Head and Neck 2020-10-23

A prospective study of intraoperative assessment of mucosal squamous cell carcinoma margins in the head and neck

\nFiona A. E. Smithers, \nGeorg Haymerle, \nCarsten E. Palme, \nTsu‐Hui (Hubert) Low, \nCatriona Froggatt, \nRuta Gupta, \nJonathan R. Clark\n

Publicatie 23-10-2020


AbstractBackgroundIn head and neck cancers, tumor margin assessment has important prognostic and therapeutic implications. Frozen section control of margins is commonly employed intraoperatively. However, this is not without limitations. The aim of this study is to determine whether intraoperative slicing of the whole specimen is feasible and what impact this may have on tumor margin assessment and the requirement for postoperative radiotherapy.MethodsFrom September 2016 to August 2018, we recruited 22 patients as a pilot study looking at both the practicalities and the clinical relevance of whole margin tumor analysis intraoperatively. Our project is a prospective single arm study with historical controls.ResultsForty‐one percent of our patients required further intraoperative resection for close or involved margins. Seven of these patients who otherwise would have required adjuvant radiotherapy due to their margin status did not, after our intervention.ConclusionsWe found that although requiring resources, this process was feasible without unduly increasing operative times and with potential patient benefit including reduced incidence of adjuvant radiotherapy.

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Evidence for different molecular parameters in head and neck squamous cell carcinoma of nonsmokers and nondrinkers: Systematic review and meta‐analysis on HPV, p16, and TP53

\nFrans J. Mulder, \nDamiana D. C. G. Pierssens, \nLaura W. J. Baijens, \nBernd Kremer, \nErnst‐Jan M. Speel\n

Publicatie 23-10-2020


AbstractBackgroundThe goal of this review was to present an overview of the currently identified molecular parameters in head and neck squamous cell carcinoma (HNSCC) of nonsmokers and nondrinkers (NSND).MethodsFollowing the PRISMA guidelines, a systematic search was performed using the electronic databases PubMed, Embase, and Google Scholar.ResultsOf the 902 analyzed unique studies, 74 were included in a quantitative synthesis and 24 in a meta‐analysis. Human papillomavirus (HPV) was reported as a molecular parameter in 38 studies, followed by p16 and TP53 (23 and 14 studies, respectively). The variety of other molecular parameters concerned sporadic findings in small numbers of NSND.ConclusionsHNSCC in NSND is more often related to HPV and p16 overexpression compared to tumors of smokers‐drinkers. In a third of virus‐negative tumors, TP53 mutations were detected with a mutational profile associated with aging and ultraviolet light exposure rather than to tobacco consumption.

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Islanded facial artery musculo‐mucosal flap for partial pharyngeal defect reconstruction after total laryngectomy: Case report

\nNisha Rajrattansingh Akali, \nArya Chandrababu Jaya, \nDeepak Balasubramanian, \nSubramania Iyer, \nKrishnakumar Thankappan\n

Publicatie 23-10-2020


AbstractBackgroundPartial pharyngeal defect reconstruction after total laryngectomy with regional and free fasciocutaneous flaps has been described. However, mucosal flaps for such defects have not been reported.MethodsAn islanded facial artery musculo‐mucosal (FAMM) flap was used to reconstruct a partial pharyngeal defect after total laryngectomy. Surgical, swallowing, and speech outcomes were analyzed at 6 months postoperatively.ResultsAt 6 months, videofluoroscopy showed no post swallow residue, fistula, trachea‐esophageal puncture leak, or stricture. Perceptual analysis of recorded cold speech, native language passage sample, and the intelligibility analysis was good. The patient had normal mouth opening and marginal mandibular nerve function.ConclusionIslanded FAMM flap is ideal for partial pharyngeal defects, which cannot be closed primarily. Speech and swallowing outcomes were good. It provided a robust and predictable blood supply and adequate reach. There was no significant donor site morbidity. The musculo‐mucosal flap replaced “like‐with‐like” tissue.

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Head and neck surgery during the coronavirus‐19 pandemic: The University of California San Francisco experience

\nKatherine C. Wai, \nMary Jue Xu, \nRex H. Lee, \nIvan H. El‐Sayed, \nJonathan R. George, \nChase M. Heaton, \nP. Daniel Knott, \nAndrea M. Park, \nWilliam R. Ryan, \nRahul Seth, \nPatrick K. Ha\n

Publicatie 23-10-2020


AbstractBackgroundGuidelines regarding head and neck surgical care have evolved during the coronavirus‐19 (COVID‐19) pandemic. Data on operative management have been limited.MethodsWe compared two cohorts of patients undergoing head and neck or reconstructive surgery between March 16, 2019 and April 16, 2019 (pre‐COVID‐19) and March 16, 2020 and April 16, 2020 (COVID‐19) at an academic center. Perioperative, intraoperative, and postoperative outcomes were recorded.ResultsThere were 63 operations during COVID‐19 and 84 operations during pre‐COVID‐19. During COVID‐19, a smaller proportion of patients had benign pathology (12% vs 20%, respectively) and underwent thyroid procedures (2% vs 23%) while a greater proportion of patients underwent microvascular reconstruction±ablation (24% vs 12%,). Operative times increased, especially among patients undergoing microvascular reconstruction±ablation (687 ± 112 vs 596 ± 91 minutes, P = .04). Complication rates and length of stay were similar.ConclusionsDuring COVID‐19, perioperative outcomes were similar, operative time increased, and there were no recorded transmissions to staff or patients. Continued surgical management of head and neck cancer patients can be provided safely.

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Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria

\nDanielle N. Margalit, \nAssuntina G. Sacco, \nJay S. Cooper, \nJohn A. Ridge, \nRichard L. Bakst, \nBeth M. Beadle, \nJonathan J. Beitler, \nSteven S. Chang, \nAllen M. Chen, \nTom J. Galloway, \nShlomo A. Koyfman, \nCarol Mita, \nJared R. Robbins, \nC. Jillian Tsai, \nMinh T. Truong, \nSue S. Yom, \nFarzan Siddiqui\n

Publicatie 23-10-2020


AbstractBackgroundThe aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non‐oncologic outcomes and (b) identify the optimal evidence‐based postoperative therapy recommendations for commonly encountered clinical scenarios.MethodsAn analysis of the medical literature from peer‐reviewed journals was conducted using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guideline. Prospective studies and methodology‐based systematic reviews and meta‐analyses of postoperative therapy for SCCHN were identified by searching Medline (OVID) and EMBASE (Elsevier) using controlled vocabulary terms (ie, National Library of Medicine Medical Subject Headings MeSH, EMTREE). Study screening and selection was performed with Covidence software and full‐text review. The RAND/UCLA appropriateness method was used by the expert panel to rate the appropriate use of postoperative therapy, and the modified Delphi method was used to come to consensus.ResultsA total of 5660 studies were identified and screened using the title and abstract, leading to 201 studies assessed for relevance using full‐text review. After limitation to the eligibility criteria, 101 studies from 1977 to 2020 were identified, including 77 with oncologic endpoints and 24 with function and quality of life endpoints. All studies reported staging prior to the implementation of American Joint Committee on Cancer (AJCC‐8).ConclusionsProspective clinical studies and systematic reviews identified through the PRISMA systematic review provided good evidence for consensus statements regarding the appropriate use of postoperative therapy for resected SCCHN. Further research is needed in domains where consensus by the expert panel could not be achieved for the appropriateness of specific postoperative therapeutic interventions.

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Hypomagnesemia and incidence of osteoradionecrosis in patients with head and neck cancers

\nWenli Liu, \nAiham Qdaisat, \nShouhao Zhou, \nClifton D. Fuller, \nRenata Ferrarotto, \nMing Guo, \nStephen Y. Lai, \nRichard Cardoso, \nAbdallah S. R. Mohamed, \nGabriel Lopez, \nSanthosshi Narayanan, \nLisanne V. Dijk, \nLorenzo Cohen, \nEduardo Bruera, \nSai‐Ching J. Yeung, \nEhab Y. Hanna\n

Publicatie 23-10-2020


AbstractBackgroundWe aimed to determine whether hypomagnesemia predicts osteoradionecrosis development in patients with squamous cell carcinoma of the oropharynx and oral cavity who received platinum‐based concurrent chemoradiation with or without induction therapy.MethodsWe reviewed data from patients with head and neck cancers who had undergone chemoradiation with weekly cisplatin/carboplatin between January 1, 2010 and December 31, 2014 at our institution. Pathologic features, laboratory test results, disease stage, and social histories were recorded. The association between hypomagnesemia and osteoradionecrosis was analyzed controlling for known confounding factors.ResultsHypomagnesemia during cancer treatment was associated with osteoradionecrosis development (HR = 2.72, P = .037) independent of total radiation dose (HR = 1.07, P = .260) and smoking history (HR = 2.05, P = .056) among the patients who received platinum‐based induction chemotherapy followed by concurrent chemoradiation.ConclusionsHypomagnesemia was predictive of the development of osteoradionecrosis in patients with cancers of the oropharynx and oral cavity receiving platinum‐based induction followed by concurrent chemoradiation.

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Cumulative suppressive index as a predictor of relapse free survival and overall survival in Human Papilloma Virus‐negative oral squamous cell carcinomas with negative resection margins

\nLauren Hum, \nDaniel Bethmann, \nZipei Feng, \nShu‐Ching Chang, \nAlexander Eckert, \nCarmen Ballesteros‐Merino, \nClaudia Keschke, \nMatthias Kappler, \nCarlo B. Bifulco, \nClaudia Wickenhauser, \nBarbara Seliger, \nBernard A. Fox, \nRichard Bell\n

Publicatie 23-10-2020


AbstractBackgroundThis study aimed to analyze margin status and the impact of the immune elements on recurrence in patients with oral squamous cell carcinoma (OSCC), employing a prognostic biomarker, cumulative suppressive index (CSI), which reflects FoxP3+, PD‐L1+, and CD8+ cell spatial relationships in the tumor microenvironment.MethodsCox proportional hazards regression was used to evaluate the interactive effect of the margin by CSI discrepancy (high, 3‐4 vs low, 0‐2) on recurrence free survival (RFS) and overall survival (OS) in 119 patients with stage I to IVA OSCC.ResultsIn cases with negative margins, multivariable analysis showed high CSI was significantly associated with worse RFS (HR = 2.59, 95% CI 1.03, 6.49, P = .04) and OS (HR = 5.49, 95% CI 1.48, 20.35, P = .01) compared to low CSI. However, high CSI was not significantly associated with recurrence in cases with positive margins.ConclusionsImmune architecture analysis can augment our current histopathological risk assessment of margin status.

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Safety of fibula free flap in patients following total knee replacement

\nBrianna N. Harris, \nShabnam Ghazizadeh, \nRodrigo Bayon, \nAlexandra E. Kejner, \nSteven B. Cannady, \nBenjamin J. Greene, \nAndrew T. Huang, \nJoseph Curry, \nKeith E. Blackwell, \nYadranko Ducic, \nMark K. Wax\n

Publicatie 21-10-2020


AbstractBackgroundFibula free flap (FFF) is the preferred osteocutaneous flap for reconstruction of large head and neck composite defects. There is a paucity of data whether FFF can be performed safely in patients with knee replacement (total knee arthroplasty TKA).MethodsMulti‐institutional review of outcomes following FFF in patients who had prior TKA.ResultsTen surgeons reported successful FFF in 53 patients with prior TKA. The most common preoperative imaging was a CT angiogram of the bilateral lower extremities. There was no evidence of intraoperative vascular abnormality. Physical therapy began between postoperative day 1 to postoperative day 3. At 1 month postoperatively, 40% of patients were using a cane or walker to ambulate, but by 3 months all had returned to baseline ambulatory status. At >1 year, there were no gait complications.ConclusionFFF appears safe in patients with prior knee replacement without an increased risk of complications compared to baseline.

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Association of human papillomavirus integration with better patient outcomes in oropharyngeal squamous cell carcinoma

\nLisa M. Pinatti, \nHana N. Sinha, \nCollin V. Brummel, \nChristine M. Goudsmit, \nTimothy J. Geddes, \nGeorge D. Wilson, \nJan A. Akervall, \nChad J. Brenner, \nHeather M. Walline, \nThomas E. Carey\n

Publicatie 19-10-2020


AbstractBackgroundThe molecular drivers of human papillomavirus‐related head and neck squamous cell carcinoma (HPV + HNSCC) are not entirely understood. This study evaluated the relationship between HPV integration, expression of E6/E7, and patient outcomes in p16+ HNSCCs.MethodsHPV type was determined by HPV PCR‐MassArray, and integration was called using detection of integrated papillomavirus sequences polymerase chain reaction (PCR). We investigated whether fusion transcripts were produced by reverse transcriptase polymerase chain reaction (RT‐PCR). E6/E7 expression was assessed by quantitative RT‐PCR. We assessed if there was a relationship between integration and E6/E7 expression, clinical variables, or patient outcomes.ResultsMost samples demonstrated HPV integration, which sometimes resulted in a fusion transcript. HPV integration was positively correlated with age at diagnosis and E6/E7 expression. There was a significant difference in survival between patients with vs without integration.ConclusionsContrary to previous reports, HPV integration was associated with improved patient survival. Therefore, HPV integration may act as a molecular marker of good prognosis.

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Ipsilateral radiation for squamous cell carcinoma of the tonsil: American Radium Society appropriate use criteria executive summary

\nC. Jillian Tsai, \nThomas J. Galloway, \nDanielle N. Margalit, \nRichard L. Bakst, \nBeth M. Beadle, \nJonathan J. Beitler, \nSteven Chang, \nAllen Chen, \nJay Cooper, \nShlomo A. Koyfman, \nJohn A. Ridge, \nJared Robbins, \nMinh Tam Truong, \nSue S. Yom, \nFarzan Siddiqui\n

Publicatie 17-10-2020


AbstractBackgroundWe conducted the current systemic review to provide up‐to‐date literature summary and optimal evidence‐based recommendations for ipsilateral radiation for squamous cell carcinoma of the tonsil.MethodsWe performed literature search of peer‐reviewed journals through PubMed. The search strategy and subject‐specific keywords were developed based on the expert panels consensus. Articles published from January 2000 to May 2020 with full text available on PubMed and restricted to the English language and human subjects were included. Several prespecified search terms were used to identify relevant publications and additional evidence published since the initial American College of Radiology Appropriateness Criteria Ipsilateral Tonsil Radiation recommendation was finalized in 2012. The full bibliographies of identified articles were reviewed and irrelevant studies were removed.ResultsThe initial search and review returned 46 citations. The authors added three citations from bibliographies, websites, or books not found in the literature search. Of the 49 citations, 30 citations were retained for further detailed review, and 14 of them were added to the evidence table. Articles were removed from the bibliography if they were not relevant or generalizable to the topic, or focused on unknown primary disease. Several commonly encountered clinical case variants were created and panelists anonymously rated each treatment recommendation. The results were reviewed and disagreements discussed.ConclusionsThe panel provided updated evidence and recommendations for ipsilateral radiation for squamous cell carcinoma of the tonsil in the setting of primary radiation‐based therapy and postoperative adjuvant radiotherapy. This committee did not reach agreements for some case variants due to a lack of strong evidence supporting specific treatment decisions, indicating a further need for research in these topics.

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Short‐term and long‐term unstimulated saliva flow following unilateral vs bilateral radiotherapy for oropharyngeal carcinoma

"\nShao Hui Huang, \nJohn R. de Almeida, \nErin Watson, \nMichael Glogauer, \nWei Xu, \nSareh Keshavarzi, \nBrian OSullivan, \nJolie Ringash, \nAndrew Hope, \nAndrew Bayley, \nScott V. Bratman, \nJohn Cho, \nMeredith Giuliani, \nJohn Kim, \nJohn Waldron, \nAnna Spreafico, \nDavid P Goldstein, \nDouglas B. Chepeha, \nTong Li, \nAli Hosni\n"

Publicatie 15-10-2020


AbstractBackgroundWe aimed to compare unstimulated saliva flow using 3‐minute modified Schirmer test (MST) following bilateral vs unilateral radiotherapy (RT) in oropharyngeal carcinoma (OPC).MethodsWe reviewed OPC patients treated with definitive intensity‐modulated radiation therapy (IMRT) between 2011 and 2017. MST was measured at baseline, 1‐/6‐/12‐/24‐month post‐RT. MST values were compared between bilateral‐RT vs unilateral‐RT groups. Multivariable logistic regression analysis (MVA) identified predictors of hyposalivation (MST < 25 mm).ResultsTotal 498 bilateral‐RT and 36 unilateral‐RT patients were eligible. The MST values at 1‐/6‐/12‐/24‐month post‐RT were all significantly reduced from baseline for the entire cohort. Baseline unilateral‐RT and bilateral‐RT MST values (in mm) were similar (P = .2), but much higher for unilateral‐RT 1‐month (mean: 19.1 vs 13.0, P = .03), 6‐month (20.5 vs 9.3, P < .001), 12‐month (20.1 vs 11.9, P < .01), and 24‐month post‐RT (22.2 vs 13.9, P = .04). MVA confirmed that unilateral RT reduced the likelihood of hyposalivation vs bilateral RT (OR 2.36, P = .006).ConclusionUnilateral RT reduces unstimulated salivary flow in OPC patients.

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Long‐term donor site morbidity after radial forearm flap elevation for tongue reconstruction: Prospective observational study

\nJie Liu, \nFei Liu, \nQigen Fang, \nJuanjuan Feng\n

Publicatie 15-10-2020


AbstractBackgroundTo assess long‐term donor site morbidity after radial forearm free (RFF) flap harvesting.MethodsEnrolled patients were asked to complete the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and undergo wrist motion and hand strength examinations at different time points. The data were prospectively collected and retrospectively analyzed.ResultsThe postoperative DASH score did not return to normal until 24 months after the operation. The mean postoperative wrist motion degree of flexion was significantly decreased compared to the preoperative level and returned to normal at 12 months after the operation. Similar trends were noted regarding extension, radial abduction, and ulnar abduction. The mean postoperative grip strength was significantly decreased compared to the preoperative level and remained dysfunctional at 24 months after the operation. A similar trend was also noted with regard to tip pinch and key pinch.ConclusionThe long‐term negative effect on hand strength is sustained.

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Long term outcomes with linear accelerator stereotactic radiosurgery for treatment of jugulotympanic paragangliomas

\nAnkur K. Patel, \nJoshua L. Rodríguez‐López, \nBarry E. Hirsch, \nSteven A. Burton, \nJohn C. Flickinger, \nDavid A. Clump\n

Publicatie 13-10-2020


AbstractBackgroundData supporting linear accelerator (linac) stereotactic radiosurgery (SRS) for jugulotympanic paragangliomas (JTPs) come from small series with minimal follow‐up. Herein, we report a large series of JTPs with extended follow‐up after frameless linac‐based SRS.MethodsJTPs treated with linac‐based SRS from 2002 to 2019 with 1+ follow‐up image were reviewed for treatment failure (radiographic or clinical progression, or persistent symptoms after SRS requiring intervention) and late toxicities (CTCAE v5.0).ResultsForty JTPs were identified; 30 were treated with a multifraction regimen. Median clinical and radiographic follow‐up was 79.7 (interquartile range IQR 31.7‐156.9) and 54.4 months (IQR 17.9‐105.1), respectively, with a median 4.5 follow‐up scans (IQR 2‐9). Seven‐year progression‐free survival (PFS) was 97.0% (95% confidence interval 91.1%‐100.0%). PFS was similar between single‐ and multifraction regimens (log rank P = .99). Toxicity was seen in 7.7% (no grade III).ConclusionsWith extended clinical and radiographic follow‐up, frameless linac‐based SRS provides excellent local control with mild toxicity <8%.

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Impact of treatment delay on survival of oral/oropharyngeal cancers: Results of a nationwide screening program

\nWilliam Wang‐Yu Su, \nYi‐Huah Lee, \nAmy Ming‐Fang Yen, \nSam Li‐Sheng Chen, \nChen‐Yang Hsu, \nSherry Yueh‐Hsia Chiu, \nJean Ching‐Yuan Fann, \nYi‐Chia Lee, \nHan‐Mo Chiu, \nShu‐Chun Hsiao, \nTsui‐Hsia Hsu, \nHsiu‐Hsi Chen\n

Publicatie 13-10-2020


AbstractBackgroundTo assess the impact of treatment delay on survival of oral/oropharyngeal cancer (OSCC).MethodsWe followed 5743 OSCCs between 2004 and 2009 from a population‐based screening program and ascertained death until the end of 2012.ResultsThe hazard ratios (HRs) of mortality from OSCC were 1.46 (1.30‐1.65) and 1.18 (1.04‐1.33) in univariable and multivariable analyses, respectively, for treatment delay longer than 6 weeks compared with that shorter than 3 weeks. The corresponding figures were 1.12 (1.01‐1.24) and 1.00 (0.91‐1.11) for treatment delay between 3 and 6 weeks. Advancing age (1.01), higher stage (stage II: 1.84, stage III: 2.97, stage IV: 6.33), cancer in tongue (1.37), or hard palate (1.63) had higher HR of mortality (P < .05). However, treatment at medical center had a lower mortality (0.83, 0.75‐0.91) than local/regional hospital.ConclusionsTreatment delay longer than 6 weeks for OSCCs detected via a population‐based screening program had unfavorable survival.

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Programmed cell death ligand‐1 and cytotoxic T cell infiltrates in metastatic cutaneous squamous cell carcinoma of the head and neck

\nStefan Kraft, \nShekhar K. Gadkaree, \nDaniel G. Deschler, \nDerrick T. Lin, \nMai P. Hoang, \nKevin S. Emerick\n

Publicatie 12-10-2020


AbstractBackgroundMetastatic cutaneous squamous cell carcinoma (cSCC) carries a poor prognosis. Increased numbers of CD8+ cytotoxic T cells are associated with a favorable prognosis and programmed cell death receptor‐1 is a suppressor of the CD8+ cytotoxic T cell response. We aim to define their expression in metastatic cutaneous squamous cell carcinoma.MethodsCytotoxic T cell infiltrates and tumoral PD‐L1 expression in lymph node metastases from patients with cSCC of the head and neck were analyzed.ResultsHigh tumoral PD‐L1 expression, intratumoral and peritumoral CD8+ cell density in metastases were significantly associated with poor primary tumor differentiation. Low PD‐L1 expression, intratumoral and peritumoral CD8+ density were associated with lower grade primary tumor differentiation. Low PD‐L1 expression correlated with disease progression.ConclusionsIncreased expression of PD‐L1 correlates with increased CD8+ cell density. Increased expression of PD‐L1 in poorly differentiated tumors may be more likely to benefit from anti PD‐1/PD‐L1 therapy.

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The underappreciated role of auriculotemporal nerve involvement in local failure following parotidectomy for cancer

\nBrian P. Swendseid, \nRamez H. W. Philips, \nNeeta K. Rao, \nRichard A. Goldman, \nAdam J. Luginbuhl, \nJoseph M. Curry, \nWilliam M. Keane, \nDavid M. Cognetti\n

Publicatie 12-10-2020


AbstractBackgroundLocoregional recurrence rates following parotidectomy for cancer remain as high as 20‐30%. The auriculotemporal nerve (ATN) may allow parotid cancers to spread from the facial nerve (FN) toward the skull base, causing local recurrence.MethodsRetrospective review of 173 parotidectomies for malignancy. Preoperative and post‐recurrence imaging were reviewed by a neuroradiologist for signs of tumor adjacent to the ATN.ResultsClinical and imaging signs of possible ATN involvement correlated with FN weakness and sacrifice. Eight patients had pathologically confirmed tumor from the ATN or V3. Forty‐four percent of local recurrences had post‐recurrence imaging showing tumor along the course of the ATN. Locoregional failure along the ATN was also associated with preoperative FN weakness, intraoperative FN sacrifice, and failure to complete recommended adjuvant therapy.ConclusionsParotid cancers may invade the FN and spread to the skull base via the ATN. If not appropriately managed, this may lead to local recurrence.

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Role of programmed death‐ligand 1 in predicting the treatment outcome of salvage chemotherapy after nivolumab in recurrent/metastatic head and neck squamous cell carcinoma

\nYushi Ueki, \nTakeshi Takahashi, \nHisayuki Ota, \nRyusuke Shodo, \nKeisuke Yamazaki, \nArata Horii\n

Publicatie 12-10-2020


AbstractBackgroundIt was reported that treatment outcomes of the salvage chemotherapy (SCT) following nivolumab are fairly good compared with those of nivolumab itself. However, predictive factors of SCT for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) were not determined.MethodsTwenty‐one R/M HNSCC patients received SCT following nivolumab. The treatment outcome and predictive factors for the favorable response to SCT were investigated.ResultsThe objective response rate (ORR) and the disease control rate of SCT were 52.4% and 81.0%, respectively. The median progression‐free survival and the median overall survival time were 5.4 and 12.9 months, respectively. Patients with positive programmed death‐ligand 1 (PD‐L1) expression showed greater tumor shrinkage evaluated by the response evaluation criteria in solid tumors and higher ORR than those with negative PD‐L1 expression.ConclusionsTreatment outcome of SCT following nivolumab in R/M HNSCC was favorable. PD‐L1 expression may be a predictive factor of SCT.

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Prelacrimal approach vs conventional surgery for inverted papilloma in the maxillary sinus

\nTsuguhisa Nakayama, \nYasuhiro Tsunemi, \nAkihito Kuboki, \nDaiya Asaka, \nTetsushi Okushi, \nToshiharu Tsukidate, \nNobuyoshi Otori, \nHiromi Kojima, \nShin‐ichi Haruna\n

Publicatie 12-10-2020


AbstractBackgroundThe prelacrimal approach, termed endoscopic modified medial maxillectomy (EMMM), has recently been applied for treatment of inverted papilloma (IP) in the maxillary sinus. EMMM provides wider access to the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct.MethodsWe reviewed patients with IP in the maxillary sinus to compare the surgical results obtained by conventional surgery (ie, endoscopic maxillary sinus antrostomy or in combination with the Caldwell‐Luc approach) with those obtained by EMMM.ResultsAll patients had a T3 on the Krouse staging system, and the average follow‐up time was 46.0 months. Of the 18 patients in the conventional group, recurrence was seen in 3 patients (16.6%). No recurrence was seen in the 27 patients who showed preservation of the inferior turbinate and nasolacrimal duct, and no complications occurred in the EMMM group.ConclusionsEMMM is an effective surgical approach that reduces recurrence with fewer complications.

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Comparing the prevalence, location, and severity of head and neck lymphedema after postoperative radiotherapy for oral cavity cancers and definitive chemoradiotherapy for oropharyngeal, laryngeal, and hypopharyngeal cancers

\nClaire Jeans, \nBena Brown, \nElizabeth C. Ward, \nAnne E. Vertigan, \nAmanda E. Pigott, \nJodie L. Nixon, \nChris Wratten\n

Publicatie 12-10-2020


AbstractBackgroundThis study aimed to examine the prevalence, location, and severity of chronic internal, external, and combined head and neck lymphedema (HNL) in patients with head and neck (HNC) who were treated with definitive chemoradiotherapy (CRT) or postoperative radiotherapy (PORT).MethodsSixty‐two participants between 1 and 3 years post‐treatment were recruited. Internal HNL was rated with Pattersons Scale. External HNL was graded with the MD Anderson Cancer Center Lymphedema Rating Scale.ResultsNinety‐eight percent of participants presented with some form of chronic HNL. Sixty‐one percent had internal HNL only, 35% had combined HNL, and 2% had external HNL only. Participants treated with PORT were more likely to experience combined HNL (69% vs 24%, P = .001), whereas those treated with CRT were more likely to have internal HNL only (74% vs 25%, P = .001).ConclusionsChronic HNL is highly prevalent following multimodal treatment, and differences in HNL presentations exist between treatment modalities.

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Salivary and lacrimal dysfunction after radioactive iodine for differentiated thyroid cancer: American Head and Neck Society Endocrine Surgery Section and Salivary Gland Section joint multidisciplinary clinical consensus statement of otolaryngology, ophthalmology, nuclear medicine and endocrinology

\nMichael C. Singer, \nFrancis Marchal, \nPeter Angelos, \nVic Bernet, \nLaura Boucai, \nSamanta Buchholzer, \nBrian Burkey, \nDavid Eisele, \nEvren Erkul, \nFrederic Faure, \nSuzanne K. Freitag, \nMarion Boyd Gillespie, \nRichard Mack Harrell, \nDana Hartl, \nMegan Haymart, \nJonathan Leffert, \nSusan Mandel, \nBarbra S. Miller, \nJohn Morris, \nElizabeth N. Pearce, \nRahmatullah Rahmati, \nWilliam R. Ryan, \nBarry Schaitkin, \nMartin Schlumberger, \nBrendan C. Stack, \nDoug Van Nostrand, \nKa Kit Wong, \nGregory Randolph\n

Publicatie 12-10-2020


AbstractBackgroundPostoperative radioactive iodine (RAI) administration is widely utilized in patients with differentiated thyroid cancer. While beneficial in select patients, it is critical to recognize the potential negative sequelae of this treatment. The prevention, diagnosis, and management of the salivary and lacrimal complications of RAI exposure are addressed in this consensus statement.MethodsA multidisciplinary panel of experts was convened under the auspices of the American Head and Neck Society Endocrine Surgery and Salivary Gland Sections. Following a comprehensive literature review to assess the current best evidence, this group developed six relevant consensus recommendations.ResultsConsensus recommendations on RAI were made in the areas of patient assessment, optimal utilization, complication prevention, and complication management.ConclusionSalivary and lacrimal complications secondary to RAI exposure are common and need to be weighed when considering its use. The recommendations included in this statement provide direction for approaches to minimize and manage these complications.

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Oral squamous carcinoma: Aggressive tumor pattern of invasion predicts direct mandible invasion

\nLauren E. Yue, \nKayvon F. Sharif, \nJohn R. Sims, \nMykayla L. Sandler, \nFred M. Baik, \nStanislaw Sobotka, \nSedef Everest, \nMargaret Brandwein‐Weber, \nAzita S. Khorsandi, \nIlya Likhterov, \nMark L. Urken\n

Publicatie 12-10-2020


AbstractBackgroundAggressive histologic worst pattern of invasion (WPOI) in surrounding soft tissue has been shown to be predictive of higher local recurrence and poorer survival in oral cavity squamous cell carcinoma (OCSCC) patients. This study investigates whether aggressive WPOI can predict the mandibular invasion phenotype.MethodsPatients consecutively diagnosed with OCSCC undergoing a mandibulectomy (marginal or segmental) between 2013 and 2018 were reviewed. Senior physicians re‐reviewed radiologic scans and pathologic slides of 44 cases.ResultsAggressive WPOI (WPOI‐4, 5) is significantly associated with infiltrative bone invasion. Non‐aggressive WPOI (WPOI‐1, 2, 3) is significantly associated with the absence of bone invasion.ConclusionsWPOI has become a useful tool that further characterizes the biologic behavior of OCSCC. Potentially, planned surgery may escalate from a marginal to segmental mandibulectomy based on aggressive WPOI for patients with radiographically uncertain cortical status. Further studies are needed to validate the relationship between OCSCC WPOI and mandible status.

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Outcome in patients with isolated regional recurrence after primary radiotherapy for head and neck cancer

\nAnne Marie Lindegaard, \nChristian Buchwald, \nJacob H. Rasmussen, \nLena Specht, \nIvan R. Vogelius, \nMartin Zamani, \nNina Claire Woller, \nGiedrius Lelkaitis, \nJeppe Friborg\n

Publicatie 12-10-2020


AbstractBackgroundIsolated regional recurrences following head‐neck squamous‐cell carcinomas (HNSCC) are often accessible for curatively intended salvage treatment. Factors prognostic for outcome were investigated in a large cohort of HNSCC patients.MethodsIn total, 1811 patients receiving curatively intended radiotherapy from 2007 to 2017 were reviewed and isolated cervical nodal recurrences were identified. Factors associated with survival and second recurrence were investigated using univariate and multivariate analyses.ResultsIsolated regional recurrence was seen in 95/1811 (5.2%) patients. Eighty of 95 patients (84%) received salvage surgery. Two‐year survival after isolated regional recurrence was 40%. Overall survival (OS) and time to second recurrence were associated with resection status of the salvage surgery and presence of extranodal spread (ENS), while p16‐positive oropharyngeal squamous‐cell carcinoma (OPSCC) was associated with better OS.ConclusionLong‐term survival after regional recurrence in HNSCC is possible. p16‐positive OPSCC, complete salvage surgery, and lack of ENS are associated with better outcome.

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Revisiting the temporal artery posterior auricular skin flap with an anatomical basis stepwise pedicle dissection for use in targeted facial subunit reconstruction

\nLaurent Ganry, \nKyle S. Ettinger, \nGuillaume Rougier, \nQuentin Qassemyar, \nRui P. Fernandes\n

Publicatie 12-10-2020


AbstractBackgroundThis study demonstrates the anatomy of the pedicled temporal artery posterior auricular skin (TAPAS) flap, its variable arc of rotation based on stepwise dissection, and case reports demonstrating clinical use. This flap provides excellent color match and ultrathin tissue for targeted reconstruction of small‐ to medium‐sized facial subunit defects.MethodsTwenty‐six cadaver dissections were performed. The authors measured the reach and rotation limits of the flap in a pedicled fashion depending on a stepwise approach for vascular pedicle dissection. Two clinical cases demonstrating maximum arc of rotation are seen.ResultsThe pedicled TAPAS flap maximal rotation limits allow for reconstruction of facial subunits encompassing nearly the entire ipsilateral face. No venous congestion, wound complications, or partial/total flap loss were encountered with extreme clinical applications.ConclusionThe pedicled TAPAS flap has extensive versatility for reconstruction of a variety of facial subunit defects. The flap also has, in theory, multiple applications for intraoral reconstruction.

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Immune related proteins and tumor infiltrating CD8+ lymphocytes in hypopharyngeal cancer in relation to human papillomavirus (HPV) and clinical outcome

\nDavid Landin, \nAndreas Ährlund‐Richter, \nLeila Mirzaie, \nMichael Mints, \nAnders Näsman, \nAeneas Kolev, \nLinda Marklund, \nTina Dalianis, \nEva Munck‐Wikland, \nTorbjörn Ramqvist\n

Publicatie 12-10-2020


AbstractBackgroundHypopharyngeal cancer (HPSCC) shows a poor clinical outcome, while HPSCC, caused by human papillomavirus (HPV), presents a better outcome. Here, HPCC, immune proteins, and tumor infiltrating CD8+ lymphocytes (CD8+ TILs) were evaluated in relation to HPV and outcome.MethodsFresh frozen tissue from four HPV‐positive HPSCC, 39 HPV‐negative HPSCC, and normal samples were analyzed for protein expression by the Proseek immuno‐oncology immunoassay. CD8+ TIL numbers evaluated by immunohistochemistry on 144 formalin‐fixed biopsies were analyzed in relation to clinical outcome.ResultsProteins differing between HPV‐positive and negative HPSCC included CD8A, PD‐L1, Fas ligand, and chemokines. High CD8+ TIL numbers were correlated to improve clinical outcome in HPV‐negative HPSCC.ConclusionsHigh expression of immune proteins in HPV‐positive HPSCC may explain the better clinical outcome. CD8+ TILs are of relevance for outcome of HPV‐negative HPSCC, while tumors with high immune activity but poor patient survival suggest a role for immune therapy.

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Affective symptoms and swallow‐specific quality of life in total laryngectomy patients

\nGlen J. F. Kemps, \nIris Krebbers, \nWalmari Pilz, \nSophie Vanbelle, \nLaura W. J. Baijens\n

Publicatie 12-10-2020


AbstractBackgroundThe aim of this study is to determine the prevalence of clinically relevant affective symptoms and level of swallow‐specific quality of life (QoL) in dysphagic patients with total laryngectomy (TL) and to explore the relationship between affective symptoms and swallow‐specific QoL.MethodsThirty‐five TL patients completed the Hospital Anxiety and Depression Scale (HADS) and the MD Anderson Dysphagia Inventory (MDADI). Students t test and linear regression were used.ResultsEight (23%) patients showed clinically relevant symptoms of anxiety, 8 (23%) of depression, and 11 (31%) showed either one. These groups had significantly lower mean MDADI scores. One‐point increase in HADS‐anxiety or HADS‐depression subscale score corresponds with a decrease of 2.7 or 3.0 points, on average, respectively, of the MDADI total score.ConclusionsClinically relevant affective symptoms were present in approximately one‐third of the TL patients. These preliminary results show that increased affective symptom scores correlate with a decreased swallow‐specific QoL.

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The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma: A multi‐institutional study of within‐stage heterogeneity and impact on prognostic performance

\nArdalan Ebrahimi, \nPeter P. Luk, \nHubert Low, \nLachlan McDowell, \nMatthew J. R. Magarey, \nPaul N. Smith, \nDiana M. Perriman, \nBruce Shadbolt, \nMichael Veness, \nRuta Gupta, \nJonathan R. Clark\n

Publicatie 12-10-2020


AbstractBackgroundThe American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) stratifies risk poorly. We hypothesized that this results from prognostic heterogeneity within N and TNM groups.MethodsRetrospective analysis of disease‐specific survival (DSS) in a multicenter study of 1146 patients with nodal metastases from HNcSCC.ResultsThe majority of patients were classified as pN2a or pN3b (83.1%) and TNM stage IV (90.6%). On multivariate analysis, there was statistically significant prognostic heterogeneity within these groups based on the number and size of nodal metastases, immunosuppression, and perineural invasion. When stage IV patients were categorized into low, moderate, and high‐risk groups based on adverse features, there was wide variation in prognosis with 5‐year DSS ranging from 90% to 60% (P < .001).ConclusionsThe AJCC staging system stratifies risk poorly in HNcSCC due to significant prognostic heterogeneity within pN2a, pN3b, and stage IV groups.

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Primary tumor volume as a predictor of distant metastases and survival in patients with sinonasal mucosal melanoma

\nStephanie Flukes, \nShivangi Lohia, \nChristopher A. Barker, \nJennifer R. Cracchiolo, \nIan Ganly, \nSnehal G. Patel, \nBenjamin R. Roman, \nJatin P. Shah, \nAlexander N. Shoushtari, \nViviane Tabar, \nAkash Shah, \nMarc A. Cohen\n

Publicatie 12-10-2020


AbstractBackgroundSinonasal mucosal melanoma (SNMM) is an aggressive cancer with high mortality. Identifying patients at risk of distant metastasis assists with management and prognostication. We aimed to define the relationship between volume, survival, and risk of distant metastases.MethodsA retrospective review of all patients with SNMM treated at a single institution over a 21‐year period was conducted. Tumor volume was calculated using cross‐sectional imaging and survival analysis was performed.ResultsSixty‐one patients were included. Tumor volume was predictive of local progression‐free survival (P = .03), distant metastases‐free survival (DMFS) (P = .002), and overall survival (OS) (P = .02). It was a better predictor than AJCC stage and T‐classification. Tumor volume equal to or greater than 5 cm3 was associated with a significantly worse DMFS and OS (P = .02 and .009, respectively).ConclusionCalculation of tumor volume assists in quantifying the risk of distant metastases and death in SNMM.

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Shape‐modified radial forearm free tissue transfer in oral cavity reconstruction: Technique and a prospective comparison with the conventional technique

\nSachin Chavre, \nKrishnakumar Thankappan, \nJimmy Mathew, \nMohit Sharma, \nSubramania Iyer\n

Publicatie 12-10-2020


AbstractBackgroundDonor site morbidity is a significant drawback of the radial forearm flap. The purpose of this study is to describe a new shape‐modified technique. The donor site morbidity was compared to that of the conventional technique, in terms of the esthetic, functional outcomes, and quality of life (QOL).MethodsThis is a prospective study of 30 patients with oral cancer who underwent reconstruction using radial forearm flaps, in two groups.ResultsRegarding the donor site characteristics, the differences in the time for healing (P = .006), the scar score (P < .0001), and the QOL score (P < .0001) were significant. The number of patients with sensory deficit was 11 in the conventional group and 3 in the shape‐modified group (P = .009).ConclusionsThe functional and esthetic outcomes of the donor site were better for the shape‐modified technique. It is best suited for small defects. Compromise of the pedicle length is a limitation.

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Cosmetic outcomes following transoral versus transcervical thyroidectomy

\nLena W. Chen, \nChristopher R. Razavi, \nHanna Hong, \nAkeweh Fondong, \nRohit Ranganath, \nSurya Khatri, \nWojciech K. Mydlarz, \nAarti Mathur, \nMasaru Ishii, \nJason Nellis, \nMohammad Shaear, \nRalph P. Tufano, \nJonathon O. Russell\n

Publicatie 12-10-2020


AbstractBackgroundCentral neck scars following thyroidectomy can negatively impact patient quality of life. Transoral endoscopic thyroidectomy can reduce postoperative cosmetic burden.MethodsProspective cohort study of patients seen between June 2018 and January 2019. Scar cosmesis was determined using the validated Scar Cosmesis Assessment and Rating (SCAR) scale and a Visual Analog Scale (VAS) measuring color, contour, and irregularity.ResultsEighty‐one patients (80% female, mean age 43.7 years) were analyzed, with 60% and 40% receiving transcervical and transoral thyroidectomy. Median time from surgery was 3.4 (range: 1‐37.1) weeks. Mean SCAR score was greater for transcervical recipients (4.69 vs transoral 0.99, P < .001), indicating worse cosmesis. Mean surgeon‐rated total VAS score was similarly increased for transcervical recipients (72.84 vs transoral 16.73, P < .001). Interrater reliability for both SCAR and total VAS scores was excellent (intraclass correlation 0.93; 95% CI: 0.90‐0.95 for both).ConclusionTransoral thyroidectomy provides significantly enhanced early cosmesis over the transcervical approach.

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Prediction of distant metastases in patients with squamous cell carcinoma of head and neck using DWI and DCE‐MRI

\nSanjeev Chawla, \nSungheon G Kim, \nLaurie A Loevner, \nSumei Wang, \nSuyash Mohan, \nAlexander Lin, \nHarish Poptani\n

Publicatie 12-10-2020


AbstractBackgroundThe primary purpose was to evaluate the prognostic potential of diffusion imaging (DWI) and dynamic contrast enhanced magnetic resonance imaging (DCE‐MRI) in predicting distant metastases in squamous cell carcinoma of head and neck (HNSCC) patients. The secondary aim was to examine differences in DWI and DCE‐MRI‐derived parameters on the basis of human papilloma virus (HPV) status, differentiation grade, and nodal stage of HNSCC.MethodsFifty‐six patients underwent pretreatment DWI and DCE‐MRI. Patients were divided into groups who subsequently did (n = 12) or did not develop distant metastases (n = 44). Median values of apparent diffusion coefficient (ADC), volume transfer constant (Ktrans), and mean intracellular water‐lifetime (τi) and volume were computed from metastatic lymph nodes and were compared between two groups. Prognostic utility of HPV status, differentiation grading, and nodal staging was also evaluated both in isolation or in combination with MRI parameters in distinguishing patients with and without distant metastases. Additionally, MRI parameters were compared between two groups based on dichotomous HPV status, differentiation grade, and nodal stage.ResultsLower but not significantly different Ktrans (0.51 ± 0.15 minute−1 vs 0.60 ± 0.05 minute−1) and not significantly different τi (0.13 ± 0.03 second vs 0.19 ± 0.02 second) were observed in patients who developed distant metastases than those who did not. Additionally, no significant differences in ADC or volume were found. τi, was the best parameter in discriminating two groups with moderate sensitivity (67%) and specificity (61.4%). Multivariate logistic regression analyses did not improve the overall prognostic performance for combination of all variables. A trend toward higher τi was observed in HPV‐positive patients than those with HPV‐negative patients. Also, a trend toward higher Ktrans was observed in poorly differentiated HNSCCs than those with moderately differentiated HNSCCs.ConclusionPretreatment DCE‐MRI may be useful in predicting distant metastases in HNSCC.

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Long‐term survival of head and neck squamous cell carcinoma after bone marrow transplant

\nCatriona M. Douglas, \nAshock R. Jethwa, \nWael Hasan, \nAmy Liu, \nRalph Gilbert, \nDavid Goldstein, \nJohn De Almedia, \nJeff Lipton, \nJonathan C. Irish\n

Publicatie 12-10-2020


AbstractPurposeThe risk of developing head and neck squamous cell carcinoma (HNSCC) in patients with graft versus host disease (GVHD) after bone marrow transplant (BMT) is well established but large series reporting outcomes are sparse.MethodsRetrospective, single institution, study of patients with GVHD and HNSCC after BMT, between January 1, 1968, and June 30, 2016.ResultsIn total, 25 patients were studied, of which 21 (84%) were male and 4 (16%) were female. Mean age for BMT was 41 (18‐65) years. All patients developed GVHD, most common site was oral cavity (19 patients, 76%). Mean age for diagnosis of HNSCC was 52 (28‐76) years. Mean time between BMT and diagnosis of HNSCC was 12 (2‐13) years. The 2‐year progression‐free survival (PFS) was 61.4%, 5‐year PFS was 56.7%. The 2‐year overall survival (OS) was 82.8%, 5‐year OS was 68.7%.ConclusionHNSCC can develop many years after BMT in patients without the classic risk factors for head and neck cancer. The majority were seen with oral cancer and with early‐stage disease likely due to active surveillance and early detection in this patient population.

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Induction chemotherapy for locally advanced laryngeal and hypopharyngeal cancer: Single institution experience

\nOr Dagan, \nAssaf Moore, \nYuval Nachalon, \nUri Alkan, \nAmeen Biadsee, \nIsaac Shochat, \nAron Popovtzer\n

Publicatie 12-10-2020


AbstractBackgroundThe role of induction chemotherapy (IC) in locally‐advanced head and neck squamous cell carcinoma (LAHNSCC) is unclear.MethodsA retrospective study of 104 patients with LAHNSCC of the larynx and hypopharynx, treated with IC or up‐front chemoradiotherapy (CRT).ResultsEighty patients received CRT and 24 IC followed by CRT; median follow up was 51.33 months. IC significantly improved median overall survival (OS) in the hypopharyngeal cancer group (64.7 vs 21 months, P = .003); with significant difference in the proportion of complete response at first imaging assessment post definitive CRT; no significant difference in disease free survival (DFS), loco‐regional or distant failure in the hypopharyngeal cancer group; or OS and DFS in the laryngeal cancer group. Patients with laryngeal cancer had significantly better median OS than those with hypopharyngeal cancer.ConclusionsIC significantly improved complete response rates after CRT, and improved outcomes for patients with locally advanced hypopharyngeal, not laryngeal, cancers.

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Sinonasal undifferentiated carcinoma: Institutional trend toward induction chemotherapy followed by definitive chemoradiation

\nNyall R. London, \nAhmed Mohyeldin, \nGeorges Daoud, \nMauricio E. Gamez, \nDukagjin Blakaj, \nMarcelo Bonomi, \nDaniel M. Prevedello, \nRicardo L. Carrau\n

Publicatie 12-10-2020


AbstractBackgroundRecent reports have investigated the nascent role of induction chemotherapy for sinonasal undifferentiated carcinoma (SNUC). The goal of this study was to ascertain trends in treatment pattern changes for SNUC at a single institution and design a treatment algorithm utilized at our institution.MethodsRetrospective chart analysis of 21 cases of SNUC from 2010 to 2018.ResultsOf 21 patients in this cohort, 18 (85.7%) presented with T4 disease, 7 (33.3%) presented with nodal disease, and 3 (14.3%) presented with distant metastasis. Since 2016, patients have been managed by induction chemotherapy followed by concurrent chemoradiation. To this point, patients treated with TPF induction chemotherapy followed by concurrent chemoradiation show no evidence of disease; however, the average follow up time is 16.8 months.ConclusionsThe multimodality treatment for SNUC continues to evolve, as highlighted by this study, toward increased use of induction chemotherapy followed by chemoradiotherapy.

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Pilot study of loss of the p53/p63 target gene PERP at the surgical margin as a potential predictor of local relapse in head and neck squamous cell carcinoma

\nBrittany J. Holmes, \nRie Eyben, \nLaura D. Attardi, \nChristina S. Kong, \nQuynh‐Thu Le, \nCherie‐Ann O. Nathan\n

Publicatie 12-10-2020


AbstractBackgroundPERP (p53 apoptosis effector related to PMP22) localizes to desmosomes and suppresses squamous cell carcinoma development. Loss of PERP leads to worse local control in head and neck squamous cell carcinoma (HNSCC), likely by destabilizing desmosomes. We evaluated PERP loss at HNSCC surgical margins as a predictor of local relapse.MethodsCombining discovery (n = 17) and validation (n = 31) cohorts, we examined membranous PERP protein expression by immunohistochemistry in surgical mucosal margins with competing risk analysis of the relationship between local relapse and PERP expression.ResultsOf the 44 analyzable patients, the 2‐year cumulative incidence of local relapse was 44.4% for the PERP‐negative group and 16.4% for the PERP‐positive group (P = .01). A trend toward worse progression‐free survival (P = .09) and overall survival (P = .06) was observed with loss of PERP.ConclusionsPERP loss at surgical margins is associated with higher risk of local recurrence in HNSCC, warranting further evaluation in a larger prospective study.

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Salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma: Long‐term study

\nMarc‐Kevin Le Roux, \nNicolas Graillon, \nLaurent Guyot, \nDavid Taieb, \nPhilippe Galli, \nYves Godio‐Raboutet, \nCyrille Chossegros, \nJean‐Marc Foletti\n

Publicatie 12-10-2020


AbstractBackgroundAlthough many studies focus on short‐term side effects of radioiodine therapy, almost none studied long‐term side effects. We assessed radioiodine long‐term salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma and compared it to short‐term morbidity within the same population.MethodsA standardized self‐administrated questionnaire was submitted in 2019 by patients treated with radioiodine between January 2011 and December 2012. These patients had already answered the same questionnaire 6 years before.ResultsOur study showed a significant reduction for salivary side effects: discomfort in submandibular or parotid area, swelling, pain, a bad or salty taste in the mouth, allowing to get back to a “normal” diet.ConclusionsOur study suggests that a significant rate of patients will recover from I131 therapy salivary side effects. As almost 30% of these remissions happened during our late stage follow‐up, we highlight the necessity of a long‐term follow‐up in these patients.

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Global On Line Fellowship in head and neck surgery and oncology

"\nJatin P. Shah, \nJames P. ONeil, \nMurray F. Brennan\n"

Publicatie 12-10-2020


AbstractThe International Federation of Head and Neck Oncologic Societies and Memorial Sloan Kettering Cancer Center in New York have partnered to create the Global On Line Fellowship program, a postgraduate fellowship training opportunity for candidates all around the world who are not able to get on‐site fellowship training at centers of excellence. This article delineates the successes, challenges, and future goals for the program.

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Pluripotency transcription factor Nanog and its association with overall oral squamous cell carcinoma progression, cisplatin‐resistance, invasion and stemness acquisition

\nTanushree Kashyap, \nNidhi Nath, \nPrajna Mishra, \nArpita Jha, \nSiddavaram Nagini, \nRajakishore Mishra\n

Publicatie 12-10-2020


AbstractBackgroundCisplatin‐resistant oral squamous cell carcinoma (OSCC) cells acquire stem‐like characteristics and are difficult to treat. Nanog is a transcription factor and needed for maintenance of pluripotency, but its transcription‐promoting role in OSCC progression and cisplatin resistance is poorly understood.MethodsHere, 110 fresh human tissue specimens of various stages, including invasive (N1‐3)/chemoradiation‐resistant OSCC samples, cisplatin‐resistant (CisR‐SCC‐4/‐9) OSCC cells/parental cells, photochemical ECGC, and siRNA (Nanog) were used.ResultsNanog overexpression was associated with overall progression, chemoresistance, and invasion of OSCC. Nanog recruitment to c‐Myc, Slug, E‐cadherin, and Oct‐4 gene promoter was observed. Positive correlation of Nanog protein expression with c‐Myc, Slug, cyclin D1, MMP‐2/‐9, and Oct‐4 and negative correlation with E‐cadherin gene expression were found. Knockdown of Nanog and treatment of epicatechin‐3‐gallate reversed cisplatin resistance and diminished invasion/migration potential.ConclusionNanog directly participated in the regulation of Slug, E‐cadherin, Oct‐4, and c‐Myc genes, causing cisplatin resistance/recurrence of OSCC.

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Prognostic value of preoperative systemic inflammation response index in patients with oral squamous cell carcinoma: Propensity score‐based analysis

\nJing Lin, \nLin Chen, \nQing Chen, \nZhaocheng Zhuang, \nXiaodan Bao, \nJiawen Qian, \nYihong Hong, \nLingjun Yan, \nLisong Lin, \nBin Shi, \nYu Qiu, \nLizhen Pan, \nLihong Wei, \nXiaoyan Zheng, \nJing Wang, \nFengqiong Liu, \nBaochang He, \nFa Chen\n

Publicatie 12-10-2020


AbstractBackgroundThe aim of the study was to elucidate the relationship between systemic inflammation response index (SIRI) and the prognosis of postoperative oral squamous cell carcinoma (OSCC) patients.MethodsThe prognostic value of SIRI was evaluated in a prospective cohort consisting of 535 OSCC patients with surgical resection. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses were used to further verify the prognostic value of SIRI.ResultsPatients with a higher SIRI had a significantly increased risk of mortality compared with those with a low SIRI (HR hazard ratio: 1.60, 95% CI confidence interval: 1.04‐2.47). The similar association pattern was observed following PSM (HR: 1.97, 95% CI: 1.14‐3.40) and IPTW (HR: 1.70, 95% CI: 1.29‐2.24) analyses. Of note, receiving postoperative chemotherapy resulted in a 72% of decreased risk of death among patients with a higher SIRI (HR: 0.28, 95% CI: 0.08‐0.95). Additionally, a novel prognostic nomogram, based on TNM stage, tumor differentiation, and SIRI, demonstrated superior accuracy for the prediction of overall survival than that of the seventh edition of the AJCC staging system.ConclusionPreoperative SIRI may be a valuable tool for prediction of survival of OSCC patients.

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Global, regional, and national burden of nasopharyngeal carcinoma from 1990 to 2017—Results from the Global Burden of Disease Study 2017

\nChuan‐Yu Hu, \nWei‐Ming Wang, \nXiu‐Hong Chu, \nZhen‐Hu Ren, \nJun Lyu\n

Publicatie 12-10-2020


AbstractBackgroundThe aim of this study is to estimate the incidence, mortality, and disability‐adjusted life years (DALYs) of nasopharyngeal carcinoma from 1990 to 2017.MethodsWe collected detailed information on nasopharyngeal carcinoma from 1990 to 2017 based on data from Global Burden of Disease (GBD) study 2017. The global incidence, mortality, and DALYs attributable to nasopharyngeal carcinoma was reported, as well as the age‐standardized rates (ASRs).ResultsThe ASR of nasopharyngeal carcinoma incidence decreased from 1.88 (95% UI: 1.76‐2.00) in 1990 to 1.35 (95% UI: 1.28‐1.42) in 2017. The ASR of mortality decreased from 1.19 (95% UI: 1.13‐1.25) in 1990 to 0.86 (95% UI: 0.82‐0.89) in 2017, while ASR‐DALYs decreased from 38.2 (95% UI: 35.9‐40.2) in 1990 to 25.4 (95% UI: 24.4‐26.5) in 2017.ConclusionsThe ASR of incidence, mortality, and DALYs of nasopharyngeal carcinoma have decreased slightly worldwide. East Asia carried the heaviest burden of nasopharyngeal carcinoma. The majority of nasopharyngeal carcinoma burden was observed in men, especially among male aged 55 to 69 years.

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Highly conformal reirradiation in patients with prior oropharyngeal radiation: Clinical efficacy and toxicity outcomes

\nAlexander F. Bagley, \nAdam S. Garden, \nJay P. Reddy, \nAmy C. Moreno, \nSteven J. Frank, \nDavid I. Rosenthal, \nWilliam H. Morrison, \nGary Brandon Gunn, \nClifton D. Fuller, \nShalin J. Shah, \nRenata Ferrarotto, \nErich M. Sturgis, \nNeil D. Gross, \nJack Phan\n

Publicatie 12-10-2020


AbstractBackgroundReirradiation of head and neck cancer is associated with high rates of locoregional failure and potentially severe treatment‐related toxicity. We report our institutional experience of reirradiation using modern highly conformal radiotherapy approaches in patients with prior oropharyngeal radiation.MethodsWe reviewed patients receiving curative‐intent reirradiation with intensity‐modulated radiation therapy, stereotactic body radiation therapy, and proton beam radiotherapy at our institution from 1999 to 2019. Disease control, survival, and toxicity rates following reirradiation were determined.ResultsSixty‐nine patients were evaluated. Local control (LC), progression‐free survival, and overall survival at 2 years following reirradiation were 77%, 35%, and 51%, respectively. Grade 3 or greater (G3+) late toxicities occurred in 46% of patients and 41% required feeding tube placement during or after reirradiation.ConclusionsIn select patients with prior oropharyngeal radiation, highly conformal reirradiation offers acceptable LC, but G3+ toxicity and out‐of‐field failure rates remain high. These findings warrant continued evaluation of new multimodality approaches to improve oncologic outcomes.

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The epidemiology, surgical management, and impact of margins in skull and mandibular osseous‐site tumors

\nSina J. Torabi, \nAlexandra Bourdillon, \nParsa P. Salehi, \nSamipya Kafle, \nSaral Mehra, \nRahmatullah Rahmati, \nBenjamin L. Judson\n

Publicatie 12-10-2020


AbstractObjectiveThe aim of the study was to characterize the epidemiology and treatment outcomes of head and neck (HN) osseous‐site tumors.MethodsDescriptive analyses and multivariate Cox regressions were performed to analyze the effect of surgery on overall survival (OS) utilizing the National Cancer Database (2004‐2016).ResultsOf 2449 tumors, surgery was utilized in 84.5% of cases. OS was worse in osteosarcoma (5‐year OS: 53.4% SE: 2.5%) compared with cartilage tumors (5‐year OS: 84.6% SE: 1.8%) (log‐rank P < .001). Treatment regimens that included surgery were associated with improved OS on multivariate analysis (hazard ratio HR 0.495 95% CI: 0.366‐0.670). Positive margins were found in 40.8% of cases, and associated with decreased OS in osteosarcomas (HR 1.304 0.697‐2.438).ConclusionTreatment that included surgery was associated with an increased OS within our cohort of HN osseous‐site tumors, although the rates of positive margins were >40%. These findings may be limited by inherent selection bias in the database.

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e‐Health self‐management intervention for oral and oropharyngeal cancer survivors: design and single‐arm pilot study of empowered survivor

\nSharon Manne, \nShawna Hudson, \nSara Frederick, \nAnna Mitarotondo, \nSoly Baredes, \nEvelyne Kalyoussef, \nPamela Ohman‐Strickland, \nDeborah A. Kashy\n

Publicatie 12-10-2020


AbstractBackgroundSelf‐management regimens for oral and oropharyngeal cancer survivors can be complex and challenging. Effective self‐management skills can foster better outcomes. We report on the development, feasibility, and pilot testing of a web‐based self‐management tool called “Empowered Survivor” (ES) for survivors of oral and oropharyngeal cancer.MethodsES content was developed in two phases, with modules focusing on oral care, swallowing and muscle strength, and long‐term follow‐up. This single‐arm pilot study consisted of a pre‐, 2‐month, and a 6‐month postintervention survey.ResultsEnrollment rates were relatively low. Once enrolled, data collected from the ES website indicated that 81.8% viewed ES. Participants provided positive evaluations of ES. Preliminary results indicate that ES had a beneficial impact on self‐management self‐efficacy, preparedness for survivorship care, and quality of life. ES improved survivors engagement in oral self‐exams and head and neck strengthening exercises, improved ability to address barriers, and decreased information and support needs.ConclusionsThis study provides preliminary evidence of engagement, acceptability, and beneficial impact of ES, which should be evaluated in a larger controlled clinical trial.

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New series of surgical design for anterior maxillary reconstruction with deep circumflex iliac artery flap

\nBimeng Jie, \nXiaoming Lv, \nLei Zheng, \nYi Zhang, \nYang He\n

Publicatie 12-10-2020


AbstractMicrosurgical reconstruction for anterior maxillary defects presents a surgical challenge. The objective of this study was to ascertain the feasibility of a new series of intraoral surgical approach using deep circumflex iliac artery (DCIA) flap to achieve functional reconstruction for anterior maxillary defects. Two male patients with anterior maxillary defects (Brown Class IC) were treated in this study. Both patients underwent computer‐assisted maxillary reconstruction with a DCIA flap (with pedicle positioning laterally to the bony flap) using intraoral anastomosis techniques. The overall DCIA flap survival rate was 100% and mucosa was all healed uneventfully. One patient received dental implantation and loaded with prosthetic superstructures. Both patients were satisfied with their postoperative oral function and appearance. This study illustrated a new and feasible series of surgical design for anterior maxillary bone defect reconstruction with DCIA flaps and intraoral anastomosis assisted by digital techniques.

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Sensory change in the chin and neck after transoral thyroidectomy: Prospective study of mental nerve injury

\nKyung Tae, \nDong Won Lee, \nHyang Sook Bang, \nYou Hern Ahn, \nJung Hwan Park, \nDong Sun Kim\n

Publicatie 12-10-2020


AbstractBackgroundThe study aimed to evaluate the sensory changes on the chin and neck in transoral thyroidectomy.MethodsWe prospectively assessed the cutaneous sensation of 10 zones of the chin, face, and neck in 43 patients who underwent transoral robotic or endoscopic thyroidectomy using the Semmes‐Weinstein monofilaments test, preoperatively and postoperatively at 1 week, 1 month, and 3 months.ResultsThe sensation of the chin and lower lip did not differ before and after surgery. However, the pressure threshold of the submental and level VI area increased significantly after surgery, and returned to the preoperative level 1 month and 3 months postoperatively, respectively.ConclusionIn terms of mental nerve injury, transoral thyroidectomy is safe when performed successfully. However, proper placement of oral vestibular incisions and minimal dissection of the chin is essential to avoid mental nerve injury.

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Minimally important differences for interpreting European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 scores in patients with head and neck cancer

\nJammbe Z. Musoro, \nCorneel Coens, \nSusanne Singer, \nSilke Tribius, \nSjoukje F. Oosting, \nMogens Groenvold, \nChristian Simon, \nJean‐Pascal Machiels, \nVincent Grégoire, \nGalina Velikova, \nKim Cocks, \nMirjam A. G. Sprangers, \nMadeleine T. King, \nAndrew Bottomley, \nEORTC Head and Neck and Quality of Life Groups\n

Publicatie 12-10-2020


AbstractBackgroundWe aimed to estimate minimally important difference (MID) for interpreting group‐level change over time for European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ‐C30) scores in head and neck cancer.MethodsData were derived retrospectively from two published EORTC trials. Clinical anchors were selected using correlation strength and clinical plausibility of the given anchor/QLQ‐C30 scale pair. MIDs for within‐group and between‐group change were estimated via the mean change method and linear regression, respectively. Distribution‐based MIDs were also examined. MIDs for two of the scales, dyspnea and nausea/vomiting, are more uncertain considering their low correlations with the anchors.ResultsAnchor‐based MIDs could be determined for deterioration in 7 of the 14 QLQ‐C30 scales assessed, and in 3 scales for improvement. MIDs varied by scale, direction of change, and anchor. Absolute MID values ranged from 5 to 15 points for within‐group change and 4 to 12 for between‐group change. Most MIDs were within 4 to 10 points.ConclusionsOur findings, if confirmed, will aid interpreting changes in selected QLQ‐C30 scale scores over time and inform sample size calculations in future clinical trials in head and neck cancer.

Pubmed PDF Web

Feasibility of methylated ctDNA detection in plasma samples of oropharyngeal squamous cell carcinoma patients

\nLais Machado Jesus, \nMariana Bisarro Reis, \nRaiany Santos Carvalho, \nCristovam Scapulatempo Neto, \nGisele Caravina Almeida, \nAna Carolina Laus, \nGabriella Taques Marczynski, \nLeticia Ferro Leal, \nMatias Eliseo Melendez, \nPedro Marchi, \nRui Reis, \nAndré Lopes Carvalho, \nAna Carolina Carvalho\n

Publicatie 12-10-2020


AbstractBackgroundOropharyngeal squamous cell carcinomas (OpSCCs) are commonly associated with high rates of treatment failure.ObjectivesTo evaluate methylation‐based markers in plasma from OpSCC patients as emerging tools for accurate/noninvasive follow‐up.MethodsPretreatment formalin‐fixed paraffin‐embedded (FFPE) biopsies (n = 52) and paired plasma (n = 15) were tested for the methylation of CCNA1, DAPK, CDH8, and TIMP3 by droplet digital PCR (ddPCR).ResultsSeventy‐one percent (37/52) of the biopsies showed methylation of at least one of the evaluated genes and tumor CCNA1 methylation was associated with recurrence‐free survival. Methylated circulating tumor DNA (meth‐ctDNA) was detected in 11/15 (73.3%) plasma samples; conversely, plasma samples from healthy controls were all negative for DNA methylation (area under the curve = 0.867; 95% confidence interval = 0.720‐1.000). Additionally, preliminary results on the detection of meth‐ctDNA in plasma collected during follow‐up closely matched patient outcome.ConclusionsThe results suggest the feasibility of detecting meth‐ctDNA in plasma using ddPCR and a possible application on routine setting after further validation.

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Postoperative extracorporeal membrane oxygenation can successfully support patients following upper airway reconstruction

\nWilliam Cohen, \nSaeid Mirzai, \nPamela Combs, \nRebecca Rose, \nViktoriya Kagan, \nCamil Correia, \nLawrence J. Gottlieb, \nTae Song\n

Publicatie 12-10-2020


AbstractBackgroundPatients requiring intensive upper airway reconstruction are anatomically restricted in terms of the respiratory support they can receive. While intraoperative extracorporeal membrane oxygenation (ECMO) has been effectively utilized, little has been shown regarding the utility of ECMO for long‐term support in these patients.MethodsWe demonstrate how a patient with tongue and hypopharyngeal squamous cell carcinoma that necessitated upper airway reconstruction was supported with veno‐venous (VV) ECMO due to postoperative respiratory failure and an inability to maintain a stable airway.ResultsBy initiating VV ECMO, we were able to decrease positive pressure ventilation and FiO2, thereby minimizing ventilator‐associated trauma and irritation to facilitate wound healing. Over time, ventilatory support was increased in parallel with decreasing ECMO support, allowing discharge to rehabilitation after 74 days of ECMO.ConclusionECMO can effectively support patients with ongoing respiratory requirements following upper airway reconstruction when standard ventilatory techniques are inadequate or not feasible.

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Recurrent audiovestibular dysfunction and associated neurological immune‐related adverse events in a melanoma patient treated with nivolumab and ipilimumab

\nJonathan S. Choi, \nMerry Chen, \nJennifer L. McQuade, \nEric Appelbaum, \nPaul W. Gidley, \nMarc‐Elie Nader\n

Publicatie 12-10-2020


AbstractBackgroundRecurrent immunotherapy‐induced audiovestibular toxicity despite cessation of therapy has not been reported.MethodsWe report the first case of recurrent audiovestibular toxicity following immune‐checkpoint inhibitor (ICI) therapy. The patient was seen with sudden bilateral hearing loss and disequilibrium. After ruling out other etiologies, he was diagnosed with audiovestibular and neurological immune‐related adverse events (irAEs). He received systemic steroids, with significant hearing and balance recovery. Over the following 4 months, he experienced two other episodes of sudden bilateral hearing loss despite ICIs cessation. The second episode was treated with oral steroids, and hearing improved. On the third episode, he received oral and intratympanic steroids, and he was started on infliximab.ResultsAudiogram 8 months following the last recurrence showed hearing improvement and stability.ConclusionImmunotherapy‐induced ototoxicity may recur despite therapy cessation. High dose steroids remain the mainstay of treatment. If audiovestibular irAEs recur despite multiple courses of steroids, immunosuppressive agents may be considered.

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Nivolumab‐related tracheobronchial chondritis: Extremely rare manifestation of an immune‐related adverse effect

\nKiyomi Kuba, \nMitsuhiko Nakahira, \nHitoshi Inoue, \nYasunao Kogashiwa, \nYasuhiro Ebihara, \nMasashi Sugasawa\n

Publicatie 12-10-2020


AbstractBackgroundProgrammed death‐1 checkpoint inhibitors, such as nivolumab, have successfully been utilized for recurrent or metastatic squamous cell carcinoma of the head and neck; however, their use may be associated with immune‐related adverse effects (irAEs).MethodsWe describe a case of tracheobronchial chondritis as a rare irAE in a 72‐year‐old man with multiple pulmonary metastases of hypopharyngeal squamous cell carcinoma treated with nivolumab, who was seen with a 2‐week history of fever, nonproductive cough, and dyspnea.ResultsCT revealed a thickened tracheobronchial wall and narrowed intraluminal space resulting in respiratory symptoms, despite significant clinical response of the metastases. He was clinically diagnosed with tracheobronchial chondritis and treated successfully by steroid therapy. His diagnosis was confirmed by a positive serum anti‐collagen type 2 antibody test.ConclusionsIn addition to interstitial lung disease, tracheobronchial chondritis should be considered as a possible irAE in patients with acute respiratory symptoms after nivolumab administration.

Pubmed PDF Web

Reply to Letter to the Editor regarding “Identification of genes associated with cancer stem cell characteristics in head and neck squamous cell carcinoma through co‐expression network analysis”

\nXiaodong Zhu\n

Publicatie 12-10-2020


Pubmed PDF Web

Function preservation for resection of vagal schwannoma of the head and neck: Are we talking about the same technique?

\nRupert Obholzer, \nDaniele Borsetto, \nAnn Sandison\n

Publicatie 12-10-2020


Pubmed PDF Web

Soft tissue deposits: Surrogate marker for distant metastasis?

\nAbhijith George, \nRitvi K. Bagadia, \nB.M Joshna, \nAnand Subash, \nShalini Thakur, \nVishal U.S. Rao\n

Publicatie 12-10-2020


Pubmed PDF Web

Reply to Letter to the Editor regarding “Soft tissue deposits in oral cancers”

\nAkshat Malik, \nSudhir Nair\n

Publicatie 12-10-2020


Pubmed PDF Web

Reply to “Function preservation for resection of vagal schwannoma of the head and neck: Are we talking about the same technique?”

\nMonica H. Xing, \nMykayla L. Sandler, \nMark L. Urken\n

Publicatie 12-10-2020


Pubmed PDF Web

Identification of genes associated with cancer stem cell characteristics in head and neck squamous cell carcinoma

\nGuan‐Jiang Huang, \nBei‐Bei Yang\n

Publicatie 12-10-2020


Pubmed PDF Web

Issue Information

Publicatie 12-10-2020


Pubmed PDF Web

Comparing endoscopic surgeries with open surgeries in terms of effectiveness and safety in salvaging residual or recurrent nasopharyngeal cancer: Systematic review and meta‐analysis

\nGang Li, \nJianqi Wang, \nHaocheng Tang, \nRi Han, \nYunteng Zhao, \nXianwen Wang, \nHuijun Zhou\n

Publicatie 12-10-2020


AbstractConsensus has yet to be reached on the optimal operation for patients with residual or recurrent nasopharyngeal carcinoma (NPC). To compare effectiveness and safety of open surgery and endoscopic surgery for patients with residual or recurrent NPC. Pubmed, Embase, and Cochrane were searched for relevant publications from January 1, 2000 to May 1, 2017. Included studies reported specific residual or local recurrent nasopharyngeal cancer survival data. Proportional meta‐analysis was performed on both outcomes with a random‐effects model, and the 95% confidential intervals were calculated by Stata 12.0 software. For patients with different tumor classification, a downward trend of 2‐year overall survival (OS) was observed for both surgical populations. Endoscopic surgeries achieved bigger rates than open surgeries in patients with recurrent tumor (rT) 1, rT2, and rT3 (93% vs 87%, 77% vs 63%, 67% vs 53%). As for patients with rT4, 2‐year OS was similar (35% vs 35%).In addition, the former is less severe complications, lower local recurrence rates (27% vs 32%). Our study found that, compared to open surgery, endoscopic surgery was a safer and more effective treatment modality in managing patients with recurrent or residual NPC.

Pubmed PDF Web

Updates in the evidence‐based management of cutaneous melanoma

\nRyan P. Goepfert, \nJeffrey N. Myers, \nJeffrey E. Gershenwald\n

Publicatie 12-10-2020


AbstractTreatment of cutaneous melanoma is changing with significant developments over the past several years that promise to reshape the field of melanoma surgical oncology. Modifications to the staging system based on analysis of a large international dataset, the timing and extent of regional lymphadenectomy, the emergence of effective systemic therapies in the neoadjuvant and adjuvant setting, and the role of adjuvant radiation are all undergoing a data‐driven evolution. Surgeon engagement in multidisciplinary decision making remains an essential component of contemporary management for patients across all stages of melanoma and demands specific involvement of head and neck surgical oncologists.

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Moderately accelerated intensity‐modulated radiation therapy using simultaneous integrated boost: Practical reasons or evidence‐based choice? A critical appraisal of literature

\nFrancesca De Felice, \nPierluigi Bonomo, \nGiuseppe Sanguineti, \nEster Orlandi\n

Publicatie 12-10-2020


AbstractConcurrent chemo‐radiotherapy is the non‐surgical mainstay of treatment for locally advanced head and neck squamous cell carcinoma (HNSCC). The following aspects have emerged as fundamental components of the combined approach: first, intensity modulated radiotherapy (IMRT) is the minimum standard technical requirement, with level 1 evidence in support of its reduction of late treatment‐induced morbidity in comparison with 3D conformal radiotherapy. Second, cisplatin‐based chemotherapy is the preferred systemic agent to be associated with radiation, with 100 mg/m2 every 3 weeks deemed as the reference schedule. Because of significant progress in irradiation techniques achieved in last 15 years, the optimal fractionation schedule in modern radiation era remains controversial, especially for locally advanced disease. The purpose of this work was to perform a critical review on the value of moderately accelerated IMRT using simultaneous‐integrated boost (SIB) in HNSCC, aiming to provide insights on current clinical practice and directions for future research.

Pubmed PDF Web

Utility of narrowband imaging in the diagnosis of laryngeal leukoplakia: Systematic review and meta‐analysis

\nSejad Ahmadzada, \nKartik Vasan, \nNiranjan Sritharan, \nNarinder Singh, \nMark Smith, \nIsabelle Hull, \nFaruque Riffat\n

Publicatie 12-10-2020


AbstractThis systematic review and meta‐analysis evaluates the validity of narrowband imaging (NBI) in differentiating between low‐risk leukoplakia and high‐risk leukoplakia. Medline, EMBASE, Scopus, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects were searched. Studies evaluating the diagnostic accuracy of NBI in the assessment of laryngeal leukoplakia were included. Pooled sensitivity, specificity and diagnostic odds ratio were calculated. Seven studies met the inclusion criteria assessing a total of 586 lesions with laryngeal leukoplakia. In differentiating between low‐risk and high‐risk leukoplakia, NBI had a pooled sensitivity and specificity of 85.4% (95% CI 76‐99.9) and 94.9% (95% CI 91.1‐97.2) respectively. Pooled diagnostic odds ratio was 99.2 (95% CI 38.28‐257.18). NBI is a useful imaging modality in differentiating between low‐risk leukoplakia and high‐risk laryngeal leukoplakia. The high sensitivity, specificity and diagnostic odds ratio make NBI a useful tool in the workup of laryngeal leukoplakia.

Pubmed PDF Web

Perforator‐based propeller flaps for reconstruction of massive anterolateral thigh donor site wounds

\nCaroline S. Hudson, \nAndrew T. Huang\n

Publicatie 12-10-2020


AbstractBackgroundWide anterolateral thigh (ALT) flap donor site defects may make primary closure difficult or impossible, with split thickness skin grafting and/or negative pressure therapy often used instead. Here, we describe a technique using propeller flaps based on varying thigh perforating vasculature in donor site reconstruction for these larger deformities.MethodsCase seriesResultsThree patients are described that had perforator‐based propeller flap reconstruction of large ALT donor site wounds that were not amenable to primary closure. Two propeller flaps were supplied by perforators of the transverse branch of the lateral circumflex femoral artery and one by a perforator of the deep femoral system. One patient experienced partial loss of the propeller flap, but completely healed with local wound care.ConclusionThe propeller flap is a safe method to reconstruct large ALT donor sites not amenable to primary closure.

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Risk factors for carcinoma ex pleomorphic adenoma in patients presenting with recurrence after resection of pleomorphic adenoma

\nLinda X. Yin, \nKathryn M. Van Abel, \nSteven A. Rooker, \nAlex A. Nagelschneider, \nKerry D. Olsen, \nDaniel L. Price, \nJeffrey R. Janus, \nJan L. Kasperbauer, \nEric J. Moore\n

Publicatie 12-10-2020


AbstractBackgroundIn patients presenting with recurrent pleomorphic adenoma (rPA), clinical evaluation can fail to recognize carcinoma ex PA (cxPA). We aim to identify the risk factors for cxPA.MethodsThis is a single institution retrospective case‐control study from 2000 to 2015. CxPA was diagnosed based on surgical pathology. Demographics, clinical, and social histories were collected.ResultsA number of 13/106 (12.3%) patients were diagnosed with cxPA, of which only 4/13 (31%) had clinical features suspicious for malignancy. Compared to benign rPA, factors associated with cxPA included age >50 (odds ratio OR 6.67, 95% confidence interval CI: 1.71‐25.98, P < .01), >10 pack‐years of smoking history (OR 3.36, 95% CI: 1.01‐11.14, P = .04), and the largest tumor being >2 cm on pathology (OR 4.42, 95% CI: 1.14‐17.10, P = .03).ConclusionsIn patients presenting with rPA, risk factors for malignant transformation include age >50, significant smoking history, and tumors larger than 2 cm. Clinical signs of malignancy such as rapid growth or pain are not always present.

Pubmed PDF Web

Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy: Meta‐analysis

\nYichao Wang, \nShengliang Zhou, \nXueting Liu, \nShu Rui, \nZhihui Li, \nJingqiang Zhu, \nTao Wei\n

Publicatie 12-10-2020


AbstractBackgroundTo conduct a meta‐analysis to compare the safety and efficacy of transoral endoscopic thyroidectomy vestibular approach (TOETVA) with conventional open thyroidectomy (COT).MethodsMEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials in the Cochrane Library from January 2007 to March 2020 were searched to identify studies comparing TOETVA and COT.ResultsSix eligible nonrandomized studies involving 1151 patients were included. Meta‐analysis results revealed that TOETVA group had a significantly longer operative time (weighted mean difference WMD, 66.09; 95% confidence interval CI, 35.22‐96.96; P < .0001) and larger amount of drainage (WMD, 98; 95% CI, 20.14‐175.86; P = .01). There were no significant differences in terms of postoperative outcomes.ConclusionTOETVA appears to be as feasible and safe as the COT for the treatment of patients with benign thyroid nodules and selected differential thyroid carcinomas.

Pubmed PDF Web

Bipedicled submental musculofascial “hammock” flap for salvage laryngectomy closure reinforcement

\nRichard E. Hayden, \nBrent A. Chang, \nDavid P. Mullin, \nAndrew K. Patel, \nThomas H. Nagel, \nBrittany E. Howard, \nMichael L. Hinni, \nDavid G. Lott, \nCarrlene B. Donald\n

Publicatie 12-10-2020


AbstractBackgroundThe aim of the study was to describe a novel technique for reinforcement of salvage laryngectomy closure using a bipedicled musculofascial submental flap.MethodsA retrospective cohort study design identified patients who underwent salvage laryngectomy reinforcement with a bipedicled submental hammock flap between January 2008 and December 2016 were compared to salvage laryngectomy patients treated with primary closure of the neopharynx during the same time period. Pharyngocutaneous fistula rates were compared between groups.ResultsPharyngocutaneous fistula rate in the submental hammock group (2/31, 6.5%) was significantly lower compared to the primary closure group (14/45, 31%, P < .05).ConclusionThe bipedicled musculofascial submental hammock flap is a viable method for reinforcement of salvage laryngectomy defects. It has a favorable pharyngocutaneous fistula rate compared to primary closure alone and has unique advantages over conventional methods of reinforcement.

Pubmed PDF Web

Clinical significance of tumor‐associated immune cells in patients with oral squamous cell carcinoma

\nMasahiro Kikuchi, \nDaisuke Yamashita, \nShigeo Hara, \nShinji Takebayashi, \nKiyomi Hamaguchi, \nKeisuke Mizuno, \nKoichi Omori, \nShogo Shinohara\n

Publicatie 07-10-2020


AbstractBackgroundThe expression of PD‐L1 in tumor cells and infiltration of tumor‐associated immune cells (TAICs) might reflect the tumor biology of head and neck cancer. We aimed to characterize their prognostic roles in oral squamous cell carcinomas (OSCCs).MethodsWe enrolled 103 OSCC patients who underwent definitive surgery. Immune expression levels of PD‐L1, PD‐1, CD3, CD4, CD8, and CD68 were assessed in surgically resected specimens. We evaluated the effects of immune marker expression and localization on survival outcomes.ResultsMultivariate analysis results adjusted by the pathological stage, resection margin, and extracapsular extension showed that a high number of PD‐1+ TAICs and intratumoral CD68+ TAICs were independent positive and negative prognostic markers (hazard ratio: 0.20 and 4.15, respectively; P = .02 and .01, respectively).ConclusionPD‐1+ TAICs in the tumor microenvironment and CD68+ TAICs in the intratumoral area could act as novel biomarkers for predicting overall survival outcomes in OSCC patients.

Pubmed PDF Web

Clinical variables and magnetic resonance imaging‐based radiomics predict human papillomavirus status of oropharyngeal cancer

\nPaula Bos, \nMichiel W. M. Brekel, \nZeno A. R. Gouw, \nAbrahim Al‐Mamgani, \nSelam Waktola, \nHugo J. W. L. Aerts, \nRegina G. H. Beets‐Tan, \nJonas A. Castelijns, \nBas Jasperse\n

Publicatie 07-10-2020


AbstractBackgroundHuman papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) have better prognosis and treatment response compared to HPV‐negative OPSCC. This study aims to noninvasively predict HPV status of OPSCC using clinical and/or radiological variables.MethodsSeventy‐seven magnetic resonance radiomic features were extracted from T1‐weighted postcontrast images of the primary tumor of 153 patients. Logistic regression models were created to predict HPV status, determined with immunohistochemistry, based on clinical variables, radiomic features, and its combination. Model performance was evaluated using area under the curve (AUC).ResultsModel performance showed AUCs of 0.794, 0.764, and 0.871 for the clinical, radiomic, and combined models, respectively. Smoking, higher T‐classification (T3 and T4), larger, less round, and heterogeneous tumors were associated with HPV‐negative tumors.ConclusionModels based on clinical variables and/or radiomic tumor features can predict HPV status in OPSCC patients with good performance and can be considered when HPV testing is not available.

Pubmed PDF Web

Full percutaneous intraoperative neuromonitoring technique in remote thyroid surgery: Porcine model feasibility study

\nTzu‐Yen Huang, \nYi‐Chu Lin, \nHsin‐Yi Tseng, \nHoon Yub Kim, \nGianlorenzo Dionigi, \nI‐Cheng Lu, \nPi‐Ying Chang, \nFeng‐Yu Chiang, \nChe‐Wei Wu\n

Publicatie 07-10-2020


AbstractBackgroundIn remote thyroid surgery, a reliable intraoperative neuromonitoring (IONM) procedure is an important tool for reducing injury to recurrent laryngeal nerve (RLN). This study proposes an alternative or adjunct technique for performing full percutaneous (PC) IONM and confirms its feasibility in animal experiments.MethodsThis prospective porcine model study enrolled four piglets with eight nerve sides. Evoked electromyography (EMG) was stimulated from PC ball‐tip probe, and recorded from EMG endotracheal tube (ETT) and from PC paired long‐needle electrodes on the perichondrium of the lateral aspect of thyroid cartilage.ResultsIn all RLNs and vagus nerves, typical laryngeal EMG waveforms were successfully evoked by PC probe stimulation and recorded by both ETT and PC needle electrodes.ConclusionsThis study confirms the feasibility of the full PC IONM techniques in porcine model. However, further clinical studies are needed to compare the practicality of different remote‐access approaches for thyroid surgery.

Pubmed PDF Web

Lymph node characteristics and their prognostic significance in oral squamous cell carcinoma

\nIndu Arun, \nNamrata Maity, \nShahin Hameed, \nPrateek Vijay Jain, \nKapila Manikantan, \nRajeev Sharan, \nPattatheyil Arun\n

Publicatie 06-10-2020


AbstractBackgroundThe prognostic significance of various histopathologic lymph node‐based biomarkers in oral squamous cell carcinoma (OSCC) needs further evaluation.MethodsRetrospective analysis of 212 OSCC patients with regional metastasis to determine the association of extranodal extension (ENE), extent of ENE, size of metastatic deposit, lymph node yield (LNY), lymph node ratio (LNR), and topography of involvement with survival outcomes.ResultsThe presence of ENE, larger nodal deposit, higher pN stage, lymph nodes in the lower levels, and patients who did not receive adjuvant treatment had poor disease‐free survival (DFS). In addition, more positive nodes and high LNR showed worse overall survival (OS). ENE beyond 5 mm resulted in poorer outcomes.Larger sizes of metastatic deposit predisposed to ENE. Multivariate analyses showed only lower level of neck involvement to affect both DFS and OS.ConclusionsLymph node metastasis to lower levels and other lymph node characteristics affect prognosis and must be considered in the evolution of staging systems for OSCC.

Pubmed PDF Web

Effects of early nutritional intervention by a nutritional support team for patients with head and neck cancer undergoing chemoradiotherapy or radiotherapy

\nMichihisa Kono, \nRisa Wakisaka, \nTakumi Kumai, \nRyusuke Hayashi, \nHiroki Komatsuda, \nRyosuke Sato, \nYasushi Abe, \nHidekiyo Yamaki, \nMiki Takahara, \nAkihiro Katada, \nTatsuya Hayashi, \nYasuaki Harabuchi\n

Publicatie 05-10-2020


AbstractBackgroundWe analyzed the effects of early nutritional intervention by a nutritional support team (NST) in patients with head and neck squamous cell carcinoma (HNSCC) undergoing chemoradiotherapy or radiotherapy.MethodsThis study investigated whether early nutritional interventions by a multidisciplinary NST improve body weight loss, mucositis, serum albumin level, and hospital length of stay.ResultsSixty‐one patients with HNSCC were treated during the study, and 32 patients received NST intervention since admission. The median weight loss rates were 3.3% and 7.3% and grade 3 mucositis was observed in 25.0% and 70.0% of patients in the intervention and nonintervention groups, respectively. In the intervention group, serum albumin level through treatment increased and the hospital length of stay from the end of treatment was shortened.ConclusionEarly nutritional intervention by a multidisciplinary NST improved body weight loss rate, mucositis, albumin level, and hospital length of stay, which might lead to better clinical outcomes.

Pubmed PDF Web

Role of physician density in predicting stage and survival for head and neck squamous cell carcinoma

\nShekhar K. Gadkaree, \nJustin C. McCarty, \nAllen L. Feng, \nJennifer M. Siu, \nCiersten A. Burks, \nDaniel G. Deschler, \nJeremy D. Richmon, \nMark A. Varvares, \nRegan W. Bergmark\n

Publicatie 04-10-2020


AbstractBackgroundIdentifying and linking barriers to access to head and neck cancer care, specifically provider density, to stage of diagnosis and survival outcomes is important to serve as a foundation for policy interventions.MethodsRetrospective cohort study using patients with head and neck squamous cell (HNSCC) in the Surveillance, Epidemiology, and End Results (SEER) database from 2007 to 2016 and Area Resource File. Primary outcomes included stage of presentation and cancer‐specific 5‐year survival and relation to provider density.ResultsThe initial cohort consisted of 18 342 patients with oral cavity, 21 809 oropharyngeal, 15 860 laryngeal, and 2887 patients with hypopharyngeal malignancy. Non‐Hispanic Black race and being uninsured increased the odds of presenting with advanced stage HNSCC and increased hazard of death. There was no significant and consistent association identified between Health Service Areas provider density and advanced stage at diagnosis or cancer‐specific 5‐year mortality.ConclusionsProvider density of otolaryngologists and primary care physicians and dentists was not significantly associated with stage of presentation or cancer‐specific survival for HNSCC while race and insurance status remained independent predictors for worse outcomes.

Pubmed PDF Web

Outpatient vs inpatient parotidectomy: Systematic review and meta‐analysis

\nDaniel A. Benito, \nLuke J. Pasick, \nDaniel Bestourous, \nPunam Thakkar, \nJoseph F. Goodman, \nArjun S. Joshi\n

Publicatie 03-10-2020


AbstractThe primary aim of this study was to conduct a systematic review and meta‐analysis to compare complications between outpatient vs inpatient parotidectomy. A systematic review was performed to identify patients undergoing either outpatient or inpatient partodiectomy, in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines, using PUBMED, SCOPUS, CINAHL, and the Cochrane library. Risk of bias was assessed using the Newcastle‐Ottawa Scale. Postoperative complications (hematoma, seroma/sialocele, salivary fistula formation, Frey syndrome, surgical site infection SSI) were compared. Our search yielded 4958 nonduplicate articles, of which 13 studies were ultimately included (11 retrospective cohort, 2 prospective cohort), encompassing a total of 1323 patients (outpatient 46.33% vs inpatient 53.67%). There was no significant difference in total complications, hematoma, seroma, salivary fistula, or SSI rates between outpatient and inpatient groups. No significant difference in total complications was found between outpatient and inpatient groups when stratified by surgical approach (partial/superficial and total parotidectomy). Our findings suggest outpatient parotidectomy may be as safe as inpatient parotidectomy in appropriately selected patients.

Pubmed PDF Web

Prognostic value of immune‐related genes and immune cell infiltration analysis in the tumor microenvironment of head and neck squamous cell carcinoma

\nZizhuo Wang, \nHuangbo Yuan, \nJia Huang, \nDianxing Hu, \nXu Qin, \nChaoyang Sun, \nGang Chen, \nBeibei Wang\n

Publicatie 03-10-2020


AbstractBackgroundHead and neck squamous cell carcinoma (HNSCC) is one of the few malignant tumors that respond well to immunotherapy. We aimed to investigate the immune‐related genes and immune cell infiltration of HNSCC and construct a predictive model for its prognosis.MethodsWe calculated the stromal/immune scores of patients with HNSCC from The Cancer Genome Atlas using the Estimation of STromal and Immune cells in MAlignant Tumor tissues using Expression data algorithm and investigated the relationship between the scores and patients prognosis. Three machine learning algorithms (LASSO, Random Forest, and Rbsurv) were performed to screen key immune‐related genes and constructed a predictive model. The immune cell infiltrating was calculated by the Tumor Immune Estimation Resource algorithm.ResultsThe stromal and immune scores significantly correlated with prognosis. A 6‐gene signature was selected and displayed a robust predictive effect. The expressions of key genes were associated with immune infiltrating. GSE65858 validated the results.ConclusionOur study comprehensively analyzed the tumor microenvironment of HNSCC and constructed a robust predictive model, providing a basis for further investigation of therapy.

Pubmed PDF Web

Self‐reported medication adherence in differentiated thyroid cancer survivors: Role of illness perception and medication beliefs

\nPelin Basım, \nDerya Argun, \nYaşar Özdenkaya\n

Publicatie 02-10-2020


AbstractBackgroundTo investigate medication adherence (MA) to Levothyroxine in differentiated thyroid cancer survivors and analyze the related factors for nonadherence.MethodsThe Medication Adherence Report Scale (MARS), Hospital Anxiety and Depression Scale (HAD), Brief Illness Perception Questionnaire (B‐IPQ), and Beliefs about Medicines Questionnaire (BMQ) were used to assess MA.ResultsNonadherence was reported in 77 of 197 patients (39.1%). Socioeconomic status and education levels were found to be significantly related to MA. The HAD scores, all items of B‐IPQ, and BMQ were associated with MA and showed a correlation with the MARS scores. The primary predictors of MA were greater confidence in treatment modality (odds ratio OR: 0.48, 95% confidence interval (CI): 0.37‐0.63) and greater belief that the medication had minimal risk of harm (OR: 3.35, 95% CI: 1.50‐7.49).ConclusionsSpecial attention should be paid to educational programs for differentiated thyroid carcinoma patients concerning the effectiveness and low risk of harm of medication in order to improve MA.

Pubmed PDF Web

Extent of salvage neck dissection following chemoradiation for locally advanced head and neck cancer

\nWataru Okano, \nRyuichi Hayashi, \nKazuto Matsuura, \nTakeshi Shinozaki, \nToshifumi Tomioka\n

Publicatie 01-10-2020


AbstractBackgroundSalvage neck dissection (ND) is the only treatment modality for persistent or recurrent nodal disease after chemoradiotherapy (CRT) for locally advanced head and neck cancer. However, the optimal extent of ND at salvage surgery after definitive CRT is controversial.MethodsOur salvage ND procedure is targeted extirpation of nodal disease with resection of only involved areas of nonlymphatic structures. A retrospective analysis of the data indicated a total of 28 targeted NDs performed in 28 patients following definitive CRT. The efficacy of targeted ND was evaluated based on survival rate, regional control rate, complications, and shoulder syndromes.ResultsOver a median follow‐up period of 30 months, cervical disease recurred in 7 patients but did not lead to death, and 2 patients died of pulmonary metastasis. The 3‐year disease‐specific survival rate was 66%.ConclusionThe targeted ND procedure was effective as an intervention for patients with cervical disease recurrence (149/150).

Pubmed PDF Web

Adoption of the transoral endoscopic vestibular approach by head and neck surgeons without prior laparoscopic/robotic experience

\nAvi Khafif, \nOded Cohen, \nMuhamed Masalha, \nIris Yaish, \nKeren Hod, \nNiddal Assadi\n

Publicatie 01-10-2020


AbstractBackgroundTransoral endoscopic vestibular approach (TOEVA) for thyroidectomy (TOETVA) and parathyroidectomy (TOEPVA) is gaining popularity, yet knowledge is based on a limited number of studies, mostly performed by surgeons experienced in laparoscopic\robotic surgery.MethodsAll patients who underwent TOEVA at our institution between February 2018 and October 2019 were followed prospectively. Main outcomes were ability to accomplish surgery endoscopically (failure defined as conversion to open approach) and complications.ResultsSeventy‐one patients (52 TOETVA and 19 TOEPVA) were included. 98% (51/52) and 100% (19/19) of TOETVA and TOEPVA surgeries were accomplished endoscopically, respectively. Transient vocal cord and mental nerve injuries rates were 8.4% (6/71) and 2.8% (2/71), respectively. Thyroid carcinoma was diagnosed in 27 patients (51.9%), all completely excised with clean margins.ConclusionsAdoption of the TOEVA suggested framework by head and neck surgeons without prior experience in laparoscopic/robotic techniques is feasible resulting in nearly 100% of surgeries accomplished endoscopically.

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Comprehensive in silico analysis for identification of novel candidate target genes, including DHX36, OPA1, and SENP2, located on chromosome 3q in head and neck cancers

\nOmer Faruk Karatas, \nOzel Capik, \nNeslisah Barlak, \nElanur Aydin Karatas\n

Publicatie 01-10-2020


AbstractBackgroundMajor milestones of head and neck carcinogenesis have been associated with various genetic abnormalities; however, a clear picture of the molecular networks deregulated during the carcinogenesis of head and neck squamous cell carcinoma (HNSC) has not yet completely revealed.MethodsIn this study, we used in silico tools and online data sets to evaluate the underlying reasons for the expressional changes of genes residing within the chromosome 3q and to help understanding their contributions to HNSC carcinogenesis.ResultsWe found that 13 of 20 most upregulated genes in HNSC are localized to 3q. Further analysis revealed a gene signature consisting of DHX36, OPA1, and SENP2, which showed significant correlation in HNSC samples and potentially be deregulated through similar mechanisms including DNA amplification, transcriptional, and posttranscriptional regulation.ConclusionsConsidering our findings, we suggest DHX36, OPA1, and SENP2 genes as overexpressed in HNSC tumors and that might be concurrently involved in HNSC carcinogenesis, tumor progression, and induction of angiogenic pathways.

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Association between external and internal lymphedema and chronic dysphagia following head and neck cancer treatment

\nClaire Jeans, \nElizabeth C. Ward, \nBena Brown, \nAnne E. Vertigan, \nAmanda E. Pigott, \nJodie L. Nixon, \nChris Wratten, \nMay Boggess\n

Publicatie 01-10-2020


AbstractBackgroundTo examine the relationship between chronic external and internal head and neck lymphedema (HNL) and swallowing function in patients following head and neck cancer (HNC) treatment.MethodsSeventy‐nine participants, 1‐3 years post treatment were assessed for external HNL using the MD Anderson Cancer Centre Lymphedema Rating Scale, and internal HNL using Pattersons Radiotherapy Edema Rating Scale. Swallowing was assessed via instrumental, clinical and patient‐reported outcome measures.ResultsHNL presented as internal only (68%), combined external/internal (29%), and external only (1%). Laryngeal penetration/aspiration was confirmed in 20%. Stepwise multivariable regression models, that accounted for primary site, revealed that a higher severity of external HNL and internal HNL was associated with more severe penetration/aspiration (P < .004 and P = .006, respectively), diet modification (P < .001 both), and poorer patient‐reported outcomes (P = .037 and P = .014, respectively).ConclusionIncreased swallowing issues can be expected in patients presenting with more severe external HNL and/or internal HNL following HNC treatment.

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Endoscopic transoral nasopharyngectomy

\nRoberto M. Soriano, \nRima S. Rindler, \nSamuel N. Helman, \nGustavo Pradilla, \nC. Arturo Solares\n

Publicatie 30-09-2020


AbstractBackgroundA minimal access technique for the management of nasopharyngeal tumors extending below the palatal plane and laterally beyond the pterygoid musculature is yet to be developed. In this study we demonstrate the feasibility of endoscopic transoral nasopharyngectomy (ETON) for resection of large nasopharyngeal lesions as a natural orifice alternative to traditional approaches.MethodsETON was completed in three latex‐injected specimens. Surgical freedom (SF) and angles of attack (AoA) were calculated along the internal carotid artery (ICA).ResultsAn endoscopic transoral approach was successfully used to identify the parapharyngeal ICA and subsequently perform a complete nasopharyngeal resection. SF and AoA (sagittal) were found to be the greatest at the anterior genu of the ICA.ConclusionsETON is feasible. It provides wide exposure of the skull base and proximal control of the ICA. It may be indicated for the management of nasopharyngeal tumors with inferolateral extension, involving the ICA.

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Impact of age and comorbidity on survival among patients with oral cavity squamous cell carcinoma

\nKrupal B. Patel, \nDaniel Martin, \nSongzhu Zhao, \nBhavna Kumar, \nRicardo Carrau, \nEnver Ozer, \nAmit Agrawal, \nStephen Kang, \nJames W. Rocco, \nDavid Schuller, \nTheodoros Teknos, \nGuy Brock, \nMatthew Old\n

Publicatie 30-09-2020


AbstractObjectiveTo identify predictors of overall survival (OS) and to stratify patients according to significant prognostic variables.MethodsA retrospective study of 274 consecutive patients with primary Oral Cavity Squamous Cell Carcinoma. Kaplan‐Meier, Cox proportional hazard models, and recursive partitioning analysis (RPA) were used for analysis of OS. These results were further validated using National Cancer Database cohort of 21 895 patients.ResultsMedian OS was 3.65 years. T‐classification and N‐classification, alcoholic beverages/week, age, and adjuvant treatment were significant predictors of OS. RPA identified high‐risk subpopulations: N0‐1 patients with CCI ≥ 4.5 and N2‐3 patients ordered by those not receiving adjuvant treatment, those with T3‐4 disease despite adjuvant therapy, and those having T1‐2 disease with adjuvant therapy.ConclusionsThis study utilized significant prognostic indicators and RPA to highlight the importance of age, N‐classification, T‐classification, comorbidity, and adjuvant therapy in conjunction with American Joint Committee on Cancer staging to improve preoperative counseling.

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Radical external beam re‐irradiation in the treatment of recurrent head and neck cancer: Critical review

\nMichaela Svajdova, \nPavol Dubinsky, \nTomas Kazda\n

Publicatie 30-09-2020


AbstractManagement of patients with recurrent head and neck cancer remains a challenge for the surgeon as well as the treating radiation oncologist. Even in the era of modern radiotherapy, the rate of severe toxicity remains high with unsatisfactory treatment results. Intensity‐modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and heavy‐ion irradiation have all emerged as highly conformal and precise techniques that offer many radiobiological advantages in various clinical situations. Although re‐irradiation is now widespread in clinical practice, little is known about the differences in treatment response and toxicity using diverse re‐irradiation techniques. In this review, we provide a comprehensive overview of the role of radiation therapy in recurrent or second primary head and neck cancer including patient selection, therapeutic outcome, and risk using different re‐irradiation techniques. Critical review of published evidence on IMRT, SBRT, and heavy‐ion full‐dose re‐irradiation is presented including data on locoregional control, overall survival, and toxicity.

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Epidemiologic factors in patients with advanced head and neck cancer treated with radiation therapy

\nMichael T. Brennan, \nNathaniel S. Treister, \nThomas P. Sollecito, \nBrian L. Schmidt, \nLauren L. Patton, \nYi Yang, \nAlexander Lin, \nLinda S. Elting, \nJames S. Hodges, \nRajesh V. Lalla\n

Publicatie 29-09-2020


AbstractBackgroundApproximately 50% of patients with head and neck cancer (HNC) initially were seen with advanced disease. We aimed to evaluate the association of epidemiologic factors with advanced HNC at diagnosis.MethodsThe OraRad multicenter prospective cohort study enrolled HNC patients receiving curative‐intent radiation therapy. Factors assessed for association with advanced HNC presentation at diagnosis included demographics, social and medical history, cancer characteristics, human papilloma virus (HPV) status, and dental disease measures.ResultsWe enrolled 572 participants; 77% male and mean (SD) age of 61.7 (11.2) years. Oropharyngeal squamous cell carcinomas (88% HPV‐related) were seen with smaller tumors, but more frequent nodal involvement. Private medical insurance and no Medicaid were associated with smaller tumors. A higher dental disease burden was associated with larger tumors.ConclusionsInsurance status, cancer type/location, and dental disease are associated with advanced HNC and may represent potentially modifiable factors or factors to be considered in the screening process of new lesions.

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Rapid recurrence in head and neck cancer: Underappreciated problem with poor outcome

\nDouglas Y. Lee, \nJesty Abraham, \nEric Ross, \nJohn A. Ridge, \nMiriam N. Lango, \nJeffrey C. Liu, \nJessica R. Bauman, \nVladimir Avkshtol, \nThomas J. Galloway\n

Publicatie 29-09-2020


AbstractBackgroundRapid recurrence, defined as gross tumor recurrence after primary operation but prior to initiating postoperative radiation therapy (PORT), is underappreciated in head and neck cancer (HNC).MethodsCT simulation images in patients with HNC managed surgically with adjuvant therapy at a single center between 2010 and 2017 were retrospectively reviewed.ResultsA total of 194 patients with HNC were included. Rapid recurrence occurred in 39 patients (20%) with a median time from operation to CT simulation of 37 days. On multivariable analysis (MVA), extranodal extension (ENE) was the only predictor of rapid recurrence (P = .03). While rapid recurrence, ENE, and perineural invasion were all associated with poor overall survival (OS) on MVA, rapid recurrence was the strongest predictor (hazard ratio HR 5.47).ConclusionRapid recurrence occurs at an underappreciated rate and is associated with poor survival outcomes. Patients with ENE are at highest risk and may benefit from diagnostic imaging evaluations immediately prior to PORT.

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Transcervical endoscopic retropharyngeal lymph node (RPLN) dissection in nasopharyngeal carcinoma with RPLN recurrence

\nYou‐Ping Liu, \nShun‐Lan Wang, \nXiong Zou, \nRui You, \nQi Yang, \nMeng‐Xia Zhang, \nZhi‐Qiang Wang, \nMei Lin, \nYu‐Long Xie, \nSi‐Yuan Chen, \nYan‐Feng Ouyang, \nZi‐Kun Yu, \nXue‐Kui Liu, \nRui Sun, \nYi‐Jun Hua, \nPei‐Yu Huang, \nHao Li, \nMing‐Yuan Chen\n

Publicatie 28-09-2020


AbstractBackgroundSurgical access for retropharyngeal lymph node (RPLN) dissection is difficult. We aimed to examine the efficacy of transcervical endoscopic RPLN dissection (TSE‐RPLND) for recurrent RPLN in nasopharyngeal carcinoma (NPC).MethodsFrom April 2013 to February 2019, a total of 31 patients with NPC diagnosed with RPLN recurrence underwent TSE‐RPLND. The clinical characteristics, complications, and survival outcomes were retrospectively analyzed.ResultsThe mean duration of surgery, quantity of bleeding and postoperative hospitalization stay were 347.9 minutes, 107.7 mL, and 8.7 days, respectively. After a median follow‐up of 31.0 months, the 2‐year locoregional relapse‐free survival, distant metastasis‐free survival, progression‐free survival, and overall survival rates were 63.9%, 95.2%, 59.9%, and 83.3%, respectively. The long‐term incidences of swallowing problems, permanent nutrient tube, tongue atrophy, and shoulder problems were 6 (19.4%), 3 (9.7%), 3 (9.7%), and 3 (9.7%), respectively.ConclusionsTSE‐RPLND is an effective method to treat RPLN recurrence in NPC, but nerve injury‐related complications should not be ignored.

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Transcervical arterial ligation for prevention of postoperative hemorrhage in transoral oropharyngectomy: Systematic review and meta‐analysis

\nDaniel D. Sharbel, \nMary Abkemeier, \nJames Sullivan, \nZach Zimmerman, \nWilliam G. Albergotti, \nUmamaheswar Duvvuri, \nJames Kenneth Byrd\n

Publicatie 25-09-2020


AbstractBackgroundTranscervical arterial ligation has been studied as a useful procedure to prevent bleeding events after transoral robotic surgery (TORS).MethodsA systematic review of English‐language literature on arterial ligation in TORS from 2005 to 2019 was conducted using Cochrane, PubMed, Web of Science (WoS), and ScienceDirect databases. Studies evaluating ligation and rates of postoperative hemorrhage were included. Meta‐analysis of included studies was performed to assess impact of ligation on postoperative hemorrhage.ResultsFive studies with 2008 patients were included. History of radiation (odds ratio OR = 2.26, P = .02) and advanced tumor stage (OR = 1.93, P = .02) were found to predispose patients to postoperative hemorrhage. Arterial ligation was protective against severe hemorrhage in the mixed primary surgical modality cohort (OR = 0.33, P = .03) and in the TORS‐only subgroup (OR = 0.21, P = .02), but did not significantly impact overall odds of postoperative hemorrhage.ConclusionTranscervical arterial ligation offers protection against major/severe postoperative hemorrhage in patients undergoing TORS.Level of EvidenceII.

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Human papillomavirus oropharynx carcinoma: Aggressive de‐escalation of adjuvant therapy

\nEric J. Moore, \nKathryn M. Van Abel, \nDavid M. Routman, \nChristine M. Lohse, \nKatharine A. R. Price, \nMichelle Neben‐Wittich, \nAshish V. Chintakuntlawar, \nDaniel L. Price, \nJan L. Kasperbauer, \nJoaquin J. Garcia, \nMichael L. Hinni, \nSamir H. Patel, \nJeffrey R. Janus, \nRobert L. Foote, \nDan J. Ma\n

Publicatie 23-09-2020


AbstractBackgroundAggressive dose de‐escalated adjuvant radiation therapy (RT) in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC).MethodsPatients with HPV(+)OPSCC on a phase II clinical trial of primary surgery and neck dissection followed by dose de‐escalated RT (N = 79) were compared with a cohort of patients who received standard adjuvant therapy (N = 115). Local recurrence‐free, regional recurrence‐free, distant metastases‐free survival, and progression‐free survival (PFS) were assessed.ResultsOf 194 patients, 23 experienced progression at a median of 1.1 years following surgery (interquartile range IQR 0.7‐2.0; range 0.3‐5.4); 10 patients in the de‐escalated cohort and 13 patients in the standard cohort. The 3‐year PFS rate for the de‐escalated cohort was 87%, and in the standard cohort was 90% (hazard ratio HR 1.18, 95% confidence interval (CI) 0.50‐2.75).ConclusionPatients with HPV(+)OPSCC who undergo surgical resection and neck dissection and meet criteria for adjuvant therapy can undergo aggressive dose de‐escalation of RT without increasing risk of progression locally, regionally or at distant sites.

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Postoperative radiotherapy is associated with improved overall survival for alveolar ridge squamous cell carcinoma with adverse pathologic features

\nCorbin D. Jacobs, \nHannah Williamson, \nIan Barak, \nDaniel J. Rocke, \nRussel R. Kahmke, \nGita Suneja, \nYvonne M. Mowery\n

Publicatie 23-09-2020


AbstractBackgroundAlveolar ridge squamous cell carcinoma (ARSCC) is poorly represented in randomized trials.MethodsAdults in the National Cancer Database diagnosed with ARSCC between 2010 and 2014 who should be considered for postoperative radiotherapy (PORT) based on National Comprehensive Cancer Network (NCCN)‐defined risk factors were identified.ResultsEight hundred forty‐five (58%) of 1457 patients meeting the inclusion criteria received PORT. PORT was associated with improved overall survival (OS) on unadjusted (hazard ratio HR 0.83, 95% confidence interval CI 0.70‐0.98, P = .02) and multivariable (HR 0.78, 95% CI 0.64‐0.94, P = .002) analyses. PORT was associated with significantly improved 5‐year OS for patients with 1 (68% vs 58%, P < .001), 2 (52% vs 31%, P < .001), and ≥3 (38% vs 24%, P < .001) NCCN‐defined risk factors. Prognostic variables significantly associated with worse OS on multivariable analysis included advanced age, primary tumor size ≥3 cm, high grade, positive margin(s), stage N2‐3, level IV/V nodal metastasis, and extranodal extension.ConclusionPORT for resected ARSCC with adverse pathologic features is associated with significantly improved OS.

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Diabetes mellitus in major head and neck cancer surgery

\nGuan‐Jiang Huang, \nXiao‐Yang Kong\n

Publicatie 23-09-2020


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Reply to Letter to the Editor regarding “Diabetes mellitus in major head and neck cancer surgery: Systematic review and meta‐analysis”

\nRahul Mhaskar, \nMathew P. Caputo, \nMatthew J. Mifsud\n

Publicatie 23-09-2020


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Trends in chronic opioid therapy among survivors of head and neck cancer

\nAnuja Kriplani, \nJessica A. Lavery, \nAkriti Mishra, \nDeborah Korenstein, \nAllison N. Lipitz‐Snyderman, \nDenise M. Boudreau, \nNatalie Moryl, \nErin F. Gillespie, \nTalya Salz\n

Publicatie 22-09-2020


AbstractBackgroundSurvivors of head and neck cancer (HNC) have increased risk of opioid misuse.MethodsUsing Surveillance, Epidemiology and End‐Results‐Medicare data, we matched adults ≥66 years diagnosed with HNC 2008‐2015 with cancer‐free controls. We computed odds ratios (OR) for receipt of chronic opioid therapy (COT, claims for ≥90 consecutive days) for HNC survivors compared to controls each year after matching through 2016.ResultsThe cohort of HNC survivors declined from 5107 in the first year after diagnosis to 604 in the sixth year after diagnosis. For 5 years, rates of COT among HNC survivors exceeded that of controls. Differences between survivors and controls declined each year (ORs: year 1, 4.36; year 2, 2.60; year 3, 2.18; year 4, 1.85; and year 5, 1.35; all P‐values <.05).ConclusionsAmong older HNC survivors, cancer‐associated opioid use in the first years after diagnosis suggests that the benefit of opioids must balance the risk of opioid misuse.

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Aspirin use predicts prolonged survival in patients with oropharyngeal cancer: Nationwide Veterans Affairs database study

\nChristine M. Clark, \nAnnemarie C. Newark, \nAli Fokar, \nJessica H. Maxwell\n

Publicatie 22-09-2020


AbstractBackgroundSingle‐institution studies suggest that aspirin reduces the risk of death in head and neck cancer. The aim of this study was to investigate the effect of aspirin use on overall survival (OS) in veterans with oropharyngeal cancer (OPC).MethodsA total of 23 083 veterans with OPC were identified between 2005 and 2018 from the Veterans Health Administration Corporate Data Warehouse. Records were queried for clinical‐demographic data, aspirin prescriptions, and outcomes. Three‐year OS was estimated. A Cox model was used to estimate hazard ratios (HR) for aspirin use.ResultsAmong the 23 083 identified veterans, 17 206 veterans met inclusion criteria. 21.8% used aspirin. Three‐year OS was prolonged for aspirin users (66%) compared to nonaspirin users (54%; P < .001). Adjusted HR for death for nonaspirin users was 1.75 (95% confidence interval (CI) 1.60‐1.91). The average treatment effect of aspirin on survival using inverse probability weighting was 10% (95% CI 0.08‐0.11).ConclusionAspirin use following OPC diagnosis was independently associated with improved 3‐year OS among veterans nationwide.

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Mortality and cause of death in patients with tracheostomy: Longitudinal follow‐up study using a national sample cohort

\nYoung Ju Jin, \nSeung Yoon Han, \nBumjung Park, \nIl‐Seok Park, \nJin‐Hwan Kim, \nHyo Geun Choi\n

Publicatie 21-09-2020


AbstractBackgroundThe purpose of this study was to evaluate the long‐term mortality and cause of death in patients with tracheostomy.MethodsData from the Korean National Health Insurance Service‐Health Screening Cohort were collected from 2002 to 2013. A total of 2394 tracheostomy participants and 9536 control participants were included in this study. The crude and adjusted hazard ratios (HRs) for tracheostomy‐associated mortality were analyzed. Subgroup analysis according to age and cause of death was analyzed.ResultsThe tracheostomy group showed a significantly higher rate of death (69.1%) than the nontracheostomy group (13.3%). The adjusted HR for mortality was 13.5 in the tracheostomy group. The most common cause of death after tracheostomy was a circulatory disease, followed by neoplasm, respiratory disease, and trauma.ConclusionsPatients with tracheostomy had a significantly increased long‐term mortality rate compared with patients with nontracheostomy. The circulatory disease was the most common cause of death following tracheostomy.

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Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment

\nVaninder K. Dhillon, \nGregory W. Randolph, \nBrendan C. Stack, \nBrenessa Lindeman, \nGary Bloom, \nCatherine F. Sinclair, \nGayle Woodson, \nJennifer A. Brooks, \nLesley F. Childs, \nNazanene H. Esfandiari, \nLisa Evangelista, \nElizabeth Guardiani, \nLourdes Quintanilla‐Dieck, \nMatthew R. Naunheim, \nMaisie Shindo, \nMichael Singer, \nNeil Tolley, \nPeter Angelos, \nRobbi Kupfer, \nVictoria Banuchi, \nWhitney Liddy, \nRalph P. Tufano\n

Publicatie 21-09-2020


AbstractBackgroundLaryngeal dysfunction after thyroid and parathyroid surgery requires early recognition and a standardized approach for patients that present with voice, swallowing, and breathing issues. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to define the terms “immediate vocal fold paralysis” and “partial neural dysfunction” and to provide clinical consensus statements based on review of the literature, integrated with expert opinion of the group.MethodsA multidisciplinary expert panel constructed the manuscript and recommendations for laryngeal dysfunction after thyroid and parathyroid surgery. A meta‐analysis was performed using the literature and published guidelines. Consensus was achieved using polling and a modified Delphi approach.ResultsTwenty‐two panelists achieved consensus on five statements regarding the role of early identification and standardization of evaluation for patients with “immediate vocal fold paralysis” and “partial neural dysfunction” after thyroid and parathyroid surgery.ConclusionAfter endorsement by the AHNS Endocrine Section and Quality of Care Committee, it received final approval from the AHNS Council.

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Synergistic effects of combined treatment with ultrasound‐mediated cisplatin‐loaded microbubbles and atorvastatin on head and neck cancer

\nAi‐Ho Liao, \nWan‐Ting Lin, \nHang‐Kang Chen, \nCheng‐Ping Shih, \nChih‐Hung Wang, \nYueng‐Hsiang Chu\n

Publicatie 21-09-2020


AbstractBackgroundPreviously, we used ultrasound (US)‐mediated cisplatin (CDDP)‐loaded microbubbles (CDDP‐MBs) to increase intratumoral CDDP level while decreasing systemic cytotoxicity. Statins have shown antitumorigenic properties. Our study investigated the effects of atorvastatin with CDDP‐MBs and US on head neck cancer.MethodsCell viability analysis with CDDP‐MBs and atorvastatin combined with US in FaDu cell line were tested. Cell proliferation and glutathione level were also evaluated.ResultsBoth CDDP and atorvastatin reduced cells viability. Coadministration of CDDP and atorvastatin resulted in synergistic inhibitory effect. After US sonication, cell viability with atorvastatin and CDDP was significantly reduced for CDDP combined with MBs (65.98% to 49.13%) and for CDDP‐MBs (86.17% to 50.15%). CDDP‐MBs combined with atorvastatin and US inhibited the proliferation of cells: 19.61% for CDDP‐MBs + atorvastatin + US, 36.28% for CDDP + atorvastatin, and 71.73% for atorvastatin alone. Also, CDDP‐MBs + atorvastatin + US induced apoptosis by decreasing cellular level of glutathione.ConclusionsAtorvastatin combined with MB‐conjugated CDDP exerts synergistic inhibitory effect on head neck cancer.

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Prognostic potential of mid‐treatment nodal response in oropharyngeal squamous cell carcinoma

\nDavid J. Byun, \nMoses M. Tam, \nAdam S. Jacobson, \nMark S. Persky, \nTheresa T. Tran, \nBabak Givi, \nMark D. DeLacure, \nZujun Li, \nLouis B. Harrison, \nKenneth S. Hu\n

Publicatie 21-09-2020


AbstractBackgroundWe examine the prognostic implications of mid‐course nodal response in oropharyngeal cancer (OPX) to radiation therapy.MethodsIn 44 patients with node‐positive OPX undergoing concurrent chemoradiation, nodal volumes were measured on cone beam CTs from days 1, 10, 20, and 35. Nodal decrease (ND) was based on percent shrinkage from day 1.ResultsAt a median follow‐up of 17 months, the 2‐year disease‐free survival (DFS), locoregional control (LRC), distant metastasis‐free survival (DMFS), and overall survival (OS) were 87%, 92%, 89%, and 92%, respectively. Patients with ND ≥43% at D20 had improved LRC (100% vs 78.4%, P = .03) compared to D20 ND <43%. On multivariate analysis, D20 ≥43% was independently prognostic for LRC (HR 1.17, P = .05).ConclusionPatients with low‐risk oropharynx cancer with ND of ≥43% by treatment day 20 had significantly improved LRC. The prognostic benefit of ND may assist in identifying candidates for treatment de‐escalation.

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A real‐world comparison of cisplatin vs cetuximab used concurrently with radiation in the treatment of locally advanced oropharyngeal carcinoma

\nAndrea S. Fung, \nArfan Raheen Afzal, \nRobyn Banerjee, \nBrock Debenham, \nDesiree Hao\n

Publicatie 19-09-2020


AbstractBackgroundThis population‐based retrospective study compares the efficacy of cisplatin (cis‐RT) vs cetuximab (cetux‐RT) with concurrent radiation as definitive treatment in patients with oropharyngeal carcinoma (OPC).MethodsPatients with OPC treated in Alberta with cis‐RT or cetux‐RT between 2006 and 2016 were evaluated. Median disease‐free survival (DFS) and overall survival (OS) were assessed using the Kaplan‐Meier method. Multivariable analysis (MVA) was completed with a Cox proportional hazards model.ResultsAmong 546 patients with OPC, 431 (78.9%) received cis‐RT and 115 (21.1%) cetux‐RT. Patients treated with cetux‐RT were more likely to develop a recurrence after treatment compared to cis‐RT (25% vs 15%, P = .01). On MVA, current smoking, human papillomavirus (HPV)‐negative status, higher Charlson comorbidity index (CCI), T‐stage, and cetux‐RT predicted for worse DFS and OS. Outcomes in older patients with a higher CCI still favored cis‐RT.ConclusionsOur data reaffirm results from randomized studies showing better survival outcomes with cis‐RT compared to cetux‐RT even among those who are >65 with CCI ≥3.

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Hybrid positron emission tomography imaging for initial staging of sinonasal tumors: Total lesion glycolysis as prognosticator of treatment response

\nChristian M. Meerwein, \nAlexander Maurer, \nPaul Stolzmann, \nThomas M. Stadler, \nMichael B. Soyka, \nDavid Holzmann, \nMartin W. Hüllner\n

Publicatie 18-09-2020


AbstractBackgroundTo assess hybrid positron emission tomography (PET) imaging in the initial staging and outcome prediction of sinonasal malignancies.MethodsRetrospective study on patients with sinonasal malignancies undergoing hybrid PET imaging for initial staging.ResultsComplete remission (CR) was achieved in 45 of 65 patients (69.2%). Overall sensitivity for detection of primaries using 18F‐fluoro‐deoxy‐d‐glucose PET (FDG‐PET) was 95.4%, for lymph node metastases 100% and distant metastases (DM) 100%. On univariate analysis, PET parameter total lesion glycolysis (TLG) was associated with achieving CR after primary treatment (176.8 ± 157.2 vs 83.7 ± 110.8, P = .03). Multivariate logistic regression demonstrated that TLG adjusted for the T classification best predicted achievement of CR.ConclusionsHybrid PET imaging yields an excellent sensitivity in detecting primary tumors, lymph node metastases and DM in sinonasal malignancies. TLG of the primary tumor is an independent prognostic factor for achieving CR after initial treatment.

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Changes in treatment trends in the early glottic cancer population after the Affordable Care Act

\nBharat Akhanda Panuganti, \nEmelia Stuart, \nPhilip Weissbrod\n

Publicatie 18-09-2020


AbstractBackgroundThe clinical impact of Medicaid expansion in otolaryngology is uncertain. Herein, we evaluate the impact of Medicaid expansion on treatment patterns (primary radiotherapy vs surgery) in the early glottic cancer population.MethodsData regarding adults with Tis‐T2N0M0 glottic cancer that were treated with either surgery or radiotherapy between January 2010 and December 2016 were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer database. Changes in treatment trends and survival in the Medicaid expansion setting were discerned.ResultsThe proportion of patients undergoing radiotherapy decreased from 64.8% to 59% after the Patient Protection and Affordable Care Act (PPACA) was implemented. State Medicaid expansion status was associated with reduced odds of radiation therapy (odds ratio OR = 0.66). Patients were diagnosed more often with earlier stage disease (20.6% vs 17.0% T2 diagnoses) in the Medicaid expansion cohort.ConclusionThe implementation of the PPACA was associated with a significant increase in surgical therapy for and earlier diagnosis of glottic cancer.

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Diagnostic value of exosomal circMYC in radioresistant nasopharyngeal carcinoma

\nYanwei Luo, \nJinqi Ma, \nFengxia Liu, \nJie Guo, \nRong Gui\n

Publicatie 18-09-2020


AbstractBackgroundThe relationship between circulating exosomal circular RNA (circRNA) and prognosis of patients with nasopharyngeal carcinoma (NPC) remain unknown. This study focused on the expression of exosomal circMYC and its relationship with the recurrence and prognosis of patients with NPC.MethodsThe circulating exosomes were obtained from 210 patients with NPC. Quantitative polymerase chain reaction, 5‐ethynyl‐2′‐deoxyuridine (EdU) staining, colony formation, and bioinformatic analysis were performed.ResultsCirculating exosomal circMYC was significantly increased in patients with NPC and was associated with tumor size, lymph node metastasis, TNM stage, survival rate, and disease recurrence. Gain‐functional and loss‐functional experiments revealed that overexpression of circMYC promoted cell proliferation and reduce radiosensitivity, while knockdown of circMYC inhibited cell proliferation and enhanced radiotherapy.ConclusioncircMYC is an oncogene in NPC cells and can enhance the radiotherapy resistance of NPC cells. Circulating exosomal circMYC can be used as a potential therapeutic target for NPC.

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Early fiberoptic endoscopic evaluation of swallow in transoral robotic surgery: Description of swallow function and recovery in the acute postoperative period for oropharyngeal squamous cell carcinoma

\nEmma K. Charters, \nHans Bogaardt, \nAmy L. Freeman‐Sanderson, \nKirrie J. Ballard, \nSarah Davies, \nJustine Oates, \nJonathan Clark\n

Publicatie 16-09-2020


AbstractBackgroundTransoral robotic surgery (TORS) is a minimally invasive approach for the treatment of oropharyngeal cancer. The effects on swallowing and speech need to be comprehensively evaluated to understand the associated morbidity.MethodsA prospective cohort of 21 patients was recruited to undergo pre‐TORS and post‐TORS swallowing and communication assessment. Fiberoptic endoscopic evaluation of swallowing (FEES) was used in the first postoperative week.ResultsSixteen participants (76.2%) had penetration‐aspiration scores ≥3 or higher, seven (33.3%) aspirated on thin liquids, three (14.3%) did so silently. Prolonged recovery trajectory occurred for the majority of the cohort, particularly if TORS was followed by adjuvant radiotherapy. Swallowing and communication scores were significantly worse in base of tongue primary tumors and with advanced age.ConclusionEarly FEES demonstrates a significant decline in swallowing function, including increased secretion load, pharyngeal residue, laryngeal penetration, and aspiration. Silent aspiration occurred in 14% and thus highlights the necessity for instrumental assessment to ascertain aspiration risk.

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Transoral robotic parapharyngeal approach to the submandibular space

\nPeter Floros, \nMariano Sorrentino, \nJ. Scott Magnuson\n

Publicatie 15-09-2020


AbstractThe aim of the study was to demonstrate a novel transoral parapharyngeal approach to the submandibular space. The method used was the clinical case of a patient presenting with an anteriorly based tumor in the left submandibular space. The video shows the transoral robotic technique for access to the submandibular space through the parapharyngeal space for removal of the tumor. This approach allows for high definition visibility and complete access to structures in the submandibular space including the submandibular gland. For robotic head and neck surgeons performing lateral oropharyngectomies, the anatomy is familiar, and the technique avoids potential access issues with traditional floor of mouth incisions. Furthermore, it provides a novel technique for identification of the hypoglossal nerve for potential preservation in oropharyngeal malignancy. The transoral robotic parapharyngeal approach to the submandibular space is safe, reproducible, and avoids unnecessary cervical incisions.

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Population‐based analysis on the effect of nodal and distant metastases in sinonasal adenocarcinoma

\nCynthia M. Chweya, \nChristopher M. Low, \nJamie J. Van Gompel, \nKathryn M. Van Abel, \nJanalee K. Stokken, \nGarret Choby\n

Publicatie 15-09-2020


AbstractBackgroundMinimal information has been reported on the effect of distant and nodal metastases at the time of diagnosis on survival in patients with sinonasal adenocarcinoma (SNAC).MethodsThe Surveillance, Epidemiology, and End Results database was utilized to compare overall survival (OS) and disease‐specific survival (DSS).ResultsOf the 325 patients with SNAC identified, 5‐year and 10‐year OS for all included patients was 64% and 58%, respectively. On multivariate analysis, the presence of distant metastases (P < .0001), maxillary and frontal sinus primary tumors (P = .0042, P = .0006), and increasing age (P = .007) were risk factors for worsened DSS. The presence of regional spread to multiple cervical nodal basins (OS RR 3.26, P = .002; DSS RR 2.51, P = .013) and a single nodal basin (DSS RR 2.19, P = .046) was associated with worsened survival compared to no regional spread.ConclusionSurvival in SNAC was significantly worsened with increasing age, tumor site of origin, and distant metastatic disease.

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The effectiveness of radiotherapy in the treatment of head and neck mucosal melanoma: Systematic review and meta‐analysis

"\nMarc C. Grant‐Freemantle, \nBilly Lane ONeill, \nAnthony James P. Clover\n"

Publicatie 14-09-2020


AbstractIntroductionMucosal melanoma (MM) is a rare condition with a poor prognosis. Surgery is the corner stone of treatment, however, radiotherapy has been commonly employed as a treatment strategy and recent studies suggesting that survival outcomes may be improving are emerging.MethodsA systematic review and meta‐analysis comparing risk ratios of radiotherapy and surgery and radiotherapy (SRT) with surgery for 5‐year overall survival, local recurrence and distant metastasis in head and neck mucosal melanoma (HNMM).ResultsSRT has a lower risk of death compared to surgery RR 0.93 95% CI = 0.87, 0.98 (P = .01) and a reduced risk of local recurrence RR 0.63 95% CI = 0.48, 0.82 (P = .005). SRT has no effect on distant metastasis. Radiotherapy has worse survival when compared to surgery RR 1.2 95% CI = 1.03, 1.33 (P = .0006).ConclusionsSRT confers a moderate survival advantage in HNMM compared to surgery. This is most likely secondary to reduced local recurrence.

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Evolving Otolaryngology Resident Roles and Concerns at the Peak of the US COVID‐19 Pandemic

\nYi Cai, \nArushi Gulati, \nNicole T. Jiam, \nKatherine C. Wai, \nElizabeth A. Shuman, \nSteven D. Pletcher, \nMegan L. Durr, \nJolie L. Chang\n

Publicatie 14-09-2020


AbstractBackgroundThe roles of US otolaryngology residents have changed in response to the coronavirus disease 2019 (COVID‐19) pandemic. As the pandemic peaked in the United States, we characterized resident activities and concerns.MethodsA cross‐sectional study of US otolaryngology residents between April 20, 2020 and May 2, 2020.ResultsA total of 219 residents at 65/118 (55%) institutions responded. Thirty (14%) residents had been redeployed. Residents reported greatest concerns regarding education (P < .00001). Assuming adequate protective equipment, 55% desired active participation in high‐risk procedures on COVID‐19‐positive patients. Redeployed residents had greater concern for burnout and reduced in‐hospital well‐being (P < .05). Resident satisfaction correlated with comfort communicating concerns to their department (odds ratio OR = 4.9, 95% confidence interval CI 1.4‐17.3, P = .01) and inversely correlated with low perceived meaning in work (OR = 3.1, CI 1.1‐9.1, P = .03).ConclusionOtolaryngology resident concerns have evolved as the pandemic progressed. Residency programs should prioritize resident education, well‐being in redeployed residents, and open communication as they transition toward recovery.

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Evaluating compliance with process‐related quality metrics and survival in oral cavity squamous cell carcinoma: Multi‐institutional oral cavity collaboration study

\nSara W. Liu, \nNeil M. Woody, \nWei Wei, \nSwathi Appachi, \nKevin J. Contrera, \nJillian C. Tsai, \nAhmed I. Ghanem, \nBrian Matia, \nNikhil P. Joshi, \nJessica L. Geiger, \nJamie A. Ku, \nBrian B. Burkey, \nJoseph Scharpf, \nBrandon L. Prendes, \nJimmy J. Caudell, \nNeal E. Dunlap, \nDavid J. Adelstein, \nSandro Porceddu, \nHoward Liu, \nFarzan Siddiqui, \nNancy Y. Lee, \nShlomo Koyfman, \nEric D. Lamarre\n

Publicatie 12-09-2020


AbstractBackgroundProcess‐related measures have been proposed as quality metrics in head and neck cancer care. A recent single‐institution study identified four key metrics associated with increased survival. This study sought to validate the association of these quality metrics with survival in a multi‐institutional cohort.MethodsMulticenter retrospective study of patients with oral cavity squamous cell (1/2005‐1/2015). Baseline patient and disease characteristics and compliance with quality metrics was evaluated. Association between compliance with quality metrics with overall survival (OS), disease‐free survival (DFS), and disease‐specific survival (DSS) was evaluated using Cox proportional hazards models.ResultsFailure to comply with two or more of the quality metrics was associated with worse OS, DFS, and DSS. Adherence to all or all but one of the quality metrics was found to be associated with improved survival.ConclusionsProcess‐related quality metrics are associated with increased survival in patients with oral cavity squamous cell carcinoma in a multi‐institutional cohort.

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National trends in oropharyngeal cancer incidence and survival within the Veterans Affairs Health Care System

\nJose P. Zevallos, \nJennifer R. Kramer, \nVlad C. Sandulache, \nSean T. Massa, \nChristine M. Hartman, \nAngela L. Mazul, \nBenjamin M. Wahle, \nSophie P. Gerndt, \nErich M. Sturgis, \nElizabeth Y. Chiao\n

Publicatie 12-09-2020


AbstractBackgroundOropharyngeal squamous cell carcinoma (OPSCC) epidemiology has not been examined previously in the nationwide Veterans Affairs (VA) population.MethodsJoinpoint regression analysis was applied to OPSCC cases identified from VA administrative data from 2000 to 2012.ResultsWe identified 12 125 OPSCC cases (incidence: 12.2 of 100 000 persons). OPSCC incidence declined between 2000 and 2006 (annual percent change APC = −4.27, P < .05), then increased between 2006 and 2012 (APC = 7.02, P < .05). Significant incidence increases occurred among white (APC = 7.19, P < .05) and African American (APC = 4.87, P < .05) Veterans and across all age cohorts. The percentage of never‐smokers increased from 8% in 2000 to 15.7% in 2012 (P < .001), and 2‐year overall survival improved from 31.2% (95% confidence interval (CI) 30‐33.4) to 55.7% (95% CI 54.4‐57.1).ConclusionsOPSCC incidence is increasing across all racial and age cohorts in the VA population. Smoking rates remain high among Veterans with OPSCC and gains in survival lag those reported in the general population.

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Cost‐effectiveness of endoscopic endonasal vs transcranial approaches for olfactory groove meningioma

\nTerence S. Fu, \nChristopher M. K. L. Yao, \nHedyeh Ziai, \nEric Monteiro, \nJoao Paulo Almeida, \nGelareh Zadeh, \nFred Gentili, \nJohn R. Almeida\n

Publicatie 12-09-2020


AbstractBackgroundEndoscopic endonasal approaches (EEAs) have been adopted as an alternative to standard transcranial approaches for olfactory groove meningiomas (OGMs). However, the relative cost‐effectiveness remains controversial.MethodsCost‐utility analysis from a societal perspective comparing EEA vs transcranial approaches for OGM was used in this study. Surgical treatment was modeled using decision analysis, and a Markov model was adopted over a 20‐year horizon. Parameters were obtained from literature review. Costs were expressed in 2017 Canadian dollars.ResultsIn the base case, EEA was cost‐effective compared with transcranial surgery with an incremental cost‐effectiveness ratio of $33 523 ($30 475 USD)/QALY. There was a 55% likelihood that EEA was cost‐effective at a willingness‐to‐pay of $50 000/QALY. EEA remained cost‐effective at a cerebrospinal fluid leak rate below 60%, gross total resection rate above 25%, and base cost less than $66 174 ($60 158 USD).ConclusionEEA may be a cost‐effective alternative to transcranial approaches for selected OGM.

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