Examinando por Autor "Chiesa Estomba, Carlos Miguel"

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  • Miniatura
    Ítem
    Precision diagnosis in cutaneous head and neck squamous cell carcinoma †
    (Multidisciplinary Digital Publishing Institute (MDPI), 2026-02-28) Asarkar, Ameya A.; Kattar, Nrusheel; Rao, Karthik N.; Rinaldo, Alessandra ; Sreeram, M.P.; De Bree, Eelco ; Rodrigo, Juan Pablo; Chiesa Estomba, Carlos Miguel ; Guntinas Lichius, Orlando; Shaha, Ashok R.; Ferlito, Alfio
    Precision oncology has been evolving rapidly, with increasing emphasis on early detection and personalized diagnostic approaches that translate into tailored treatment algorithms. The integration of molecular markers, quantitative imaging approaches and artificial intelligence (AI) in the diagnostic workflow of cutaneous squamous cell carcinoma (cSCC) has increased accuracy and has the potential to improve early detection rates in these cancers. Sun exposure is the primary etiologic factor in the development of cSCC. The primary objective of this review is to evaluate the current state and future directions of modalities and practices in diagnostic techniques for cSCC. Specifically, this review summarizes the key genetic alterations and potential molecular targets in cSCC. High-risk genetic mutations and pathways implicated in the pathogenesis of cSCC include p53, NOTCH, RAS/MAPK, cell-cycle, and adhesion pathways. This review further explores current and emerging modalities in optical imaging techniques and molecular-based diagnostic modalities in cSCC. Further, we discuss the role of radiomics and AI in the diagnostic work-up of cSCC. These techniques have the potential to enable more accurate risk models that refine conventional histopathology and guide personalized interventions. However, there are limitations to the clinical application of several of these modalities, with cost being an important driver. These challenges have been discussed in detail within this review. Nevertheless, ongoing research is focused on improving the workflow and initiating a shift in clinical practice with application of precision diagnostics as a standard of care.
  • Miniatura
    Ítem
    Stereotactic body radiotherapy as a curative treatment for de novo mucosal carcinoma of the head and neck: a feasible alternative option for fragile patients with small lesion: a systematic review
    (Multidisciplinary Digital Publishing Institute (MDPI), 2024-05-31) Strojan, Primož; Kokalj, Marko; Plavc, Gaber; Ng, Sweet Ping; Nuyts, Sandra; Chiesa Estomba, Carlos Miguel; Eisbruch, Avraham; Bree, Remco de; Chow, James C. H.; Mäkitie, Antti A.; López Álvarez, Fernando; Saba, Nabil F.; Ferlito,Alfio
    Stereotactic body radiotherapy (SBRT) is characterized by a high dose per fraction, well-defined small targets, superior dose conformity, and a steep off-target dose gradient. A literature search was conducted to examine the experience with SBRT as a curative treatment for newly diagnosed mucosal carcinoma of the head and neck (MCHN). Four retrospective case series and one prospective phase I clinical trial published between 2012 and 2020 described 124 patients. SBRT was mainly performed in older patients with different tumor sites. The median size of the planning target volumes ranged from 5.3 to 41 cm3. Different approaches were used to create margins. In two studies, limited elective nodal irradiation was performed. The equivalent doses used were 60–83.33 Gy delivered in five fractions. Considerable heterogeneity was observed in the radiation dose specification. The incidence of grade ≥3 late toxicity was 0–8.3%, with local and regional control ranging from 73% to 100%. Improved or stable quality of life after SBRT was reported in two studies. Curative-intent SBRT for de novo MCHN appears to be an effective and relatively safe treatment for small tumor targets, preferably without concomitant elective tissue irradiation. Standardization of SBRT practice and well-designed prospective clinical trials are needed to better define the role of SBRT in this setting.