Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic On January 30, 2020, the World Health Organization formally announced that the novel coronavirus disease (COVID-19) caused by SARS-CoV-2 is a worldwide health emergency. Subsequently, all National Health Systems and each medical center faced the exceptional emergency and severe changes in their organizations. Consequently, there were various implications that needed to be addressed for oncology patients. In this sense, there are some practical and important issues in the management of head and neck cancer patients: (i) they are usually older and usually present with medical comorbidities (e.g., COPD and other tobacco-related diseases) that are associated with a higher risk of severe complications associated with COVID-19; (ii) high risk of SARS-CoV-2 exposure (transportation, daily radiation fractions, multiple consultations with multidisciplinary team members); (iii) cancer treatment can potentially and theoretically increase the risk of more severe complications of COVID-19 [1]. Of interest, the main risk factors for head and neck squamous cell carcinoma (HNSCC), tobacco and alcohol, also increase the risk for COVID-19 infection. One Chinese study reported an increased risk of cancer-related deaths associated with notorious difficulties of access to oncologic care. In addition, a nationwide analysis in China indicated that the risk of severe respiratory complications leading to admission to the intensive care unit, invasive ventilation, or death was much higher in cancer patients than in patients without cancer (39% vs. 8%, p = 0.0003). Moreover, patients who underwent chemotherapy or surgery in the past month had a numerically higher risk of clinically severe events than did those not receiving chemotherapy or surgery, irrespective of age, smoking history or co-morbidity (odds ratio 5.34, p = 0.0026) [2-5]. The majority of hospitals will be treating thousands of COVID-19 patients in the next few weeks and thus, there is an urgent need to preserve patient and staff safety. For this reason, the Center for Diseases Control (CDC) in the United States recommends that healthcare facilities interrupt elective care and restrict their activities to providing urgent and emergency visits and procedures. It is recommended that all elective and non-time sensitive procedures and admissions must be rescheduled [6]. There is a critical need to share skills and expertise to propose recommendations for the diagnosis and treatment of HNSCC patients throughout the COVID-19 pandemic. As healthcare professionals and HNSCC experts, we aim to offer emergency guidelines aiming to reduce the risk of patient harm, by reducing their risk of exposure to SARS-CoV-2, without compromising their treatment and outcome. As a disclaimer, this is a general guideline and the following recommendations are suggested to help the multidisciplinary teams in the diagnosis and treatment of HNSCC patients, considering local constraints...

Over the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

Our study, which is one of the largest to date on the topic, shows that FHD lesions are a common complication after radiotherapy for childhood PCNST. The young brain is probably more susceptible to radiation-induced late cerebrovascular injury. Diffuse small vessel disease and ceiling effect may account for the low topographic concordance we found. The clinical implications of FHD lesions in this specific population are yet to be clarified.

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BackgroundEarly-stage oropharyngeal squamous cell carcinoma (OPSCC) can currently be treated by surgical resection or definitive radiotherapy (RT). The aim of this study is to review the outcomes of early-stage OPSCC submitted to surgery or primary RT. Preliminary results have shown similar overall survival (OS) and locoregional recurrence-free survival (LRFS).Material/MethodsRetrospective study of patients with cT1-T2 cN0-N1 OPSCC, diagnosed between January 2009 and December 2014, treated with surgery or primary RT.Results61 patients with cT1-T2 cN0-N1 OPSCC were included. Forty-two (69%) were submitted to surgical resection, of which 37 (88%) had adjuvant treatment (24 received RT and 13 chemoradiotherapy). Nineteen (31%) were treated with primary RT, and 3 of them had concurrent chemotherapy. RT was given with intensity-modulated radiation therapy (IMRT) (71%) or three-dimensional conformal radiation therapy (3D-CRT) (29%). At a median follow-up of 5.4 years, there were 3 tumor persistences, 5 local failures, 2 regional failures and no distant metastasis. The 3-year and 5-year OS were 77% and 71% in the RT group vs. 71% and 59% in the surgery group, respectively (HR 0.60, 95% CI 0.22–1.61; p = 0.30). The 3-year and 5-year LRFS were 71% and 64% in the RT group vs. 66% and 50% in the surgery group, respectively (HR 0.59, 95% CI 0.24–1.45; p = 0.24). Up to 34% had acute grade 3 toxicity and 11% had grade 4 osteoradionecrosis of the jaw.ConclusionsLonger follow-up still does not show a significant difference in OS and LRFS between both treatments. Because most patients submitted to surgery required adjuvant RT and since its side-effects were not negligible, further studies are warranted to better suit the first treatment for each patient and to prevent the need for adjuvant treatment and the risk of toxicity.

Our findings indicate a small deterioration for a global QoL status, and large deterioration for cognitive function after radiation treatments, as well as worsening of brain metastasis related symptom items. Further research is necessary to refine treatment selection for patients with brain metastases, since it may at least contribute to the stabilization of their QoL status.

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