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Carlos Suárez,1,2 Fernando López,1– 3 William M Mendenhall,4 Simon Andreasen5– 7†, Lauge Hjorth Mikkelsen,7 Johannes A Langendijk,8 Stefano Bondi,9 Juan P Rodrigo,1– 3 Leif Bäck,10 Antti A Mäkitie,10– 12 Verónica Fernández-Alvarez,13 Andrés Coca-Pelaz,1– 3 Robert Smee,14 Alessandra Rinaldo,15 Alfio Ferlito16 1Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain; 2Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain; 3Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain; 4Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA; 5Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark; 6Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark; 7Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 8Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 9Department of Otorhinolaryngology-Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy; 10Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland; 11Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; 12Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; 13Vascular Surgery Department, Hospital Universitario Central de Asturias, Oviedo, Spain; 14Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia; 15University of Udine School of Medicine, Udine, Italy; 16International Head and Neck Scientific Group, Padua, Italy†Simon Andreasen passed away on February 28, 2020Correspondence: Carlos SuárezInstituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Avenida de Roma s/n, Oviedo 33011, SpainEmail csuareznieto@gmail.comFernando LópezDepartment of Otorhinolaryngology, Hospital Universitario Central de Asturias, Avenida de Roma s/n, Oviedo 33011, SpainEmail flopez_1981@yahoo.esAbstract: The aim of this review is to analyze the latest trends in the management of non-vestibular skull base and intracranial schwannomas in order to optimize tumor control and quality of life. Non-vestibular cranial nerve schwannomas are rare lesions, representing 5– 10% of cranial nerve schwannomas. Management decisions should be individualized depending on tumor size, location and associated functional deficits. Generally, large sized schwannomas exerting significant mass effect with increased intracranial pressure are treated surgically. In some cases, even after optimal skull base resection, it is not possible to achieve a gross total resection because tumor location and extent and/or to reduce morbidity. Thus, subtotal resection followed by stereotactic radiosurgery or fractioned radiotherapy offers an alternative approach. In certain cases, stereotactic radiosurgery or radiotherapy alone achieves good tumor control rates and less morbidity to gross total resection. Finally, given the slow growth rate of most of these tumors, observation with periodic radiographic follow-up approach is also a reasonable alternative for small tumors with few, if any, symptoms.Keywords: schwannoma, head and neck, cranial nerves, non-vestibular, skull base

Objectives: To assess five-year local control and ultimate local control rates of patients treated for locally advanced T3–4 glottic carcinoma with surgery only, radiotherapy only, or surgery plus radiotherapy. Cancer-specific survival, overall survival and rates of malignancy development were also assessed. Methods: A retrospective review was conducted on patients from 1967 to 2015, with analysis of local control, ultimate local control, overall survival and cancer-specific survival performed using Kaplan–Meier and Cox regression. Results: Of 169 eligible patients, the majority (59 per cent) were treated with surgery plus radiotherapy, with laryngectomy being the most common surgical procedure. Local control and ultimate local control rates were higher with surgery only (94.1 per cent) and surgery plus radiotherapy (87.9 and 86.8 per cent respectively), compared to radiotherapy only (46.8 and 52.4 per cent) (both p < 0.001). Cancer-specific survival, overall survival and malignancy development did not differ between groups. Conclusion: Surgery, with or without radiotherapy, offers significantly higher five-year local control and ultimate local control for patients with advanced glottic carcinoma, compared to radiotherapy only. [ABSTRACT FROM AUTHOR]

Purpose: MRI is routinely used to define the target volume for planning vestibular schwannomas for SRS. There are many MRI sequences available for planning these patients. The aim is to use the sequence that gives the most accurate representation of these targets, in order to achieve the best clinical outcome for these patients. Consideration should be given to the target dose coverage as well as the dose delivered to the dose limiting structures or OARs. Methods: The patients all have an MPRAGE sequence to identifying the target volume for SRS planning and treatment. This is a volumetric T1 weighted sequence with contrast, which is then fused to a stereotactically localised CT scan for planning. For the purpose of this study, selected patients also hada CISS sequence. We have been advised by the Radiologists that a CISS sequence will give more accurate definition of the target volume. The MPRAGE datset includes the entire skull with slices reconstructed at 3mm spacing. The CISS data set is a 20mm block centred on the target with slices reconstructed at 0.5mm spacing. Both data sets are fused to the localised CT scan for planning - chained fusion. The target volume is outlined on both data sets so that a comparison of volume and position can be made. To complete the study, model of a typical vestibular schwannoma target of known volume was made and placed in a phantom. This was scanned with both MPRAGE and CISS sequences to determine which sequence more accurately demonstrated the target. Results: There was a demonstrable difference in volume and position of the target volumes. Although the differences are quite small, the target volumes are also small so this maybe important. The comparison with the phantom study needs to be considered when making recommendations for the clinical setting. Conclusion: There are many different sequences available for MRI. Careful consideration must be given when selecting the imaging used clinical cases in order to most accurately demonstrate these small targets located in close proximity to critical organs at risk. Every effort is made when planning these cases to limit the dose to normal tissue whilst delivering an effective dose to the target. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Purpose: Fatigue occurs as a symptom in cancer and also as a side effect of radiotherapy treatment. Participation in aerobic exercise is becoming recognised as an integral part for rehabilitation/recovery. Results: from our Prince of Wales Hospital-POWH SRS (Stereotactic Radiosurgery) III-Phase Dairy Patient Study, current recruitment 647 patients, reported 'fatigue' high on the Likert scoring-scale, day 1, and 1-12 weeks after their SRS, evaluating their physical, psychological/social well-being post treatment. Of major interest was the high response level of fatigue for both benign and malignant tumours at 1 and 12 weeks, with fatigue remaining high at 71%. This study will address how to influence this. Methods: Benchmarking pre SRS fatigue-level commenced in June 2008. To parallel our findings with the above study we have gained HREC approval to commence a translational prospective "12 Week Randomised 2-Arm-Control Exercise Intervention Study Post Radiotherapy", measuring pre/post fatigue levels after SRS, in collaboration with the Physiotherapy Department, POWH. Recruitment commenced in October 2012, anticipated sample size being n=72. Arm-1 group-'an at home individualised exercise program wearing a heart-rate monitor doing programmed exercise 5 times per week, Arm-2 group-participants to continue their normal activities. Participants will have standard physical assessment-6 minute walking test + 3 minute step test, along with fatigue (PIPER SCALE) and Qol (EORTC) questionnaires to complete. Patients will record their physical activities in their exercise diary and will be contacted to assess their weekly progress. At completion of the 12 week study, participants will return to the Physiotherapy Dept. for a second physical assessment, 6 minute walking test and step test. Post study Fatigue and Qol questionnaires will be completed. All assessment data forms and questionnaires will be entered into SPSS version_20. Results: Thus to date 163 patients recorded nil fatigue pre-SRS study, while fatigue on the evening of day 1 (procedure day) was 246 (80%), resulting from compounding factors such as total travel time, length of day, anxiety & tension. Fatigue recorded at 1 and 12 weeks post SRS respectively were 221, 161 (72%, 52%). The patients suitable for the translational exercise intervention study will be recruited from this SRS population. Conclusion: It is anticipated that participating in exercise intervention, post radiotherapy for brain tumour patients will result in a decrease level of general fatigue and well-being, and a positive effect on their QoL outcome, compared to the current standard treatment course. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Introduction:The main purpose of this study was to investigate the psychological and functional impact attributed to acoustic neuroma symptoms.Materials and methods:A sample of 207 acoustic neuroma patients completed a study-specific questionnaire about the severity, frequency, and psychological and functional impact of 9 acoustic neuroma symptoms.Results:The survey response rate was 56.4 per cent. All symptoms had some degree of psychological impact for the majority of participants; hearing loss was the symptom most often reported to have a severe psychological impact. The majority of respondents reported functional impact attributed to hearing loss, balance disturbance, dizziness, eye problems, headache and fatigue; balance disturbance was the symptom most often reported to have a severe functional impact. For most symptoms, psychological and functional impact were related to severity and frequency.Conclusion:Of the acoustic neuroma symptoms investigated, hearing loss and balance disturbance were the most likely to have a severe psychological and functional impact, respectively. [ABSTRACT FROM PUBLISHER]

Objectives: Second Primary Tumours (SPTs) have been implicated in poor Overall Survival (OS) of Head and Neck Squamous Cell Carcinomas (HNSCCs). The incidence of SPTs; the SPT diagnostic time lag; the impact on OS; and the mean annual risk was assessed. Methods: 987 consecutive patients treated for primary larynx SCC (1967–2004) were analysed in this study. 96.3% and 91.4% of patients reached a minimum follow up period of 3 and 5 years. Results: 208 (21.1%) patients were diagnosed with SPTs. 143 (14.5%) patients developed upper aero-digestive tract UAD-SPTs, 83 (8.4%) were HNSCCs, 56 (5.7%) were lung, and 4 (0.41%) were oesophageal SPTs. Survival analysis demonstrated unexpected but clear superior OS rates for the UAD-SPT (p < 0.008) and HNSCC-SPTs (p < 0.001). Patients with synchronous SPTs had a poorer overall survival (p < 0.001). The mean annual risk of developing UAD-SPTs was 2.4%. Conclusion: These results suggest that HNSCC-SPT should not be viewed as an adverse prognostic factor. Reclassifications of UAD-SPTs into HNSCC-SPT and non HNSCC-SPT better reflects their clinical behaviour and prognosis. [ABSTRACT FROM AUTHOR]