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Background: Treatment of head and neck cancer (HNC) often leads to visible and severe functional impairments. In addition, patients often suffer from a variety of psychosocial problems, significantly associated with a decreased quality of life. We aimed to compare depression, anxiety, fatigue and quality of life (QoL) between HNC patients and a large sample of the general population in Germany and to examine the impact of sociodemographic, behavioral and clinical factors on these symptoms.Methods: We assessed data of HNC patients during the aftercare consultation at the Leipzig University Medical Center with a patient reported outcome (PRO) tool named "OncoFunction". Depression, anxiety, fatigue and QoL were assessed using validated outcome measures including the PHQ-9, the GAD-2, and the EORTC QLQ-C30 questionnaire.Results: A total of 817 HNC patients were included in our study and compared to a sample of 5018 individuals of the general German population. HNC patients showed significantly higher levels of impairment in all dimensions assessed. Examination of association between depression, anxiety, fatigue and QoL and clinical as well as sociodemographic variables showed significant relationships between occupational status, ECOG-state, body mass index and time since diagnosis.Conclusions: HNC patients suffer significantly from psychological distress. The used questionnaires are suitable for the use in daily routine practice and can be helpful to increase the detection of depression, anxiety and fatigue and therefore can improve HNC aftercare. [ABSTRACT FROM AUTHOR]

There is an empirical association between stress and symptoms of food addiction (FA), but it is still not clear which domains of stress are the most relevant when it comes to FA, limiting the ability of researchers and practitioners to address problematic eating-related health outcomes. In order to address this gap in the literature, we analysed how different domains of chronic stress are related to FA. We used data from a subsample of the LIFE-Adult-Study (N = 1172), a German cohort study. We conducted a linear regression analysis with stress domains (Trier Inventory for Chronic Stress, TICS) as predictors of FA (Yale Food Addiction Scale, YFAS). In the second regression analysis we included sociodemographic variables, personality, and smoking as control variables. There was a significant and positive association between Social Overload, Work Discontent, Excessive Demands from Work, and Chronic Worrying and FA. After adding control variables, only Social Overload, Excessive Demands from Work, and Chronic Worrying remained significant predictors. Connections between stress domains and FA can serve as starting points for the development of meaningful interventions that support individuals self-care strategies (Social Overload), complexity management (Excessive Demands from Work), and coping with negative emotions (Chronic Worrying)., (© 2023 The Authors. Stress and Health published by John Wiley & Sons Ltd.)

In the near future, immunotherapy with checkpoint inhibitors will not only reach the relevant ENT clinics, but also the oncologically integrated ENT practice, since more and more patients under long-term therapy (currently up to 2 years) also have to be seen during clinical follow-up in the specialist practice. In this respect, we also consider as necessary that the basics of immuno-oncology in head and neck tumors are already taught as part of the ENT specialist training. In this review article, the background and the definitions of the therapy sections (first, second line treatment, marker, etc.) should be discussed in detail and the basic tools for understanding this new therapy option should be provided. Since 2017, we have been experiencing a high level of approval dynamics for checkpoint inhibitors in Germany, which is to be assessed as an expression of a new effective principle of action and, after surgery, radiation and chemotherapy, is establishing a fourth strong pillar in the multimodal spectrum against head and neck tumors. Right from the start, the checkpoint inhibitors in the first phase 1b, 2 and 2b studies achieved overall response rates of 16-22 % with overall survival rates of 6-8 months in seriously ill patients with HNSCC who already had a first- and/or even second-line therapy. Nivolumab and Pembrolizumab are currently approved in Germany for the first and second line therapy of relapsed/metastatic squamous cell carcinoma of the head and neck region (HNSCC), Cemiplimab for recurrent/metastatic cutaneous squamous cell carcinoma and Avelumab for metastatic recurrent Merkel-cell carcinoma. The synopsis article about immune checkpoint inhibitors is intended to convey the basic understanding of the principle of action, the indication, toxicity management and the further development within trials in head and neck oncology., Competing Interests: Erklärung zu finanziellen InteressenForschungsförderung erhalten: Ja; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: Ja; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: Ja; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Sponsor der Veranstaltung): Nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Nicht-Sponsor der Veranstaltung): Nein.Erklärung zu nichtfinanziellen InteressenDie Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

A significantly increasing proportion of oropharyngeal head and neck carcinomas (OSCC) in North America and Europe are associated with human papillomavirus (HPV) infections. HPV-related OSCC is regarded as a distinct tumor type with regard to its cellular, biologic, and clinical characteristics. Patients with HPV-related OSCC have significantly better local control, but higher rates of regional lymph node and distant metastases as compared to patients with HPV-negative OSCC. Classical molecular genetic investigations demonstrated specific chromosomal aberration signatures in HPV-related OSCC, and recent developments in next generation sequencing (NGS) technology have rendered possible the sequencing of entire genomes, and thus detection of specific mutations, in just a few days. Initial data from The Cancer Genome Atlas (TCGA) project obtained by using genome-wide high throughput methods have confirmed that HPV-related OSCC contain fewer, albeit more specific mutations than HPV-negative tumors. Additionally, these data revealed the presence of specific-potentially therapeutically targetable-activating driver mutations in subgroups of HPV-positive OSCC, some of which have a prognostic impact. Specific targeted NGS technologies provide new possibilities for identification of diagnostic, prognostic, and predictive biomarkers and the development of personalized cancer treatment. Patients with HPV-positive tumors are likely to profit from these developments in the future, since the genetic alterations are relatively homogenous and frequently lead to signal pathway activation. There is an urgent need for network research activities to carry out the necessary basic research in prospective cohort studies.

Based on level I evidence, postoperative platinum-based radiochemotherapy (PORCT) is the recommended standard of care in defined risk situations after resection of squamous cell carcinomas of the larynx and hypopharynx (LHSCC). The value of the addition of chemotherapy to adjuvant radiation in intermediate and high risk situations other than extracapsular spread or R1-/R2 resection is still debated. From 1993 to 2009, 555 patients (median follow-up: 24.4 months) with advanced LHSCC (UICC stages III-IVB) were treated in a curative intent. Patient data were continuously documented in the county of Leipzig cancer registry and were retrospectively analyzed as mono institutional survey. PORCT was introduced into the standard procedures in 2004, but also applied before in selected cases. Based on this paradigm shift, the patient population was divided into two comparative groups treated before and after 2004. 361 patients were treated before 2004. 43.8 % received primary surgery (OP) + postoperative radiotherapy (PORT) and 20.2 % OP + PORCT. 194 patients were treated after 2004: 21.1 % received OP + PORT and 35.6 % OP + PORCT. Regarding the PORCT groups, 20.6 % received cisplatin plus 5FU before 2004 which shifted to 59.4 % after 2004. The 3-year tumor-specific-survival rate of the whole cohort was improved from 47 to 60 % (p = 0.006). The subgroup treated with OP + PORT or PORCT improved from 56.1 to 68.5 % (p = 0.028). Localization proved to be a significant and independent factor. Only patients with advanced laryngeal cancer had significant improved survival (p < 0.01), while the improvement for hypopharyngeal cancer patients was not significant (p < 0.2). After 2004, there was a slight increase (+10.2 %) of primary radiochemotherapy (pRCT) due to stronger selection if R0 > 5 mm-resectability is unlikely. Standardised use of PORCT and pRCT considering clear indications showed to be significantly involved in improved survival in advanced LHSCC.

Emissions from waste incineration plants can be monitored relatively simply and cost-effectively via stack gas condensates. We compared quantitative chemical-analytic data of stack gases with two genotoxicity tests. The tests employed, i.e. a new, simple UDS assay variant with the human lung cell lines NCI-H 322 and 358, developed for this purpose, and an automated version of the SOS chromotest, were validated with respect to the contents of stack gases analytically detected. As judged by Bavarian waste incineration plants, sampled in the years 1990 to 1995, we obtained the following principle results: A drastic reduction of the genotoxicity from stack gases in the sampling period was observed with both tests. There were found genotoxic stack gases with the more sensitive UDS assay also in modern plants at the end of sampling period. Up to 99% of the organic components were not detected by chemical analysis despite an extensive program of analytics. The concentration of the quantified cancerogenic organic single substances from the samples did not suffice to explain genotoxic effects in the stack gases. Unknown, not identified stack gas contents are mainly responsible for the genotoxic potential of the stack gases. According to our results, emissions of modern waste incineration plants are likely to increase the genotoxic hazardous potential of the air only insignificantly even in pollution-free zones.

For the validation of the genotoxicity testing on stack gas condensates from waste incineration plants using bacterial short time tests (15), a modified UDS assay with the lung cell lines NCI-H 322 and 358 was developed. The UDS assay is more sensitive than the SOS chromotest and discriminates better between the negative or weakly positive and the clearly positive samples. It has a high sensitive and specificity and also accuracy, is practicable in a comparatively simple, speedy and reasonably priced manner and is therefore appropriate for an emission monitoring similar to simple bacterial short time tests. Especially in strongly concentrated crude and clean gas condensates, maximal induction factors were seen in the range of strong UDS inducers. From 55 samples on 16 incineration plants tested in the years 1992 to 1995, in 48 we found weak to strong UDS inductions in at least one of the two test cell lines. From three plants examined continuously in this period only two emitted stack gases with constantly low genotoxicity at the end of sampling. 5 clean gas condensates, that were taken in random samples from 3 other plants in the period 1994 to 1995, proved to be non-genotoxic in the UDS assay. However, one of these plants emitted stack gases with high cytotoxicity, which might have masked UDS-inducing single substances. It is not possible to make a statement on the human toxicological relevance. However, a clearly positive development towards more harmless stack gas condensates was established. A definite correlation could not be shown between the chemical analysis of the detected cancerogenic organic single substances of the samples and the detected UDS inductions. Further investigations for finding strong UDS inducers from the substance spectrum of municipal stack gas emissions are necessary.

The genotoxicity of stack gas condensates of 21 waste incineration plants (located in Bavaria) was examined in the years 1990-1995 using two bacterial short time tests. The SOS chromotest was carried out with the tester strains Escherichia coli PQ37, PQ243 and PQ300. In addition, for the purpose of comparison, the Ames-Test was performed for selected examples with the tester strains Salmonella typhimurium TA97, TA98, TA100 and TA1537. In a pilot study, carried out in the years 1990 to 1991, the stack gas condensates from five plants were examined. They showed clear genotoxic and mutagenic effects. On the other hand, in subsequent tests we generally discovered only weak inductions for 9 of 18 crude and 24 of 78 clean gas condensate extracts, mostly after metabolic activation. Four plants were tested continuously in the years 1992 to 1995. Three of them showed a clear reduction of the detectable genotoxic potential. The fourth one gave negligible SOS inducing emissions in the whole examining period. On the other hand, for 6 of the 21 tested plants we found chromotest positive results even at the last test point. Correlations between the SOS inducing potential of the stack gas condensates and the analytical parameters detected at the same time (6 summary parameters, 24 inorganic and 63 organic chemical parameters) were not evident. Only the two highest emissions of nitropyrenes were associated with SOS inductions. Organic substances which are not analytically detected or synergistic effects might be responsible for the SOS inducing potency of the other genotoxic stack gas condensates.

Investigations into the toxicity and the chemical analytics of stack gas condensates from 21 waste incineration plants (locations in Bavaria) were undertaken in the years 1990 to 1995. A decisive prerequisite was the development of a simple, standardizable technique for sample collection. It was done by condensating stack gases at 0 to 5 degrees C in an intensive glass condensator. Certain types of compounds showed a different behaviour of separation at the temperatures which were used. Whereas bivalent ionic mercury and chlorophenols were comparatively well separated with amounts of 60 to 95% and the polychlorinated dioxins, furans and biphenyls (PCBs) were sufficiently separated with 20 to 60%, less than 10% of the chlorobenzenes and polycyclic aromatics (PAHs) were found in the condensates. Sufficiently sensitive biological test procedures must be chosen for a biomonitoring of the condensates on geno- and immunotoxic effects to keep the required quantity of the condensates within practicable limits. The concentration of organic wastes was done through a solid phase extraction for the genotoxicity testing in the period from 1990 to 1991, and uniformly through a dichloromethane extraction for the biological and the simultaneous chemical analytical investigations from 1992 to 1995.