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To evaluate the role of parathyroid near-infrared autofluorescence in reducing the incidence of postoperative hypocalcemia and hypoparathyroidism after total thyroidectomy, and to determine which surgeons benefit most from parathyroid near-infrared autofluorescence use. A literature search was conducted in PubMed, Web of Science, and the Cochrane Library databases for English-language articles published from June 2011 to October 31, 2023. The inclusion criteria were studies conducted on patients who underwent total thyroidectomy for benign or malignant thyroid pathologies, comparing postoperative parathyroid function between parathyroid near-infrared autofluorescence techniques and conventional surgery with data on calcium and/or parathyroid hormone levels. The exclusion criteria included: reviews, letters, meta-analyses, case reports, animal experiments, or basic research. Of the initial 387 articles retrieved, we included 14. A meta-analysis was performed to calculate the pooled odds ratio and weighted mean deviation with a random-effects model. Main outcomes were Calcium and parathyroid hormone levels after total thyroidectomy with or without parathyroid near-infrared autofluorescence use. Fourteen studies were included in the meta-analysis. Pooled odds ratios of temporary and permanent hypocalcemia were 0.56 (95% confidence interval 0.43-0.72) and 0.61 (95% confidence interval 0.33-1.13), respectively. Meta-regression analysis revealed that near-infrared autofluorescence benefits surgeons with the high incidence of temporary hypocalcemia by naked eye surgery (≥15%) by reducing temporary hypocalcemia (p = 0.0091) and skillful surgeons by increasing the number of autotransplanted parathyroid glands (p = 0.0225). Parathyroid near-infrared autofluorescence has different benefits depending on the skill level of the surgeon.

BackgroundAs a substantial waiting time is usually required for radical surgery, safe and effective preoperative neoadjuvant chemotherapy (NAC) is desired for the treatment of locally advanced head and neck squamous cell carcinoma (HNSCC). However, the significance of NAC in advanced HNSCC is still unclear. This study aimed to assess the safety and efficacy of NAC using the paclitaxel, carboplatin, and cetuximab (PCE) regimen.MethodsWe retrospectively evaluated the background characteristics, incidence of adverse events, overall response rate (ORR), pathological response, recurrence-free survival (RFS), and overall survival (OS) in 26 patients. Patients receiving the PCE regimen were further divided into two groups based on the number of chemotherapy cycles (one cycle or more) and eligibility for cisplatin. Patients aged ≥ 75 years and those with an estimated glomerular filtration rate (eGFR) < 60 mL/min were classified as ineligible for cisplatin.ResultsThe median age was 70 (27–81) years. The median eGFR at treatment initiation was 63.2 (41.1–89.7) mL/min. Fourteen (53.8%) patients were ineligible for cisplatin. Grade 3 or higher neutropenia was observed in 11 of 25 (42.3%) patients. No delay in or withdrawal from surgery was observed. The ORR was 65.4%. The 2-year RFS and OS were 61.5% and 76.7%, respectively. No significant differences in safety and efficacy between the number of chemotherapy cycles and cisplatin eligibility were observed.ConclusionNAC using the PCE regimen for patients with locally advanced HNSCC, including cisplatin-ineligible patients, has acceptable toxicity and favorable efficacy.

BackgroundThe optimal chemotherapy regimen in concurrent chemoradiotherapy (CCRT) for cisplatin-ineligible head and neck squamous cell carcinoma (HNSCC) has not been established. We aimed to evaluate the feasibility, efficacy, and safety of CCRT with weekly low-dose carboplatin for the treatment of advanced HNSCC in patients who are cisplatin-ineligible.MethodsThis prospective phase II study enrolled adult patients (age ≥ 20 years) with HNSCC receiving whole-neck irradiation including bilateral levels II–IV and who were aged (≥ 75-year-old patients with 40 mL/min estimated glomerular filtration rate [eGFR] or better) or had renal dysfunction (< 75-year-old patients with 30–60 mL/min eGFR). Carboplatin was administered weekly (area under the plasma concentration–time curve = 2.0) for up to seven cycles during concurrent radiotherapy (70 Gy/35 Fr). The primary endpoint was the completion rate of CCRT. Secondary endpoints included overall response rate and incidence of adverse events.ResultsAmong the 30 patients enrolled, 28 were men. The median age was 73.5 years. Seventeen patients were < 75 years whereas 13 were ≥ 75 years old. The completion rate of CCRT was 90%. The overall response rate was 90%. Grade 3 adverse events that occurred in 10% or more patients were oral/pharyngeal mucositis (47%), leukocytopenia (20%), and neutropenia (10%). Grade 4 adverse events occurred in one patient (elevation of alanine aminotransferase level). No treatment-related deaths occurred.ConclusionCCRT with weekly low-dose carboplatin is a promising treatment option, with favorable feasibility, efficacy, and acceptable toxicity, for patients who are cisplatin-ineligible with advanced HNSCC.Clinical Trial Registration NumberjRCTs031190028.

Introduction Immune‐related adverse events (irAEs) are prognostic factors for patients on nivolumab. However, predictors of irAEs have not yet been identified. We aimed to investigate the predictors of irAEs occurrence and nivolumab discontinuation due to irAEs. Methods Sixty‐two patients with recurrent/metastatic head and neck squamous cell carcinoma received nivolumab therapy between June 2017 and December 2020. Treatment outcome was compared between the groups with or without irAEs. The irAE (+) group was further divided by nivolumab discontinuation. Progression‐free survival (PFS) and overall survival (OS) were compared between the groups. Predictors of irAE occurrence were analyzed. Results Twenty‐one patients (33.9%) developed irAEs, and six (28.6%) discontinued nivolumab due to severe irAEs. The irAE (+) group had significantly longer PFS and OS than the irAE (−) group (median PFS, 12.7 vs. 1.9 months; median OS, 33.1 vs. 12.8 months). The treatment outcomes in the discontinuation group were comparable to those in the non‐discontinuation group. The maximum absolute eosinophil count (AEC) during nivolumab therapy was significantly higher in the irAE (+) group than in the irAE (−) group (548.8 vs. 182) and higher in the discontinuation group than in the non‐discontinuation group (729.3 vs. 368.6). The receiver operating characteristic curve showed that the maximum AEC had a moderate‐to‐high accuracy for predicting irAE occurrence (area under the curve [AUC], 0.757) and nivolumab discontinuation (AUC, 0.893). Discussion Monitoring AEC during nivolumab therapy may be useful in predicting irAE occurrence, nivolumab discontinuation, and disease prognosis.

Introduction Immune-related adverse events (irAEs) due to immune checkpoint inhibitors may lead to discontinuation and treatment-related death. Acute aortitis is a rare but severe irAE. Case presentation A 67-year-old man with recurrent lower gingival carcinoma received nivolumab therapy. Twenty-three months later, he experienced chest compression, which resulted in syncope. Following a whole-body computed tomography (CT) scanning, which revealed diffuse thickening of the aorta, and systemic assessments of the causes of aortitis, he was diagnosed with acute aortitis due to irAE. Nivolumab discontinuation and oral steroids improved CT findings. However, 11 months after nivolumab discontinuation, he developed an aortic aneurysmal rupture. Endovascular aortic repair rescued him. A durable anti-cancer response was still observed 4 months after the aortic rupture. Conclusion Although severe irAE, such as acute aortitis, occurred, the patient may still achieve a durable response. A broad examination and prompt treatment of irAE can help improve the patient’s survival.