Purpose Concurrent chemoradiotherapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases both local tumor control and toxicity. This study evaluates clinical factors that are associated with and might predict severe late toxicity after CCRT. Methods Patients were analyzed from a subset of three previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3 to 4 pharyngeal/laryngeal toxicity (RTOG/European Organisation for the Research and Treatment of Cancer late toxicity scoring system) and/or requirement for a feeding tube ≥ 2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Case-control analysis was performed, with a multivariable logistic regression model that included pretreatment and treatment potential factors. Results A total of 230 patients were assessable for this analysis: 99 p...

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Factors Associated with Severe Late Toxicity After Concurrent Chemoradiation for Locally Advanced Head and Neck Cancer: An RTOG Analysis

The traditional Mediterranean diet (MedDiet) is a well-known dietary pattern associated with longevity and improvement of life quality as it reduces the risk of the most common chronic pathologies, such as cancer and cardiovascular diseases (CVDs), that represent the principal cause of death worldwide. One of the most characteristic foods of MedDiet is olive oil, a very complex matrix, which constitutes the main source of fats and is used in the preparation of foods, both raw as an ingredient in recipes, and in cooking. Similarly, strawberries and raspberries are tasty and powerful foods which are commonly consumed in the Mediterranean area in fresh and processed forms and have attracted the scientific and consumer attention worldwide for their beneficial properties for human health. Besides olive oil and berries, honey has lately been introduced in the MedDiet thanks to its relevant nutritional, phytochemical and antioxidant profile. It is a sweet substance that has recently been classified as a functional food. The aim of this review is to present and discuss the recent evidence, obtained from in vitro, in vivo and epidemiological studies, on the potential roles exerted by these foods in the prevention and progression of different types of cancer and CVDs.

Relevance of functional foods in the Mediterranean diet: the role of olive oil, berries and honey in the prevention of cancer and cardiovascular diseases

The core function of a multidisciplinary team (MDT) is to bring together a group of healthcare professionals from different fields in order to determine patients' treatment plan. Most of head and neck cancer (HNC) units are currently led by MDTs that at least include ENT and maxillofacial surgeons, radiation and medical oncologists. HNC often compromise relevant structures of the upper aerodigestive tract involving functions such as speech, swallowing and breathing, among others. The impairment of these functions can significantly impact patients' quality of life and psychosocial status, and highlights the crucial role of specialized nurses, dietitians, psycho-oncologists, social workers, and onco-geriatricians, among others. Hence, these professionals should be integrated in HNC MDTs. In addition, involving translational research teams should also be considered, as it will help reducing the existing gap between basic research and the daily clinical practice. The aim of this comprehensive review is to assess the role of the different supportive disciplines integrated in an MDT and how they help providing a better care to HNC patients during diagnosis, treatment and follow up.

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The Multidisciplinary Team (MDT) Approach and Quality of Care.

Radiotherapy (RT) is the chief nonsurgical method to control malignant tumors. RT has advanced in both methodological and biological aspects over the past few decades. Though RT is a momentous adjuvant non-invasive technique, it leaves behind some unsympathetic effects. Research is going on to surmount these pessimistic sides of RT. We made a mini review of recent articles from the period of 2000 to 2017 regarding radiotherapy and its side effects in various types of cancers. The literature review was done by searching in PUBMED, MEDLINE, and SCOPUS. Here, we spotlight the physiological and genetic risks associated with the cancer patients undergoing RT. We illustrated the course of RT in most prevalent cancers tailored with dosage distribution. Radiation-induced mutation in the patients undergoing RT has been shown with evidence. Further, the major drawbacks like the development of radiation resistance in cancerous cells and secondary malignancies have been discussed. The problems associated with radiation dosage in terms of infertility and rejuvenation of reproductive cells has also been discussed. Finally, we discussed the latest treatment stratagem of RT in cancer. Cancer treatment will not be accomplished devoid of radiotherapy. But we can brace RT using radiosensitizers and ayurvedic radioprotectors.

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Recent advances in radiotherapy and its associated side effects in cancer—a review

Background Thymus genus has been used since ancient times for their valuable health properties, which could be attributed to their chemical components, especially essential oils (EOs). Among these species, T. vulgaris has a long history of use for different food and medicinal purposes. Scope and approach This paper reviews the chemical composition of Thymus plants EOs, including thyme, describes their antimicrobial and antioxidant properties as well as recent food applications as preservatives. The role of these plants in cancer is also covered, as well as the potential these plants have to manage and treat other diseases. Furthermore, clinical studies are also detailed. Key findings and conclusions Food preservation with naturally occurring compounds is gaining increasing importance due to the consumer demand for safe and high-quality products and to reduce the use of synthetic preservatives. For this purpose, not only thyme but also other thymus plants can be used as such and combined with high-pressure, cold nitrogen plasma, in edible films (active packaging), etc. Moreover, the potential of these plants have to treat several diseases and complications reinforce their use in nutraceuticals and functional foods, but further clinical evidence is required.

Thymus spp. plants - Food applications and phytopharmacy properties

The effect of the use of thyme honey in minimizing radiation - induced oral mucositis in head and neck cancer patients: A randomized controlled trial.

The effectiveness of thyme honey for the management of treatment-induced xerostomia in head and neck cancer patients: A feasibility randomized control trial

Key Clinical Message
Melanomas of the gallbladder (GB) are extremely rare with a very poor prognosis. They feature in the literature as a few case reports and the method of their management is not clear. We report a case of patient with metastatic cutaneous melanoma to the GB, and our treatment suggestion.

Melanoma of the gallbladder: appropriate surgical management and review of the literature.

We congratulate Eduardo Rosenblatt and colleagues for an important analysis of radiotherapy capacity and demand in European countries, and we would like to add some additional arguments and evidence in support of their conclusions. In terms of cost, centralisation of services leads to an increase in number of patients treated per radiotherapy centre, which allows for a more effi cient use of linear accelerators— ie, an increased number of fractions per machine, hence a smaller cost per fraction. In other words, increased per-unit activity results in improved cost-eff ectiveness, and centralisation therefore delivers enhanced value for money. Centralisation of radiotherapy services is also necessary to maintain quality of care and optimum outcomes, since radiotherapy is the most complex treatment modality provided in a hospital. This point is especially relevant for the treatment of rare cancers, and for specialist radiotherapy modalities such as stereotactic radiotherapy, paediatric radiotherapy, and brachy therapy. In these cases the need for centralisation of services is even greater, because of the need for highly specialised multidisciplinary teams to treat an adequate number of patients to maintain the necessary clinical skills and expertise. For these reasons, to safeguard specialisation and to provide highquality and cost-eff ective care, the Calman-Hine report set the minimum population to be served by a radiotherapy centre in the UK at 1 million. This model of centralisation has also been followed in the Netherlands, where a national programme to increase radiotherapy capacity was initiated in the late 1990s, and resulted in an annual increase in equipment and personnel by an average of 3·5–4·0% per year, while the same number of radiotherapy centres was maintained. Slotman and Vos argue that the Dutch approach, with the expansion of existing radiotherapy centres instead of the creation of new ones, was a success, since in 2010 no waiting lists and no overcapacity existed in the country, which in turn allowed for the rapid introduction of new technologies (eg, intensitymodulated radiotherapy, imageguided radiotherapy) and suffi cient subspecialisation of staff . On the eff ect of centralisation on outcomes, consistent evidence shows that the more experience doctors or health-care systems have with a procedure, the better the results. Of 128 studies that assessed hospital and physician volume of work or specialisation and outcomes in cancer treatment, 123 showed some evidence of a volume–quality relation. Most of the relevant evidence with respect to oncological outcomes comes from surgical and chemotherapy studies; however, in a phase 3 study of chemoradiation for head and neck cancer by the Radiation Therapy Oncology Group (RTOG) in the USA, patients treated at low-accruing centres had a roughly 90% increase in risk of death compared with patients treated at high-accruing centres, which suggests that a volume–quality relation also exists for complex radiotherapy. In view of the available evidence, we fi rmly believe that, unless a very substantial gain is made in terms of patients’ access to radiotherapy centres (with respect to distance and travel time), radiotherapy commissioning should aim for centralisation and not fragmentation of services.

Nicos Katodritis

Papers

The effect of the use of thyme honey in minimizing radiation - induced oral mucositis in head and neck cancer patients: A randomized controlled trial.

The effectiveness of thyme honey for the management of treatment-induced xerostomia in head and neck cancer patients: A feasibility randomized control trial

Melanoma of the gallbladder: appropriate surgical management and review of the literature.

Radiotherapy capacity in Europe.

The evaluation of the reliability and validity properties of the Greek version of the xerostomia questionnaire (ΧQ).