Liucija Weselik

Treating patients with squamous cell carcinoma of the head and neck is a significant problem. There is an increase in the incidence of malignant neoplasms in this region. Surgery, radiotherapy, and chemotherapy are often not sufficient methods of treatment. Thorough analysis of processes occurring in the tumor microenvironment has allowed to distinguish three stages that make up the reaction of the human body to hostile antigens, which are tumor antigens. Understanding these mechanisms has resulted in the introduction of a new term immunooncology. It is an area of cancer treatment that focuses on the use of the patient's immune system to combat the disease. Immunotherapy has had positive effects in cancer patients. The use of immune checkpoint inhibitors, such as anti-CTLA-4 and PD-1 monoclonal antibodies has enabled the modulation of T cell functions, consequently eliminating immunosuppression in the tumor microenvironment. Clinical trials were conducted using nivolumab and ipilimumab, which confirmed their clinical usefulness. The approval by FDA of nivolumab in the treatment of recurrent and metastatic squamous cell carcinoma of the head and neck has increased the overall survival time of patients as well as disease-free survival. Statistical data indicate an advantage of immunotherapy over other treatment methods at an advanced stage of cancer. This work aims to discuss basic issues related to immunotherapy, in particular, immunotherapy in patients with squamous cell carcinoma of the head and neck.

AIM: The aim of the study was to assess the accuracy of radiological diagnosis of laryngeal cartilage infiltration by histopathological examination of laryngeal specimen after total laryngectomy. BACKGROUND: Despite the development of new medical technologies and significant clinical advances allowing early diagnosis and treatment of laryngeal cancer, mortality is still on the rise. Neoplastic infiltration of the laryngeal cartilages is the most common source of error in the assessment of cancer staging. Furthermore, cartilage invasion is listed as a contraindication to partial surgical techniques as well as radiotherapy. MATERIALS AND METHODS: The study was carried out on 21 larynges following total laryngectomy. Before taking the decision to perform surgery, high-resolution CT scans were performed in all cases. An extended histopathological examination was conducted using a unique vertical cross-section of the whole larynx. RESULTS: Pathology reported 2 cases of arytenoid cartilage invasion, 5 cases of cricoid cartilage invasion, 12 cases of thyroid cartilage penetration, 1 case of internal cortex invasion and 9 cases of extra-laryngeal spread. CT imaging identified 8 of 13 cases (61.5%) of pathologically proven invasion of thyroid cartilage and only 2 cases (2/9, 22%) of extra-laryngeal spread. According to CT results, arytenoid cartilage invasion was correctly identified in 2 cases, cricoid cartilage invasion in 4 (4/5, 80%). The positive predictive values for thyroid, cricoid and arytenoid cartilage invasion and penetration were 80%, 66.7% and 50%, respectively. In case of pre-laryngeal spread the positive predictive value was 100%. CONCLUSION: Despite increasingly advanced methods involved in the diagnosis of laryngeal cancer, many discrepancies may be observed between the radiological and histopathological assessments. CT imaging has limitations especially in thyroid cartilage penetration and extra-laryngeal spread assessment in advanced laryngeal cancer cases. An extended histopathological examination, involving vertical cross-sections of the whole larynx is a very precise study that allows a precise determination of local cancer staging (T).

INTRODUCTION: The anterolateral thigh flap (ALT) is one of the most commonly used grafts in head and neck reconstructive surgery. In this type of surgery, it is essential that the vascular pedicle be long enough to ensure proper vascular anastomosis. However, it is difficult to accurately estimate the pedicle length preoperatively. In this context, the current study had two aims: (1) to assess the value of colour Doppler sonography (CDS) in the preoperative assessment of the vascular pedicle and (2) to develop a mathematical model to predict the length of the vascular pedicle based on the ultrasound findings. MATERIALS AND METHODS: Retrospective review of patients who underwent primary surgery for head and neck cancer followed by ALT flap reconstruction at our institution from 2014 to 2018. All patients underwent CDS prior to surgical excision of the flap. RESULTS: Preoperative CDS was useful to identify the location of the vascular perforators, to estimate the pedicle length, and to identify the vascularization variant. Using the proposed mathematical formula, the estimated minimum pedicle length and actual length agreed in 73.9% of cases, increasing to 84.1% when a 5 mm margin of error was allowed. Moreover, preoperative ultrasound accurately distinguished the two anatomical variants of the ALT vasculature in nearly all cases (97.1%). CONCLUSION: This study confirms the value of preoperative colour Doppler sonography for ALT flap reconstruction. The proposed mathematical model provides a highly accurate method of preoperatively assessing the length of the vascular pedicle, which may be of value in head and neck surgery.