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The extent of surgery in cases of parotid gland pleomorphic adenoma (PA) remains challenging. This study aims to evaluate the importance of surgical margins in ensuring safe surgery for patients with PA.

This prospective study was conducted to evaluate the risk of local recurrence based on surgical margins in patients with parotid PA who underwent superficial or total parotidectomy between May 2019 and November 2021 at a tertiary referral hospital in Tehran, Iran. Patients were followed for at least 2 years. Data were analyzed using SPSS version 23. The normality of data distribution was assessed using the Kolmogorov–Smirnov test. Quantitative and qualitative variables were analyzed with the independent t‑test and Chi‑square test, respectively. A P < 0.05 was considered statistically significant.

Fifty‑seven cases were included in the study. The mean age was 40.7 years, with 37 of 57 (64.9%) patients being female. Of these, 35 of 57 (61.4%) underwent superficial parotidectomy. All tumors were resected with negative margins, with an average safe margin of 0.58 cm (range: 0–3.7 cm). The greatest margin was found at the anterior side (average: 0.76 cm), whereas the smallest margin was at the vertical side (average: 0.39 cm). Postoperative radiotherapy was not administered to patients with close surgical margins. No recurrence was observed after a 2‑year follow‑up.

In the surgical resection of parotid PA, negative margins are sufficient, and there is no need to obtain additional safe margins to reduce the risk of recurrence. Therefore, extracapsular dissection (which carries higher morbidities) can be replaced by superficial parotidectomy with negative margins (which carries lower morbidities).

Radiation therapy-induced oral mucositis is a significant acute side effect in patients with head and neck cancer. Severe mucositis can negatively impact the patient's treatment plan and decrease survival rates.

This study aimed to evaluate the effect of educational and care interventions on the severity of oral mucositis in patients undergoing radiation therapy for head and neck cancer.

This study was conducted on head and neck cancer patients referred to the chemotherapy and radiotherapy departments of Khatam Al-Anbia and Ali Ibn Abi Talib Hospitals, affiliated with Zahedan University of Medical Sciences, in 2023. A total of 60 participants were selected through convenience sampling and randomly divided into intervention and control groups. Initially, patients in both groups were examined for oral and dental conditions. Oral health was assessed using the Decayed, Missing, and Filled Teeth (DMFT) Index and the Community Periodontal Index of Treatment Needs (CPITN), based on the global WHO standard. The condition of oral mucositis was evaluated upon entry into the study to confirm eligibility. The intervention group received a comprehensive oral and dental care program during their chemotherapy sessions, which consisted of three 45 - 60-minute sessions. In contrast, the control group received routine training. Recognizing the importance of dental health, dental check-ups were performed again before radiotherapy using the DMFT Index, followed by continued monitoring during the radiotherapy period and at the end of radiotherapy to ensure the patients' teeth remained in good condition. At the conclusion of the radiotherapy, the severity of oral mucositis was assessed. Data analysis was performed using SPSS version 27 software, employing paired t -tests, independent t -tests, Fisher’s exact test, Mann-Whitney U, and chi-square tests. A significance level of less than 0.05 was considered statistically significant.

An initial examination of oral and dental conditions was conducted using the DMFT Index (Tooth Decay Index) and CPITN Index (Gingival Inflammation Index). Analysis with the independent t -test and Fisher's exact test showed no statistically significant differences between the intervention and control groups (P > 0.46 and P > 0.31, respectively). At the start of radiotherapy, the mean ± standard deviation of the DMFT Index was 16.53 ± 7.56 in the intervention group and 15.13 ± 7.07 in the control group. The independent t -test revealed no significant statistical difference between the two groups (P > 0.46). However, by the end of radiotherapy, a significant difference in the severity of mucositis was observed between the two groups, as determined by the Mann–Whitney U test (P < 0.001).

This study underscores the critical role of a collaborative treatment team, including dentists, nurses, and oncologists, in the prevention and management of oral mucositis in patients. By fostering a multidisciplinary approach to patient care, treatment effectiveness, survival rates, and the quality of life for patients can be significantly improved.

Ewing sarcoma (ES) of the head and Neck is a rare entity. The most common location for ES is long bones accounting for 58%, with head and neck accounting only for 3% of all the sites. Here we highlight a unique presentation of ES involving the maxillary region in a 21-year-old male. Patient presented with right maxillary swelling for the last 2 months. Imaging studies reveal osteolytic lesion involving the right maxilla. Ewing's sarcoma rarely affects the head and neck region, posing diagnostic challenges as it mimics many common lesions. Accurate diagnosis requires a multidisciplinary approach involving clinical, radiological, histopathological, and molecular evaluations.

The evaluation of treatment-associated errors is important in the radiotherapy process, particularly those resulting related to patient setup. This research aimed to assess the interfractional setup errors and determine the Clinical Target Volume to Planning Target Volume (CTV to PTV) margin in patients undergoing 3-Dimensional Conformal Radiation Therapy (3DCRT) for head and neck cancer by means of electronic portal imaging device. In this analytical study, 300 portal images were acquired from 50 patients undergoing 3DCRT for head and neck cancer. Using the portal images of Lateral (LAT) and Antero-Posterior (AP) fields, population systematic (∑) and random (σ) errors were obtained in the lateral, longitudinal, and vertical directions. Finally, based on the International Commission on Radiation Units and Measurements (ICRU) Report 62’s, Stroom’s and Van Herk’s methods, Planning target volume margins were determined. The translational shift ranges were 0-8.1 mm in the ML, 0-9 mm in the SI (AP), 0-8.8 mm in the SI (LAT), and 0-10 mm in the AP directions. The population systematic and random errors were respectively 3.230, 2.753, and 2.997 mm, and 1.476, 1.853, and 1.715 mm in X, Y, and Z directions. The calculated PTV margins using the ICRU-62, Stroom’s, and Van Herk’s formulae were ranging from 3.236-3.551, 6.605-7.493, and 7.932-9.108 mm, respectively.  A PTV margin of 7.5-9.5 mm seems safe for ensuring adequate treatment volume coverage. In addition, the EPID is an effective equipment for verifying patient positioning and reducing treatment setup errors.

18F-FDG PET/CT has been used to characterize the primary lesion and staging in head and neck cancers (HNC). However, prior studies for detecting distant metastasis and  synchronous tumors are sparse, especially in Indian context. To investigate the frequency and distribution of head and neck carcinomas, distant metastases and synchronous malignancies detected in HNC in a north Indian population.

Medical records and whole body 18F-FDG PET/CT examinations performed for initial staging on a total of 281 newly diagnosed HNC patients between 01/2019 to 31/6/2023 in North India were retrospectively analyzed and reviewed to look for distant metastasis and synchronous tumors.

On whole body 18F-FDG PET/CT, distant metastases were detected in 33 (11.7%) patients, all with locally advanced primary tumors corresponding to T category 3 and 4. Lung (6%) and bone (~6.7%) were the most common sites of distant metastasis. In nine patients metastases were detected below the diaphragm. Synchronous malignancies were discovered and histopathologically proven in 22 (7%) patients. Lung carcinoma was the most common synchronous tumor, detected in 9 patients.  In seven patients synchronous tumour was detected outside the aerodigestive tract, of which four were below the diaphragm.

Of the distant metastasis diagnosed in 11.7% of HNC patients with TNM  tumor category T3 and T4, 3% of metastasis lesions were detected below the diaphragm.  Synchronous malignancy was diagnosed in 7% patients irrespective of primary HNC stage.  These findings demonstrate the advantage of using whole body 18F-FDG PET/CT as an ideal and preferred modality for initial staging and screening of HNC patients since detection of distant metastasis or a synchronous malignancy changes the management approach in these patients.

The University of Washington quality of life questionnaire (UW-QOL) is widely used to evaluate the quality of life for head and neck cancer patients. The purpose of this study is translation of the UW-QOL questionnaire's into Persian.

After translation and cultural adaptation of the UW-QOL, the questionnaire was distributed among 100 head and neck cancer patients. Internal reliability of the translated UW-QOL was determined using Cronbach's alpha coefficient. The validity was determined by Spearman correlation coefficient between UW-QOL and 12-Item Short Form Survey (SF-12). The test – retest reliability was measured by Intraclass Correlation Coefficient (ICC) after one week.

Cronbach's alpha coefficient was more than 0.75 and ICC coefficient was more than 0.80 in all variables. The UW-QOL questionnaire composite score had a positive significant association with SF-12 questionnaire total score (Spearman's Correlation Coefficient= 0.70, P< 0.0001).

In conclusion Persian translation of the UW-QOL questionnaire has acceptable reliability and validity and is as valid as the original English version in evaluating the quality of life for patients with head and neck cancer.

The presence of a dental implant across the irradiation beam has the potential to perturb the dose distribution. In this study, the effect of different commercial dental implants on dose distribution was investigated in electron beam therapy.

The Varian 2100 C/D linear accelerator (Linac) head was modeled precisely with proper components for electron mode (6 and 9 MeV) by MCNPX 2.6.1 and was benchmarked according to the International Atomic Energy Agency (IAEA) protocol, TRS -398. Dose distribution was calculated for Six different implant materials, including Titanium, Titanium alloy, Zirconia (Y-TZP), Zirconium oxide, Alumina, and PolyetherEtherKetone (PEEK), and for Four different scenarios.

The highest and lowest increasing doses occurred for Y-TZP (114.44% and 108.69% for 6 and 9 MeV, respectively) and PEEK (104.85% and 98.84% for 6 and 9 MeV, respectively) directly in front of the implant, respectively. By removing an implant from the jaw, an increasing dose was not seen, but an increasing dose occurred behind its depths in the bone region (31.81 %).

The amount of dose perturbation due to the dental implant's presence depends on the beam energy, mass density, and atomic numbers of implants. Maximum and minimum increased doses were estimated for Y-TZP and PEEK implants, respectively. Considering the correction factors due to the presence of high density and atomic number dental implants are essential to estimate the accurate dose delivery in radiotherapy with electron beams.

Proton therapy (PT) is one of the latest advancements in the treatment modalities of cancers. PT is specifically used to treat HnN cancer patients due to its less toxic effects on the surrounding critical structures. Keeping in view the opportunities for further advancements, there has been quite a lot of literature covering PT in HnN cancer patients. However, there has not been a compiled study that compares the toxicities, overall survival (OS), local control (LC), and quality of life (QoL) of PT with that of IMRT. The objective of this review is to compile & summarize the literature available on the toxicities, OS, LC, and QoL in HnN cancer patients post-proton therapy.

Head and neck cancer treatment often leads to stomatitis, influenced by multiple factors. Mouthwashes, with diverse formulations, offer potential therapeutic benefits. This study examines the relationship between stomatitis severity improvement post-radiotherapy and mouthwash use, considering patient characteristics like gender, age, duration, and dosage.

A systematic review (2015–2023) evaluated mouthwash efficacy for radiotherapy-induced stomatitis. Searches in PubMed, Scopus, Web of Science, and Cochrane Library identified clinical trials, cohort, and case-control studies. Inclusion criteria focused on mouthwash effectiveness; quality was assessed using the Jadad scale.

Out of 480 screened studies, 16 met inclusion criteria. Traditional antiseptic mouthwashes (e.g., chlorhexidine) reduced infection risk but had mixed effects on pain and inflammation. Specialized formulations (e.g., aloe vera, honey, benzydamine) improved pain relief and mucosal healing. Combination therapies showed the best outcomes, though study variability limited conclusions.

Mouthwashes, from antiseptics to specialized formulations, show potential for managing stomatitis. Antiseptics reduce infection, while specialized products aid pain relief and healing. Personalized interventions and further research are needed to optimize formulations for diverse patients.

Achieving precise dose delivery in head and neck cancer is challenging, requiring effective tumor control while minimizing toxicity. This study compares Volumetric-Modulated Arc Therapy (VMAT) and 3D Conformal Radiotherapy (3D-CRT), focusing on target coverage, Organs At Risk (OARs) sparing and treatment efficiency. For 7 randomly selected patients, Two plans (3D-CRT and VMAT) were created using Monaco TPS. The prescribed doses were 70/63/56Gy for Five patients and 69.96/59.4/54Gy for Two, in 35 and 33 fractions. The t-test was used for statistical analysis. VMAT plans underwent pretreatment quality control. The mean Dmean, Dmax, and V95% of PTV70Gy were 70.86/70.23Gy, 78.95/75.28Gy, and 95.35% / 96.97% for 3D-CRT and VMAT. The Dmax for the spinal cord, brainstem and chiasma were 49.98/40.76Gy, 64.05/50.00Gy, and 54.27/47.78Gy. The mean dose for the Left (L) and Right (R) parotids was 66.93/44.18Gy and 67.79/44.98Gy. The Dmax for L/R optic nerves and eyes were 60.17/50.41Gy, 59.44/48.49Gy, 48.4/39.88, and 44.09/36.93Gy. The 0.03cc of the L/R temporal lobes received 73.37/69.59Gy and 73.17/68.33Gy. The mean dose in 2cc of the mandible was 72.88/66.99Gy. The mean volume of the larynx with 66Gy was 23.72% / 0.76%. The Homogeneity and Conformity Index were 0.12/0.08 and 0.95/0.97. The treatment time and MUs for 3D-CRT/VMAT were 3.35/6.36 min and 806.86/621.53 MUs. VMAT gamma index passing rate was 98.6%.   The VMAT limits irradiation, reduces OARs toxicity, assures higher target dose and avoids cold and hot spots. This study shows that VMAT provides superior normal tissue protection as compared to 3D-CRT.

Head and neck cancer (HNC) and its treatment can cause significant side effects like dysphagia, voice problems which can affect health related quality of life (HRQOL). Examining quality of life among these patients are helpful in streamlining cancer treatment protocols. The present study aimed to find out the relationship between dysphagia, voice problems, and HRQOL among HNC survivors.

A convenient sampling technique was adopted to recruit 110 HNC survivors. Data was collected using Eating Assessment Tool (EAT), Voice Handicap Index (VHI), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Version 3 (EORTC QLQ-C30) and head and neck specific module of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-H &N 35).

Majority of the HNC survivors (85.5%) had dysphagia, and 50% of them reported severe voice problems. The overall QOL mean (SD) score was high in cognitive functioning 80.76 (22.19) and role functioning 80.30 (25.54) of the functional domain. While considering symptom scale highest mean score was reported for pain 42.42 (25.01), fatigue 42.22 (23.82) and financial difficulties 41.21 (28.56). There was a mild positive correlation between dysphagia and voice problem (r=0.202), dysphagia and health related global health (r=0.248) and voice problem and global health (r=0.280).

Dysphagia and voice problems were common among HNC survivors and it has great impact on their HRQOL. Therefore, it is important to initiate various measures to increase awareness for prevention and early management of these symptoms and improvement of HRQOL of HNC survivors.

 Studies on head and neck cancer (HNC) patients undergoing radiotherapy have revealed increased numbers of Candida spp., leading to oral candidiasis and oral mucositis. The effects of laser therapy on Candida spp. have been studied with varied results. This study aimed to investigate the effect of low-level laser therapy (LLLT) on C. albicans colonies isolated from HNC patients undergoing radiotherapy.

 This study included a treated group, wherein 11 C. albicans isolates were obtained from the saliva of HNC patients undergoing radiotherapy at a dose exceeding 30 Gy. The control groups consisted of an untreated negative control and a positive control treated with nystatin. The treatment groups were subjected to LLLT in continuous mode for 50 seconds at a wavelength of 976 nm, 0.1 W at a dose of 5 J/cm2 for Laser 1 (L1) group and 0.2 W at a dose of 10 J/cm2 for Laser 2 (L2) group. The tests were conducted using C. albicans inoculum equivalent to a 0.5-McFarland suspension on 96-well plates. All test group inoculums were then cultured on Sabouraud dextrose agar (SDA), and the colony count was assessed at 104 CFU/mL.

 LLLT at 5 and 10 J/ cm2 reduced C. albicans colonies by 7.01% and 10.94%, respectively, but the reductions were not statistically significant (P>0.05). Nystatin eliminated all the colonies.

 LLLT shows potential for reducing C. albicans colonies in HNC patients undergoing radiotherapy. However, further studies with varied parameters and methods are necessary.

 Radiotherapy-induced xerostomia is an important side effect of head and neck cancer (HNC) treatment. Photobiomodulation (PBM) is one of the new emerging methods for preventing or reducing this problem. The aim of this study is to evaluate the effect of PBM on radiation-induced xerostomia in HNC patients.

 Thirty-seven patients with HNC were referred for radiotherapy to Mashhad Cancer Center. In the case group, an infrared diode laser was used in contact mode on 16 points (covering minor and major salivary glands). The device emitted a wavelength of 810 nm and operated at the power of 200 mW and continuous wave mode. Each area was irradiated for 4 seconds in contact mode with gentle pressure, and the laser energy was 0.8 J with an energy density of 2.85 J/cm2 at the surface of the probe (spot size, 0.28 cm2). The total dose was 45.6 J/cm2. The power density was 714.2 w/cm2. In the control group, the sham laser device was used. Subjective xerostomia was evaluated through the LENT SOMA scale (LSS). Stimulated and unstimulated saliva was also assessed. Data were analyzed with SPSS 22 statistical software.

 The study included 26 men and 11 women with a mean age of 55.6±15.3 years. In the sixth week, the case group produced more stimulated saliva than the control group (P=0.006). They also had less subjective xerostomia than the control group in weeks four to six.

 In the present study, PBM had a preventive effect on stimulated saliva and subjective xerostomia and can be recommended as an adjunctive treatment. Further studies with a higher sample size and the use of a low-level laser in more sessions are needed for definitive comment.

Dermatofibrosarcoma protuberans (DFSP) is a rare locally aggressive tumor with high rate of local recurrence but low metastatic potential. Its occurrence in the head and neck is a rare finding but it is associated with increased morbidity and mortality.

A 53-year-old Iranian man referred to a complaint about an increase in the size of the subcutaneous mass on the right cheek that had been present since he was 17 years old. On clinical examination, the lesion was not painful and had no erythema. In examining the patient's CT scan without contrast, a mass-like area with soft tissue density was seen. During the surgery, the flap was lifted after a lateral rhinotomy incision. The biopsy sample was sent for frozen section, and the pathology result was a Spindle cell tumor. In immunohistochemistry (IHC), two factors, including CD34 and VIMENTIN, were positive and Dermatofibrosarcoma protuberans (DFSP) was reported.

The most important prognostic factor for surgery of Dermatofibrosarcoma protuberans is obtaining tumor free surgical margins. As a result, accurate diagnosis and correct management of this uncommon and locally invasive malignancy is very important, especially in head and neck surgery.

The study assesses radiation-induced sensorineural hearing loss (SNHL) in head and neck cancer patients, highlighting the common occurrence of SNHL as a significant side effect of radiation therapy (RT) targeting the cochlea and acoustic pathways.
The study included 34 patients (22 men, 12 women, mean age 40.13 ± 26.8 years) with head and neck cancers undergoing three-dimensional conformal radiation therapy (3D-CRT); 16 also had chemoradiotherapy (CRT). Pure-tone audiometry (PTA: 250-8000 Hz) was done before, immediately after, and three months post-RT for all patients. Hearing impairment was evaluated using the CTCAE 4.03 scoring system.
According to the findings, 19% and 37% of ears experienced SNHL immediately post-RT and 3 months after RT, respectively. The mean cochlear dose was 25.48 ± 13.56 Gy. A significant correlation existed between the cochlear dose and SNHL incidence (P-value < 0.05). Regression analysis indicated the mean cochlear dose as a robust predictor of SNHL, particularly at 8000 Hz (β = 0.570, P-value = 0.0001). Highest SNHL incidence at 8000 Hz, 3 months post-RT. A significant difference in SNHL threshold was observed between men and women at the frequency of 1000 Hz (P-value = 0.024). There was a statistically significant difference in SNHL thresholds between patients who underwent CRT versus those treated with RT alone (P-value < 0.05).
RT commonly causes SNHL in head and neck cancer patients. Mean cochlear dose predicts SNHL, especially at higher frequencies.

We aimed to explore the prediction value of disulfidptosis-related long noncoding RNAs (lncRNAs) on the prognosis and immunotherapy efficiency of patients with head and neck squamous carcinoma (HNSCC).

Clinical and RNA-seq information were collected from The Cancer Genome Atlas (TCGA) and Genome Data Sharing (GDC) portal. The Pearson correlation analysis, univariate COX regression analysis, the least absolute shrinkage and selection operator (LASSO) COX regression were employed to construct the disulfidptosis-related lncRNAs (DRLs) prognostic model. The Kaplan-Meier survival curve, principal component analysis (PCA), receiver operating characteristic (ROC) curves and areas under the curves (AUCs) were used to examine the accuracy of the prognostic model. ssGSEA, mutation and functional and gene set enrichment analysis was performed to quantify the immune cell infiltration, immune function and functional enrichments. Finally, the mRNA expression of the DRLs was verified by real‑time PCR (RT-PCR) in HNSCC cells.

A new DRLs prognostic model (AC083967.1, AC106820.5, AC245041.2, AL590617.2, AP002478.1, and VPS9D1-AS1) with an independent prognostic value of HNSCC patients was successfully identified. In addition, the DRLs prognostic model was related with immune signature and drug therapy response. Meanwhile, the mRNA expression level of the 6 DRLs detected by RT-PCR was consistent with the results of bioinformatic analysis.

We developed a new DRLs prognostic model of HNSCC, which could effectively predicate the prognosis and therapy response of HNSCC patients and provide insights into personalized therapeutics.

 The inflammatory potential of diet may affect carcinogenesis. This study aimed to determine the association between dietary inflammatory index (DII) and the risk of head and neck cancer (HNC), as well as the interaction between DII and cigarette smoking in HNC development within the Iranian population.

Study Design: 

This is a case-control study.

 In this multicenter case-control study, participants’ dietary intake was assessed using a validated 130-item food frequency questionnaire, from which DII was computed. The study recruited 876 new cases from referral hospitals across 10 provinces and 3409 healthy controls who were frequency-matched based on age, gender, and residential place. Logistic regression was used to obtain odds ratios (ORs) for HNC across tertiles of DII, which were adjusted for confounding variables.

 A higher pro-inflammatory diet was associated with an increased risk of all HNC (OR T3 vs. T1 [95% CI]: 1.31 [1.06, 1.62]; P-trend=0.013). There was a significant association between lip and oral cavity cancers and DII (OR T3 vs. T1 [95% CI]: 1.56 [1.16, 1.66]; P-trend=0.004). Furthermore, an inflammatory diet was associated with an increased risk of pharynx cancer (OR T3 vs. T1 [95% CI]: 2.08 [1.14, 3.79]; P-trend=0.02). Additionally, no significant association was observed between DII and larynx cancer, while an interaction was found between DII and tobacco use on the risk of HNC (OR T3 vs. T1 [95% CI]: 2.52 [1.78, 3.57]; P-interaction=0.03).

 DII was positively associated with HNC risk. There was a significant association between DII and the risk of lip, oral cavity, and pharynx cancers. Additionally, there was an interaction between tobacco use and DII in determining the risk of HNC.

Surgical excision forms the principal treatment of oral cavity squamous cell carcinomas. The comprehensive surgical management consists of Wide Local Excision of the tumor and Neck Dissection with removal of Submandibular gland. The submandibular gland accounts for 70–90 % of unstimulated salivary volume. Its excision as a part of neck dissection has been found to cause high Incidence (21% vs 7%) of postoperative xerostomia. Recent studies have highlighted that the preservation of the SMG is possible and oncologically safe in early-grade OCSCC with N0 neck as the involvement of SMG in such cases is low and its preservation decreases the chances of xerostomia.
 

80 subjects were included in the study to estimate the prevalence of metastatic submandibular gland involvement in oral cavity squamous cell carcinomas. The presence of metastasis into the salivary gland was studied and the mechanism/route of involvement was analysed. The comparison was made between the early and advanced tumors for SMG metastasis irrespective of the primary subsite involvement.

In the current study low prevalence (6.2 %) of metastasis to SMG was seen. It was seen in high-grade tumors only. None of the early-grade tumors showed any evidence of SMG metastasis. The most common pattern (80%) of glandular involvement was a direct extension from the primary tumor. 

Our study concludes that SMG preservation neck dissections can be carried out in early-grade OCSCC irrespective of primary tumor site involvement. The advantages of preserving the SMG are multiple. Furthermore, the morbidity is markedly decreased with its preservation without any compromise on oncological safety.