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95. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

PD Dr.

Chairs

Prof.

NUR Wissenschaftliches Programm/ ONLY Scientific Program

Welcome from the President

Prof. Dr.

Welcome note

Greeting from the Chinese ENT Society

Interdisciplinary Management of Skull Base Tumors

MD, PhD

Referat / Keynote lecture

Proton Beam Therapy in Base of Skull Tumours

Prof. Dr. med.

Invited lecture

Tumor tissue slice cultivation – A translational tool to personalize (radio-)therapy in sinunasal squamous cell carcinoma (SNSCC)?

Experimentelle Onkologie

Tumorschnittkulturen – Ein translationales Werkzeug zur Individualisierung von (Strahlen-)therapie für sinunasale Plattenepithelkarzinome

Introduction: Sinonasal squamous cell carcinoma (SNSCC) is a rare, heterogeneous, and difficult-to-treat cancer with limited understanding of its tumor biology. A multimodal treatment approach involving surgery and radio(chemo)therapy is often necessary, but tumor relapse is common. Patient-derived tumor tissue slices of SNSCC have the potential to personalize targeted (radio-)therapy for these patients. Therefore, we compare individual radiosensitivity and the radiosensitizing capacity of dual targeting PARP and the intra-S/G2 checkpoint through Wee1 inhibition in different specimens.Materials and Methods: Fresh patient-derived SNSCC samples were sectioned into 400 mm slices and cultured on cell culture inserts. The slice cultures were irradiated, either alone or in combination with PARP and Wee1 inhibition. After 2 and 24 hours, the samples were fixed and frozen. DNA double strand breaks (DSBs) were analyzed by quantifying 53BP1 foci in nuclei co-stained with the SCC marker p63 using immunofluorescence microscopy. Results: Tumor specimens from 7 patients were successfully cultivated ex vivo (success rate 88%). Immunofluorescence microscopy revealed areas of p63-positivity in all tumors. The number of residual DSBs varied significantly between SNSCC samples, indicating high heterogeneity between different tumors. However, intratumoral heterogeneity was low. Dual targeting with Wee1/PARP inhibition increased residual DSB levels in most tumors (4/6). Conclusion: Ex vivo cultivation of SNSCC is feasible and may predict individual radiosensitivity and response to targeted approaches, allowing for personalized therapeutic concepts for this rare cancer. In this context, combined inhibition of PARP and Wee1 shows promise as an approach that warrants further investigation.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Kopf-Hals-Onkologie

Free lecture

In our article we present series number more than 200 cases and a clinical example of treatment of a patient with a giant ethmoidal osteoma with intraorbital spread.All tumors was removed using FESS

Nasenhöhle / NNH

Osteomas are benign lesions that develop from the mature bone tissue.In cases of surgical treatment of osteomas of the paranasal sinuses, various surgical approaches can be used.The type of surgical access depends on the size of the osteoma, its localization, place of attachment, degree of spread, as well as on the experience of the surgeon.Currently, the following approaches are distinguished: through the front wall of the frontal sinus; endonasal access using endovideotechnics; bicoronary access; combined access.In our article we present a clinical example of a giant osteoma of the ethmoidal labyrinth with intraorbital spread.At the Clinic of Otorhinolaryngology of the Pavlov First State Medical University in the period from January 2012 to May 2022, 209 surgeries were performed in patients with osteomas of the paranasal sinuses.Osteomas of the frontal sinuses were found in 89 cases, affection of the ethmoidal labyrinth was found in 76 cases, the maxillary sinus – in 38 cases, the sphenoid sinus – in 6 cases.Of all the osteomas after the surgery in 47 patients this type of tumor according to X-ray examination was attributed to the group of "giant" osteomas.In each clinical case, endoscopic osteoma removal was performed under guidance of the electromagnetic navigation system and under general anesthesia.Considering the above, it should be noted that proper preoperative preparation of comorbid patients, endoscopic intervention using a navigation system by an experienced rhinosurgeon and competent management of the postoperative period of patients in cases of removal of giant osteomas of the ethmoidal labyrinth with intraorbital spread are key factors contributing to successful treatment and reduction of recovery and rehabilitation time. The authors declare that there is no conflict of interest' in the text box below.

Rhinologie

Interim analysis of a pilot study on the feasibility of sentinel lymph node biopsy for squamous cell carcinoma of the nasal cavity and paranasal sinus – SentiNose Pilot

Tumorchirurgie / funktionell rekonstruktive Chirurgie

Interimsanalyse einer Pilotstudie zur Machbarkeit der Wächterlymphknotenbiopsie bei Plattenepithelkarzinomen der Nasenhaupt- und Nasennebenhöhle – SentiNose Pilot

Introduction To date, there are no clear recommendations for the treatment of a clinically inconspicuous neck in squamous cell carcinoma of the nose and paranasal sinuses. Prophylactic neck dissection or neck irradiation appears too aggressive given the relatively low occult metastasis rates. However, because the development of neck lymph node metastases is significantly associated with worse overall survival, patients at relevant risk for this need to be identified. Material and Methods A prospective feasibility study is conducted to evaluate the detection rate of a sentinel lymph node in patients with cT1-4 cN0 SNSCC and the safety of the procedure. In addition, the oncologic outcome with survival time and recurrence rate is assessed. The safety of the procedure is studied by systematically documented adverse events and especially with regard to facial nerve damage and scarring. Results Interim analysis was performed after recruitment of 12 patients. In more than 90% of cases (11/12), one or more sentinel lymph nodes could be marked and identified intraoperatively. The detection rate of a positive sentinel lymph node with micrometastasis was 17% (2/12). Nevertheless, in one case with a positive sentinel lymph node and two-stage neck dissection, lymph node recurrence occurred. No facial nerve paresis was documented. Conclusion So far, sentinel lymph node biopsy for SNSCC appears to be safe. The technical feasibility is satisfactory so far and the detection rate is sufficiently high to demonstrate an additional benefit for patients. Thus, the conditions for a continuation of the study are fulfilled.Einleitung Für die Behandlung des klinisch unauffälligen Nodalstatus bei Plattenepithelkarzinomen der Nasenhaupt- und Nasennebenhöhlen (SNSCC) gibt es bislang keine klaren Empfehlungen. Eine prophylaktische Neck dissection oder Halsbestrahlung erscheint angesichts der relativ geringen okkulten Metastasierungsraten zu aggressiv. Da die Entwicklung von Halslymphknotenmetastasen jedoch signifikant mit einem schlechteren Gesamtüberleben assoziiert ist, müssen Patienten mit einem hierfür relevanten Risiko identifiziert werden. Material und Methoden Im Rahmen einer prospektiven Machbarkeitsstudie wird die Detektionsrate eines Sentinel-Lymphknotens bei Patienten mit cT1-4 cN0 SNSCC sowie die Sicherheit des Eingriffs anhand systematisch dokumentierter unerwünschter Nebenwirkungen und insbesondere hinsichtlich der Schädigung des Nervus facialis und der Narbenbildung untersucht. Darüber hinaus wird das onkologische Outcome mit Überlebenszeit und Rezidivrate evaluiert. Ergebnisse Die Interimsanalyse wurde nach Rekrutierung von 12 Patienten durchgeführt. In über 90% der Fälle (11/12) konnte ein oder mehrere Wächterlymphknoten markiert und intraoperativ identifiziert werden. Die Detektionsrate eines positiven Wächterlymphknotens mit Mikrometastase lag bei 18% (2/11). In einem Fall mit positivem Wächterlymphknoten und zweizeitiger Neck dissection kam es zu einem Lymphknotenrezidiv. Es trat keine Fazialisparese auf. Schlussfolgerung Die Wächterlymphknotenbiopsie bei SNSCC scheint bislang sicher zu sein. Die technische Machbarkeit ist bisher zufriedenstellend und die Detektionsrate ausreichend hoch, um einen Zusatznutzen für die Patienten nachzuweisen. Damit sind die Voraussetzungen für eine Fortführung der Studie erfüllt.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

PD Dr. med.

Prof. Dr. Dr. h. c.

Predictive factors of primary tumor progression or recurrence after curative therapy of Esthesioneuroblastoma

Vordere Schädelbasis / NNH / Mittelgesicht

Prädiktive Faktoren für eine primäre Tumorprogression oder ein Rezidiv nach kurativer Therapie des Aesthesioneuroblastoms 

Background: Primary tumor progression and recurrence (TP/R) after curative therapy (CT) of esthesioneuroblastoma (ENB) indicate primary treatment failure. In hospital-/population-based data-bases progression- and recurrence-free survival (PRFS) was not adequately addressed. Methods: 46 patients were retrospectively evaluated concerning prognostic factors (PF) regarding the development of TP/R after CT of ENB. Age, sex, various tumor classifications (Morita, Dulguerov&amp;Calcaterra, Koka, Resto), parameters of CT (mono- vs. combined, R0 vs. R1/2 resection), Hyams-grading (values, grade I-II vs. III-IV), Ki-67 index (values, &lt;vs.&gt;10%). Primary endpoints were the PRFS and the time to first manifestation of TP/R. Parameters, which were significant after univariate analysis (Chi-Square-test, M-W-U-test) and did not show any overlap in the Kaplan-Meier survival analysis (Log-rank Test) were included into multiple regression analysis. Results: After univariate analysis neither sex, nor any tumor classification or any parameter of CT were significantly associated with PRFS. Age (p=0.033), age&lt;vs.&gt;50 years (p=0.007), Hyams-grades (p=0.0001), Hyams-grade I-II vs. III-IV (p=0.0001), Ki-67 index (p=0.014), Ki-67&lt;vs.&gt;10% (p=0.003) were significantly associated with PRFS. The parameter "age&lt;vs.&gt;50 years" was excluded as the Kaplan-Meier survival curves were not significant and overlapping. After multiple logistic and Cox regression analysis, only Hyams-grade III-IV (p=0.003/0.011) and Ki-67 index&gt;10% (p=0.029/0.038) were significant negative PF for RPFS. No parameter was significantly associated with the time to first manifestation of TP/R. Conclusion: TP/R in ENB was significantly associated only with Hyams-grade III-IV and an Ki-67 index&gt;10%, pointing to their particular importance. Einleitung: Primäre Tumor-Progression oder Rezidiv (TP/R) zeigen ein frühes Therapieversagen nach kurativer Therapie (KT) des Aesthesioneuroblastom (ÄNB) an. In Hospital-/Populations-basierten Datenbanken sind prognostische Faktoren (PF) für das Progressions- und Rezidiv-freie Überleben (RPFS) bisher wenig berücksichtigt worden. Methoden: Bei 46 Patienten wurden retrospektiv nach primärer KT eines ÄNB PF für die Entwicklung einer TP/R evaluiert. Parameter waren Geschlecht, Alter/Alter&lt;vs.&gt;50 Jahre, verschiedene Tumor-Klassifikationen (Morita, Dulguerov&amp;Calcaterra, Koka, Resto), die Art der KT (mono vs. kombiniert, R0 vs. R1/R2 Resektion), Hyams-Grad (Grade, I-II vs. III-IV), Ki-67-Index (Werte, &lt;vs.&gt;10%). Endpunkte waren das RPFS bzw. die Zeit bis zum Auftreten von TP/R. Parameter, welche nach univariater Analyse (Chi-Quadrat-Test, Mann-W-U-Test) und bei der Kaplan-Meier-Analyse (Log-Rank-Test) signifikante Unterschiede zeigten, wurden in die multiple Regressions-Analyse einbezogen. Ergebnisse: Nach univariater Analyse waren Geschlecht, alle Tumor-Klassifikationen und Parameter der KT keine PF für RPFS. Alter (p=0,033), Alter&lt;vs.&gt;50 Jahre (p=0,007), Hyams-Grad (p=0,0001), Hyams-Grad I-II vs. III-IV (p=0,0001), Ki-67 Index (p=0,014), Ki-67&lt;vs.&gt;10% (p=0,003) waren signifikant. Der Parameter "Alter&lt;vs.&gt;50 Jahre" wurde ausgeschlossen, da die Kaplan-Meier Kurven überlappten. Nach multipler logistischer bzw. Cox Regressions-Analyse waren Hyams-Grad III-IV (p=0,003/0,011) und Ki-67-Index&gt;10% (p=0,029/0,038) sign. negative PF für ein RPFS. Kein Parameter beeinflusste den Zeitpunkt der Erst-Manifestation von TP/R. Schlussfolgerung: PF für TP/R waren nach multipler Regressions-Analyse nur Hyams-Grad III-IV und ein Ki-67-Index&gt;10%, was auf die Bedeutung dieser Parameter hinweist. Es besteht kein Interessenskonflikt.

International Session 1
Interdisciplinary Management of Skull Base Tumors

Termin

Chairs

Themen

Sprache

Programm

International Session 1Interdisciplinary Management of Skull Base Tumors

Termin

Chairs

Themen

Sprache

Programm

International Session 1
Interdisciplinary Management of Skull Base Tumors