Angiotensin-converting enzyme insertion/deletion polymorphism and susceptibility to allergic rhinitis in Chinese populations: a systematic review and meta-analysis

In view of the controversies surrounding the angiotensin-converting enzyme (ACE)–allergic rhinitis (AR) association, a systematic review and meta-analysis of the ACE genetic association studies of AR was performed in Chinese populations. PubMed, Springer Link, OvidSP, Chinese biomedical database, Chinese national knowledge infrastructure, Chinese VIP and Wanfang databases were searched for related studies. A total of 4 studies including 415 AR patients and 309 controls were involved in this meta-analysis. Overall, significant association was found between ACE I/D polymorphism and AR risk when all studies in Chinese populations pooled into the meta-analysis (allele, OR 1.50, 95 % CI 1.19–1.90; homozygous, OR 2.59, 95 % CI 1.52–4.41, recessive, OR 2.05, 95 % CI 1.27–3.32). In the subgroup analysis by ethnicity, ACE I/D polymorphism was associated with significant elevated risks of AR in Chinese Han under homozygous and recessive models (homozygous, OR 4.36, 95 % CI 1.76–10.82, recessive, OR 2.51, 95 % CI 1.18–5.34). In conclusion, this meta-analysis provides the evidence that ACE I/D polymorphism may contribute to the AR development in Chinese populations and studies with large sample size and wider spectrum of population are warranted to verify this finding.     

Outcome of patients treated with palliative weekly Paclitaxel plus Cetuximab in recurrent head and neck cancer after failure of platinum-based therapy

Few therapeutic options are available for recurrent/metastatic head and neck cancer when progression occurs after initial chemotherapy. We analyzed retrospectively the efficacy of weekly Paclitaxel plus Cetuximab as second line of palliative chemotherapy. Patients with squamous carcinoma of head and neck with documented progression after initial treatment were enrolled. Tumor response was evaluated through the response evaluation criteria in solid tumor criteria. The retrospective analysis focused on overall survival (OS) and progression-free survival (PFS). Between 2008 and 2011, 33 consecutive patients were treated. A response rate of 55 % was observed, with median response duration of 5.0 months (95 % CI 3.3–11.1). The median PFS was 4.0 months (95 % CI 2.9–5.0) and the median OS time was 10.0 months (95 % CI 7.9–12.0). Acne-like rash/Folliculitis and chronic anemia were the most common adverse events. A weekly schedule of Paclitaxel plus Cetuximab is a promising regimen for patients with advanced head and neck cancer after failure of platinum-based therapy. Good tolerance of this treatment suggests that would be used in fragile patients.     

Quantitative assessment of the association between GSTM1 null genotype and laryngeal cancer risk

Previous studies investigating the association between glutathione S-transferase M1 (GSTM1) null genotype and laryngeal cancer risk reported controversial results. Thus, a meta-analysis was performed to clarify the effect of GSTM1 null genotype on laryngeal cancer risk. A literature search was performed for all possible studies. We estimated summary odd ratio (OR) with its 95 % confidence interval (95 % CI) to assess the association. Subgroup analyses were performed by ethnicity or the sample size. 24 individual case–control studies involving a total of 2,809 laryngeal cancer cases and 4,478 controls were finally included into this meta-analysis. Meta-analyses of total 24 studies showed the GSTM1 null genotype was significantly associated with increased laryngeal cancer risk (random-effects OR = 1.44, 95 % CI 1.19–1.73, P < 0.001). Subgroup analyses by ethnicity showed that the GSTM1 null genotype was associated with increased laryngeal cancer risk in both Caucasians (fixed-effects OR = 1.17, 95 % CI 1.04–1.33, P = 0.012) and Asians (random-effects OR = 1.89, 95 % CI 1.28–2.77, P = 0.001). Also, subgroup analyses by sample size also further identified this association above. The cumulative meta-analyses showed a trend of more obvious association between GSTM1 null genotype and increased risk of laryngeal cancer as information accumulated by year. Meta-analysis of available data suggests that GSTM1 null genotype contributes to increased laryngeal cancer risk in both Caucasians and East Asians.     

Pre‐treatment haemoglobin level predicts response and survival after TPF induction polychemotherapy in advanced head and neck cancer patients

Objective: To investigate the prognostic value of the pre‐treatment haemoglobin level in patients with advanced squamous cell head and neck cancer treated with induction polychemotherapy. Design: Seventy‐two patients with advanced squamous cell head and neck cancer received primary combination chemotherapy consisting of docetaxel 75 mg/m² on day 1, cisplatin 100 mg/m² on day 1, and 5‐fluorouracil (5‐FU) 1000 mg/m²/day on days 1–4 (total dose 4000 mg/m²), repeated on days 1, 22 and 43 followed by chemoradiation. The data collected included pre‐treatment haemoglobin, response to treatment, disease‐free and overall survival. Results: The pre‐treatment haemoglobin level was found to be a significant predictor of response to induction chemotherapy (P = 0.01) and an independent predictor of overall survival [hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.58–1.03, P = 0.0001] and disease free survival (HR 2.09, 95% CI 1.41–3.09, P = 0.0001). Furthermore N‐stage was found to be a significant prognostic factor of overall survival (HR 9.24, 95% CI 6.90–21.34, P = 0.005). The Eastern Cooperative Oncology Group performance status scale was also found to be significant for disease free survival (HR 7.66, 95% CI 2.61–22.46, P = 0.003). Conclusion: In patients with advanced squamous cell head and neck cancer, the haemoglobin level prior to induction chemotherapy is significantly related to outcome including response and survival.     

Merkel cell carcinoma of the head and neck: emphasizing the risk of undertreatment

Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine carcinoma. It occurs predominantly in the head and neck area and often behaves aggressively. In this single-institution retrospective observational cohort study, we describe the results of a treatment strategy that we developed over the past decades. Endpoints of this study were local, regional and distant control, disease-specific survival and overall survival. In total 47 patients with head and neck MCC, diagnosed in the Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AvL) between 1984 and 2012, were included in this study. Local tumor control was 82 % (95 % CI 71–95 %) at 5 years. Regional lymph node metastases were found at the moment of diagnosis in 13 cases (28 %). In the group of patients who were initially cN0, the 5-year regional control was 80 % (68–95 %). The 5-year metastasis-free interval probability was 80 % (68–94 %). The disease-specific survival (DSS) at 5 years was 70 % (56–86 %). An overall survival of 54 % (40–72 %) was found at 5-year follow-up and of 37 % (23–59 %) at 10-year follow-up. Univariable Cox regression analysis of many clinical and pathological variables did not identify any predictors for DSS. The MCC has a high propensity for locoregional and distant spread in the head and neck region. Undertreatment, especially of the lymph nodes in the neck, is a serious problem as regional (micro)metastasis are common even in T1 tumors. Future research will have to elucidate the role of the sentinel lymph node procedure versus the elective selective node dissection and standardized elective local and regional radiotherapy in the head and neck area.     

Cyclin D1 amplification and p16(MTS1/CDK4I) deletion correlate with poor prognosis in head and neck tumors

OBJECTIVES/HYPOTHESIS: Cyclin D1, a cell cycle regulator localized to chromosome 11q13, is amplified in several human tumors including head and neck squamous cell carcinoma (HNSCC). Amplification and/or overexpression of cyclin D1 have been correlated to a poor prognosis. Deletion of the p16 gene, localized to 9p21, has also been observed in a significant proportion of HNSCC. The p16 gene regulates cyclin D1-CDK4 activity and prevents retinoblastoma tumor suppressor gene phosphorylation, thereby downregulating cellular proliferation. Detection of cyclin D1 amplification and p16 deletion using a simple and sensitive method will be valuable for the development of effective treatment modalities for head and neck cancer. STUDY DESIGN: We have used fluorescence in situ hybridization (FISH) to study cyclin D1 amplification and p16 gene deletion in head and neck tumors. Both single- and dual-color FISH were performed. METHODS: Paraffin-embedded tissues from 103 patients with HNSCC were analyzed using genomic DNA probes for cyclin D1 and p16. Dual-color FISH was performed with chromosome 11 or 9 centromeric probes as a control. Twenty-eight of these samples were analyzed for p16 expression by immunohistochemistry. RESULTS: Cyclin D1 amplification was observed in 30% (31/103) of patients, and p16 deletion in 52% (54/103). Lack of p16 expression was observed in 64% (18/28) of patients. There was a good correlation between the deletion of p16 sequences and the loss of p16 expression (P = .008). Amplification of cyclin D1 had a statistically significant association with recurrence, distant metastasis, and survival at 36 months. There was a significant association between p16 deletion and the development of distant metastases. Cyclin D1 amplification and p16 deletion together correlated with recurrence, distant metastasis, and survival. CONCLUSIONS: We demonstrate that FISH is a simple and sensitive method for detecting cyclin D1 amplification and p16 deletion in head and neck cancer. Our results suggest that these two genetic aberrations together portend a poorer outcome than either of the abnormalities alone in head and neck cancer.     

Diagnostic value of sentinel lymph node biopsy in head and neck cancer: a meta-analysis

This study aimed to evaluate the diagnostic reliability of sentinel lymph node biopsy in patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx by reviewing the published literature. A systematic literature review was performed using MEDLINE from 1970 to 2011. With Boolean search strings, search terms included sentinel node, supraglottic, supraglottis, tongue, head and neck, oral, pharynx, laryngeal, and larynx. Additional studies were identified through article references. Duplicate data and articles were excluded based on treating institution and study inclusion time period. Additional studies were excluded if the head and neck subsite or tumor stage was not specifically identified or if the sentinel lymph node biopsy occurred in previously treated necks. All patients had sentinel lymph node biopsy performed followed by a concurrent neck dissection. Twenty-six studies met our inclusion criteria (n = 766 patients). The pooled sensitivity and negative predictive value of SLNB for all head and neck tumors was 95 % (95 % CI 91–99 %) and 96 % (95 %CI 94–99 %), respectively. The overall sensitivity and negative predictive value of SLNB in the subset of oral cavity tumors (n = 631) was 94 % (95 % CI 89–98 %) and 96 % (95 % CI 93–99 %), respectively. One-hundred percent of oropharyngeal (n = 72), hypopharyngeal (n = 5), and laryngeal (n = 58) tumor sentinel lymph biopsy results correlated with subsequent neck dissections giving a negative predictive value of 100 %, showing that, sentinel lymph node biopsy is a valid diagnostic technique to correctly stage regional metastases in patients with head and neck squamous cell carcinoma.     

Perineural invasion as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis

Abstract

Background: Squamous cell carcinoma (SCC) is the most common type of head and neck cancer, and head and neck squamous cell carcinoma (HNSCC) was proved to having a high prevalence of perineural invasion (PNI). Although some reports have revealed a relationship between PNI and the prognosis in HNSCC patients, the contribution of PNI to the prognosis remains unclear.

Objectives: This study was aimed to comprehensively and quantitatively summarize the prognostic value of PNI for the survival of patients with HNSCC.

Material and methods: We conducted PubMed and EMBASE to identify all relevant studies. A meta-analysis and subgroup analysis were performed to clarify the prognostic role of PNI.

Results: A total of 18 studies (n?=?3894) were included. 989 (25.4%) of the 3894 patients exhibited positive PNI, PNI was shown to be significantly associated with overall survival (OS) [hazard ratio (HR): 2.8, 95% confidence interval (CI): 1.88–4.16], disease-free survival (DFS) (HR = 2.42, 95% CI: 1.92–3.05) and disease-specific survival (DSS) (HR = 2.60, 95% CI: 1.86–3.63).

Conclusions: The presence of PNI significantly affected OS, DFS and DSS in patients with HNSCC.     

HPV status and regional metastasis in the prognosis of oral and oropharyngeal cancer

Prognostic factors are important for treatment decisions as they help adapt the therapy on a case-to-case basis. Nodal status, number of positive nodes, and presence of extracapsular spread are considered to be the important prognostic factors in head and neck cancer. Some studies suggest that human papillomavirus (HPV) status also influences the outcome of the treatment. This influence can be explained by the variation in tendency to develop regional metastases and by variation in the type of neck node involvement. The study objectives were to compare patients with HPV positive and HPV-negative tumors for survival and prevalence and type of regional metastasis, to identify prognostic factors and to test whether HPV presence is an independent factor of survival. The study included 81 patients treated by surgery including neck dissection for oral or oropharyngeal squamous cell cancer. A computerized medical report was completed for each patient. Analysis of the tumor specimen for the HPV DNA presence was done on paraffin-fixed tissue. HPV DNA detection and typing were performed by PCR with GP5 + /GP6 + BIO primers and reverse line blot hybridization. Overall, 64% (52/81) of tumors were HPV positive with 80% in the tonsillar site. HPV-positive patients had significantly better both overall (73 vs. 35%) (P = 0.0112) and disease-specific (79 vs. 45%) (P = 0.0015) survival rates than HPV-negative patients. No significant differences were found in the pN classification, in the number of positive nodes and the presence of extracapsular spread in the involved nodes between HPV positive and HPV-negative tumors. Multivariate analysis showed that significant prognostic factors of survival were the presence of HPV in the tumor, extracapsular spread and tumor size. HPV was the most significant prognostic factor in the studied group of patients with oropharyngeal tumors (HR = 0.27, 95%CI 0.12–0.61) and possibly should be considered in treatment decisions.     

Is there a higher prevalence of human papillomavirus infection in Chinese laryngeal cancer patients? A systematic review and meta-analysis

Accumulating evidence suggests that persistent human papillomavirus (HPV) infection is closely related to the risk of certain types of head and neck squamous cell carcinoma types, including laryngeal cancer (LC). Some reports indicated a higher HPV prevalence in Chinese LC patients, which remains to be established due to small study sample sizes. The aim of this study was to estimate the HPV infection rate in Chinese LC patients and assess the LC risk conferred by high-risk subtype HPV infection by meta-analysis. We searched MEDLINE, the Embase Database, Chinese National Knowledge Infrastructure, Wanfang Database, and VIP Database for studies published in either English or Chinese up to October 2013, and systematically reviewed 28 original research articles that met the inclusion criteria. Both the HPV infection rate in the LC group (all 28 studies) and the LC risk from high-risk HPV infection (a subgroup of 12 case–control studies) were analyzed by R 3.0 software. Overall HPV, HPV-16/18, and HPV-6/11 infection rates were 32 % (95 % CI 22–44 %), 30 % (95 % CI 24–37 %), and 12 % (95 % CI 9–17 %), respectively. There was a strong association between high-risk HPV-16/18 infection and LC (P < 0.01; OR = 8.07, 95 % CI 5.67–11.48). Our research indicates that there is a higher HPV prevalence in Chinese LC patients compared to LC patients outside of China and that HPV infection significantly increases LC risk.     

The effect of cyclin D1 overexpression in human head and neck cancer cells

Overexpression of cyclin D1 in head and neck cancer has been suggested to be a poor prognostic factor. To understand the role of cyclin D1 expression in head and neck cancer, we overexpressed cyclin D1 in TU182 (a cell line derived from pharyngeal cancer) using a retroviral vector. Stable transfectants were isolated by neomycin (G418) selection. Compared to the parental and control-vector transfected cells, the cyclin D1 transfected cells revealed a decrease of the G1/G0 population and resulted in continuous proliferation under low serum conditions. Proliferation assays revealed an increase in resistance to cisplatin in cyclin D1 overexpressing cells. These observation suggest that deregulation of cyclin D1 may reduce growth factor requirements and contribute to the resistance to some chemotherapeutic agents among head and neck cancer patients.     

Antisense inhibition of cyclin D1 in human head and neck squamous cell carcinoma

OBJECTIVE: To study the role of cyclin D1 in regulating the biological behavior of head and neck cancer. DESIGN: Squamous cell carcinoma of the head and neck (SCCHN) cells were stably transfected with an antisense cyclin D1 using lipofectin-mediated transfection. In vitro growth assays, cell cycle analyses, cytotoxicity assays, and in vivo tumorigenicity assays were performed. MATERIALS: Human SCCHN cell lines TU138, TU167, TU177, TU182, MDA183, and MDA1386 and athymic nude mice were used for this study. RESULTS: The antisense cyclin D1 transfected cells revealed decreased growth rates in vitro and decreased tumorigenicity in athymic nude mice. Furthermore, antisense cyclin D1 transfection enhanced the chemosensitivity against cisplatin. CONCLUSIONS: These studies provided evidence that overexpression of cyclin D1 may play an important role in growth rates and biological behavior of human head and neck cancer. Additionally, expression of cyclin D1 may make human head and neck cancer cells resistant to platinum-based chemotherapeutic approaches. The ability to suppress the malignant phenotype by down-regulating cyclin D1 expression may provide a new gene therapy approach for patients with head and neck cancer.     

Head and neck cancer in renal transplant patients in Finland

Conclusions. This study found a 0.8% incidence of non-cutaneous head and neck cancer during a mean follow-up of 10 years. The benefits of successful renal transplantation clearly outweigh the observed risk of malignancy. Objective. Increased cancer incidence after organ transplantation is well documented but few studies have reported on the rate of head and neck malignancies among these patients. This study aimed to determine the incidence and specific sites of head and neck cancer in a nationwide series of renal transplant patients in Finland. Patients and methods. Data from the National Kidney Transplant Registry and the Finnish Cancer Registry were used. A total of 2884 kidney transplant patients from the period 1964 to 1997 were followed for cancer incidence during the period from 1967 to 2003. Results. There were 113 non-lymphomatous head and neck malignancies. The standardized incidence ratio (SIR), as compared with the general population, was 13.6, with a 95% confidence interval (CI) of 11.2–16.2. The SIR was significantly elevated for cancers of the skin (47.3, 95% CI 36.3–60.7), lip (31.8, 95% CI 20.8–46.6), oral cavity (6.5, 95% CI 2.4–14.0) and thyroid (5.8, 95% CI 3.0–10.2).     

The increase in incidence of cancer of the tongue in the Nordic countries continues into the twenty-first century

Conclusions This study shows that heavy drinking is a risk factor for prolonged delay in presenting with head and neck cancer and for presenting with a large tumour in the head and neck region. Excessive smoking is only a risk factor for being diagnosed with a large tumour, although there is a weak association between smoking and prolonged diagnostic delay.

Objective It is reasonable to assume that prolonged delay in presenting with head and neck cancer is associated with an advanced stage of cancer at diagnosis. In this study we analysed the effects of drinking and smoking habits on diagnostic delay and the T stage of the tumour at diagnosis.

Material and methods A total of 427 patients with newly diagnosed head and neck carcinomas were eligible for this study. Of these, 306 (72%) actually participated: 134 (77%) with an oral tumour; 117 (69%) with a larynx tumour; and 55 (65%) with a pharynx tumour. Diagnostic delay was defined as a period of >30 days between the appearance of the first tumour-related symptoms and the first visit to a physician. T3–4 tumours were defined as advanced tumours. Drinking behaviour was classified into three types: light (0–2 drinks/day); moderate (3–4 drinks/day); and heavy (>4 drinks/day). Smoking habits were classified into 4 types: never; stopped; light (0–20 cigarettes/day); and heavy (>20 cigarettes/day).

Results Logistic regression showed that there were significantly more heavy than light drinkers [p=0.04; odds ratio (OR) 1.8; 95% CI 1.0–3.1] in the delay group than in the non-delay group. Light smokers showed a tendency towards prolonged delay (p=0.06; OR 2.2; 95% CI 1.0–5.0). Both heavy drinking (p=0.01; OR 2.0; 95% CI 1.2–3.6) and heavy smoking (p=0.03; OR 3.1; 95% CI 1.1–8.4) were risk factors for a patient to be diagnosed with a large tumour.     

Surgical site infection in clean-contaminated head and neck cancer surgery: risk factors and prognosis

Since new treatment strategies, such as chemoradiotherapy, have been introduced for head and neck cancer, a higher number of unknown factors may be involved in surgical site infection in clean-contaminated head and neck cancer surgery. The aim of the present study was to clarify the risk factors of surgical site infection in clean-contaminated surgery for head and neck cancer and the prognosis of patients with surgical site infection. Participants were 277 consecutive patients with head and neck cancer who underwent clean-contaminated surgery for primary lesions at the Aichi Cancer Center over a 60-month period. A total of 22 putative risk factors were recorded in each patient and statistically analyzed to elucidate surgical site infection related factors. Surgical site infection was observed in 92 (32.1 %) of 277 cases. Univariate analysis indicated that alcohol consumption, T classification, neck dissection, reconstructive procedure, and chemoradiotherapy were significantly associated with surgical site infection. Multiple logistic regression analysis identified two independent risk factors for surgical site infection: reconstructive surgery (p = 0.04; odds ratio (OR) 1.77) and chemoradiotherapy (p = 0.01; OR 1.93). In spite of surgical site infection, the five-year overall survival rate of patients with surgical site infection was not significantly different from those without surgical site infection. Although surgical site infection did not impact the overall survival of patients with surgical procedures, head and neck surgeons should pay attention to patients with previous chemoradiotherapy as well as to those with a high risk of surgical site infection requiring reconstructive surgery.     

Association between radiotherapy and obstructive sleep apnea in head and neck cancer patients: A systematic review and meta-analysis

ObjectiveOur aim was to investigate association between OSA and radiotherapy in head and neck cancer patients.MethodsOn 9th of September 2018, we have searched 12 electronic databases to retrieve relevant studies. All eligible studies that assessed association between OSA and radiotherapy in head and neck cancer patients were included in our meta-analysis. Quality assessment of included studies was done using the NIH tools for cohort, cross-sectional and case series studies.ResultsFourteen studies met our study selection criteria, and six studies were eligible for our meta-analysis. There was no significant association between occurrence of OSA and radiotherapy in head and neck cancer patients (Odds ratio 1.54, 95% CI [0.66–3.60]; P  =  0.322).ConclusionThese findings point to no significant association between OSA risk and radiotherapy in head and neck cancer patients. We suggest more studies to be conducted to investigate any confounders that may influence the effect of radiotherapy on development of OSA in head and neck cancer patients.     

Human papillomavirus and head and neck cancer: a systematic review and meta‐analysis

?It has been suggested that the link between human papillomavirus (HPV) and head and neck squamous cell carcinoma (HNSCC) is specific to carcinoma of the tonsil. ? We systematically reviewed studies that tested for HPV16 exposure in anatomically defined sites in the head and neck and a control group. ? The association between HPV16 and cancer was strongest for tonsil (OR: 15.1, 95% CI: 6.8–33.7), intermediate for oropharynx (OR: 4.3, 95% CI: 2.1–8.9) and weakest for oral (OR: 2.0, 95% CI: 1.2–3.4) and larynx (OR: 2.0, 95% CI: 1.0–4.2). ? To investigate heterogeneity, further stratification by method of HPV16 detection, suggested that variation in the magnitude of the HPV‐cancer association with cancer site was restricted to studies using ELISA: among studies using PCR, the magnitude of the summary odds ratios was similar across the four sites. ? The association between HPV16 infection and HNSCC in specific sites suggests the strongest and most consistent association is with tonsil cancer, and the magnitude of this association is consistent with an infectious aetiology. ? However, the method of viral detection may be an important source of heterogeneity. Resolution of this issue will require further studies using both methods, examining associations separately in different sites.     

Post-operative MRSA infections in head and neck surgery

Purpose

Surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution.

Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi‐institution study,systematic review and meta‐analysis

Objectives: To measure morbidity and mortality rates following insertion of gastrostomy tubes in head and neck cancer patients. To determine evidence for any relationship between gastrostomy insertion technique and complication rates. Design: A prospective cohort study and qualitative systematic review. Setting: Multi‐cancer networks in the South West of England, Hampshire and the Isle of White. Participants: One hundred and seventy‐two patients with head and neck cancer undergoing gastrostomy tube insertion between 2004 and 2005. Percutaneous endoscopic gastrostomy (PEG) was performed in 121 patients. Fifty‐one patients had radiologically inserted gastrostomy (RIG). Twenty‐seven studies reporting outcomes following 2353 gastrostomy procedures for head and neck cancer. Main outcome measures: Post‐procedure mortality, major and minor complications. Results: In the present series, mortality rates were 1.0% (1/121) for PEG and 3.9% (2/51) for RIG. Overall major complication rates following PEG and RIG were 3.3% (4/121) and 15.6% (9/51) respectively. In our systematic review and meta‐analysis of 2379 head and neck cancer patients, we observed fatality rates of 2.2% (95% CI 0.014–0.034) following PEG and 1.8% (95% CI 0.010–0.032) following RIG. Furthermore, major complication rates following PEG were 7.4% (95% CI 5.9–9.3%) and 8.9% (95% CI 7.0–11.2%) after RIG. Conclusions: Procedure related mortality rates following gastrostomy in head and neck cancer patients are higher than those in mixed patient populations. Major complication rates following RIG in head and neck cancer patients are greater than those following PEG. Major complications following PEG in patients with head and neck cancer appear no worse than in mixed pathology groups. We have identified that RIG is associated with increased morbidity and mortality in patients who are ineligible for PEG. The serious nature of the complications associated with gastrostomy particularly in patients with head and neck cancer requires careful consideration by the referring physician.     

Antibiotic efficacy in patients with a moderate probability of acute rhinosinusitis: a systematic review

The aim of this systematic review was to synthesize the results of original studies assessing antibiotic efficacy at different time points after initiating treatment in patients with a moderate probability of acute bacterial rhinosinusitis. We searched the Cochrane library for systematic reviews on the efficacy of antibiotic treatment in patients with acute rhinosinusitis (ARS). Only randomized controlled trials (RCTs) that compared treatment of any antibiotic with placebo were included. The synthesis of the results of six RCTs showed a benefit of antibiotic treatment compared to placebo for the rate of improvement after 3 [pooled odds ratio (OR) 2.78 (95 % confidence interval (CI) 1.39–5.58)] and 7 [OR 2.29 (95 % CI 1.19–4.41)] days after initiation in patients with symptoms and signs of ARS lasting for 7 or more days. After 10 days [pooled OR 1.36 (95 % CI 0.66–2.90)], improvement rates did not differ significantly between patients treated with or without antibiotics. Compared to placebo, antibiotic treatment relieves symptoms in a significantly higher proportion of patients within the first days of treatment. Reporting an overall average treatment efficacy may underestimate treatment benefits in patients with a self-limiting illness.