Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis

Blanchard P, Lee A, Marguet S, Leclercq J, Ng W, Ma J, Chan A, Huang P, Benhamou E, Zhu G, Chua D, Chen Y, Mai H, Kwong D, Cheah S, Moon J, Tung Y, Chi K, Fountzilas G, Zhang L, Hui E, Lu T, Bourhis J, Pignon J, MAC-NPC Collaborative Group ; Lancet Oncology (May 2015)

BACKGROUND A previous individual patient data meta-analysis by the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma (MAC-NPC) collaborative group to assess the addition of chemotherapy to radiotherapy showed that it improves overall survival in nasopharyngeal carcinoma. This benefit was restricted to patients receiving concomitant chemotherapy and radiotherapy. The aim of this study was to update the meta-analysis, include recent trials, and to analyse separately the benefit of concomitant plus adjuvant chemotherapy.

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Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

Schwab R, Kim C, Bagchi S, Keenan B, Comyn F, Wang S, Tapia I, Huang S, Traylor J, Torigian D, Bradford R, Marcus C; American Journal of Respiratory and Critical Care Medicine (Apr 2015)   
RATIONALE Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Since many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than children.
OBJECTIVES To investigate the anatomic risk factors in adolescents with OSAS compared to obese and lean controls, using magnetic resonance imaging (MRI).
METHODS Three groups of adolescents (12-16 years) underwent MRI: obese OSAS (n=56), obese controls (n=41) and lean controls (n=53).
MEASUREMENTS AND MAIN RESULTS We studied 150 subjects and found that (1) obese adolescents with OSAS had increased adenotonsillar tissue compared to obese and lean controls; (2) obese OSAS adolescents had a smaller nasopharyngeal airway compared to controls; (3) the size of other upper airway soft tissue structures (volume of the tongue, parapharyngeal fat pads, lateral walls, soft palate) was similar between OSAS and obese controls; (4) although there were no major craniofacial abnormalities in most adolescents with OSAS, the ratio of soft tissue to craniofacial space surrounding the airway was increased; and (5) there were gender differences in the pattern of lymphoid proliferation.
CONCLUSIONS Increased size of the pharyngeal lymphoid tissue, rather than enlargement of the upper airway soft tissue structures, is the primary anatomic risk factor for OSAS in obese adolescents. These results are important for clinical decision making, and suggest that adenotonsillectomy should be considered as the initial treatment for OSAS in obese adolescents, a group with poor CPAP adherence and difficulty achieving weight loss.

Morbidities after maxillary swing nasopharyngectomy for recurrent nasopharyngeal carcinoma

 Chan J, Tsang R, Wei W; Head & Neck 37 (4), 487-92 (Apr 2015) 

BACKGROUND The purpose of this study was to investigate the complications after maxillary swing nasopharyngectomy.
METHODS Salvage nasopharyngectomy was performed for 338 patients during 1990 to 2012. Patient and tumor characteristics, perioperative and intraoperative information, and long-term morbidities were analyzed.RESULTS There were significantly more patients with locally advanced tumors (rT3 and rT4) operated during the recent study period (2002-2012). However, the mean operative time and blood loss was significantly lower than in the earlier period (1990-2001). There was no hospital mortality. There was a significant reduction in the postoperative trismus and palatal fistula formation. Patients with locally advanced tumor, particularly those who required adjuvant chemoradiation, had a higher chance of facial numbness, nasal blockage, and swallowing problems after surgery.
CONCLUSION Salvage nasopharyngectomy via the maxillary swing approach is safe with acceptable long-term morbidities. Prevention of complications associated with surgery, particularly for patients with locally advanced tumors, is crucial to ensure the best outcome of surgery.

Mini-invasive surgery of infratemporal fossa schwannomas

 Haidar H, Deveze A, Lavieille J; Journal of Laryngology & Otology 1-7 (Jan 2015)

Background: Infratemporal fossa schwannomas are benign, encapsulated tumours of the trigeminal nerve limited to the infratemporal fossa. Because of the complications and significant morbidity associated with traditional surgical approaches to the infratemporal fossa, which include facial nerve dysfunction, hearing loss, dental malocclusion and cosmetic problems, less invasive alternatives have been sought.

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Nasal and oral snoring endoscopy: novel and promising diagnostic tools in OSAS patients

 Lovato A, Kotecha B, Vianello A, Giacomelli L, Staffieri A, Marchese-Ragona R; European Archives of Oto-Rhino-Laryngology (Jan 2015)

 The aim of the present study was to investigate if any of the three awake procedures [fiberoptic nasopharyngoscopy with modified Müller Maneuver (FNMM), nasal snoring endoscopy (NSE), or oral snoring endoscopy (OSE)] could efficiently predict the grade or pattern of upper airway (UA) collapse found with drug-induced sleep endoscopy (DISE), which is considered by many authors as the current gold standard in optimizing obstructive sleep apnea syndrome (OSAS) patient selection for UA surgery.

Leer más: Nasal and oral snoring endoscopy: novel and promising diagnostic tools in OSAS patients