René Leemans - Academia.edu (original) (raw)

Papers by René Leemans

Research paper thumbnail of Psychological Problems among Head and Neck Cancer Patients in Relation to Utilization of Healthcare and Informal Care and Costs in the First Two Years after Diagnosis

Current Oncology

Background: To investigate associations between psychological problems and the use of healthcare ... more Background: To investigate associations between psychological problems and the use of healthcare and informal care and total costs among head and neck cancer (HNC) patients. Method: Data were used of the NETherlands QUality of Life and Biomedical Cohort study. Anxiety and depression disorder (diagnostic interview), distress, symptoms of anxiety and depression (HADS), and fear of cancer recurrence (FCR) and cancer worry scale (CWS) were measured at baseline and at 12-month follow-up. Care use and costs (questionnaire) were measured at baseline, 3-, 6-, 12-, and 24-month follow-up. Associations between psychological problems and care use/costs were investigated using logistic and multiple regression analyses. Results: Data of 558 patients were used. Distress, symptoms of anxiety or depression, FCR, and/or anxiety disorder at baseline were significantly associated with higher use of primary care, supportive care, and/or informal care (odds ratios (ORs) between 1.55 and 4.76). Symptoms ...

Research paper thumbnail of Early Response Prediction of Multiparametric Functional MRI and 18F-FDG-PET in Patients with Head and Neck Squamous Cell Carcinoma Treated with (Chemo)Radiation

Cancers

Background: Patients with locally-advanced head and neck squamous cell carcinoma (HNSCC) have var... more Background: Patients with locally-advanced head and neck squamous cell carcinoma (HNSCC) have variable responses to (chemo)radiotherapy. A reliable prediction of outcomes allows for enhancing treatment efficacy and follow-up monitoring. Methods: Fifty-seven histopathologically-proven HNSCC patients with curative (chemo)radiotherapy were prospectively included. All patients had an MRI (DW,-IVIM, DCE-MRI) and 18F-FDG-PET/CT before and 10 days after start-treatment (intratreatment). Primary tumor functional imaging parameters were extracted. Univariate and multivariate analysis were performed to construct prognostic models and risk stratification for 2 year locoregional recurrence-free survival (LRFFS), distant metastasis-free survival (DMFS) and overall survival (OS). Model performance was measured by the cross-validated area under the receiver operating characteristic curve (AUC). Results: The best LRFFS model contained the pretreatment imaging parameters ADC_kurtosis, Kep and SUV_pe...

Research paper thumbnail of A Prospectively Validated Prognostic Model for Patients with Locally Advanced Squamous Cell Carcinoma of the Head and Neck Based on Radiomics of Computed Tomography Images

Cancers

Background: Locoregionally advanced head and neck squamous cell carcinoma (HNSCC) patients have h... more Background: Locoregionally advanced head and neck squamous cell carcinoma (HNSCC) patients have high relapse and mortality rates. Imaging-based decision support may improve outcomes by optimising personalised treatment, and support patient risk stratification. We propose a multifactorial prognostic model including radiomics features to improve risk stratification for advanced HNSCC, compared to TNM eighth edition, the gold standard. Patient and methods: Data of 666 retrospective- and 143 prospective-stage III-IVA/B HNSCC patients were collected. A multivariable Cox proportional-hazards model was trained to predict overall survival (OS) using diagnostic CT-based radiomics features extracted from the primary tumour. Separate analyses were performed using TNM8, tumour volume, clinical and biological variables, and combinations thereof with radiomics features. Patient risk stratification in three groups was assessed through Kaplan–Meier (KM) curves. A log-rank test was performed for sig...

Research paper thumbnail of The Additional Value of Ultrafast DCE-MRI to DWI-MRI and 18F-FDG-PET to Detect Occult Primary Head and Neck Squamous Cell Carcinoma

Cancers

To evaluate diagnostic accuracy of qualitative analysis and interobserver agreement of single ult... more To evaluate diagnostic accuracy of qualitative analysis and interobserver agreement of single ultrafast-DCE, DWI or 18F-FDG-PET and the combination of modalities for the detection of unknown primary tumor (UPT) in patients presenting with cervical lymph node metastasis from squamous cell carcinoma (SCC). Between 2014–2019, patients with histologically proven cervical lymph node metastasis of UPT SCC were prospectively included and underwent DWI, ultrafast-DCE, and 18F-FDG-PET/CT. Qualitative assessment was performed by two observers per modality. Interobserver agreement was calculated using the proportion specific agreement. Diagnostic accuracy of combined use of DWI, ultrafast-DCE and 18F-FDG-PET/CT was assessed. Twenty-nine patients were included (20 males. [68%], median age 60 years). Nine (31%) primary tumors remained occult. Ultrafast-DCE added reader confidence for suspicious locations (one additional true positive (5%), 2 decisive true malignant (10%). The per-location analys...

Research paper thumbnail of s response to reviews Title : Genomic profiling identifies common HPV-associated chromosomal alterations in squamous cell carcinomas of cervix and head and neck

Research paper thumbnail of Prevalence of neurocognitive and perceived speech deficits in patients with head and neck cancer before treatment: Associations with demographic, behavioral, and disease‐related factors

Head & Neck, 2021

Background: Neurocognition and speech, relevant domains in head and neck cancer (HNC), may be aff... more Background: Neurocognition and speech, relevant domains in head and neck cancer (HNC), may be affected pretreatment. However, the prevalence of pretreatment deficits and their possible concurrent predictors are poorly understood. Methods: Using an HNC prospective cohort (Netherlands Quality of Life and Biomedical Cohort Study, N ≥ 444) with a cross-sectional design, we investigated the estimated prevalence of pretreatment deficits and their relationship with selected demographic, behavioral, and disease-related factors.

Research paper thumbnail of Controversies on the management of the clinically negative neck

Nowotwory, 2003

Adequate management of the clinically negative neck is vital and should be balanced between over ... more Adequate management of the clinically negative neck is vital and should be balanced between over and undertreatment. Compared to clinical examination ultrasound-guided fine-needle aspiration cytology (USgFNAC) at initial staging can reduce the risk of occult metastases for T1-T2 squamous cell carcinoma of the oral cavity or oropharynx considerably to 20%, which justifies local excision of the tumour and a wait-and-see policy for the neck. SN identification and aspiration did not decrease the false-negative rate, and we have therefore abandoned its use in this setting. Using USgFNAC for follow-up enabled early detection of a significant percentage of neck failures and a high salvage rate with therapeutic neck dissection of 80%. Detecting subclinical neck metastases continues to challenge clinicians and debate continues. Uk∏ad ch∏onny szyi klinicznie wolny od przerzutow – co robic?

Research paper thumbnail of Microvascular reconstructive surgery of the head and neck

Nowotwory, 2003

Reconstructive objectives after major head and neck surgery include adequate wound healing, optim... more Reconstructive objectives after major head and neck surgery include adequate wound healing, optimal residual function (i.e., swallowing and speech), restoration of sensation and bulk replacement when necessary. With the techniques available it is not feasible to replace excised tissues with tissue that mimics its complex movements and changes in shape. We must therefore attempt to maximise the patient's possibility for compensatory mechanisms. The most appropriate means to achieve this is currently through the application of free flaps, i.e., transfer of suitable distant tissue to the recipient site by means of microvascular anastomoses [1-3]. Our recent experience in selecting donor vessels in free flap reconstruction with a total of 370 free flaps performed in the last 72 months, include for arterial anastomosis the facial artery in 64% of cases, the remainder being the superior thyroid (25%), transverse cervical (10%), and superficial temporal arteries (1%). For venous anasto...

Research paper thumbnail of 935 Attraction of immune cells by head and neck cancer cell lines and primary tumor-conditioned supernatants

Journal for ImmunoTherapy of Cancer, 2021

BackgroundHead and neck squamous cell carcinomas (HNSCC) are classified in human papillomavirus (... more BackgroundHead and neck squamous cell carcinomas (HNSCC) are classified in human papillomavirus (HPV)-positive and HPV-negative tumors. In general, HPV-negative HNSCC are genetically characterized by many chromosomal gains and losses.1 Previously, we and others identified a HPV-negative subgroup with few or absent copy number alterations (CNA-silent), and a more favorable prognosis.2 3 Tumors with low copy number changes have generally been associated with high immune infiltration scores,4 but for CNA-silent versus CNA-high HPV-negative HNSCC such data are lacking.In this study we aim to unravel by functional assays immunological differences between HPV-negative and HPV-positive HNSCC, as well as between CNA-silent and CNA-high HPV-negative HNSCC. We analyzed the immune cell subsets attracted by HNSCC cell lines and by tumor-conditioned supernatants.MethodsEight HNSCC cell lines (3 HPV-positive, 3 HPV-negative CNA-high, 2 HPV-negative CNA-silent) and 24-hour supernatants of thirteen...

Research paper thumbnail of NK Cell-Dependent Antibody-Mediated Immunotherapy Is Improved In Vitro and In Vivo When Combined with Agonists for Toll-like Receptor 2 in Head and Neck Cancer Models

International Journal of Molecular Sciences, 2021

The immunosuppressive character of head and neck cancers may explain the relatively low response ... more The immunosuppressive character of head and neck cancers may explain the relatively low response rates to antibody therapy targeting a tumor antigen, such as cetuximab, and anti-PD-1 checkpoint inhibition. Immunostimulatory agents that overcome tumor-derived inhibitory signals could augment therapeutic efficacy, thereby enhancing tumor elimination and improving patient survival. Here, we demonstrate that cetuximab treatment combined with immunostimulatory agonists for Toll-like receptor (TLR) 2 induces profound immune responses. Natural killer (NK) cells, isolated from healthy individuals or patients with head and neck cancer, harbored enhanced cytotoxic capacity and increased tumor-killing potential in vitro. Additionally, combination treatment increased the release of several pro-inflammatory cytokines and chemokines by NK cells. Tumor-bearing mice that received cetuximab and the TLR2 ligand Pam3CSK4 showed increased infiltration of immune cells into the tumors compared to mice th...

Research paper thumbnail of Resection Margins in Head and Neck Cancer Surgery: An Update of Residual Disease and Field Cancerization

Cancers, 2021

Surgery is one of the mainstays of head and neck cancer treatment, and aims at radical resection ... more Surgery is one of the mainstays of head and neck cancer treatment, and aims at radical resection of the tumor with 1 cm tumor-free margins to obtain locoregional control. Surgical margins are evaluated by histopathological examination of the resection specimen. It has been long an enigma that approximately 10–30% of surgically treated head and neck cancer patients develop locoregional recurrences even though the resection margins were microscopically tumor-free. However, the origins of these recurrences have been elucidated by a variety of molecular studies. Recurrences arise either from minimal residual disease, cancer cells in the surgical margins that escape detection by the pathologist when examining the specimen, or from precancerous mucosal changes that may remain unnoticed. Head and neck tumors develop in mucosal precursor changes that are sometimes visible but mostly not, fueling research into imaging modalities such as autofluorescence, to improve visualization. Mostly unno...

Research paper thumbnail of Body image distress in head and neck cancer patients: what are we looking at?

Supportive Care in Cancer, 2020

Purpose The aim of the present study is to investigate the prevalence of body image distress amon... more Purpose The aim of the present study is to investigate the prevalence of body image distress among head and neck cancer (HNC) patients after treatment and to examine its association with sociodemographic and clinical factors, health-related quality of life (HRQOL), HNC symptoms, sexuality, self-compassion, and psychological distress. Second, we aim to explore daily life experiences of HNC patients regarding body image. Methods A cross-sectional survey among HNC patients investigated the prevalence of body image distress based on the Body Image Scale. Multivariable logistic regression analysis was applied to study associations with sociodemographic and clinical factors, HRQOL (EORTC QLQ-C30), HNC symptoms (QLQ-HN43), sexuality (FSFI-6; IIEF-5), self-compassion (SCS-SF), and psychological distress (HADS). Qualitative data from a body image writing intervention was used to explore experiences in daily life related to body image. Results Body image distress was prevalent in 13–20% (depe...

Research paper thumbnail of A structured expressive writing activity targeting body image-related distress among head and neck cancer survivors: who do we reach and what are the effects?

Supportive Care in Cancer, 2021

Purpose The aim of this pretest–posttest study was to investigate the reach and effects of My Cha... more Purpose The aim of this pretest–posttest study was to investigate the reach and effects of My Changed Body (MyCB), an expressive writing activity based on self-compassion, among head and neck cancer (HNC) survivors. Methods This pilot study had a pretest–posttest design. HNC survivors received an invitation to complete a baseline survey on body image-related distress. At the end of the survey, HNC survivors were asked if they were interested in the intervention study. This entailed the writing activity and a survey 1 week and 1 month post-intervention. The reach was calculated by dividing the number of participants in the intervention study, by the number of (1) eligible HNC survivors and (2) those who filled in the baseline survey. Linear mixed models were used to analyze the effect on body image-related distress. Logistic regression analysis was used to investigate factors associated with the reach and reduced body image-related distress. MyCB was evaluated using study-specific qu...

Research paper thumbnail of Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience

Cancers, 2020

Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modalit... more Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%, p = 0.612) and negative predictive value (NPV) (93%, p = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) (p < 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, p = 0.006) and NPV (90% vs. 97%, p = 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%, ...

Research paper thumbnail of Management of multiple secreting paragangliomas in an SDHD variant carrier

The Annals of Thoracic Surgery, 2019

Management of functional intrathoracic sympathetic paragangliomas in SDHD mutation carriers is ch... more Management of functional intrathoracic sympathetic paragangliomas in SDHD mutation carriers is challenging, and there is no uniform guideline for treatment to date. The risks of potential malignant behavior and long-term cardiovascular morbidity have to be weighed against the risks of treatment complications. We report the multidisciplinary and shared decision-making approach that resulted in successful surgical removal of three paragangliomas in a SDHD mutation carrier.

Research paper thumbnail of Neck dissection

Stell and Maran's Textbook of Head and Neck Surgery and Oncology Fifth edition, 2012

Research paper thumbnail of Objective Acoustic-Phonetic Speech Analysis in Patients Treated for Oral or Oropharyngeal Cancer

Folia Phoniatrica et Logopaedica, 2009

Objective: Speech impairment often occurs in patients after treatment for head and neck cancer. N... more Objective: Speech impairment often occurs in patients after treatment for head and neck cancer. New treatment modalities such as surgical reconstruction or (chemo)radiation techniques aim at sparing anatomical structures that are correlated with speech and swallowing. In randomized trials investigating efficacy of various treatment modalities or speech rehabilitation, objective speech analysis techniques may add to improve speech outcome assessment. The goal of the present study is to investigate the role of objective acoustic-phonetic analyses in a multidimensional speech assessment protocol. Patients and Methods: Speech recordings of 51 patients (6 months after reconstructive surgery and postoperative radiotherapy for oral or oropharyngeal cancer) and of 18 control speakers were subjectively evaluated regarding intelligibility, nasal resonance, articulation, and patient-reported speech outcome (speech subscale of the European Organization for Research and Treatment of Cancer Quali...

Research paper thumbnail of New Developments for Optimal Management of Head and Neck Cancer

Oncology Research and Treatment, 2004

Research paper thumbnail of Systematic review: Accuracy of imaging tests in the diagnosis of recurrent laryngeal carcinoma after radiotherapy

Head & Neck, 2008

This review assessed the accuracy of imaging tests for recurrent laryngeal carcinoma after radiot... more This review assessed the accuracy of imaging tests for recurrent laryngeal carcinoma after radiotherapy and concluded that 18-fluorodeoxyglucose positron emission tomography was sufficiently promising for a randomised controlled trial comparing it with conventional work-up. The included studies were small and few, which created wide confidence intervals around the sensitivity and specificity; further accuracy data might be useful before any trial. Authors' objectives To determine the diagnostic accuracy of imaging tests, which were computed tomography (CT), magnetic resonance imaging (MRI), thallium-201 scintigraphy, and 18-fluorodeoxyglucose (FDG) positron emission tomography (PET), in patients with a suspicion of recurrent laryngeal carcinoma after radiotherapy. This means that the authors' conclusion that these data were sufficient to justify a randomised controlled trial might be an overstatement and further accuracy data might be useful before a trial.

Research paper thumbnail of Detection of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG-PET versus conventional modalities

European Journal of Nuclear Medicine and Molecular Imaging, 2002

In 1%-2% of head and neck oncology patients, the only symptom of a malignancy is a positive cervi... more In 1%-2% of head and neck oncology patients, the only symptom of a malignancy is a positive cervical node. The aim of this study was to compare the value of positron emission tomography using fluorine-18 fluoro-2-deoxy-D-glucose (FDG-PET) and conventional diagnostic modalities (CT and/or MRI, panendoscopy) in detecting unknown primary tumours and distant metastases in patients suffering from such a cervical metastasis. Fifty patients (37 men and 13 women) with cervical metastases of an unknown primary tumour were included. All patients underwent FDG-PET. In addition, CT and/or MRI was obtained and panendoscopy was performed. All clinically known metastases were detected by FDG-PET. The primary tumour could be diagnosed in 16 patients (four primary tumours were detected exclusively by FDG-PET). Seven patients had multiple distant metastases, that in six cases were detected exclusively by FDG-PET. The sensitivity and specificity of FDG-PET for detection of unknown primary tumours were 100% and 94%, respectively. For the conventional diagnostic modalities these values were 92% and 76%. FDG-PET had an exclusive effect on the applied therapy in 20% of the patients referred for diagnosis of an unknown primary tumour. The data obtained in this study strongly support the diagnostic strategy of performing FDG-PET in patients suffering from cervical metastases of an unknown primary tumour before any other diagnostic technique.

Research paper thumbnail of Psychological Problems among Head and Neck Cancer Patients in Relation to Utilization of Healthcare and Informal Care and Costs in the First Two Years after Diagnosis

Current Oncology

Background: To investigate associations between psychological problems and the use of healthcare ... more Background: To investigate associations between psychological problems and the use of healthcare and informal care and total costs among head and neck cancer (HNC) patients. Method: Data were used of the NETherlands QUality of Life and Biomedical Cohort study. Anxiety and depression disorder (diagnostic interview), distress, symptoms of anxiety and depression (HADS), and fear of cancer recurrence (FCR) and cancer worry scale (CWS) were measured at baseline and at 12-month follow-up. Care use and costs (questionnaire) were measured at baseline, 3-, 6-, 12-, and 24-month follow-up. Associations between psychological problems and care use/costs were investigated using logistic and multiple regression analyses. Results: Data of 558 patients were used. Distress, symptoms of anxiety or depression, FCR, and/or anxiety disorder at baseline were significantly associated with higher use of primary care, supportive care, and/or informal care (odds ratios (ORs) between 1.55 and 4.76). Symptoms ...

Research paper thumbnail of Early Response Prediction of Multiparametric Functional MRI and 18F-FDG-PET in Patients with Head and Neck Squamous Cell Carcinoma Treated with (Chemo)Radiation

Cancers

Background: Patients with locally-advanced head and neck squamous cell carcinoma (HNSCC) have var... more Background: Patients with locally-advanced head and neck squamous cell carcinoma (HNSCC) have variable responses to (chemo)radiotherapy. A reliable prediction of outcomes allows for enhancing treatment efficacy and follow-up monitoring. Methods: Fifty-seven histopathologically-proven HNSCC patients with curative (chemo)radiotherapy were prospectively included. All patients had an MRI (DW,-IVIM, DCE-MRI) and 18F-FDG-PET/CT before and 10 days after start-treatment (intratreatment). Primary tumor functional imaging parameters were extracted. Univariate and multivariate analysis were performed to construct prognostic models and risk stratification for 2 year locoregional recurrence-free survival (LRFFS), distant metastasis-free survival (DMFS) and overall survival (OS). Model performance was measured by the cross-validated area under the receiver operating characteristic curve (AUC). Results: The best LRFFS model contained the pretreatment imaging parameters ADC_kurtosis, Kep and SUV_pe...

Research paper thumbnail of A Prospectively Validated Prognostic Model for Patients with Locally Advanced Squamous Cell Carcinoma of the Head and Neck Based on Radiomics of Computed Tomography Images

Cancers

Background: Locoregionally advanced head and neck squamous cell carcinoma (HNSCC) patients have h... more Background: Locoregionally advanced head and neck squamous cell carcinoma (HNSCC) patients have high relapse and mortality rates. Imaging-based decision support may improve outcomes by optimising personalised treatment, and support patient risk stratification. We propose a multifactorial prognostic model including radiomics features to improve risk stratification for advanced HNSCC, compared to TNM eighth edition, the gold standard. Patient and methods: Data of 666 retrospective- and 143 prospective-stage III-IVA/B HNSCC patients were collected. A multivariable Cox proportional-hazards model was trained to predict overall survival (OS) using diagnostic CT-based radiomics features extracted from the primary tumour. Separate analyses were performed using TNM8, tumour volume, clinical and biological variables, and combinations thereof with radiomics features. Patient risk stratification in three groups was assessed through Kaplan–Meier (KM) curves. A log-rank test was performed for sig...

Research paper thumbnail of The Additional Value of Ultrafast DCE-MRI to DWI-MRI and 18F-FDG-PET to Detect Occult Primary Head and Neck Squamous Cell Carcinoma

Cancers

To evaluate diagnostic accuracy of qualitative analysis and interobserver agreement of single ult... more To evaluate diagnostic accuracy of qualitative analysis and interobserver agreement of single ultrafast-DCE, DWI or 18F-FDG-PET and the combination of modalities for the detection of unknown primary tumor (UPT) in patients presenting with cervical lymph node metastasis from squamous cell carcinoma (SCC). Between 2014–2019, patients with histologically proven cervical lymph node metastasis of UPT SCC were prospectively included and underwent DWI, ultrafast-DCE, and 18F-FDG-PET/CT. Qualitative assessment was performed by two observers per modality. Interobserver agreement was calculated using the proportion specific agreement. Diagnostic accuracy of combined use of DWI, ultrafast-DCE and 18F-FDG-PET/CT was assessed. Twenty-nine patients were included (20 males. [68%], median age 60 years). Nine (31%) primary tumors remained occult. Ultrafast-DCE added reader confidence for suspicious locations (one additional true positive (5%), 2 decisive true malignant (10%). The per-location analys...

Research paper thumbnail of s response to reviews Title : Genomic profiling identifies common HPV-associated chromosomal alterations in squamous cell carcinomas of cervix and head and neck

Research paper thumbnail of Prevalence of neurocognitive and perceived speech deficits in patients with head and neck cancer before treatment: Associations with demographic, behavioral, and disease‐related factors

Head & Neck, 2021

Background: Neurocognition and speech, relevant domains in head and neck cancer (HNC), may be aff... more Background: Neurocognition and speech, relevant domains in head and neck cancer (HNC), may be affected pretreatment. However, the prevalence of pretreatment deficits and their possible concurrent predictors are poorly understood. Methods: Using an HNC prospective cohort (Netherlands Quality of Life and Biomedical Cohort Study, N ≥ 444) with a cross-sectional design, we investigated the estimated prevalence of pretreatment deficits and their relationship with selected demographic, behavioral, and disease-related factors.

Research paper thumbnail of Controversies on the management of the clinically negative neck

Nowotwory, 2003

Adequate management of the clinically negative neck is vital and should be balanced between over ... more Adequate management of the clinically negative neck is vital and should be balanced between over and undertreatment. Compared to clinical examination ultrasound-guided fine-needle aspiration cytology (USgFNAC) at initial staging can reduce the risk of occult metastases for T1-T2 squamous cell carcinoma of the oral cavity or oropharynx considerably to 20%, which justifies local excision of the tumour and a wait-and-see policy for the neck. SN identification and aspiration did not decrease the false-negative rate, and we have therefore abandoned its use in this setting. Using USgFNAC for follow-up enabled early detection of a significant percentage of neck failures and a high salvage rate with therapeutic neck dissection of 80%. Detecting subclinical neck metastases continues to challenge clinicians and debate continues. Uk∏ad ch∏onny szyi klinicznie wolny od przerzutow – co robic?

Research paper thumbnail of Microvascular reconstructive surgery of the head and neck

Nowotwory, 2003

Reconstructive objectives after major head and neck surgery include adequate wound healing, optim... more Reconstructive objectives after major head and neck surgery include adequate wound healing, optimal residual function (i.e., swallowing and speech), restoration of sensation and bulk replacement when necessary. With the techniques available it is not feasible to replace excised tissues with tissue that mimics its complex movements and changes in shape. We must therefore attempt to maximise the patient's possibility for compensatory mechanisms. The most appropriate means to achieve this is currently through the application of free flaps, i.e., transfer of suitable distant tissue to the recipient site by means of microvascular anastomoses [1-3]. Our recent experience in selecting donor vessels in free flap reconstruction with a total of 370 free flaps performed in the last 72 months, include for arterial anastomosis the facial artery in 64% of cases, the remainder being the superior thyroid (25%), transverse cervical (10%), and superficial temporal arteries (1%). For venous anasto...

Research paper thumbnail of 935 Attraction of immune cells by head and neck cancer cell lines and primary tumor-conditioned supernatants

Journal for ImmunoTherapy of Cancer, 2021

BackgroundHead and neck squamous cell carcinomas (HNSCC) are classified in human papillomavirus (... more BackgroundHead and neck squamous cell carcinomas (HNSCC) are classified in human papillomavirus (HPV)-positive and HPV-negative tumors. In general, HPV-negative HNSCC are genetically characterized by many chromosomal gains and losses.1 Previously, we and others identified a HPV-negative subgroup with few or absent copy number alterations (CNA-silent), and a more favorable prognosis.2 3 Tumors with low copy number changes have generally been associated with high immune infiltration scores,4 but for CNA-silent versus CNA-high HPV-negative HNSCC such data are lacking.In this study we aim to unravel by functional assays immunological differences between HPV-negative and HPV-positive HNSCC, as well as between CNA-silent and CNA-high HPV-negative HNSCC. We analyzed the immune cell subsets attracted by HNSCC cell lines and by tumor-conditioned supernatants.MethodsEight HNSCC cell lines (3 HPV-positive, 3 HPV-negative CNA-high, 2 HPV-negative CNA-silent) and 24-hour supernatants of thirteen...

Research paper thumbnail of NK Cell-Dependent Antibody-Mediated Immunotherapy Is Improved In Vitro and In Vivo When Combined with Agonists for Toll-like Receptor 2 in Head and Neck Cancer Models

International Journal of Molecular Sciences, 2021

The immunosuppressive character of head and neck cancers may explain the relatively low response ... more The immunosuppressive character of head and neck cancers may explain the relatively low response rates to antibody therapy targeting a tumor antigen, such as cetuximab, and anti-PD-1 checkpoint inhibition. Immunostimulatory agents that overcome tumor-derived inhibitory signals could augment therapeutic efficacy, thereby enhancing tumor elimination and improving patient survival. Here, we demonstrate that cetuximab treatment combined with immunostimulatory agonists for Toll-like receptor (TLR) 2 induces profound immune responses. Natural killer (NK) cells, isolated from healthy individuals or patients with head and neck cancer, harbored enhanced cytotoxic capacity and increased tumor-killing potential in vitro. Additionally, combination treatment increased the release of several pro-inflammatory cytokines and chemokines by NK cells. Tumor-bearing mice that received cetuximab and the TLR2 ligand Pam3CSK4 showed increased infiltration of immune cells into the tumors compared to mice th...

Research paper thumbnail of Resection Margins in Head and Neck Cancer Surgery: An Update of Residual Disease and Field Cancerization

Cancers, 2021

Surgery is one of the mainstays of head and neck cancer treatment, and aims at radical resection ... more Surgery is one of the mainstays of head and neck cancer treatment, and aims at radical resection of the tumor with 1 cm tumor-free margins to obtain locoregional control. Surgical margins are evaluated by histopathological examination of the resection specimen. It has been long an enigma that approximately 10–30% of surgically treated head and neck cancer patients develop locoregional recurrences even though the resection margins were microscopically tumor-free. However, the origins of these recurrences have been elucidated by a variety of molecular studies. Recurrences arise either from minimal residual disease, cancer cells in the surgical margins that escape detection by the pathologist when examining the specimen, or from precancerous mucosal changes that may remain unnoticed. Head and neck tumors develop in mucosal precursor changes that are sometimes visible but mostly not, fueling research into imaging modalities such as autofluorescence, to improve visualization. Mostly unno...

Research paper thumbnail of Body image distress in head and neck cancer patients: what are we looking at?

Supportive Care in Cancer, 2020

Purpose The aim of the present study is to investigate the prevalence of body image distress amon... more Purpose The aim of the present study is to investigate the prevalence of body image distress among head and neck cancer (HNC) patients after treatment and to examine its association with sociodemographic and clinical factors, health-related quality of life (HRQOL), HNC symptoms, sexuality, self-compassion, and psychological distress. Second, we aim to explore daily life experiences of HNC patients regarding body image. Methods A cross-sectional survey among HNC patients investigated the prevalence of body image distress based on the Body Image Scale. Multivariable logistic regression analysis was applied to study associations with sociodemographic and clinical factors, HRQOL (EORTC QLQ-C30), HNC symptoms (QLQ-HN43), sexuality (FSFI-6; IIEF-5), self-compassion (SCS-SF), and psychological distress (HADS). Qualitative data from a body image writing intervention was used to explore experiences in daily life related to body image. Results Body image distress was prevalent in 13–20% (depe...

Research paper thumbnail of A structured expressive writing activity targeting body image-related distress among head and neck cancer survivors: who do we reach and what are the effects?

Supportive Care in Cancer, 2021

Purpose The aim of this pretest–posttest study was to investigate the reach and effects of My Cha... more Purpose The aim of this pretest–posttest study was to investigate the reach and effects of My Changed Body (MyCB), an expressive writing activity based on self-compassion, among head and neck cancer (HNC) survivors. Methods This pilot study had a pretest–posttest design. HNC survivors received an invitation to complete a baseline survey on body image-related distress. At the end of the survey, HNC survivors were asked if they were interested in the intervention study. This entailed the writing activity and a survey 1 week and 1 month post-intervention. The reach was calculated by dividing the number of participants in the intervention study, by the number of (1) eligible HNC survivors and (2) those who filled in the baseline survey. Linear mixed models were used to analyze the effect on body image-related distress. Logistic regression analysis was used to investigate factors associated with the reach and reduced body image-related distress. MyCB was evaluated using study-specific qu...

Research paper thumbnail of Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience

Cancers, 2020

Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modalit... more Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%, p = 0.612) and negative predictive value (NPV) (93%, p = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) (p < 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, p = 0.006) and NPV (90% vs. 97%, p = 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%, ...

Research paper thumbnail of Management of multiple secreting paragangliomas in an SDHD variant carrier

The Annals of Thoracic Surgery, 2019

Management of functional intrathoracic sympathetic paragangliomas in SDHD mutation carriers is ch... more Management of functional intrathoracic sympathetic paragangliomas in SDHD mutation carriers is challenging, and there is no uniform guideline for treatment to date. The risks of potential malignant behavior and long-term cardiovascular morbidity have to be weighed against the risks of treatment complications. We report the multidisciplinary and shared decision-making approach that resulted in successful surgical removal of three paragangliomas in a SDHD mutation carrier.

Research paper thumbnail of Neck dissection

Stell and Maran's Textbook of Head and Neck Surgery and Oncology Fifth edition, 2012

Research paper thumbnail of Objective Acoustic-Phonetic Speech Analysis in Patients Treated for Oral or Oropharyngeal Cancer

Folia Phoniatrica et Logopaedica, 2009

Objective: Speech impairment often occurs in patients after treatment for head and neck cancer. N... more Objective: Speech impairment often occurs in patients after treatment for head and neck cancer. New treatment modalities such as surgical reconstruction or (chemo)radiation techniques aim at sparing anatomical structures that are correlated with speech and swallowing. In randomized trials investigating efficacy of various treatment modalities or speech rehabilitation, objective speech analysis techniques may add to improve speech outcome assessment. The goal of the present study is to investigate the role of objective acoustic-phonetic analyses in a multidimensional speech assessment protocol. Patients and Methods: Speech recordings of 51 patients (6 months after reconstructive surgery and postoperative radiotherapy for oral or oropharyngeal cancer) and of 18 control speakers were subjectively evaluated regarding intelligibility, nasal resonance, articulation, and patient-reported speech outcome (speech subscale of the European Organization for Research and Treatment of Cancer Quali...

Research paper thumbnail of New Developments for Optimal Management of Head and Neck Cancer

Oncology Research and Treatment, 2004

Research paper thumbnail of Systematic review: Accuracy of imaging tests in the diagnosis of recurrent laryngeal carcinoma after radiotherapy

Head & Neck, 2008

This review assessed the accuracy of imaging tests for recurrent laryngeal carcinoma after radiot... more This review assessed the accuracy of imaging tests for recurrent laryngeal carcinoma after radiotherapy and concluded that 18-fluorodeoxyglucose positron emission tomography was sufficiently promising for a randomised controlled trial comparing it with conventional work-up. The included studies were small and few, which created wide confidence intervals around the sensitivity and specificity; further accuracy data might be useful before any trial. Authors' objectives To determine the diagnostic accuracy of imaging tests, which were computed tomography (CT), magnetic resonance imaging (MRI), thallium-201 scintigraphy, and 18-fluorodeoxyglucose (FDG) positron emission tomography (PET), in patients with a suspicion of recurrent laryngeal carcinoma after radiotherapy. This means that the authors' conclusion that these data were sufficient to justify a randomised controlled trial might be an overstatement and further accuracy data might be useful before a trial.

Research paper thumbnail of Detection of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG-PET versus conventional modalities

European Journal of Nuclear Medicine and Molecular Imaging, 2002

In 1%-2% of head and neck oncology patients, the only symptom of a malignancy is a positive cervi... more In 1%-2% of head and neck oncology patients, the only symptom of a malignancy is a positive cervical node. The aim of this study was to compare the value of positron emission tomography using fluorine-18 fluoro-2-deoxy-D-glucose (FDG-PET) and conventional diagnostic modalities (CT and/or MRI, panendoscopy) in detecting unknown primary tumours and distant metastases in patients suffering from such a cervical metastasis. Fifty patients (37 men and 13 women) with cervical metastases of an unknown primary tumour were included. All patients underwent FDG-PET. In addition, CT and/or MRI was obtained and panendoscopy was performed. All clinically known metastases were detected by FDG-PET. The primary tumour could be diagnosed in 16 patients (four primary tumours were detected exclusively by FDG-PET). Seven patients had multiple distant metastases, that in six cases were detected exclusively by FDG-PET. The sensitivity and specificity of FDG-PET for detection of unknown primary tumours were 100% and 94%, respectively. For the conventional diagnostic modalities these values were 92% and 76%. FDG-PET had an exclusive effect on the applied therapy in 20% of the patients referred for diagnosis of an unknown primary tumour. The data obtained in this study strongly support the diagnostic strategy of performing FDG-PET in patients suffering from cervical metastases of an unknown primary tumour before any other diagnostic technique.