The edition · ENT & Head and Neck Surgery
Five years on, weekly cisplatin holds against the three-weekly schedule
JCOG1008's final analysis confirms non-inferiority in postoperative high-risk head and neck cancer; plus where circulating tumour DNA actually stands, antiviral treatment for congenital cytomegalovirus started after the neonatal period, and three doses of dexamethasone that cut opioid prescriptions after tonsillectomy.
The edition in brief
Today's ENT desk leads with the final five-year analysis of JCOG1008, which randomised 261 patients with postoperative high-risk locally advanced head and neck squamous cell carcinoma to chemoradiotherapy with cisplatin 40 mg/m² weekly for seven cycles or 100 mg/m² three-weekly for three cycles. At a median follow-up of 5.6 years, five-year overall survival was 71.2% with the weekly schedule against 58.7% with three-weekly, hazard ratio 0.76 (95% CI 0.52 to 1.12 against a non-inferiority margin of 1.32), and no late adverse event differed by more than 10 percentage points. An American Head and Neck Society review sets out where circulating tumour DNA and oncogenic viral DNA stand: promising for diagnosis, surveillance and minimal residual disease in human papillomavirus-associated oropharyngeal and Epstein-Barr virus-associated nasopharyngeal cancer, but with unresolved test variability and no established role in routine decisions. A single-arm meta-analysis of eight studies and 192 children given ganciclovir or valganciclovir for congenital cytomegalovirus after the first month of life found hearing normalised in 42.3% of affected ears and improved in 38.5%, with deterioration in 5.5%, though heterogeneity was very high. A pearl covers the unilateral middle-ear effusion in an adult. The edition closes with a quadruple-blinded trial of oral dexamethasone on days 2, 4 and 6 after paediatric adenotonsillectomy: pain fell modestly, but the odds of an opioid prescription fell to 0.23 and of an emergency visit for pain to 0.12, with no rise in haemorrhage.
Weekly cisplatin survives the long look
Weekly cisplatin with radiotherapy is a confirmed alternative to the three-weekly schedule after high-risk head and neck surgery — provided the seven cycles are delivered.
Circulating tumour DNA: where it is, and where it is not yet
Keep circulating tumour DNA out of routine surveillance decisions, and decide what a discordant result would mean before ordering one.
Antivirals started after the neonatal window still moved hearing
For a child with congenital cytomegalovirus diagnosed after the neonatal period, antiviral treatment is worth discussing rather than dismissing — with serial audiometry and explicit uncertainty.
A unilateral middle-ear effusion in an adult is a nasopharynx until proven otherwise
Look at the nasopharynx endoscopically before you call an adult's unilateral middle-ear effusion benign.
Three doses of dexamethasone after tonsillectomy, and far fewer opioid prescriptions
Give oral dexamethasone on days 2, 4 and 6 after paediatric adenotonsillectomy — the pain gain is modest, the opioid and emergency-visit reduction is not, and bleeding did not increase.
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