Otolaryngology (ENT)

Mepolizumab improves CT burden across diffuse CRS phenotypes with variable symptom response

In 277 adults with primary diffuse chronic rhinosinusitis treated with mepolizumab for at least 6 months, serum eosinophils and Lund-Mackay CT scores improved significantly. Radiographic gains were similar across CRSwNP and CRSsNP and independent of prior endoscopic sinus surgery, supporting an endotype-focused selection strategy. SNOT-22 and endoscopic scores improved only modestly and inconsistently, highlighting heterogeneous symptomatic benefit despite objective disease reduction. Biologic switching occurred in about one-quarter and discontinuation in roughly one-sixth, mainly for recalcitrant disease, underscoring the need for expectation management. 1

European guidance narrows imaging indications for nasal obstruction and epistaxis

These recommendations prioritize clinical history and nasal endoscopy for nasal obstruction and epistaxis, reserving imaging for inconclusive or persistent cases. CT is the primary modality for structural obstruction and preoperative planning, and for differentiating uncomplicated from complicated sinonasal disease. MRI is added when soft tissue characterization or suspected intracranial extension is relevant, complementing CT findings. In epistaxis, imaging is discouraged for routine cases but CT angiography is advised for severe, recurrent, or posterior bleeding to localize lesions and plan intervention. 2

Low-dose fractionated RT during induction chemotherapy deepens response in high-risk LANPC

This randomized phase 2 trial included 82 patients with high-risk locally advanced nasopharyngeal carcinoma undergoing induction chemotherapy and concurrent chemoradiotherapy. Adding low-dose fractionated radiotherapy to involved lymph nodes during each induction cycle raised objective response to 100% versus 85.4% in controls. Lymph node and total tumor volume regression were significantly greater with low-dose radiotherapy, without excess acute toxicity reported. Two-year progression-free and distant metastasis-free survival numerically favored the low-dose radiotherapy arm but were not statistically different, requiring larger confirmatory trials. 3

Lobectomy yields survival comparable to total thyroidectomy in T3b differentiated thyroid carcinoma

In a SEER analysis of 6,920 T3b differentiated thyroid carcinoma patients, 6,638 had total thyroidectomy and 282 underwent lobectomy. Random survival forest modeling showed surgical extent contributed minimally to outcome prediction compared with age, tumor size, and nodal status. Multivariable Cox analysis demonstrated equivalent overall survival between lobectomy and total thyroidectomy, with nearly identical 10-year overall survival rates. Survival equivalence persisted across tumor size and nodal subgroups, with favorable-risk patients achieving excellent disease-specific survival regardless of surgical extent. 4