Otolaryngology (ENT)

Selective prophylactic tracheostomy is safe in free-flap oral and oropharyngeal surgery

Among 411 adults undergoing oral or oropharyngeal free-flap reconstruction, a 2018 initiative promoted selective rather than routine prophylactic tracheostomy. Tracheostomy rates dropped from 92.6% to 42.7% without increasing airway compromise or flap failure. After 2018, tracheostomy use clustered in oropharyngeal primaries, advanced nodal disease, and bilateral neck dissections. Longer surgical and anesthetic times and advanced clinical nodes increased tracheostomy odds, while scapula versus radial forearm flaps decreased them. Patients with tracheostomies had longer hospital stays and more postoperative complications, underscoring morbidity from routine tracheostomy. 1

mHNSRI improves prediction of treatment intolerance in operable HPV-negative HNSCC

An ambispective cohort of 568 patients with operable HPV-negative stage II–IV head and neck cancer was used to develop the modified Head and Neck Surgery Risk Index. Treatment intolerance, including severe toxicity or therapy non-completion, occurred in nearly half of patients. Low cervical paraspinal skeletal muscle index, higher Risk Analysis Index, reduced high-to-low attenuation muscle ratio, and obesity independently predicted intolerance. Sarcopenia and frailty showed synergistic effects, and adding muscle metrics significantly improved discrimination compared with traditional indices. The mHNSRI achieved an AUC of 0.71 in external validation and outperformed RAI, mFI-5, ASA, and Charlson scores. 2

Early cfEBV DNA clearance guides induction chemotherapy cycles in LA-NPC

This study analyzed 1,590 patients with locoregionally advanced nasopharyngeal carcinoma treated with induction chemotherapy plus chemoradiotherapy. After one induction cycle, 45.5% had undetectable cfEBV DNA, which was combined with N-stage and overall stage to create a risk model. The model stratified patients into high- and low-risk groups with the best 5-year progression-free survival discrimination. In matched low-risk patients, three induction cycles improved 5-year progression-free survival versus two cycles without significantly more grade 3–4 toxicity. High-risk patients gained no progression-free survival benefit from additional induction, suggesting a need for alternative systemic strategies. 3

ctHPV-DNA sequencing offers highly sensitive surveillance in HPV-positive OPSCC

Target-enrichment sequencing for circulating tumor HPV DNA was applied to plasma from 33 HPV-positive OPSCC patients and 30 non-cancer controls. Baseline ctHPV-DNA was detected in all cancer patients and absent in all controls using robust statistical cutoffs. Post-treatment plasma from patients who remained disease-free stayed ctHPV-DNA negative during up to 24 months’ follow-up. All patients with recurrent disease had ctHPV-DNA detected, sometimes up to a year before clinical diagnosis. Patients with suspected residual neck disease but only necrotic metastasis remained ctHPV-DNA negative, helping distinguish necrosis from viable tumor. 4