was studied in all patients using diffusion-tensor imaging brain MRI and in two patients using navigated transcranial magnetic stimulation. The transsylvian approach was the most frequently used. A gross total resection was achieved in two patients, a subtotal resection in five and a partial resection in one. In three patients, a second treatment was performed due to the regrowth of the tumor, performing an additional surgery in two cases and a second-look surgery followed by adjuvant therapy in one. After the surgery, four patients maintained stability in their postoperative neurological exam, two patients improved, and two worsened but in one of them, an improvement during recovery occurred. At the last follow-up available, three patients were disease-free, four had a stable tumor residual, and only one patient died from the progression of the disease. Conclusions: Advanced preoperative tools allow one to define a safe surgical strategy. Due to the indolent behavior of thalamopeduncular tumors, surgery should be encouraged. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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14 pages, 581 KiB  
Article
Radiologically Defined Sarcopenia as a Biomarker for Frailty and Malnutrition in Head and Neck Skin Cancer Patients
by Aniek T. Zwart, Laurence M. C. Kok, Julius de Vries, Marloes S. van Kester, Rudi A. J. O. Dierckx, Geertruida H. de Bock, Anouk van der Hoorn and Gyorgy B. Halmos
J. Clin. Med. 2023, 12(10), 3445; https://doi.org/10.3390/jcm12103445 - 13 May 2023
Cited by 2 | Viewed by 1390
Abstract
The aim of this study was to evaluate whether radiologically defined sarcopenia, or a low skeletal muscle index (SMI), could be used as a practical biomarker for frailty and postoperative complications (POC) in patients with head and neck skin cancer (HNSC). This was [...] Read more.
The aim of this study was to evaluate whether radiologically defined sarcopenia, or a low skeletal muscle index (SMI), could be used as a practical biomarker for frailty and postoperative complications (POC) in patients with head and neck skin cancer (HNSC). This was a retrospective study on prospectively collected data. The L3 SMI (cm2/m2) was calculated with use of baseline CT or MRI neck scans and low SMIs were defined using sex-specific cut-off values. A geriatric assessment with a broad range of validated tools was performed at baseline. POC was graded with the Clavien–Dindo Classification (with a grade of > II as the cut-off). Univariate and multivariable regression analyses were performed with low SMIs and POC as the endpoints. The patients’ (n = 57) mean age was 77.0 ± 9 years, 68.4% were male, and 50.9% had stage III–IV cancer. Frailty was determined according to Geriatric 8 (G8) score (OR 7.68, 95% CI 1.19–49.66, p = 0.032) and the risk of malnutrition was determined according to the Malnutrition Universal Screening Tool (OR 9.55, 95% CI 1.19–76.94, p = 0.034), and these were independently related to low SMIs. Frailty based on G8 score (OR 5.42, 95% CI 1.25–23.49, p = 0.024) was the only variable related to POC. However, POC was more prevalent in patients with low SMIs (∆ 19%, OR 1.8, 95% CI 0.5–6.0, p = 0.356).To conclude, a low SMI is a practical biomarker for frailty and malnutrition in HNSC. Future research should be focused on interventions based on low SMI scores and assess the effect of the intervention on SMI, frailty, malnutrition, and POC. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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13 pages, 2064 KiB  
Article
EGFR-Driven Mutation in Non-Small-Cell Lung Cancer (NSCLC) Influences the Features and Outcome of Brain Metastases
by Daniele Armocida, Alessandro Pesce, Mauro Palmieri, Fabio Cofano, Giuseppe Palmieri, Paola Cassoni, Carla Letizia Busceti, Francesca Biagioni, Diego Garbossa, Francesco Fornai, Antonio Santoro and Alessandro Frati
J. Clin. Med. 2023, 12(10), 3372; https://doi.org/10.3390/jcm12103372 - 9 May 2023
Cited by 3 | Viewed by 1714
Abstract
Background: Brain metastases (BMs) is one of the most frequent metastatic sites for non-small-cell lung cancer (NSCLC). It is a matter of debate whether EGFR mutation in the primary tumor may be a marker for the disease course, prognosis, and diagnostic imaging of [...] Read more.
Background: Brain metastases (BMs) is one of the most frequent metastatic sites for non-small-cell lung cancer (NSCLC). It is a matter of debate whether EGFR mutation in the primary tumor may be a marker for the disease course, prognosis, and diagnostic imaging of BMs, comparable to that described for primary brain tumors, such as glioblastoma (GB). This issue was investigated in the present research manuscript. Methods: We performed a retrospective study to identify the relevance of EGFR mutations and prognostic factors for diagnostic imaging, survival, and disease course within a cohort of patients affected by NSCLC-BMs. Imaging was carried out using MRI at various time intervals. The disease course was assessed using a neurological exam carried out at three-month intervals. The survival was expressed from surgical intervention. Results: The patient cohort consisted of 81 patients. The overall survival of the cohort was 15 ± 1.7 months. EGFR mutation and ALK expression did not differ significantly for age, gender, and gross morphology of the BM. Contrariwise, the EGFR mutation was significantly associated with MRI concerning the occurrence of greater tumor (22.38 ± 21.35 cm3 versus 7.68 ± 6.44 cm3, p = 0.046) and edema volume (72.44 ± 60.71 cm3 versus 31.92 cm3, p = 0.028). In turn, the occurrence of MRI abnormalities was related to neurological symptoms assessed using the Karnofsky performance status and mostly depended on tumor-related edema (p = 0.048). However, the highest significant correlation was observed between EGFR mutation and the occurrence of seizures as the clinical onset of the neoplasm (p = 0.004). Conclusions: The presence of EGFR mutations significantly correlates with greater edema and mostly a higher seizure incidence of BMs from NSCLC. In contrast, EGFR mutations do not affect the patient’s survival, the disease course, and focal neurological symptoms but seizures. This contrasts with the significance of EGFR in the course and prognosis of the primary tumor (NSCLC). Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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13 pages, 776 KiB  
Article
Impact of Alcohol and Smoking on Outcomes of HPV-Related Oropharyngeal Cancer
by Yu-Hsuan Lai, Chien-Chou Su, Shang-Yin Wu, Wei-Ting Hsueh, Yuan-Hua Wu, Helen H. W. Chen, Jenn-Ren Hsiao, Ching-Hsun Liu and Yi-Shan Tsai
J. Clin. Med. 2022, 11(21), 6510; https://doi.org/10.3390/jcm11216510 - 2 Nov 2022
Cited by 6 | Viewed by 3111
Abstract
Background: The aim of this study was to evaluate the impact of adverse lifestyle factors on outcomes in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Methods: From 2010 to 2019, 150 consecutive non-metastatic OPSCC patients receiving curative treatment in our [...] Read more.
Background: The aim of this study was to evaluate the impact of adverse lifestyle factors on outcomes in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Methods: From 2010 to 2019, 150 consecutive non-metastatic OPSCC patients receiving curative treatment in our institution were retrospectively enrolled. HPV positivity was defined as p16 expression ≥75%. The effects of adverse lifestyle factors on overall survival (OS) and disease-free survival (DFS) on OPSCC patients were determined. Results: The median follow-up duration was 3.6 years. Of the 150 OPSCCs, 51 (34%) patients were HPV-positive and 99 (66%) were HPV-negative. The adverse lifestyle exposure rates were 74.7% (n = 112) alcohol use, 57.3% (n = 86) betel grid chewing, and 78% (n = 117) cigarette smoking. Alcohol use strongly interacted with HPV positivity (HR, 6.00; 95% CI, 1.03–35.01), leading to an average 26.1% increased risk of disease relapse in patients with HPV-positive OPSCC. Heavy smoking age ≥30 pack-years was associated with increased risk of death (HR, 2.05; 95% CI, 1.05–4.00) and disease relapse (HR, 1.99; 95% CI, 1.06–3.75) in OPSCC patients. In stratified analyses, the 3-year absolute risk of disease relapse in HPV-positive OPSCC patients reached up to 50% when alcohol use and heavy smoking for ≥30 pack-years were combined. Conclusions: Alcohol acted as a significant treatment-effect modifier for DFS in HPV-positive OPSCC patients, diluting the favorable prognostic effect of HPV positivity. Heavy smoking age ≥30 pack-years was an independent adverse prognostic factor of OS and DFS in OPSCC patients. De-intensification treatment for HPV-related OPSCC may be avoided when these adverse lifestyle factors are present. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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Review

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12 pages, 269 KiB  
Review
Understanding and Managing Pineal Parenchymal Tumors of Intermediate Differentiation: An In-Depth Exploration from Pathology to Adjuvant Therapies
by Andrea Bianconi, Flavio Panico, Bruna Lo Zito, Andrea Do Trinh, Paola Cassoni, Umberto Ricardi, Diego Garbossa, Fabio Cofano, Cristina Mantovani and Luca Bertero
J. Clin. Med. 2024, 13(5), 1266; https://doi.org/10.3390/jcm13051266 - 23 Feb 2024
Viewed by 638
Abstract
Background: Pineal parenchymal cell tumors constitute a rare group of primary central nervous system neoplasms (less than 1%). Their classification, especially the intermediate subtype (PPTIDs), remains challenging. Methods: A literature review was conducted, navigating through anatomo-pathological, radiotherapy, and neurosurgical dimensions, aiming for a [...] Read more.
Background: Pineal parenchymal cell tumors constitute a rare group of primary central nervous system neoplasms (less than 1%). Their classification, especially the intermediate subtype (PPTIDs), remains challenging. Methods: A literature review was conducted, navigating through anatomo-pathological, radiotherapy, and neurosurgical dimensions, aiming for a holistic understanding of these tumors. Results: PPTIDs, occupying an intermediate spectrum of malignancy, reveal diverse histological patterns, mitotic activity, and distinct methylation profiles. Surgical treatment is the gold standard, but when limited to partial removal, radiotherapy becomes crucial. While surgical approaches are standardized, due to the low prevalence of the pathology and absence of randomized prospective studies, there are no shared guidelines about radiation treatment modalities. Conclusion: Surgical removal remains pivotal, demanding a personalized approach based on the tumor extension. This review underscores the considerable variability in treatment approaches and reported survival rates within the existing literature, emphasizing the need for ongoing research to better define optimal therapeutic strategies and prognostic factors for PPTIDs, aiming for further and more detailed stratification among them. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
17 pages, 601 KiB  
Review
Primary Intracranial Gliosarcoma: Is It Really a Variant of Glioblastoma? An Update of the Clinical, Radiological, and Biomolecular Characteristics
by Domenico La Torre, Attilio Della Torre, Erica Lo Turco, Prospero Longo, Dorotea Pugliese, Paola Lacroce, Giuseppe Raudino, Alberto Romano, Angelo Lavano and Francesco Tomasello
J. Clin. Med. 2024, 13(1), 83; https://doi.org/10.3390/jcm13010083 - 22 Dec 2023
Viewed by 870
Abstract
Gliosarcomas (GS) are sporadic malignant tumors classified as a Glioblastoma (GBM) variant with IDH-wild type phenotype. It appears as a well-circumscribed lesion with a biphasic, glial, and metaplastic mesenchymal component. The current knowledge about GS comes from the limited literature. Furthermore, recent studies [...] Read more.
Gliosarcomas (GS) are sporadic malignant tumors classified as a Glioblastoma (GBM) variant with IDH-wild type phenotype. It appears as a well-circumscribed lesion with a biphasic, glial, and metaplastic mesenchymal component. The current knowledge about GS comes from the limited literature. Furthermore, recent studies describe peculiar characteristics of GS, such as hypothesizing that it could be a clinical–pathological entity different from GBM. Here, we review radiological, biomolecular, and clinical data to describe the peculiar characteristics of PGS, treatment options, and outcomes in light of the most recent literature. A comprehensive literature review of PubMed and Web of Science databases was conducted for articles written in English focused on gliosarcoma until 2023. We include relevant data from a few case series and only a single meta-analysis. Recent evidence describes peculiar characteristics of PGS, suggesting that it might be a specific clinical–pathological entity different from GBM. This review facilitates our understanding of this rare malignant brain tumor. However, in the future we recommend multi-center studies and large-scale metanalyses to clarify the biomolecular pathways of PGS to develop new specific therapeutic protocols, different from conventional GBM therapy in light of the new therapeutic opportunities. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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12 pages, 470 KiB  
Review
Primary Anaplastic-Lymphoma-Kinase-Positive Large-Cell Lymphoma of the Central Nervous System: Comprehensive Review of the Literature
by Antonio Colamaria, Augusto Leone, Francesco Carbone, Yasser Andres Dallos Laguado, Nicola Pio Fochi, Matteo Sacco, Cinzia Fesce, Francesca Sanguedolce, Guido Giordano, Giorgio Iaconetta, Uwe Spetzger, Luigi Coppola, Elena De Santis, Giulia Coppola and Matteo De Notaris
J. Clin. Med. 2023, 12(24), 7516; https://doi.org/10.3390/jcm12247516 - 5 Dec 2023
Viewed by 817
Abstract
Background: Primary anaplastic-lymphoma-kinase (ALK)-positive large-cell lymphoma of the central nervous system (PCNS ALK-positive ALCL) is a rare entity, with a limited consensus reached regarding its management. While this pathology often presents as solitary lesions, the occurrence of multiple tumors within the brain is [...] Read more.
Background: Primary anaplastic-lymphoma-kinase (ALK)-positive large-cell lymphoma of the central nervous system (PCNS ALK-positive ALCL) is a rare entity, with a limited consensus reached regarding its management. While this pathology often presents as solitary lesions, the occurrence of multiple tumors within the brain is not uncommon. The lack of distinctive radiological features poses a diagnostic challenge, leading to delays in initiating targeted therapy. Methods: We conducted a comprehensive literature search, identifying seventeen publications for qualitative analysis. Results: The management options and reported patient outcomes in the literature varied significantly, emphasizing the need for a patient-specific approach. The emergence of ALK-specific inhibitors represents a new frontier in this field, demonstrating promising results. Conclusion: PCNS ALK-positive ALCL necessitates a comprehensive understanding and optimized management strategies. A tailored therapeutic approach, integrating surgical intervention with radiotherapy and chemotherapy, appears pivotal in addressing this pathology. The implementation of a therapeutic protocol is anticipated for further advancement in this field. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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Other

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12 pages, 1257 KiB  
Case Report
Real-Time Neuropsychological Testing (RTNT) and Music Listening during Glioblastoma Excision in Awake Surgery: A Case Report
by Grazia D’Onofrio, Nadia Icolaro, Elena Fazzari, Domenico Catapano, Antonello Curcio, Antonio Izzi, Aldo Manuali, Giuliano Bisceglia, Angelo Tancredi, Vincenzo Marchello, Andreaserena Recchia, Maria Pia Tonti, Luca Pazienza, Vincenzo Carotenuto, Costanzo De Bonis, Luciano Savarese, Alfredo Del Gaudio and Leonardo Pio Gorgoglione
J. Clin. Med. 2023, 12(18), 6086; https://doi.org/10.3390/jcm12186086 - 20 Sep 2023
Cited by 1 | Viewed by 1066
Abstract
In this case report, real-time neuropsychological testing (RTNT) and music listening were applied for resections in the left temporal–parietal lobe during awake surgery (AS). The case is based on a 66-year-old with glioblastoma and alterations in expressive language and memory deficit. Neuropsychological assessment [...] Read more.
In this case report, real-time neuropsychological testing (RTNT) and music listening were applied for resections in the left temporal–parietal lobe during awake surgery (AS). The case is based on a 66-year-old with glioblastoma and alterations in expressive language and memory deficit. Neuropsychological assessment was run at baseline (2–3 days before surgery), discharge from hospital (2–3 days after surgery), and follow-up (1 month and 3 months). RTNT was started before beginning the anesthetic approach (T0) and during tumor excision (T1 and T2). At T0, T1, and T2 (before performing neuropsychological tests), music listening was applied. Before AS and after music listening, the patient reported a decrease in depression and anxiety. During AS, an improvement was shown in all cognitive parameters collected at T0, T1, and T2. After the excision and music listening, the patient reported a further decrease in depression and anxiety. Three days post surgery, and at follow-ups of one month and three months, the patient reported a further improvement in cognitive aspects, the absence of depression, and a reduction in anxiety symptoms. In conclusion, RTNT has been useful in detecting cognitive function levels during tumor excision. Music listening during AS decreased the patient’s anxiety and depression symptoms. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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28 pages, 2545 KiB  
Systematic Review
Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes
by Edoardo Agosti, Marco Zeppieri, Lucio De Maria, Marcello Mangili, Alessandro Rapisarda, Tamara Ius, Leopoldo Spadea, Carlo Salati, Alessandro Tel, Antonio Pontoriero, Stefano Pergolizzi, Filippo Flavio Angileri, Marco Maria Fontanella and Pier Paolo Panciani
J. Clin. Med. 2023, 12(18), 5840; https://doi.org/10.3390/jcm12185840 - 8 Sep 2023
Cited by 3 | Viewed by 1114
Abstract
Background: Spheno-orbital meningiomas (SOMs) are rare tumors arising from the meninges surrounding the sphenoid bone and orbital structures. Surgical resection is the primary treatment approach for SOMs. Several surgical approaches have been described during the decades, including microsurgical transcranial (MTAs), endoscopic endonasal (EEAs), [...] Read more.
Background: Spheno-orbital meningiomas (SOMs) are rare tumors arising from the meninges surrounding the sphenoid bone and orbital structures. Surgical resection is the primary treatment approach for SOMs. Several surgical approaches have been described during the decades, including microsurgical transcranial (MTAs), endoscopic endonasal (EEAs), endoscopic transorbital (ETOAs), and combined approaches, and the choice of surgical approach remains a topic of debate. Purpose: This systematic review and meta-analysis aim to compare the clinical and surgical outcomes of different surgical approaches used for the treatment of SOMs, discussing surgical techniques, outcomes, and factors influencing surgical decision making. Methods: A comprehensive literature review of the databases PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted for articles published on the role of surgery for the treatment of SOMs until 2023. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Meta-analysis was performed to estimate pooled event rates and assess heterogeneity. Fixed- and random-effects were used to assess 95% confidential intervals (CIs) of presenting symptoms, outcomes, and complications. Results: A total of 59 studies comprising 1903 patients were included in the systematic review and meta-analysis. Gross total resection (GTR) rates ranged from 23.5% for ETOAs to 59.8% for MTAs. Overall recurrence rate after surgery was 20.7%. Progression-free survival (PFS) rates at 5 and 10 years were 75.5% and 49.1%, respectively. Visual acuity and proptosis improvement rates were 57.5% and 79.3%, respectively. Postoperative cranial nerve (CN) focal deficits were observed in 20.6% of cases. The overall cerebro-spinal fluid (CSF) leak rate was 3.9%, and other complications occurred in 13.9% of cases. MTAs showed the highest GTR rates (59.8%, 95%CI = 49.5–70.2%; p = 0.001) but were associated with increased CN deficits (21.0%, 95%CI = 14.5–27.6%). ETOAs had the lowest GTR rates (23.5%, 95%CI = 0.0–52.5%; p = 0.001), while combined ETOA and EEA had the highest CSF leak rates (20.3%, 95%CI = 0.0–46.7%; p = 0.551). ETOAs were associated with better proptosis improvement (79.4%, 95%CI = 57.3–100%; p = 0.002), while anatomical class I lesions were associated with better visual acuity (71.5%, 95%CI = 63.7–79.4; p = 0.003) and proptosis (60.1%, 95%CI = 38.0–82.2; p = 0.001) recovery. No significant differences were found in PFS rates between surgical approaches. Conclusion: Surgical treatment of SOMs aims to preserve visual function and improve proptosis. Different surgical approaches offer varying rates of GTR, complications, and functional outcomes. A multidisciplinary approach involving a skull base team is crucial for optimizing patient outcomes. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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8 pages, 1195 KiB  
Brief Report
A Treatment Approach for Carotid Blowout Syndrome and Soft Tissue Reconstruction after Radiotherapy in Patients with Oral Cancer: A Report of 2 Cases
by Tobias Moest, Marco Rainer Kesting, Maximilian Rohde, Werner Lang, Alexander Meyer, Manuel Weber and Rainer Lutz
J. Clin. Med. 2023, 12(9), 3221; https://doi.org/10.3390/jcm12093221 - 30 Apr 2023
Viewed by 1700
Abstract
Background: This retrospective case series study aims to demonstrate a salvage technique for the treatment of carotid blow-out syndrome (CBS) in irradiated head and neck cancer patients with a vessel-depleted neck. Methods: Between October 2017 and October 2021, two patients (N = 2) [...] Read more.
Background: This retrospective case series study aims to demonstrate a salvage technique for the treatment of carotid blow-out syndrome (CBS) in irradiated head and neck cancer patients with a vessel-depleted neck. Methods: Between October 2017 and October 2021, two patients (N = 2) with CBS were treated at our institution in a multidisciplinary approach together with the Department of Vascular Surgery. Patients were characterized based on diagnoses, treatment procedures, and the subsequent postoperative course. Results: Surgical emergency intervention was performed in both cases. The transition zone from the common carotid artery (CCA) to the internal carotid artery (ICA) was resected and reconstructed with a xenogic (case 1) or autogenic (case 2) interposition (end-to-end anastomosis). To allow reconstruction of the vascular defect, an additional autologous vein graft was anastomosed to the interposition graft in an end-to-side technique, allowing arterial anastomosis for a free microvascular flap without re-clamping of the ICA. Because of the intraoperative ICA reconstruction, none of the patients suffered a neurological deficit. Conclusions: The techniques presented in the form of two case reports allow for acute bleeding control, cerebral perfusion, and the creation of a vascular anastomosis option in the vessel-depleted neck. Full article
(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)
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