@article{KaemmererTribiusCohrsetal.2023, author = {K{\"a}mmerer, Peer W. and Tribius, Silke and Cohrs, Lena and Engler, Gabriel and Ettl, Tobias and Freier, Kolja and Frerich, Bernhard and Ghanaati, Shahram and Gosau, Martin and Haim, Dominik and Hartmann, Stefan and Heiland, Max and Herbst, Manuel and Hoefert, Sebastian and Hoffmann, J{\"u}rgen and H{\"o}lzle, Frank and Howaldt, Hans-Peter and Kreutzer, Kilian and Leonhardt, Henry and Lutz, Rainer and Moergel, Maximilian and Modabber, Ali and Neff, Andreas and Pietzka, Sebastian and Rau, Andrea and Reichert, Torsten E. and Smeets, Ralf and Sproll, Christoph and Steller, Daniel and Wiltfang, J{\"o}rg and Wolff, Klaus-Dietrich and Kronfeld, Kai and Al-Nawas, Bilal}, title = {Adjuvant radiotherapy in patients with squamous cell carcinoma of the oral cavity or oropharynx and solitary ipsilateral lymph node metastasis (pN1) — a prospective multicentric cohort study}, series = {Cancers}, volume = {15}, journal = {Cancers}, number = {6}, issn = {2072-6694}, doi = {10.3390/cancers15061833}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-311024}, year = {2023}, abstract = {(1) Background: Evaluation of impact of adjuvant radiation therapy (RT) in patients with oral squamous cell carcinoma of the oral cavity/oropharynx (OSCC) of up to 4 cm (pT1/pT2) and solitary ipsilateral lymph node metastasis (pN1). A non-irradiated group with clinical follow-up was chosen for control, and survival and quality of life (QL) were compared; (2) Methods: This prospective multicentric comprehensive cohort study included patients with resected OSCC (pT1/pT2, pN1, and cM0) who were allocated into adjuvant radiation therapy (RT) or observation. The primary endpoint was overall survival. Secondary endpoints were progression-free survival and QL after surgery; (3) Results: Out of 27 centers, 209 patients were enrolled with a median follow-up of 3.4 years. An amount of 137 patients were in the observation arm, and 72 received adjuvant irradiation. Overall survival did not differ between groups (hazard ratio (HR) 0.98 [0.55-1.73], p = 0.94). There were fewer neck metastases (HR 0.34 [0.15-0.77]; p = 0.01), as well as fewer local recurrences (HR 0.41 [0.19-0.89]; p = 0.02) under adjuvant RT. For QL, irradiated patients showed higher values for the symptom scale pain after 0.5, two, and three years (all p < 0.05). After six months and three years, irradiated patients reported higher symptom burdens (impaired swallowing, speech, as well as teeth-related problems (all p < 0.05)). Patients in the RT group had significantly more problems with mouth opening after six months, one, and two years (p < 0.05); (4) Conclusions: Adjuvant RT in patients with early SCC of the oral cavity and oropharynx does not seem to influence overall survival, but it positively affects progression-free survival. However, irradiated patients report a significantly decreased QL up to three years after therapy compared to the observation group.}, language = {en} } @article{VollmerVollmerLangetal.2023, author = {Vollmer, Andreas and Vollmer, Michael and Lang, Gernot and Straub, Anton and K{\"u}bler, Alexander and Gubik, Sebastian and Brands, Roman C. and Hartmann, Stefan and Saravi, Babak}, title = {Automated assessment of radiographic bone loss in the posterior maxilla utilizing a multi-object detection artificial intelligence algorithm}, series = {Applied Sciences}, volume = {13}, journal = {Applied Sciences}, number = {3}, issn = {2076-3417}, doi = {10.3390/app13031858}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-305050}, year = {2023}, abstract = {Periodontitis is one of the most prevalent diseases worldwide. The degree of radiographic bone loss can be used to assess the course of therapy or the severity of the disease. Since automated bone loss detection has many benefits, our goal was to develop a multi-object detection algorithm based on artificial intelligence that would be able to detect and quantify radiographic bone loss using standard two-dimensional radiographic images in the maxillary posterior region. This study was conducted by combining three recent online databases and validating the results using an external validation dataset from our organization. There were 1414 images for training and testing and 341 for external validation in the final dataset. We applied a Keypoint RCNN with a ResNet-50-FPN backbone network for both boundary box and keypoint detection. The intersection over union (IoU) and the object keypoint similarity (OKS) were used for model evaluation. The evaluation of the boundary box metrics showed a moderate overlapping with the ground truth, revealing an average precision of up to 0.758. The average precision and recall over all five folds were 0.694 and 0.611, respectively. Mean average precision and recall for the keypoint detection were 0.632 and 0.579, respectively. Despite only using a small and heterogeneous set of images for training, our results indicate that the algorithm is able to learn the objects of interest, although without sufficient accuracy due to the limited number of images and a large amount of information available in panoramic radiographs. Considering the widespread availability of panoramic radiographs as well as the increasing use of online databases, the presented model can be further improved in the future to facilitate its implementation in clinics.}, language = {en} } @article{WuenschRiesHeinzelmannetal.2023, author = {W{\"u}nsch, Anna Chiara and Ries, Elena and Heinzelmann, Sina and Frabschka, Andrea and Wagner, Peter Christoph and Rauch, Theresa and Koderer, Corinna and El-Mesery, Mohamed and Volland, Julian Manuel and K{\"u}bler, Alexander Christian and Hartmann, Stefan and Seher, Axel}, title = {Metabolic silencing via methionine-based amino acid restriction in head and neck cancer}, series = {Current Issues in Molecular Biology}, volume = {45}, journal = {Current Issues in Molecular Biology}, number = {6}, issn = {1467-3045}, doi = {10.3390/cimb45060289}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-319257}, pages = {4557 -- 4573}, year = {2023}, abstract = {In recent years, various forms of caloric restriction (CR) and amino acid or protein restriction (AAR or PR) have shown not only success in preventing age-associated diseases, such as type II diabetes and cardiovascular diseases, but also potential for cancer therapy. These strategies not only reprogram metabolism to low-energy metabolism (LEM), which is disadvantageous for neoplastic cells, but also significantly inhibit proliferation. Head and neck squamous cell carcinoma (HNSCC) is one of the most common tumour types, with over 600,000 new cases diagnosed annually worldwide. With a 5-year survival rate of approximately 55\%, the poor prognosis has not improved despite extensive research and new adjuvant therapies. Therefore, for the first time, we analysed the potential of methionine restriction (MetR) in selected HNSCC cell lines. We investigated the influence of MetR on cell proliferation and vitality, the compensation for MetR by homocysteine, the gene regulation of different amino acid transporters, and the influence of cisplatin on cell proliferation in different HNSCC cell lines.}, language = {en} } @article{VollmerSaraviBreitenbuecheretal.2023, author = {Vollmer, Andreas and Saravi, Babak and Breitenbuecher, Niko and Mueller-Richter, Urs and Straub, Anton and Šimić, Luka and K{\"u}bler, Alexander and Vollmer, Michael and Gubik, Sebastian and Volland, Julian and Hartmann, Stefan and Brands, Roman C.}, title = {Realizing in-house algorithm-driven free fibula flap set up within 24 hours}, series = {Frontiers in Surgery}, volume = {10}, journal = {Frontiers in Surgery}, doi = {10.3389/fsurg.2023.1321217}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-353945}, year = {2023}, abstract = {Objective: This study aims to critically evaluate the effectiveness and accuracy of a time safing and cost-efficient open-source algorithm for in-house planning of mandibular reconstructions using the free osteocutaneous fibula graft. The evaluation focuses on quantifying anatomical accuracy and assessing the impact on ischemia time. Methods: A pilot study was conducted, including patients who underwent in-house planned computer-aided design and manufacturing (CAD/CAM) of free fibula flaps between 2021 and 2023. Out of all patient cases, we included all with postoperative 3D imaging in the study. The study utilized open-source software tools for the planning step, and three-dimensional (3D) printing techniques. The Hausdorff distance and Dice coefficient metrics were used to evaluate the accuracy of the planning procedure. Results: The study assessed eight patients (five males and three females, mean age 61.75 ± 3.69 years) with different diagnoses such as osteoradionecrosis and oral squamous cell carcinoma. The average ischemia time was 68.38 ± 27.95 min. For the evaluation of preoperative planning vs. the postoperative outcome, the mean Hausdorff Distance was 1.22 ± 0.40. The Dice Coefficients yielded a mean of 0.77 ± 0.07, suggesting a satisfactory concordance between the planned and postoperative states. Dice Coefficient and Hausdorff Distance revealed significant correlations with ischemia time (Spearman's rho = -0.810, p = 0.015 and Spearman's rho = 0.762, p = 0.028, respectively). Linear regression models adjusting for disease type further substantiated these findings. Conclusions: The in-house planning algorithm not only achieved high anatomical accuracy, as reflected by the Dice Coefficients and Hausdorff Distance metrics, but this accuracy also exhibited a significant correlation with reduced ischemia time. This underlines the critical role of meticulous planning in surgical outcomes. Additionally, the algorithm's open-source nature renders it cost-efficient, easy to learn, and broadly applicable, offering promising avenues for enhancing both healthcare affordability and accessibility.}, language = {en} } @article{VollmerNaglerHoerneretal.2023, author = {Vollmer, Andreas and Nagler, Simon and H{\"o}rner, Marius and Hartmann, Stefan and Brands, Roman C. and Breitenb{\"u}cher, Niko and Straub, Anton and K{\"u}bler, Alexander and Vollmer, Michael and Gubik, Sebastian and Lang, Gernot and Wollborn, Jakob and Saravi, Babak}, title = {Performance of artificial intelligence-based algorithms to predict prolonged length of stay after head and neck cancer surgery}, series = {Heliyon}, volume = {9}, journal = {Heliyon}, number = {11}, issn = {2405-8440}, doi = {10.1016/j.heliyon.2023.e20752}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350416}, year = {2023}, abstract = {Background Medical resource management can be improved by assessing the likelihood of prolonged length of stay (LOS) for head and neck cancer surgery patients. The objective of this study was to develop predictive models that could be used to determine whether a patient's LOS after cancer surgery falls within the normal range of the cohort. Methods We conducted a retrospective analysis of a dataset consisting of 300 consecutive patients who underwent head and neck cancer surgery between 2017 and 2022 at a single university medical center. Prolonged LOS was defined as LOS exceeding the 75th percentile of the cohort. Feature importance analysis was performed to evaluate the most important predictors for prolonged LOS. We then constructed 7 machine learning and deep learning algorithms for the prediction modeling of prolonged LOS. Results The algorithms reached accuracy values of 75.40 (radial basis function neural network) to 97.92 (Random Trees) for the training set and 64.90 (multilayer perceptron neural network) to 84.14 (Random Trees) for the testing set. The leading parameters predicting prolonged LOS were operation time, ischemia time, the graft used, the ASA score, the intensive care stay, and the pathological stages. The results revealed that patients who had a higher number of harvested lymph nodes (LN) had a lower probability of recurrence but also a greater LOS. However, patients with prolonged LOS were also at greater risk of recurrence, particularly when fewer (LN) were extracted. Further, LOS was more strongly correlated with the overall number of extracted lymph nodes than with the number of positive lymph nodes or the ratio of positive to overall extracted lymph nodes, indicating that particularly unnecessary lymph node extraction might be associated with prolonged LOS. Conclusions The results emphasize the need for a closer follow-up of patients who experience prolonged LOS. Prospective trials are warranted to validate the present results.}, language = {en} }