BACKGROUND:Radiotherapy-related normal tissue injury is clinically important in salvage surgery for hypopharyngeal cancer, but its histopathological features in clinical specimens remain poorly defined. AIMS/OBJECTIVES:To propose a practical descriptive histopathological framework for radiotherapy-related muscle injury using salvage surgical specimens. MATERIAL AND METHODS:We retrospectively examined anterior cervical muscle specimens obtained during salvage total pharyngolaryngectomy after definitive radiotherapy or chemoradiotherapy. Two head and neck surgeons with postgraduate training in pathology independently reviewed H&E-stained sections without reference to treatment exposure and, after discussion, established a four-tier semiquantitative framework based on recurring morphologic patterns. A board-certified head and neck pathologist subsequently reviewed all specimens blinded to treatment exposure and clinical information. No statistical comparison between treatment groups was intended. RESULTS:Thirteen previously irradiated patients and two non-irradiated controls were included. Irradiated muscles showed a spectrum of changes ranging from mild myofiber swelling and atrophy to rupture, fibrosis, necrosis, and scarring. Non-irradiated controls showed preserved muscle architecture. CONCLUSIONS AND SIGNIFICANCE:This study proposes a practical descriptive framework for radiotherapy-related muscle injury in salvage surgery. The grades should be interpreted as predominant morphologic patterns rather than rigid chronological stages or statistically validated treatment-specific categories.
OBJECTIVES:Approximately 30% of patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) have poor outcomes despite standardized treatment. Reliable biomarkers for identifying high-risk patients remain insufficiently established. To investigate the clinical significance of systemic inflammatory indices for identifying high-risk patients and to explore their associations with clinicopathological characteristics. METHODS:A total of 99 patients with HPV-associated (p16-positive) OPSCC were included. Systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), C-reactive protein-to-albumin ratio (CAR), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), were evaluated for their associations with clinical outcomes and clinicopathological characteristics. Their prognostic significance was assessed using Cox proportional hazards regression and Kaplan-Meier survival analyses. RESULTS:Most systemic inflammatory indices were associated with overall survival (OS) in univariate analysis, whereas only NLR was associated with progression-free survival (PFS); furthermore, none remained independently significant in multivariate analyses. Notably, all indices were significantly associated with T classification, whereas associations with N and M classifications were limited. CONCLUSIONS:Systemic inflammatory indices primarily reflected tumor burden rather than serving as independent prognostic determinants in HPV-associated OPSCC. Biomarkers derived from the local tumor immune microenvironment may provide more informative tools for risk stratification and treatment optimization.
BACKGROUND:Informed consent documents often exceed recommended readability levels, potentially compromising patients' decision-making. AIMS/OBJECTIVES:This pilot feasibility study evaluated two large language models (LLMs), ChatGPT-5.2 and Gemini 3 Pro, as tools for generating more comprehensible otolaryngology surgical consent forms, and estimated effect-size parameters for a future trial. MATERIALS AND METHODS:In a prospective, double-blind design, 123 Turkish consent documents (41 procedures × 3 sources: official forms, ChatGPT-5.2 and Gemini 3 Pro) were evaluated. Three independent otolaryngologists rated medical quality on five 5-point criteria; five blinded lay volunteers rated comprehensibility. Two validated Turkish readability indices (Ateşman; Bezirci-Yılmaz) provided objective measurement. Comparisons used linear mixed-effects models. RESULTS:Official forms showed the highest expert-rated quality (4.62 ± 0.35) versus ChatGPT5.2 (3.85 ± 0.48) and Gemini 3 Pro (3.99 ± 0.44; p < 0.001). Gemini forms achieved the highest comprehensibility (4.33 ± 0.42 vs 3.18 ± 0.51 for official forms; p < 0.001). Objective readability mirrored this, with the Ateşman score correlating with comprehensibility (r = 0.81). CONCLUSIONS AND SIGNIFICANCE:Publicly available LLMs, particularly Gemini 3 Pro, can substantially improve consent-form comprehensibility at some cost to medical-accuracy and ethical-legal adequacy; these findings motivate evaluation of a hybrid AI-plus-expert workflow in a future confirmatory trial.
BACKGROUND:Despite rising survival rates and high-quality health data available - no large-scale study has mapped the full Danish Childhood Cancer Survivor population with auditory late effects. AIMS/OBJECTIVES:This study aimed to estimate the prevalence of auditory late effects among Danish children and adolescents diagnosed with cancer in a national register-based study. MATERIALS AND METHODS:Using data from the Danish Cancer Register and the Danish National Patient Register, we identified children diagnosed with cancer before the age of 18 between 2014 and 2024. Statistical analyses including descriptive statistics, chi-square tests, relative risks and trend analysis were performed to explore patterns and potential associations between cancer diagnosis and the development of auditory late effects. RESULTS:The study population consisted of 3075 children with a registration in the Danish Cancer Register. The prevalence of auditory late effects was 5.7%. The risk was higher among younger patients, patients with malignant neoplasms and patients receiving high-dose chemotherapy at a younger age.. CONCLUSION AND SIGNIFICANCE:These findings highlight auditory late effects as a relevant late effect with implications for quality of life. Early identification and monitoring are essential to support developmental outcomes, particularly in younger patients, and to increase awareness in survivorship care.
BACKGROUND:Research on the hearing implant journey in older adults is scarce. AIMS/OBJECTIVES:To conduct a multicenter scoping survey on the clinical routine in the treatment of hearing loss, specifically cochlear implantation, in older adults. MATERIALS AND METHODS:A survey comprising 39 questions on the treatment of hearing loss in older adults was sent to 20 cochlear implant clinics worldwide. RESULTS:Most respondents referred to older adults in the context of cochlear implantation as adults aged 60 years or older with postlingual, mostly progressive hearing loss with different aetiologies. Preoperative assessment in older adults should go beyond standard audiometric tests, including cognitive screening and involving a multidisciplinary team. Significant others and social support play a key role in the rehabilitation process in older adult CI recipients and users. CONCLUSIONS AND SIGNIFICANCE:A guideline for the management of cochlear implantation in older adults is needed.
