Head and Neck 2020-11-28

Ambulatory thyroidectomy is safe and beneficial in papillary thyroid carcinoma: Randomized controlled trial

\nZeyu Zhang, \nFada Xia, \nWenlong Wang, \nBo Jiang, \nLei Yao, \nYun Huang, \nXinying Li\n

Publicatie 28-11-2020


AbstractBackgroundCurrently, no randomized controlled trial has been performed to investigate the safety profiles, economic benefit and mental health of ambulatory thyroidectomy in patients with papillary thyroid carcinoma (PTC).MethodsPatients diagnosed with PTC were enrolled in this study and were randomly assigned to ambulatory group and control group. The safety profiles, economic benefit and mental health were investigated.ResultsFour hundred and eleven patients completed the study. There was no significant difference in demographic or tumor index. The incidence of complications was not significantly different (P = .631). The economic cost was significantly lower (P < .001) and hospitalization was significantly shorter (P < .001) in ambulatory group. No significant difference was shown in depression (P = .758) and stress disorder (P = .390). However, the ambulatory group showed a higher point of anxiety (P < .001).ConclusionThe ambulatory thyroidectomy is safe in patients with PTC, with significant benefits of economic cost and hospitalization.

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Not only gustatory sweating and flushing: Signs and symptoms associated to the Frey syndrome and the role of botulinum toxin A therapy

\nMaria Raffaella Marchese, \nFrancesco Bussu, \nStefano Settimi, \nEmanuele Scarano, \nGiovanni Almadori, \nJacopo Galli\n

Publicatie 28-11-2020


AbstractBackgroundThe classic symptoms of Frey syndrome are gustatory sweating and flushing. Aims of the study were to describe prevalenceand severity of typical and atypical presentations of the disorder and to assess the effects of botulinum neurotoxin A (BoNT‐A) therapy in patients with Frey syndrome after parotidectomy.MethodsIn this prospective, observational study on 18 patients, we assessed symptom severity before therapy, after 15 days, 1, 3 and 6 months follow‐up with the sweating‐flushing‐itch‐paresthesia‐pain (SFIPP) Frey scale specifically designed by the authors themselves for this study.ResultsBefore BoNT‐A injection, all patients (100%) complained gustatory sweating, 80% paresthesia, 77% gustatory flushing, 60% pain and 60% gustatory itch. The SFIPP‐Frey overall score and the symptom‐specific ones decreased significantly at each post‐therapy control.ConclusionsThe prevalence of “unusual” manifestations is not negligible. BoNT‐A improves symptoms severity. The SFIPP‐Frey scale may be useful to assess symptoms and to monitor post‐therapy outcomes.

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Circular RNA circ_0004507 contributes to laryngeal cancer progression and cisplatin resistance by sponging miR‐873 to upregulate multidrug resistance 1 and multidrug resistance protein 1

\nXuehan Yi, \nWei Chen, \nChen Li, \nXiaoqiang Chen, \nQin Lin, \nShuchun Lin, \nDesheng Wang\n

Publicatie 28-11-2020


AbstractBackgroundCircular RNAs (circRNAs) play critical roles in various types of cancer and chemosensitivity.MethodsThe expression levels of circ_0004507 and microRNA‐873 (miR‐873) were measured by quantitative real‐time polymerase chain reaction (qRT‐PCR). The interaction between circ_0004507 and miR‐873 was predicted by circinteractome and verified by dual‐luciferase reporter assay and RNA pull‐down assay. Xenograft tumor model was established to confirm the biological role of circ_0004507 in vivo.Resultscirc_0004507 was highly expressed and miR‐873 was lowly expressed in laryngeal cancer tissues. circ_0004507 knockdown or miR‐873 overexpression inhibited cell proliferation, migration and invasion, and increased apoptosis and cisplatin sensitivity in laryngeal cancer cells. miR‐873 was identified as a direct target of circ_0004507. circ_0004507 interference inhibited tumor growth and promoted cisplatin sensitivity by upregulating miR‐873 in vivo.ConclusionKnockdown of circ_0004507 inhibited laryngeal cancer progression and cisplatin resistance by sponging miR‐873, providing a potential target for laryngeal cancer therapy.

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Solid organ transplantation worsens the prognosis of patients with cutaneous squamous cell carcinoma of the head and neck region—Comparison between solid organ transplant recipients and immunocompetent patients

\nAmit Ritter, \nSamih Badir, \nMuhammad Mansour, \nZvi Segal, \nDean Ad‐El, \nGideon Bachar, \nThomas Shpitzer, \nAron Popovtzer, \nAviram Mizrachi\n

Publicatie 27-11-2020


AbstractBackgroundCutaneous squamous cell carcinoma of the head and neck (CSCC‐HN) appears to behave more aggressively in immunosuppressed patients. We aimed to investigate this hypothesis by comparing solid organ transplant recipients (SOTR) with CSCC‐HN to immunocompetent patients.MethodsA retrospective comparative study was conducted for SOTR and immunocompetent patients who were treated for CSCC‐HN.ResultsA total of 177 SOTR and 157 immunocompetent patients with CSCC‐HN were included. Lymph node metastases were more common in the SOTR group (9% vs 3%), and distant metastases occurred only in SOTR (3% of patients). SOTR had a higher rate of recurrences (19% vs 10%), which were mostly regional (7%) and distant (3%). The 2‐year disease‐specific survival of SOTR was lower (93% vs 100%).ConclusionsSOTR with CSCC‐HN has significantly worse outcomes compared to immunocompetent patients. Solid‐organ transplantation should be regarded as a negative prognostic factor in patients with CSCC‐HN.

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Parotid gland stem cells: Mini yet mighty

\nSezin Yuce Sari, \nMelek Tugce Yilmaz, \nAysenur Elmali, \nFazli Yagiz Yedekci, \nDeniz Yuce, \nGokhan Ozyigit, \nMustafa Cengiz, \nGozde Yazici\n

Publicatie 27-11-2020


AbstractBackgroundOur aim was to evaluate the correlation between the radiation doses to parotid gland (PG) stem cells and xerostomia.MethodsPatients diagnosed with head and neck cancer (HNC) were retrospectively evaluated, and xerostomia inventory (XI) was applied to these patients. PG stem cells were delineated on the treatment planning CT, and the mean doses to the PG stem cells calculated.ResultsThe total test score and mean doses to bilateral PGs were significantly correlated (r = .34, P = .001), and the mean doses to bilateral PG stem cell niches were significantly correlated with the total test score (r = .32, P = .002).ConclusionsIn this study, we found that the mean dose to PG stem cells can predict dry mouth as much as the mean dose to the PG.

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Experimental investigation of esophageal reconstruction with electrospun polyurethane nanofiber and 3D printing polycaprolactone scaffolds using a rat model

\nHanaro Park, \nIn Gul Kim, \nYanru Wu, \nHana Cho, \nJung‐Woog Shin, \nSu A Park, \nEun‐Jae Chung\n

Publicatie 26-11-2020


AbstractBackgroundWe evaluated the outcome of esophageal reconstructions using tissue‐engineered scaffolds.MethodPartial esophageal defects were reconstructed with the following scaffolds; animals were grouped (n = 7 per group) as follows: (a) normal rats; (b) rats implanted with three‐dimensional printing (3DP) polycaprolactone (PCL) scaffolds; (c) with human adipose‐derived mesenchymal stem cell (ADSC)‐seeded 3DP PCL scaffolds; (d) with polyurethane (PU)‐nanofiber(Nf) scaffolds; and (e) with ADSC‐seeded PU‐Nf scaffolds.ResultsThe esophageal defects were successfully repaired; however, muscle regeneration was greater in the 3DP PCL + ADSC groups than in the PU‐Nf + ADSC groups (P < .001). Regeneration of the epithelium was greater in PU‐Nf and PU‐Nf + ADSC groups than in the 3DP PCL and 3DP PCL + ADSC groups (P < .001).ConclusionA tendency for more re‐epithelization was observed with the PU‐Nf scaffolds, while more muscle regeneration was achieved with the 3DP PCL scaffolds.

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Handheld reflectance confocal microscopy: Personalized and accurate presurgical delineation of lentigo maligna (melanoma)

\nYannick S. Elshot, \nBiljana Zupan‐Kajcovski, \nWilliam M. C. Klop, \nMarcel W. Bekkenk, \nMarianne B. Crijns, \nMenno A. Rie, \nAlfons J. M. Balm\n

Publicatie 24-11-2020


AbstractBackgroundThe surgical treatment of lentigo maligna melanoma is associated with high rates of local recurrence. Handheld reflectance confocal microscopy (HH‐RCM) allows for in vivo presurgical detection of subclinical lentigo maligna (melanoma) (LM/LMM).MethodsA single‐center retrospective study from December 2015 to July 2017. Frequency and extent of negative surgical margins, and the diagnostic accuracy of presurgical mapping by HH‐RCM was determined.ResultsTwenty‐six consecutive patients with LM/LMM were included. In 45.8%, HH‐RCM detected subclinical LM with a sensitivity of 0.90 and specificity of 0.86. The management was changed in two (7.7%) patients. Of the 24 remaining lesions, 95.8% were excised with negative margins with a mean histological margin of 3.1 and 5.3 mm for LM and LMM, respectively. At a mean follow‐up of 36.7 months, there was one (4.8%) confirmed recurrence.ConclusionsOur method of presurgical delineation by HH‐RCM appears to provide a reliable method for the surgical treatment of LM/LMM with a limited rate of overtreatment.

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Evaluation of opioid prescription patterns among patients undergoing thyroid surgery

\nHilary C. McCrary, \nChristopher I. Newberry, \nGeoffrey C. Casazza, \nRichard B. Cannon, \nAlexander L. Ramirez, \nJeremy D. Meier\n

Publicatie 23-11-2020


AbstractBackgroundThere is variability in opioid prescription patterns among surgeons performing thyroidectomy. Thus, the aim of this study is to evaluate opioid prescription rates and opioid use among hemithyroidectomy (HT) and total thyroidectomy (TT) patients.Design/MethodAn electronic postoperative survey was distributed to assess opiate use among patients undergoing HT/TT. Groups were compared using t‐tests, chi‐square tests, and analysis of variance.ResultsA total of 142 opiate naïve patients were included, of which 75 (52.8%) underwent HT and 67 (47.1%) underwent TT. The mean number of tablets prescribed was 21.3 (HT = 22.1, TT = 20.4; P = 0.3), with a mean of 14.1 tablets unused after surgery (HT = 13.2 tablets, TT = 15.0 tablets; P = 0.44). The mean morphine milligram equivalent (MME) prescribed was 150.1 mg (HT = 159.0 mg, TT = 140.2 mg; P = 0.3), with a mean of 98.2 MME unused after surgery (HT = 93.7 mg, TT = 103.2 mg; P = 0.6).ConclusionsOpioids are overprescribed after thyroid surgery. Avoidance of overprescribing is vital in mitigating the current opioid crisis.

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Rare case of metastatic liposarcoma to the thyroid gland and a review of the literature of metastatic sarcomas to the thyroid

\nMonica H. Xing, \nNeil Mundi, \nAparna Govindan, \nAzita Khorsandi, \nMargaret Brandwein‐Weber, \nAmmar Matloob, \nBobby Liaw, \nMark L. Urken\n

Publicatie 21-11-2020


AbstractBackgroundLiposarcomas are the second most common type of soft tissue sarcomas. Typically, myxoid liposarcomas have a metastatic rate of 10%, usually involving the retroperitoneal space, abdomen, and spine. Metastasis to the thyroid is extremely rare.Design/MethodA 62‐year‐old male with a history of metastatic myxoid liposarcoma in his right thigh presented to our clinic for evaluation of a thyroid nodule incidentally identified on a CT scan. A subsequent FNA biopsy was suggestive of a metastatic liposarcoma.ResultsThe patient underwent a left thyroid lobectomy and final pathology confirmed a grade II/III metastatic myxoid liposarcoma that measured 3.3 cm. The patient tolerated the procedure well.ConclusionsOur case highlights the role of a patients medical history when evaluating thyroid nodules to optimize accurate diagnosis, as liposarcomas do not typically metastasize to the thyroid. We also provide an updated review of the literature on all cases of metastatic sarcomas to the thyroid.

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Prior chemoradiotherapy and pathological perineural invasion predict the survival outcomes of salvage surgery in head and neck squamous cell carcinoma

\nNisha Rajrattansingh Akali, \nRahul Buggaveeti, \nSheejamol Velickakathu Sukumaran, \nDeepak Balasubramanian, \nSubramania Iyer, \nKrishnakumar Thankappan\n

Publicatie 21-11-2020


AbstractBackgroundThe purpose of the study was to evaluate the oncological outcomes of salvage surgery in squamous cell carcinoma of the head and neck (SCCHN).MethodsThis is a retrospective analysis of all patients of SCCHN with recurrence or second primary, post‐treatment, who underwent salvage surgery. The outcomes were analyzed in terms of overall survival, overall survival postsalvage surgery and disease‐free survival (DFS) postsalvage surgery. Clinical and pathological predictors were considered.ResultsTwo hundred and forty‐one patients were included. The mean follow‐up was 56.33 months. Five‐year survival OS from date of initial diagnosis of the tumor was 61.2%. The 5‐year OS survival after salvage surgery was 47.1%. Five‐year DFS after salvage surgery was 28.1%. Prior chemoradiotherapy and pathological perineural invasion were independent predictors on multivariate analysis.ConclusionsSurvival outcomes after appropriate salvage treatment are good. Prior chemoradiotherapy and perineural invasion on salvage pathology are predictors of poorer outcomes.

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Transoral robotic salvage oropharyngectomy with submental artery island flap reconstruction

\nAndrew J. Holcomb, \nJeremy D. Richmon\n

Publicatie 19-11-2020


AbstractBackgroundTransoral robotic surgery (TORS) is an effective approach for select salvage oropharyngeal resections. Reconstruction in these scenarios is often necessary for vascular coverage and optimal functional outcomes but can be challenging. The submental artery island flap (SAIF) is well‐suited to this reconstruction.Design/MethodTwo patients presented with recurrent oropharyngeal tumors after chemoradiation. Each tumor was resected using TORS, and the SAIF was utilized for reconstruction. Flap inset was completed using TORS in one case.ResultsBoth patients experienced uneventful recovery free from bleeding events or fistula formation and experienced no partial flap loss or donor site complications.ConclusionsThe SAIF is a simple reconstructive option for TORS defects that may be inset using robotic assistance and avoids the need for free tissue transfer.

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AHNS endocrine surgery section consensus statement on nasopharyngolaryngoscopy and clinic reopening during COVID‐19: How to get back to optimal safe care

\nBenjamin Bleier, \nAlan Workman, \nCiersten Burks, \nAlice Maxfield, \nBrendan C. Stack, \nCherie‐Ann Nathan, \nSusan McCammon, \nMark Varvares, \nCecelia Schmalbach, \nSteven Wang, \nJoseph Califano, \nYelizaveta Shnayder, \nMarion B. Gillespie, \nDanny Enepekides, \nIan Witterick, \nIvan El‐Sayed, \nDerrick Lin, \nUrjeet Patel, \nDennis Kraus, \nGregory Randolph\n

Publicatie 17-11-2020


AbstractThis article provides best practice guidelines regarding nasopharyngolaryngoscopy and OHNS clinic reopening during the COVID‐19 pandemic. The aim is to provide evidence‐based recommendations defining the risks of COVID‐19 in clinic, the importance of pre‐visit screening in addition to testing, along with ways to adhere to CDC guidelines for environmental, source, and engineering controls.

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Partial parotidectomy via periauricular incision: Retrospective cohort study and comparative analysis to alternative incisional approaches

\nC.Alessandra Colaianni, \nAllen L. Feng, \nJeremy D. Richmon\n

Publicatie 15-11-2020


AbstractBackgroundWe investigated a periauricular approach to the parotid and compared outcomes to alternative parotidectomy incisions.MethodsRetrospective chart review of patients (n = 97) undergoing partial parotidectomy for benign or malignant pathology by a single surgeon. After October 2017, most patients were approached via a periauricular incision (n = 59).ResultsThere was no significant difference in patient age, tumor location, length of hospital stay, postoperative complication, or pathology. Mean tumor diameter was significantly smaller in the periauricular group (2.1 cm) than in the traditional incision group (2.6 cm). No permanent injuries to facial nerve branches occurred in either group. Patients were followed for a median of 44 days after surgery.ConclusionsThis is the largest study to date that demonstrates the periauricular incision is a safe and feasible approach for most parotid neoplasms. The cosmetic advantage of this approach is that the resulting scar is smaller and does not extend into the neck.

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ERRATUM

Publicatie 15-11-2020


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Curative‐intent radiotherapy for glottic carcinoma in situ

\nWilliam M. Mendenhall, \nChristopher G. Morris, \nRobert J. Amdur, \nKathryn E. Hitchcock, \nNeil Cheddha, \nPeter T. Dziegielewski\n

Publicatie 13-11-2020


AbstractBackgroundThe aim of the study was to update our experience treating patients with glottic carcinoma in situ (CIS) with curative radiotherapy (RT).MethodsFifty patients received continuous‐course RT using once‐daily fractionation. Twenty‐eight (56%) had recurrent or persistent CIS after resection. Median total dose was 63.0 Gy; median dose per fraction was 2.25 Gy. Median follow‐up was 9.6 years for all patients and 8.4 years for survivors.ResultsAfter RT, 5 patients (10%) recurred locally; salvage surgery was performed in 4 (1 refused). Five‐year outcomes were as follows: local control, 91%; ultimate local control (including patients successfully salvaged after local recurrence), 100%; ultimate local control with larynx preservation, 93%; local‐regional control, 91%; ultimate local‐regional control, 100%; distant metastases‐free survival, 100%; cause‐specific survival, 100%; and overall survival, 81%. No patient experienced a severe complication.ConclusionRT is an excellent treatment for patients with CIS recurrent after transoral excision and those with previously untreated CIS who are unsuitable for partial laryngectomy.

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Long‐term outcomes in patients with recurrent human papillomavirus‐positive oropharyngeal cancer after upfront transoral robotic surgery

\nWilliam Su, \nGreeshma Rajeev‐Kumar, \nMartin Kang, \nMarshall Posner, \nJerry T. Liu, \nWilliam Westra, \nBrett A. Miles, \nVishal Gupta, \nSonam Sharma, \nKrzysztof Misiukiewicz, \nEric Genden, \nRichard L. Bakst\n

Publicatie 13-11-2020


AbstractBackgroundClinical course following failure of human papillomavirus (HPV)‐positive oropharyngeal cancers (HPV + OPC) is poorly understood. This study aims to characterize disease course following failure after transoral robotic surgery (TORS).MethodsWe identified patients with HPV + OPC‐treated upfront with TORS at our institution from 2007 to 2017. HPV status was confirmed with immunohistochemistry or HPV DNA polymerase chain reaction. Patient characteristics, treatment modalities, and post‐recurrence outcomes were analyzed for the recurrent cohort.ResultsOf the 317 HPV + OPC patients, 28 (8.8%) experienced recurrence, all of HPV 16/18 subtypes. Median post‐recurrence survival was 19.8 months (range 2.3‐195.8 months) in the 12 locoregional and 16 months (range 2.4‐79.5 months) in the 14 distant failures. Sixteen are alive with a median of 39.8 months (range 5.5‐209.4 months) after retreatment.ConclusionThis is one of the largest series evaluating survival following TORS failure in HPV + OPC. Despite failure, long‐term survival and durable remission are possible with single‐modal or multiple‐modal salvage treatment.

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Endoscopic transoral approach for resection of retrostyloid parapharyngeal space tumors: Retrospective analysis of 16 patients

\nLifeng Li, \nNyall R. London, \nYanyong Gao, \nRicardo L. Carrau, \nXiaohong Chen\n

Publicatie 13-11-2020


AbstractBackgroundThe purpose of this study was to assess the feasibility of the endoscopic transoral approach for resection of retrostyloid benign tumors.MethodsWe retrospectively reviewed 16 patients with retrostyloid parapharyngeal space (PPS) tumors resected via an endoscopic transoral approach. After separation and control of the internal carotid artery (ICA), tumors in the retrostyloid PPS were then removed under the guidance of angled endoscope (45°).ResultsAll 16 patients with retrostyloid PPS tumors were successfully removed via an endoscopic transoral approach. There were 15 schwannomas and 1 paraganglioma. Two tumors were removed en bloc, and the other 14 tumors were removed by piecemeal. In five patients, the tumor extended into the jugular foramen, and was completely removed via the transoral corridor, without cerebrospinal fluid leak. No ICA injury was encountered in any of the 16 patients.ConclusionThe endoscopic transoral approach is suitable for the resection of retrostyloid PPS tumors and is associated with low morbidity.

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Radiotherapy in the management of glottic squamous cell carcinoma

\nWilliam M. Mendenhall, \nPrimož Strojan, \nAnne W.M. Lee, \nAlessandra Rinaldo, \nAvraham Eisbruch, \nWai Tong Ng, \nRobert Smee, \nAlfio Ferlito\n

Publicatie 13-11-2020


AbstractIntroductionOur purpose is to review the role radiotherapy (RT) in the treatment of glottic squamous cell carcinoma (SCC).MethodsA concise review of the pertinent literature.ResultsRT cure rates are Tis‐ T1N0, 90% to 95%; T2N0, 70% to 80%; low‐volume T3‐T4a, 65% to 70%. Concomitant cisplatin is given for T3‐T4a SCCs. Severe complications occur in 1% to 2% for Tis‐T2N0 and 10% for T3‐T4a SCCs. Patients with high‐volume T3‐T4 SCCs undergo total laryngectomy, neck dissection, and postoperative RT. Those with positive margins and/or extranodal extension receive concomitant cisplatin. The likelihood of local‐regional control at 5 years is 85% to 90%. Severe complications occur in 5% to 10%.ConclusionsRT is a good treatment option for patients with Tis‐T2N0 and low‐volume T3‐T4a glottic SCCs. Patients with higher volume T3‐T4 cancers are best treated with surgery and postoperative RT.

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Synergistic anticancer activity of sorafenib, paclitaxel, and radiation therapy on anaplastic thyroid cancer in vitro and in vivo

\nSoo Young Kim, \nSeok‐Mo Kim, \nHojin Chang, \nHang‐Seok Chang, \nCheong Soo Park, \nYong Sang Lee\n

Publicatie 13-11-2020


AbstractBackgroundThis study aimed to investigate the antitumor activity of paclitaxel with radiation and sorafenib in anaplastic thyroid cancer (ATC) cells in vitro and in vivo.MethodsThe 8505C ATC cell line was exposed to radiation, sorafenib, and paclitaxel each or in combination. The effects of combined treatment on the cell cycle and intracellular signaling pathways were assessed using flow cytometry and western blot analysis. An ATC cell line xenograft model was used to examine antitumor activity in vivo.ResultsRadiation, paclitaxel plus sorafenib synergistically decreased cell viability in ATC cells and significantly increased apoptotic cell death. The combination of paclitaxel, sorafenib with radiation reduced the antiapoptotic factor in ATC. This combination therapy significantly reduced the tumor volume and increased survival in the ATC xenograft model.ConclusionsThese results suggest that the combination of radiation and paclitaxel plus sorafenib has significant anticancer activity in preclinical models.

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Panendoscopy during follow‐up in laryngeal carcinoma patients after radiotherapy

\nIsabella Stanisz, \nStefan Janik, \nMatthäus Christoph Grasl, \nBoban M. Erovic\n

Publicatie 13-11-2020


AbstractBackgroundEarly detection of a recurrent disease remains essential during follow‐up to improve outcome and reduce morbidity. The purpose of this study was to evaluate the adequacy of panendoscopy after radiotherapy for recurrent laryngeal carcinoma.MethodsIn this retrospective analysis, 623 patients were included. Clinical and radiological examinations were compared to pathohistological results of panendoscopy and clinical outcome.ResultsIn the first 6 months after therapy, a negative histopathological result was significantly higher in patients after radiotherapy (n = 394) compared to patients after surgery (n = 195) alone (odds ratio OR 0.4424, 95% confidence interval CI 0.2081‐0.969, P = .05). After radiotherapy, a suspicious radiological result was not significantly linked to recurrence (OR 1.461, 95% CI 0.7126‐3.021, P = .37). Clinical investigation was the best predictive parameter for detecting recurrent disease after radiation therapy (OR 4.061, 95% CI 2.268‐7.113, P = <.0001).ConclusionsOur results suggest that in the first 6 months after radiotherapy, emphasis should be placed on clinical evaluation during follow‐up.

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Determining the number and distribution of intraparotid lymph nodes according to parotidectomy classification of European Salivary Gland Society: Cadaveric study

\nSaid Sönmez, \nKadir Serkan Orhan, \nErdoğan Kara, \nMelek Büyük, \nLevent Aydemir, \nHızır Asliyüksek\n

Publicatie 13-11-2020


AbstractBackgroundTo investigate the distribution of the parotid glands intraglandular lymph nodes using the parotidectomy zones determined by the parotidectomy classification of the European Salivary Gland Society (ESGS).Materials and MethodsA total of 128 parotid glands were dissected from 64 fresh cadavers, by bilateral parotidectomy without additional incision within the standard autopsy procedure, and categorized.ResultsEighty‐six percent of the IGLNs were located in the superficial lobe and 14% in the deep lobe. An average of 7.09 ± 3.55 IGLNs were found for each of the gland; there were 6.11 ± 3.28 in the superficial lobe and 0.98 ± 1.46 in the deep lobe. While the most common lymph nodes were found in level 2 with 47.7%, only 5% of IGLNs were at level 4. According to the proposed modification, the most common lymph nodes (35.24%) were located at level 2B.ConclusionLevel 2B was found to contain significantly more lymph nodes than other levels, which has not been evaluated before in literature.

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Temporal bone carcinoma: Novel prognostic score based on clinical and histological features

\nElisabetta Zanoletti, \nLeonardo Franz, \nDiego Cazzador, \nSebastiano Franchella, \nLeonardo Calvanese, \nPiero Nicolai, \nAntonio Mazzoni, \nGino Marioni\n

Publicatie 13-11-2020


AbstractBackgroundThis study aimed to develop a novel temporal bone squamous cell carcinoma (TBSCC) prognosis scoring system and compare it with the revised Pittsburgh staging system.MethodsForty‐four consecutive TBSCC patients were assessed to identify predictors of recurrence. Each predictors hazard ratio for recurrence was used to develop our novel scoring system.ResultsBased on variables with P < .10 in Coxs regression model, our score included: revised Pittsburgh stage; non‐anterior spread of T4 carcinoma; dural involvement; and histological grade. A higher recurrence rate (P = .000) and shorter disease‐free survival (P = .000) were associated with scores of ≥5. The area under the curve of our score was larger than that of the revised Pittsburgh stage for both recurrence and disease‐specific mortality (P = .0178 and P = .0193, respectively).ConclusionOur TBSCC scoring system is based on variables that are obtainable preoperatively from clinical and radiological data and biopsies. Its prognostic value should be validated for published TBSCC series and then in prospective settings.

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Retroauricular thyroidectomy with a single‐arm robotic surgical system: Preclinical cadaveric study

\nJulia E. Noel, \nMyung‐Chul Lee, \nKenric Tam, \nGil‐Chai Lim, \nF. Christopher Holsinger, \nYoon Woo Koh\n

Publicatie 13-11-2020


AbstractBackgroundIn this study, we evaluate a new flexible, single‐arm robotic system in performing thyroidectomy via a retroauricular approach.MethodsFour fresh cadavers were used. Technical details of the new system are discussed, and the comprehensive surgical procedures are described step by step.ResultsThis single‐port flexible system could be used to successfully perform retroauricular thyroidectomy. The ideal angle to dock the patient‐side cart was at a 90° angle to the operating table. When the cannula tip was placed 10 to 15 cm away from the skin incision, positioning and full movement of all four instruments without collisions were possible. Three flexible instruments and an endoscope made the robotic dissection more efficient.ConclusionsWe describe the first preclinical evaluation of an innovative, flexible, single‐arm robotic surgical system for retroauricular thyroidectomy.

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Phase II study of de‐intensified intensity‐modulated radiotherapy and concurrent carboplatin/5‐fluorouracil in lateralized p16‐associated oropharyngeal carcinoma

\nHouda Bahig, \nLouise Lambert, \nEdith Filion, \nDenis Soulières, \nLouis Guertin, \nTareck Ayad, \nApostolos Christopoulos, \nEric Bissada, \nMoein Alizadeh, \nManon Bélair, \nPhuc Felix Nguyen‐Tan\n

Publicatie 13-11-2020


AbstractPurposeTo assess cancer control and patient‐reported outcomes (PROs) after de‐intensified intensity‐modulated radiotherapy (IMRT) in lateralized p16‐associated oropharyngeal cancer (p16‐OPC).MethodsLateralized p16‐OPC treated with radiotherapy and concurrent Carboplatin/5‐fluorouracil between 2011 and 2014 were enrolled. De‐intensified IMRT consisted in elective neck dose of 43.2 Gy/24 fractions and omission of contralateral retropharyngeal/level IV nodes. PROs were assessed using the EORTC QLC‐C30 and QLQ‐HN35 scales.ResultsTwenty‐nine patients were included. Median follow‐up was 44 months. As per AJCC 7th Ed, 7%, 83% and 10% of patients had stage III, IVa and IVb. 5‐year locoregional control and overall survival rates were 100% and 100%, respectively. Rates of acute were 52% and 35%, respectively. At 2 years post‐treatment, 50% and 14% of patients had grade 1 xerostomia and dysgueusia, respectively. Most PROs scores returned to baseline within 8 months post‐treatment.ConclusionDe‐intensified IMRT was associated with excellent cancer outcomes, and rapid recovery of PROs in lateralized p16‐OPC.

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Clinical evaluation of an automated virtual surgical planning platform for mandibular reconstruction

\nEdward Wang, \nJ. Scott Durham, \nDonald W. Anderson, \nEitan Prisman\n

Publicatie 13-11-2020


AbstractBackgroundVirtual surgical planning (VSP), via commercial services or developed in‐house, has been applied to facilitate head and neck reconstruction. We evaluate a custom, automated planning software.MethodsProspectively, VSP of 25 consecutive patients undergoing segmental mandibular reconstruction was performed. Postoperative CT was used to assess structural accuracy of VSP. Operative time, length of stay, and complication rate of the prospective cohort were compared with those of 25 consecutive retrospective historical cases.ResultsThe deviations between the plan and execution in mandibular width, projection, and volumetric overlap were 2.32 ± 3.91, 2.39 ± 1.72, and 0.59 ± 0.51 mm respectively. Compared with historical data, there was a significant reduction in operative time and length of stay, and no significant difference in complication rates.ConclusionThis is the largest prospective series evaluating an in‐house VSP workflow for mandibular reconstruction and the first clinical evaluation of an automated planning platform.

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Preventive use of gabapentin to decrease pain and systemic symptoms in patients with head and neck cancer undergoing chemoradiation

\nDerek K. Smith, \nAnthony Cmelak, \nKen Niermann, \nMichael Ghiam, \nDiane Lou, \nJill Gilbert, \nMichael K. Gibson, \nDeborah Hawkins, \nBarbara A. Murphy\n

Publicatie 13-11-2020


AbstractBackgroundRadiation for patients with head and neck cancer (HNC) is associated with painful mucositis that impacts the delivery of treatment and contributes to high symptom burden.MethodsThis was a prospective, randomized pilot trial. Eligible patients received primary or adjuvant chemoradiation. Patients were randomized to usual care vs usual care plus gabapentin titrated to drug tolerance during radiation. Patients completed a symptom survey at baseline and weekly during therapy.ResultsSeventy‐nine patients were enrolled in the study (38 control, 41 treatment). At interim analysis, gabapentin use resulted in a decrease in pain (P = .004), with the biggest decreases being in the latter weeks of therapy. By week 7, the median pain score in the treatment group was below the 0.25 quantile of the control group.ConclusionProphylactic use of gabapentin during chemoradiation for HNC patients resulted in a decrease in pain, neurosensory symptoms, and general systemic symptoms.

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Modification of the anterior‐posterior tongue rotation flap for oral tongue reconstruction

\nJunqin Lu, \nYahong Chen, \nRong‐Hui Xia, \nYi Shen, \nZhiwei Zheng, \nJian Sun\n

Publicatie 13-11-2020


AbstractThe aim of this study is to evaluate the efficacy and long‐term outcome of a modification of the anterior‐posterior tongue rotation flap used for reconstruction of tongue following cancer ablation. From April 2016 to September 2017, 21 consecutive patients with tumor classification (T2), lymph node classification (N0) tongue cancer on the anterior and middle one‐third portion were selected for this study. A modification of the anterior‐posterior tongue rotation flap was selected for tongue reconstruction after the cancer resection. Patients scorings of swallowing, chewing, speech and taste were recorded. Patient after tongue flap reconstruction acquired satisfied tongue movement that allows normal functional outcomes for swallowing, chewing, speech and taste. Local tumor recurrence was not observed during the follow‐up examination (range, 12‐24 months). The modification of the anterior‐posterior tongue rotation flap was a safe and reliable treatment for medium‐size tongue cancer (T2N0), especially suitable to patients who cannot endure prolonged surgery.

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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 13-11-2020


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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Simple and complex carotid paragangliomas. Three decades of experience and literature review

\nFrancisco S. Lozano, \nAngel Muñoz, \nJosé A. las Heras, \nJosé R. González‐Porras\n

Publicatie 13-11-2020


AbstractBackgroundCarotid paragangliomas are rare tumors. They are usually unique, non‐secreting, resectable, and benign. However, additional rare cases of complex tumors (bilateral, secretory, nonresectable, or malignant) complicate the management and final outcomes.MethodsRecords of paragangliomas from our hospital are reviewed. Criteria defining complex paragangliomas have been previously defined. These are compared with those of the simple group.ResultsFifty patients, two groups: simple (n = 39) and complex (n = 11). The patients in the complex group were significantly younger (47.7 vs 63.8 years). Postoperative nerve complications (45.4% vs 6.3%) and mortality during follow‐up (27.3% vs 0%) were significantly more common in the complex group. Vascular complications (0% vs 3.1%) and early mortality (0%) were similarly in both groups.ConclusionsPatients with complex carotid paragangliomas are heterogeneous. The former are younger, exhibit a high degree of diagnostic and therapeutic complexity, and have poorer morbidity and mortality. Surgical experience and interdisciplinary collaboration are essential.

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Are contralateral submental artery perforator flaps feasible for the reconstruction of postoperative defects of oral cancer?

\nXie Zhi‐jun, \nLi Yue‐xiao, \nGuan Bo‐Yu, \nJin Ya‐Tin, \nLi Si‐Si, \nZhao Kun‐Min, \nSun Chang‐Fu, \nTan Xue‐Xin\n

Publicatie 13-11-2020


AbstractBackgroundWe evaluated the clinical applications of the reconstruction of postoperative defects of the oral cavity using contralateral submental artery flaps.MethodsA retrospective study of 18 patients with postoperative intraoral cancer defects reconstructed with contralateral submental artery perforator flaps between October 2018 and October 2019 in our department was conducted. The defect area, flap size, and complications were evaluated.ResultsAll patients were diagnosed based on pathological examinations: 2 with adenoid cystic carcinoma and 16 with squamous cell carcinoma. The submental artery perforator flap used for simultaneous repair was 8 to 15 cm in length and 4 to 6.5 cm in width. The survival rate of flap reconstruction was 100% with no donor site complications.ConclusionsContralateral submental artery flap reconstruction is a suitable alternative for moderate to large intraoral defects, postoperative mouth floor defects, and oral cavity composite defects of oral malignant tumors without contralateral lymph node metastases.

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Evaluation of the modified Pittsburgh classification for predicting the disease‐free survival outcome of squamous cell carcinoma of the external auditory canal

\nCindy H. Nabuurs, \nWietske Kievit, \nNilou Labbé, \nC. René Leemans, \nConrad F. G. M. Smit, \nMichiel W. M. Brekel, \nRobert J. Pauw, \nBernard F. A. M. Laan, \nJeroen C. Jansen, \nMartin Lacko, \nWeibel W. Braunius, \nShinya Morita, \nMałgorzata Wierzbicka, \nTakuma Matoba, \nNobuhiro Hanai, \nRobert P. Takes, \nHenricus P. M. Kunst\n

Publicatie 13-11-2020


AbstractBackgroundSquamous cell carcinoma (SCC) of the external auditory canal (EAC) is a rare disease, which is commonly classified with the modified Pittsburgh classification. Our aim was to evaluate the predictive performance of this classification in relation to disease‐free survival (DFS).MethodsWe examined retrospective data from a nationwide Dutch cohort study including patients with primary EAC SCC. These data were combined with individual patient data from the literature. Using the combined data, the predictive performances were calculated using the c‐index.ResultsA total of 381 patients were included, 294 for clinical and 281 for the pathological classification analyses. The c‐indices of the clinical and the pathological modified Pittsburgh classification predicting DFS were 0.725 (0.668‐0.782) and 0.729 (0.672‐0.786), respectively.ConclusionThe predictive performance of the modified Pittsburgh classification system as such appears to be acceptable to predict the DFS of EAC SCC. Other factors need to be added to a future model to improve the predicted performance.

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Prognostic value of nutritional impairment on treatment‐related toxicity and survival in patients with nasopharyngeal carcinoma taking normal nutrition before radiotherapy

\nLi Su, \nQiaojing Lin, \nRong Li, \nYangjingling Hua, \nHairong Zhang, \nXiurong Song, \nJinru Ye, \nWeijian Zhang, \nJinsheng Hong\n

Publicatie 13-11-2020


AbstractBackgroundTo investigate nutritional impairment during intensity‐modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC) taking normal nutrition before IMRT and its effect on treatment‐related toxicities (TRTs) and survival.MethodsModified nutrition index (m‐NI) of 187 patients with NPC, comprised eight indicators (body mass index, circumference of upper arm muscles, total lymphocyte count, red blood cell count, levels of albumin, pre‐albumin, transferrin, and hemoglobin), were evaluated before/after IMRT. Patient characteristics, m‐NI, and the follow‐up data for survival and TRTs were analyzed.ResultsThe m‐NI scores of patients with NPC decreased significantly after IMRT. Severe nutritional impairment (SNI; decrease in m‐NI score ≥50%) was an independent prognostic factor for overall survival (OS) and an independent risk factor for grade ≥2 oral mucositis. Classification T4 disease and smoking were SNI risk factors.ConclusionsSNI during IMRT is a risk factor for oral mucositis and a prognostic factor for worse OS in patients with NPC.

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Factors impacting successful salvage of the failing free flap

\nLarissa Sweeny, \nJoseph Curry, \nMeghan Crawley, \nTaylor Cave, \nMatthew Stewart, \nAdam Luginbuhl, \nRyan Heffelfinger, \nHoward Krein, \nDaniel Petrisor, \nAdam Bender‐Heine, \nMark K. Wax\n

Publicatie 13-11-2020


AbstractBackgroundUnderstanding factors impacting successful salvage of a compromised free flap.MethodsMulti‐institutional review of free flap reconstructions for head and neck defects (n = 1764).ResultsFree flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; P < .001). Greater compromise (14%) and failure (8%) if inset challenging vs straightforward (6% compromise, 4% failure; P = .035). Greater compromise (23%) and failure (17%) following intraoperative anastomosis revision vs no revision (7% compromise, 4% failure; P < .0001). Success following arterial insufficiency was lower (60% failed, 40% salvaged) vs venous congestion (23% failed, 77% salvaged) (P < .0001). Greater flap salvage following thrombectomy (66%) vs no thrombectomy (34%; P < .0001). Greater flap salvage if operative duration ≤8 hours (57%), vs >8 hours (40%) (P = .04).ConclusionsThere were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision.

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Pharyngocutaneous fistulas after total laryngectomy or pharyngolaryngectomy: Place of video‐fluoroscopic swallowing study

\nFlorent Carsuzaa, \nAnne‐Laure Capitaine, \nJean‐Claude Ferrié, \nVincent Apert, \nDenis Tonnerre, \nDenis Frasca, \nXavier Dufour\n

Publicatie 13-11-2020


AbstractBackgroundSpecify place of video‐fluoroscopic swallowing study (VFS) in the decision of oral refeeding after total pharyngolaryngectomy.MethodsAt postoperative day 7, a blue dye testing was performed. If negative, a VFS was performed looking for a blind fistula. If this exam was negative, oral refeeding was started, but if a blind fistula was observed, cervical compression bandage was performed.ResultsIn 186 patients, a VFS was performed for 142 patients with negative blue dye testing. It was negative for 98 patients (69%) and positive for 44 patients (31%) (blind fistula). Patients had a probability of 7.1% to have a secondary pharyngocutaneous fistula (PCF) if the VFS was negative, and 15.9% if it was positive. No risk factor for the development of a secondary PCF or a blind fistula emerged from our analysis.ConclusionVFS should be performed before any oral refeeding in all patients operated with a total pharyngolaryngectomy.

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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 13-11-2020


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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Cost‐effectiveness analysis of using the heat and moisture exchangers compared with alternative stoma covers in laryngectomy rehabilitation: US perspective

\nAnn‐Jean C. C. Beck, \nValesca P. Retèl, \nGlenn Bunting, \nRosh K. V. Sethi, \nDaniel G. Deschler, \nMichiel W. M. Brekel, \nWim H. Harten\n

Publicatie 13-11-2020


AbstractBackgroundThis study aims to evaluate the cost‐effectiveness of using heat and moisture exchangers (HMEs) vs alternative stoma covers (ASCs) following laryngectomy in the United States.MethodsA cost‐effectiveness and budget impact analysis were conducted including uncertainty analyses using real‐world survey data with pulmonary events and productivity loss.ResultsHME use was more effective and less costly compared with ASCs. Quality‐adjusted life years were slightly higher for HME‐users. Total costs per patient (lifetime) were $59 362 (HME) and $102 416 (ASC). Pulmonary events and productivity loss occurred more frequently in the ASC‐users. Annual budget savings were up to $40 183 593. Costs per pulmonary event averted were $3770.ConclusionsHME utilization in laryngectomy patients was cost‐effective. Reimbursement of HME devices is thus recommended. Utilities may be underestimated due to the generic utility instrument used and sample size. Therefore, we recommend development of a disease‐specific utility tool to incorporate in future analyses.

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Transoral robotic parapharyngeal approach to the submandibular space

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

Publicatie 13-11-2020


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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Predictive value of CD8/FOXP3 ratio combined with PD‐L1 expression for radiosensitivity in patients with squamous cell carcinoma of the larynx receiving definitive radiation therapy

\nTakeharu Ono, \nKoichi Azuma, \nAkihiko Kawahara, \nTatsuyuki Kakuma, \nFumihiko Sato, \nJun Akiba, \nNorimitsu Tanaka, \nToshi Abe, \nShun‐ichi Chitose, \nHirohito Umeno\n

Publicatie 13-11-2020


AbstractBackgroundLittle is known about immune‐related radiosensitivity in patients with squamous cell carcinoma of the larynx (SCC‐L) treated with radiation therapy (RT).MethodsWe retrospectively reviewed 91 patients with SCC‐L treated with RT or chemoradiation therapy and performed immunohistochemical examination to analyze PD‐L1 level on tumor cells, CD4+ tumor‐infiltrating lymphocytes (TILs), CD8+TIL, and FOXP3+TIL using pretreated biopsy specimens. The association between these immune‐related parameters and radiosensitivity was evaluated.ResultsMultivariate analyses showed that high CD8/FOXP3 ratio combined with negative PD‐L1 expression was an independent and significant favorable predictive factor for local control, compared with the other groups.ConclusionsWe showed that high CD8/FOXP3 ratio combined with negative PD‐L1 expression might be a useful biomarker of radiosensitivity in patients with SCC‐L receiving definitive RT. We propose that coassessment of CD8/FOXP3 ratio and PD‐L1 expression level in tumor cells can help predict potential radiosensitivity in patients with SCC‐L.

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Elective neck dissection for T3/T4 cN0 sinonasal squamous cell carcinoma

\nKayva L. Crawford, \nAria Jafari, \nJesse R. Qualliotine, \nEmelia Stuart, \nAdam S. DeConde, \nJoseph A. Califano, \nRyan K. Orosco\n

Publicatie 13-11-2020


AbstractBackgroundIn locally advanced sinonasal squamous cell carcinoma (SNSCC), management of the clinically node‐negative (cN0) neck is variable and elective neck dissection (END) remains controversial.MethodsPatients with surgically treated T3/T4 cN0 M0 SNSCC were identified using the NCDB. Overall survival (OS) was assessed by Cox proportional hazard analysis in propensity score‐matched cohorts. Factors associated with END were evaluated with logistic regression.ResultsTwo hundred twenty patients underwent END (19.6%). END did not correlated with OS in propensity score‐matched cohorts (HR 0.971, 95% CI 0.677‐1.392), a maxillary sinus tumor subgroup (HR 1.089, 95% CI 0.742‐1.599), or by radiation status radiation: (HR 0.802, 95% CI 0.584‐1.102); no radiation: (HR 0.852, 95% CI 0.502‐1.445). The occult metastasis rate in the END cohort was 12.7%.ConclusionEND did not significantly improve OS in this study. Further information on disease‐free survival is necessary to determine its role in advanced‐stage SNSCC.

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Patient reported outcomes in patients with head and neck cancer treated with concurrent chemoradiation with weekly versus bolus cisplatin

\nMona Arbab, \nYu‐Hui Chen, \nShana Criscitiello, \nJason Glass, \nJo Ann Fugazzotto, \nJoseph H. Killoran, \nGlenn Hanna, \nJochen Lorch, \nRobert I. Haddad, \nDanielle N. Margalit, \nRoy B. Tishler, \nJonathan D. Schoenfeld\n

Publicatie 13-11-2020


AbstractBackgroundPatient Reported Outcome (PRO) data comparing bolus (B‐CP) with weekly (W‐CP) cisplatin concurrent with radiation are lacking.MethodsWe performed a retrospective study comparing PRO among 99 patients with head and neck radiation, 26% who received concurrent B‐CP and 73% treated with W‐CP.ResultsW‐CP patients had a higher Charlson comorbidity index (CCI) (P = .004). There were no differences in median cisplatin dose, PROs, percutaneous endoscopic gastrostomy (PEG) dependence or hospitalization between arms. Patients with a greater decline in their self‐reported dysphagia score were more often PEG dependent at the end of radiation therapy (P = .03). There was also a trend toward PEG dependence with a higher maximum dysphagia score and greater change in aspiration score (P = .06). The maximum decline in white cell count and absolute neutrophil count were greater in the W‐CP group (P = .04, P = .01).ConclusionBoth B‐CP and W‐CP are well tolerated. PROs do not suggest a benefit to W‐CP.

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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 13-11-2020


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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Assessment of operative competency for thyroidectomy: Comparison of resident self‐assessment vs attending surgeon assessment

\nAlexandrea H. Kim, \nCory A. Vaughn, \nDeanne L. King, \nMax Maizels, \nPatrick Meade, \nBrendan C. Stack\n

Publicatie 13-11-2020


AbstractBackgroundSelf‐awareness of skill, essential for progression as a surgeon, has direct bearing on postresidency practice; however, studies have supported that residents achieve self‐perceived competence later than believed by program directors. This study compares residents self‐perception of operative competency to attending surgeons evaluation using Computer Enhanced Visual Learning, a validated online hemithyroidectomy‐specific assessment tool.MethodsEleven otolaryngology‐Head and Neck Surgery (HNS) residents completed a preoperative module and postoperative survey, later reviewed by an attending surgeon. Eighty‐three performances were assessed for inter‐rater reliabilities of key surgical steps.ResultsAlmost perfect agreement (Kappa = 0.81‐1.00) was shown in 11 of 18 parameters. Substantial agreement (Kappa = 0.61‐0.80) was demonstrated in the remaining seven parameters.ConclusionsOtolaryngology‐HNS trainees have high self‐awareness of their performance at each step in a hemithyroidectomy. Standardized assessment tools can allow for documentation of procedural performance and serve as guides for improvement. This is the only study to examine otolaryngology‐HNS trainees self‐perceived skill compared to an attending surgeons assessment for hemithyroidectomy.

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Effects of inducing apoptosis and inhibiting proliferation of siRNA on polyadenylate‐binding protein‐interacting protein 1 in tongue cell carcinoma

\nHuixu Xie, \nLisa Yang, \nQin Hu, \nYingqi Song, \nXiaoyi Wang, \nLiming Zhou, \nLongjiang Li\n

Publicatie 13-11-2020


AbstractBackgroundIt has been reported that the polyadenylate‐binding protein‐interacting protein 1 (PAIP1) pathway is closely connected with the progression of some malignant tumors. Here we examined the potential functional mechanism of PAIP1 in tongue squamous cell carcinoma (TSCC).MethodsPAIP1 was knocked down in TSCC cell lines and proliferation and apoptosis in vitro analyzed. The molecular features of TSCC were determined using quantitative proteome and succinylome analyses. The results were confirmed in the mouse model.ResultsPAIP1 promoted cell proliferation and inhibited apoptosis. Its knockdown decreased Ki67 and Pcna expressions and increased Bax/Bcl2 index and Caspase‐3 expression. Bioinformatics analysis for proteomics revealed that PAIP1 knockdown correlated with the changes in differential protein expression.ConclusionsUpregulation of PAIP1 induces cell proliferation and inhibits apoptosis in TSCC; PAIP1 might be a diagnostic biomarker and a significant drug target.

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"Keys to successful implementation of routine symptom monitoring in head and neck oncology with “Healthcare Monitor” and patients perspectives of quality of care"

\nEmilie A. C. Dronkers, \nRobert J. Baatenburg de Jong, \nEgge F. Poel, \nAniel Sewnaik, \nMarinella P. J. Offerman\n

Publicatie 13-11-2020


AbstractBackgroundValue‐based health care is increasingly used to facilitate a systematic approach during follow‐up of patients. We developed Healthcare Monitor (HM): a structure of electronic patient‐reported outcome measures (ePROs) for the longitudinal follow‐up of head and neck cancer (HNC) patients. This study shares key lessons from implementation and seeks to provide insight into how patients experience HM.MethodsWe conducted a mixed‐methods study using quantitative data from a nonrandomized retrospective survey of patients who received HM (n = 45) vs standard care (n = 46) and qualitative data from structured interviews (n = 15).ResultsImplementation of HM included significant challenges. Finding common ground among clinicians, administrators, and IT staff was most important. Qualitative findings suggest that patients experienced better doctor‐patient communication and increased efficiency of the consultation using HM. Patients felt better prepared and experienced more focus on critical issues. Quantitative analysis did not show significant differences.ConclusionsIntegration of HM into routine care for HNC patients may have increased patient‐centered care and facilitated screening of symptoms. However, future research is needed to analyze the potential benefits more extensively.

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

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

Publicatie 13-11-2020


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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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 13-11-2020


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Transoral robotic selective neck dissection for papillary thyroid carcinoma: Is it appropriate?

"\nOttavio Piccin, \nPasquale DAlessio, \nOttavio Cavicchi\n"

Publicatie 13-11-2020


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Reply to Letter to the Editor: Transoral robotic selective neck dissection for papillary thyroid carcinoma: Is it appropriate?

\nKyung Tae\n

Publicatie 13-11-2020


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Diabetes mellitus in major head and neck cancer surgery

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

Publicatie 13-11-2020


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Issue Information

Publicatie 13-11-2020


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Age and risk of recurrence in oral tongue squamous cell carcinoma: Systematic review

\nNicholas R. Lenze, \nDouglas R. Farquhar, \nChristina Dorismond, \nSiddharth Sheth, \nJose P. Zevallos, \nJeffrey Blumberg, \nCatherine Lumley, \nSamip Patel, \nTrevor Hackman, \nMark C. Weissler, \nWendell G. Yarbrough, \nAndrew F. Olshan, \nAdam M. Zanation\n

Publicatie 13-11-2020


AbstractThe incidence of oral tongue squamous cell carcinoma has been increasing in young patients (≤45 years) without a clear etiologic driver. It is unknown if younger patients have an increased risk of recurrence compared to older patients. A literature search was conducted through January 2020 using PubMed/MEDLINE, Embase, Cochrane, Scopus, Science Direct, and clinicaltrials.gov. This review was registered with PROSPERO (ID: CRD42020167498) and the PRISMA statement was followed. Studies were eligible for inclusion if they assessed risk of recurrence by age using a time‐to‐event analysis, used an age cutoff of ≤45 years or less for the younger cohort, and limited the analysis to the oral tongue subsite. Data were extracted independently by two reviewers using a form with a prespecified list of variables. There were 13 articles that met criteria for the qualitative synthesis (n = 1763 patients). The reported 5‐year rates of disease‐free survival ranged from 30% to 72% for the younger cohorts and 42% to 81% for the older cohorts. Three studies reported a statistically significant increased risk of recurrence in younger patients, three studies reported a nonsignificant increased risk in younger patients, and seven studies reported a similar risk in younger patients based on the time‐to‐event analyses. There may be an increased risk of recurrence for younger patients with oral tongue cancer. A definitive conclusion is precluded by limitations among individual studies, and additional research is warranted to examine this question.

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Metabolic tumor volume and total lesion glycolysis as prognostic factors in head and neck cancer: Systematic review and meta‐analysis

\nJefferson Rijo‐Cedeño, \nJorge Mucientes, \nOscar Álvarez, \nAna Royuela, \nSara Seijas Marcos, \nJesús Romero, \nJosé Ramón García‐Berrocal\n

Publicatie 13-11-2020


AbstractThe role of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in head and neck cancer (HNC) prognosis is not well established. We conducted a systematic review focusing on MTV and TLG measured by 18F‐FDG positron‐emission tomography in HNC. Meta‐analyses were developed, estimating hazard ratios (HRs) for overall survival (OS) and disease‐free survival (DFS). Eighteen studies were found with a total of 1512 patients. MTV‐adjusted analysis had an HR of 4.65 (95% CI = 2.04‐10.6) for DFS and 3.89 (95% CI = 1.47‐10.30) for OS. TLG‐unadjusted analysis had an HR of 3.19 (95% CI = 2.33‐4.37) for DFS and 2.48 (95% CI = 1.82‐3.39) for OS. TLG‐adjusted analysis for DFS obtained an HR of 2.05 (95% CI = 0.96‐4.39). MTV and TLG are good prognostic factors in HNC, as high values predict a worse OS and DFS. Given the important information they provide, these parameters may be considered in clinical practice, as they are easily obtainable with current technology.

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Autofluorescence imaging to identify oral malignant or premalignant lesions: Systematic review and meta‐analysis

\nDo Hyun Kim, \nSung Won Kim, \nSe Hwan Hwang\n

Publicatie 13-11-2020


AbstractThe aim is to evaluate the accuracy of autofluorescence for screening oral cancer in comparison with toluidine blue staining and clinical examination. Oral mucosal disorders detected by autofluorescence were compared with those detected using toluidine blue staining. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. The diagnostic odds ratio (DOR) for autofluorescence was 8.197 (95% confidence interval, 4.018‐16.723). The area under the summary receiver operating characteristic curve (AUC) was 0.815. Compared with toluidine blue, autofluorescence had a similar sensitivity, negative predictive value, and AUC but a lower specificity and DOR. Compared with clinical examination, the autofluorescence had a higher sensitivity but lower specificity, DOR, and AUC. Although the diagnostic accuracy of autofluorescence in the screening work‐up of oral cancer and precancer was more sensitive than those of clinical examination and toluidine blue staining, it was not accurate enough to be used alone reliably.

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Role of resection of torus tubarius to maximize the endonasal exposure of the inferior petrous apex and petroclival area

\nLifeng Li, \nNyall R. London, \nDaniel M. Prevedello, \nRicardo L. Carrau\n

Publicatie 10-11-2020


AbstractEndoscopic access to the petrous apex and petroclival region often requires sacrificing the Eustachian tube (ET). This study aimed to compare the maximum exposure of the petrous apex and petroclival region via an endonasal corridor when sparing or resecting the ET and its torus. Six cadaveric specimens (12 sides) were dissected through an endonasal transpterygoid approach. Endonasal exposure of the petroclival region was completed using techniques that included the preservation of the ET (group 1), resection of the torus tubarius (group 2), and resection of the ET (group 3) were sequentially performed on each side. The working distances from the anterior genu of the petrous internal carotid artery (ICA) to the inferior boundaries of each corridor were measured and compared. In group 1, the medial petrous apex and petroclival sulcus could be exposed with a working distance of 4.08 ± 0.67 mm. In group 2, the fossa of Rosenmüller, inferior petrous apex, and hypoglossal canal could be exposed, with a significantly increased working distance of 18.33 ± 0.89 mm (P = .001). In group 3, the exposure and ICA control was superior and offered a working distance of 20.67 ± 0.78 mm. No statistically significant difference derived from comparing groups 2 and 3 (P = .875). Resection of the torus tubarius can increase exposure of the petrous apex and petroclival region. It provides an alternative to resecting the ET, which might be beneficial for maintenance of middle ear function. ET resection, however, seems superior when ICA control is required.

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Prognostic role of intraparotid lymph node metastasis in primary parotid cancer: Systematic review

\nOrlando Guntinas‐Lichius, \nJovanna Thielker, \nK. Thomas Robbins, \nKerry D. Olsen, \nAshok R. Shaha, \nAntti A. Mäkitie, \nRemco Bree, \nVincent Vander Poorten, \nMiquel Quer, \nAlessandra Rinaldo, \nLuiz Paulo Kowalski, \nJuan Pablo Rodrigo, \nMarc Hamoir, \nAlfio Ferlito\n

Publicatie 09-11-2020


AbstractBackgroundThe prognostic importance of intraparotid lymph node metastasis (P+) in patients with primary parotid gland carcinoma is unclear.MethodsNineteen retrospective and noncomparative cohort studies, published between 1992 and 2020, met the inclusion criteria and included 2202 patients for this systematic review.ResultsThe pooled prevalence of the P in adult patients in the unselected studies was 24.10% (95% confidence interval = 17.95‐30.25). The number of P+ lymph nodes per patient was counted in only three studies and ranged from 1 to 11. The 5‐year recurrence‐free survival rate based on Kaplan‐Meier analysis varied from 83% to 88% in P− patients compared to 36% to 54% in P+ patients. The average hazard ratio for tumor recurrence in patients with P+ compared to P− was 2.67 ± 0.58.ConclusionsP+ is an independent negative prognostic factor in primary parotid gland cancer and should be included into the treatment planning.

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Neoadjuvant selpercatinib for advanced medullary thyroid cancer

\nYelda Jozaghi, \nMark Zafereo, \nMichelle D. Williams, \nMaria K. Gule‐Monroe, \nJennifer Wang, \nElizabeth G. Grubbs, \nAra Vaporciyan, \nMimi I. Hu, \nNaifa Busaidy, \nRamona Dadu, \nSteven G. Waguespack, \nVivek Subbiah, \nMaria Cabanillas\n

Publicatie 09-11-2020


AbstractBackgroundTargeted kinase inhibitors have been increasingly utilized in the treatment of advanced medullary thyroid cancer (MTC) over the last decade. Recently, highly potent next generation selective RET inhibitors have been clinically validated, and selpercatinib was recently Food and Drug Administration (FDA)‐approved for advanced MTC. The advent of highly selective, potent RET inhibitors is broadening the treatment options for patients with RET‐mutated cancers.MethodsWe report the first published case of neoadjuvant selpercatinib followed by surgery for a patient with initially unresectable, widely metastatic, RET‐mutated MTC who was treated on a single patient protocol.ResultsAfter greater than 50% RECIST response, the patient underwent complete surgical resection followed by selpercatinib resumption. He remains locoregionally disease‐free 21 months after starting therapy with stable metastatic disease (after initial partial response); and calcitonin/CEA continue to decline.ConclusionThis novel treatment strategy for locoregionally advanced RET‐mutated MTC warrants further study in clinical trials.

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Accuracy of fine‐needle aspiration cytology in detecting cervical node metastasis after radiotherapy: Systematic review and meta‐analysis

"\nAndrea Costantino, \nGiuseppe Mercante, \nElisa DAscoli, \nFabio Ferreli, \nLuca Di Tommaso, \nCiro Franzese, \nCaterina Giannitto, \nManuele Casale, \nGiuseppe Spriano, \nArmando De Virgilio\n"

Publicatie 09-11-2020


AbstractPurposeTo define the accuracy of fine‐needle aspiration cytology (FNAC) in diagnosing persistent or recurrent neck metastases in previously irradiated patients.MethodsThe study was performed according to the PRISMA‐DTA guidelines.ResultsA total of 382 FNACs were used for calculation of diagnostic accuracy parameters. The overall pooled sensitivity and specificity in detecting malignant nodes were 69.1% (95% CI: 56.3%‐80.7%; I2 = 79.5%) and 84.2% (95% CI: 71.8%‐93.5%; I2 = 87.0%), respectively. Cumulative diagnostic odds ratio (DOR) was 16.54 (95% CI: 4.89‐38.99; I2 = 65.8%), while cumulative positive and negative likelihood ratio (PLR and NLR) were 5.4 (95% CI: 2.3‐11.2) and 0.37 (95% CI: 0.22‐0.54), respectively.ConclusionsFNAC alone could not guide the decision to perform a salvage neck dissection in previously irradiated patients, but its results should be assessed in relation to the specific clinical context.

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Institutional financial toxicity of failure to adhere to treatment guidelines for head and neck squamous cell carcinoma

\nJames M. Jurica, \nFelixnando Rubio, \nDavid J. Hernandez, \nVlad C. Sandulache\n

Publicatie 09-11-2020


AbstractBackgroundDelays in treatment of head and neck squamous cell carcinoma (HNSCC) are known to increase disease recurrence, generating the need for additional salvage treatment, often with immunotherapy.MethodsThree treatment metrics were identified: time from diagnosis to treatment initiation (TTI), time from surgery to postoperative radiotherapy (surg → PORT), and total treatment package time (TPT). Financial toxicity was calculated using hazard ratios, pembrolizumab cost, and dosing data for a Veterans Health Administration (VHA) institutional cohort (n = 338) and a standardized cohort (n = 100).ResultsEstimated financial toxicity for the VHA cohort was $2 047 407, $316 545, and $1 114 101 for TTI, surg → PORT, and TPT, respectively. Estimated financial toxicity for the standardized patient cohort was $454 028, $544 576, and $1 879 628 for TTI, surg → PORT, and TPT, respectively.ConclusionsFailure to meet established HNSCC treatment metrics generates significant, yet avoidable, institutional financial toxicity which is particularly relevant to integrated single‐payer systems such as the VHA in the modern immunotherapy era.

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Role of intraoperative recurrent laryngeal nerve monitoring for pediatric thyroid surgery: Comparative analysis

\nAmit Ritter, \nRoy Hod, \nYonatan Reuven, \nThomas Shpitzer, \nAviram Mizrachi, \nEyal Raveh, \nGideon Bachar\n

Publicatie 09-11-2020


AbstractBackgroundThe data on the advantages of intraoperative nerve monitoring (IONM) during pediatric thyroid surgeries are limited. We aimed to study the role of IONM by comparing between children who underwent thyroid surgery with and without IONM.MethodsA retrospective study of all children who underwent thyroid surgery between 2001 and 2019.ResultsThe study included 113 patients with 183 recurrent laryngeal nerve (RLN) at risk. Transient paralysis rate was more than 5‐fold lower in the IONM group compared to the control group (1.5% vs 8%; P = .114). Permanent paralysis was documented only in the control group (2.5% vs 0%; P = .552). Children <10 years and those who underwent central neck dissection had significantly higher rates of RLN injury.ConclusionsIONM was associated with decreased rate of RLN injury during pediatric thyroid surgery and should be considered especially in children under 10 years of age and those undergoing concomitant central neck dissection.

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Therapeutic implications of immune‐profiling and EGFR expression in salivary gland carcinoma

\nEmily Guazzo, \nCaroline Cooper, \nLisa Wilkinson, \nSophie Feng, \nBrigid King, \nFiona Simpson, \nSandro Porceddu, \nBenedict Panizza, \nJermaine I. G. Coward\n

Publicatie 09-11-2020


AbstractBackgroundData relating to the efficacy of immune checkpoint inhibitors (ICI) for salivary gland carcinomas (SGC) is gradually evolving with responses varying among different histotypes. To address these disparities, this retrospective analysis examined the prevalence of recognized biomarkers of response to ICI; namely programmed death‐1 (PD‐1), programmed death‐ligand 1 (PD‐L1), combined positive score (CPS), epidermal growth factor receptor (EGFR), and microsatellite instability (MSI) in patients with SGC with an aim to determine any prognostic or survival benefits and stratify the use of ICI in this disease.Patients and methodsOf 52 patients with primary SGC eligible for this study, the most common histological types were adenoid cystic carcinoma (n = 17, 33%), salivary duct carcinoma (n = 14, 27%), mucoepidermoid carcinoma (n = 11, 21%), and acinic cell carcinoma (n = 6, 11%). Immunohistochemistry (IHC) was performed using the Ventana Discovery Ultra auto‐staining platform for EGFR, PD‐1, PD‐L1, and mismatch repair (MMR) proteins. CPS ≥1 defined PD‐L1 positive cases and log‐rank testing was performed to examine the relationship between PD‐L1 expression status and disease‐free survival (DFS) and overall survival (OS).ResultsCPS positivity was seen in 9 (17.3%) patients, none of which were adenoid cystic carcinoma. All 52 (100%) cases expressed retained MMR proteins inferring microsatellite stability (MSS) and EGFR expression was identified in 45 of 52 (86.5%) patients. CPS positivity (score ≥1) was significantly associated with advanced pathological T status (P = .021), advanced pathological N status (P = .006), high histological tumor grade (P = .045), and positive histological margin (P = .023). Patients with PD‐L1 positivity in tumor cells did not have an inferior 3‐year OS (P = .93).ConclusionThe data from this retrospective study highlighting the uniform microsatellite stability alongside the low prevalence of CPS positivity suggests that only a minority of SGC patients may benefit from ICI therapy alone. The high rates of EGFR expression in SGC may be a target to augment immune checkpoint therapy response.

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microRNAs deregulation in head and neck squamous cell carcinoma

\nJuliana Carron, \nCaroline Torricelli, \nJanet K. Silva, \nGabriela S. R. Queiroz, \nManoela M. Ortega, \nCarmen S. P. Lima, \nGustavo J. Lourenço\n

Publicatie 06-11-2020


AbstractHead and neck (HN) squamous cell carcinoma (SCC) is the eighth most common human cancer worldwide. Besides tobacco and alcohol consumption, genetic and epigenetic alterations play an important role in HNSCC occurrence and progression. microRNAs (miRNAs) are small noncoding RNAs that regulate cell cycle, proliferation, development, differentiation, and apoptosis by interfering in gene expression. Expression profiling of miRNAs showed that some miRNAs are upregulated or downregulated in tumor cells when compared with the normal cells. The present review focuses on the role of miRNAs deregulations in HNSCC, enrolled in risk, development, outcome, and therapy sensitivity. Moreover, the influence of single nucleotide variants in miRNAs target sites, miRNAs seed sites, and miRNAs‐processing genes in HNSCC was also revised. Due to its potential for cancer diagnosis, progression, and as a therapeutic target, miRNAs may bring new perspectives in HNSCC understanding and therapy, especially for those patients with no or insufficient treatment options.

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Immune checkpoint expression in HNSCC patients before and after definitive chemoradiotherapy

\nJohannes Doescher, \nPeter Minkenberg, \nSimon Laban, \nUlrike Kostezka, \nAdrian Witzleben, \nThomas Karl Hoffmann, \nPatrick Johannes Schuler, \nStephanie Ellen Weissinger\n

Publicatie 06-11-2020


AbstractBackgroundPrimary platinum‐based chemoradiotherapy (CRT) remains the treatment of choice for nonresectable squamous cell carcinoma of the head and neck (HNSCC). Immune‐checkpoint modulators are used as palliative therapy and studied in combination with definitive CRT. However, the immunological changes by CRT need yet to be understood.MethodsA cohort consisting of 67 paired tissue biopsies (N = 134) of HNSCC patients before and after CRT was created. The expression of PD‐1, PD‐L1, and CD27 of tumor and immune cells by immunohistochemistry was evaluated.ResultsPD‐L1 expression on immune cells of non‐responders was significantly lower before CRT (P = .008). CD27 was expressed only on immune cells and not on cancer cells. A significant lower CD27‐expression score was observed following CRT (P = .019).ConclusionsConventional CRT changes the expression of CD27 in the tumor microenvironment. Whether this is due to a loss of expression or a reduction of CD27+ cells must be evaluated in further analyses.

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HIF‐1a expression and differential effects on survival in patients with oral cavity, larynx, and oropharynx squamous cell carcinomas

\nJustin E. Swartz, \nInge Wegner, \nRob Noorlag, \nPauline M. W. Kempen, \nRobert J. J. Es, \nRemco Bree, \nStefan M. W. Willems\n

Publicatie 05-11-2020


AbstractBackgroundHypoxia is a negative prognostic factor in head and neck squamous cell carcinomas. Under hypoxia, the hypoxia‐inducible factor (HIF)‐1a transcription factor is overexpressed. We investigated whether there were site differences in HIF‐1a expression and its effect on patient outcomes per subsite.Design/MethodA total of 941 patients with HNSCC in the squamous cell carcinoma of the oropharynx (OPSCC, n = 302), oral cavity (OSCC, n = 391), or larynx (LSCC, n = 248) were included. Expression of HIF‐1a in tissue samples was investigated using immunohistochemistry. Overall survival (OS), disease‐free survival (DFS), and locoregional control (LRC) were analyzed.ResultsHIF‐1a expression was higher in OSCC than in LSCC and OPSCC. High HIF‐1a expression led to worse prognosis in OPSCC (OS P = .029, DFS P = .085) and LSCC (OS P = .041, DFS P = .011) and better in OSCC (OS P = .055, DFS P = .012). There was no association between HIF‐1a and LRC.ConclusionsHigh HIF‐1a expression is related to poor outcome in OPSCC and LSCC and better outcome in OSCC.

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Regional disease control in sinonasal mucosal melanoma: Systematic review and meta‐analysis

\nArmando De Virgilio, \nAndrea Costantino, \nFederica Canzano, \nRemo Accorona, \nGiuseppe Mercante, \nFabio Ferreli, \nLuca Malvezzi, \nGiovanni Colombo, \nRaul Pellini, \nGiuseppe Spriano\n

Publicatie 05-11-2020


AbstractPurposeTo systematically analyze the regional disease control after sinonasal mucosal melanoma (SNMM) primary treatment.MethodsThe study was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, and Google Scholar databases.ResultsA total of 15 studies with 936 patients (median age: 68.0 years, IQR 65‐71) were included. Overall, the cumulative regional recurrence rate (RRR) was 18.4% (n = 917, 99% CI: 14.0%‐23.4%), with a median follow‐up of 30.0 months (n = 765, IQR 22.0‐37.0). The RRR in clinical node negative patients was 17.0% (99% CI: 12.2%‐22.5%), with a median follow‐up of 22.0 months (n = 327, IQR 21.5‐31.5).ConclusionsThe RRR of SNMM after primary treatment is not to be neglected. Further prospective studies should be encouraged to clarify if elective treatment of the neck could be recommended at least in a subgroup of patients.

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Mock clinical testing in the validation of fluid‐phase biomarkers for head and neck carcinoma diagnosis: A Scoping review

\nJohn Adeoye, \nChi Ching Joan Wan, \nPeter Thomson\n

Publicatie 05-11-2020


AbstractThis review sought to determine the range and nature of prospective‐sampling and blinding methods for validating nonviral biofluid markers diagnostic of head and neck carcinomas. Electronic database searching was conducted to identify studies published in English from January 1, 2009 to August 1, 2020. Sixteen studies from 17 articles published between 2011 and 2020 were included in this review. We found that about 3 out of 100 studies utilized at least one of the mock testing approaches for biomarker validation. Protein, mRNA, and metabolomic markers also represented the only groups whose validation has been attempted using these methods. Furthermore, studies that utilized both methods were found to have lower bias concerns on the quality assessment of diagnostic accuracy studies (QUADAS‐2) tool. Overall, there is a need to include these protocols in research endeavours verifying diagnostic biomarkers for head and neck carcinomas following the preliminary establishment of their classification accuracy.

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Analysis of palliative care treatment among head and neck patients with cancer: National perspective

\nChristopher Blake Sullivan, \nZaid Al‐Qurayshi, \nKristi Chang, \nNitin A. Pagedar\n

Publicatie 05-11-2020


AbstractBackgroundTo analyze the characteristics and survival patterns of patients with head and neck squamous cell carcinoma (SCC) who received palliative treatment during their first course of treatment.MethodsCohort analysis utilizing the National Cancer Data Base (NCDB) of patients with a diagnosis of oral cavity/oropharyngeal, hypopharyngeal, and laryngeal SCC. Statistical analysis included multivariate logistic regression and Cox Hazard ratio modeling, and Kaplan‐Meier survival analysis.Results165 081 patients were included, of which 2747 patients received palliative treatment. Patients who received palliative treatment tended to be ≥65 years old, black, Charlson/Deyo score ≥3, hypopharyngeal cancer, stage (III‐IV), with Medicaid insurance (P < .05). Patients were more likely to be treated with palliative intent if they underwent chemotherapy/radiotherapy and declined surgery (P < .001) compared to patients who underwent surgery and declined chemotherapy/radiotherapy (P = .006).ConclusionsPalliative care use in head and neck oncology is associated with older patients, non‐whites, Medicaid patients, and nonsurgically treated patients.

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Induction of interleukin‐6 by irradiation and its role in epithelial mesenchymal transition and radioresistance of nasopharyngeal carcinoma cells

\nXun Yuan, \nLinli Zhang, \nYu Huang, \nDongbo Liu, \nPing Peng, \nShunfang Liu, \nGuoxian Long, \nGuangyuan Hu, \nWei Sun\n

Publicatie 05-11-2020


AbstractBackgroundEpithelial mesenchymal transition (EMT) participates in the radioresistance of cancer cells. In this study, we evaluated whether interleukin‐6 (IL‐6) regulates EMT and subsequent radioresistance in nasopharyngeal carcinoma (NPC) cells.MethodsWestern blot was used to analyze the expression of proteins. Immunofluorescent assay was performed to detect the position and content of specific proteins. Colony formation assay was applied to measure the proliferation ability of NPC cells. Flow cytometry was adopted to measure cell apoptosis.ResultsNPC cells seen with typical morphological transition and unique proteins change of EMT when exposed to irradiation. IL‐6 and its downstream signal molecules elevated in irradiated cells. Blocking IL‐6 with anti‐IL‐6 receptor antibody hampered EMT and radioresistance. Cell radiosensitivity and apoptosis rates in irradiated NPC cells declined significantly upon IL‐6 stimulation.ConclusionIrradiation could induce EMT and activate IL‐6 signaling in NPC cell lines. Blocking IL‐6 was able to inhibit EMT and cellular radioresistance.

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Clinical evaluation of the efficacy of materials used for primary reconstruction of orbital floor defects: Meta‐analysis

\nMaeva Bourry, \nJean‐Benoit Hardouin, \nFabien Fauvel, \nPierre Corre, \nPierre Lebranchu, \nHélios Bertin\n

Publicatie 04-11-2020


AbstractBackgroundThe aim of this network meta‐analysis (NMA) was to compare the clinical results obtained after primary reconstruction of orbital floor fractures (OFF) using different materials.MethodsPubMed, Cochrane, and Google Scholar databases were screened from 1989 to 2019. For a study to be eligible, it had to evaluate two or more materials and report the following clinical parameters: diplopia and/or enophthalmos and/or other complications.ResultsNine studies involving 946 patients presenting with an OFF were included. After the surgical procedure, 105 patients (11%) had diplopia, while 43 patients (4.5%) suffered from enophthalmos. The NMA revealed that less postoperative diplopia and enophthalmos were obtained either by using polydioxanone (PDS), or a polymer of l‐lactic acid and dl‐lactic acid (PL/DLLA), or porous polyethylene, or titanium mesh compared with the use of autologous bone grafts.ConclusionP(L/DL)LA and PDS seem to be the best options for small and intermediate defects, whereas the association of porous polyethylene and titanium should be preferred for larger defects.

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Machine learning models to predict length of stay and discharge destination in complex head and neck surgery

\nKhodayar Goshtasbi, \nTyler M. Yasaka, \nMehdi Zandi‐Toghani, \nHamid R. Djalilian, \nWilliam B. Armstrong, \nTjoson Tjoa, \nYarah M. Haidar, \nMehdi Abouzari\n

Publicatie 03-11-2020


AbstractBackgroundThis study develops machine learning (ML) algorithms that use preoperative‐only features to predict discharge‐to‐nonhome‐facility (DNHF) and length‐of‐stay (LOS) following complex head and neck surgeries.MethodsPatients undergoing laryngectomy or composite tissue excision followed by free tissue transfer were extracted from the 2005 to 2017 NSQIP database.ResultsAmong the 2786 included patients, DNHF and mean LOS were 421 (15.1%) and 11.7 ± 8.8 days. Four classification models for predicting DNHF with high specificities (range, 0.80‐0.84) were developed. The generalized linear and gradient boosting machine models performed best with receiver operating characteristic (ROC), accuracy, and negative predictive value (NPV) of 0.72‐0.73, 0.75‐0.76, and 0.88‐0.89. Four regression models for predicting LOS in days were developed, where all performed similarly with mean absolute error and root mean‐squared errors of 3.95‐3.98 and 5.14‐5.16. Both models were developed into an encrypted web‐based interface: https://uci-ent.shinyapps.io/head-neck/.ConclusionNovel and proof‐of‐concept ML models to predict DNHF and LOS were developed and published as web‐based interfaces.

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2015 American Thyroid Association guidelines and thyroid‐stimulating hormone suppression after thyroid lobectomy

\nRobert Reed, \nAndrew Strumpf, \nTeresa G. Martz, \nKaitlin J. Kavanagh, \nKatherine L. Fedder, \nMark J. Jameson, \nDavid C. Shonka\n

Publicatie 30-10-2020


AbstractBackground2015 American Thyroid Association (ATA) guidelines recommended more conservative treatment in low‐risk well‐differentiated thyroid cancer (WDTC), stating that lobectomy alone may be sufficient. The guidelines further recommend mild thyroid‐stimulating hormone (TSH) level suppression (0.5‐2 mU/L) for this population. Our goal is to evaluate the natural history of patients undergoing lobectomy to determine the percentage that would require postoperative levothyroxine supplementation under these guidelines.MethodsRetrospective chart review of 168 patients that underwent lobectomy between 2010 and 2019 was performed. Preoperative and postoperative TSH values and the rate of patients prescribed levothyroxine were analyzed.ResultsThirty‐five percent of patients were prescribed levothyroxine postoperatively. At 6 weeks postoperatively, 66% had TSH value of >2; this increased to 76% by 6 to 12 months.ConclusionTo adhere to ATA guidelines for WDTC managed with lobectomy alone, the majority of patients (76%) would require postoperative levothyroxine supplementation. Low preoperative TSH was found to be the most significant predictor for postoperative TSH < 2.

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Prognostic value of the 8th edition American Joint Commission Cancer nodal staging system for patients with head and neck cutaneous squamous cell carcinoma: A multi‐institutional study

\nPeter P. Luk, \nArdalan Ebrahimi, \nMichael J. Veness, \nLachlan McDowell, \nMatthew Magarey, \nKan Gao, \nCarsten E. Palme, \nJonathan R. Clark, \nRuta Gupta\n

Publicatie 29-10-2020


AbstractBackgroundThe 8th edition American Joint Committee on Cancer staging manual (AJCC8) introduced a separate staging system for head and neck cutaneous squamous cell carcinoma (HNcSCC) which parallels mucosal SCC and incorporates extranodal extension (ENE). This study aims to evaluate its prognostic utility.MethodsUnivariate analysis of 1146 patients with metastatic HNcSCC from four Australian cancer centers was performed according to both AJCC 7th (AJCC7) and the 8th editions.ResultsAJCC8 increased classification of 924 (80.6%) patients to either pN2a or pN3b and 341 patients (29.8%) from stage III to IV compared to AJCC7. The disease‐specific survival (DSS) was not significantly different between pN1, pN2 or pN3a categories per AJCC8. Estimates of model performance for the AJCC8 pN staging revealed modest predictive capacity (Harrells C of 0.62 for DSS).ConclusionsThe risk stratification according to pN classification of AJCC8 staging system performed poorly as a prognostic indicator.

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Combined endoscopic and transoral resection of a high‐staged juvenile nasopharyngeal angiofibroma: A pictorial essay

\nWilson P. Lao, \nKristelle J. Lagabon, \nGabriel A. Arom, \nPaul C. Walker, \nSteve C. Lee\n

Publicatie 28-10-2020


AbstractJuvenile nasopharyngeal angiofibromas (JNAs) are highly vascular and benign tumors that can expand into the skull base. Delay of treatment can result in intracranial invasion, requiring extensive open approaches such as a facial translocation, maxillary swing, or an orbitozygomatic craniotomy. We describe a single‐stage, combined endoscopic and transoral approach on a 14‐year‐old male with extensive high‐stage dumbbell‐shaped JNA involving the infratemporal fossa, orbit, buccal space, and intracranial extension into Meckels cave. Successful resection of the tumor and good postoperative outcome was achieved. A transoral approach allowed for greater access to the infratemporal fossa, where endonasal resection was not possible, allowing for improved visualization, greater traction, and dissection. In select highly staged JNAs with significant lateral extension and intracranial involvement, successful and complete resection may be accomplished with this combined approach. Utilization of this approach avoids the morbidity of more invasive open approaches.

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Development of a multiomics database for personalized prognostic forecasting in head and neck cancer: The Big Data to Decide EU Project

\nStefano Cavalieri, \nLoris De Cecco, \nRuud H. Brakenhoff, \nMara Serena Serafini, \nSilvana Canevari, \nSilvia Rossi, \nDavide Lanfranco, \nFrank J. P. Hoebers, \nFrederik W. R. Wesseling, \nSimon Keek, \nKathrin Scheckenbach, \nDavide Mattavelli, \nThomas Hoffmann, \nLaura López Pérez, \nGiuseppe Fico, \nMarco Bologna, \nIrene Nauta, \nC. René Leemans, \nAnnalisa Trama, \nThomas Klausch, \nJohannes Hans Berkhof, \nVasilis Tountopoulos, \nRon Shefi, \nLuca Mainardi, \nFranco Mercalli, \nTito Poli, \nLisa Licitra, \nthe BD2Decide Consortium\n

Publicatie 27-10-2020


AbstractBackgroundDespite advances in treatments, 30% to 50% of stage III‐IV head and neck squamous cell carcinoma (HNSCC) patients relapse within 2 years after treatment. The Big Data to Decide (BD2Decide) project aimed to build a database for prognostic prediction modeling.MethodsStage III‐IV HNSCC patients with locoregionally advanced HNSCC treated with curative intent (1537) were included. Whole transcriptomics and radiomics analyses were performed using pretreatment tumor samples and computed tomography/magnetic resonance imaging scans, respectively.ResultsThe entire cohort was composed of 71% male (1097)and 29% female (440): oral cavity (429, 28%), oropharynx (624, 41%), larynx (314, 20%), and hypopharynx (170, 11%); median follow‐up 50.5 months. Transcriptomics and imaging data were available for 1284 (83%) and 1239 (80%) cases, respectively; 1047 (68%) patients shared both.ConclusionsThis annotated database represents the HNSCC largest available repository and will enable to develop/validate a decision support system integrating multiscale data to explore through classical and machine learning models their prognostic role.

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Nodal disease burden and outcome of medullary thyroid carcinoma

\nLindsey E. Moses, \nJamie R. Oliver, \nJanine M. Rotsides, \nQianhui Shao, \nKepal N. Patel, \nLuc G. T. Morris, \nBabak Givi\n

Publicatie 27-10-2020


AbstractBackgroundMedullary thyroid carcinoma (MTC) is a rare malignancy with high incidence of cervical lymph node (CLN) metastasis. We investigated the impact of nodal disease burden on survival.MethodsWe searched the National Cancer Database for MTC patients treated surgically. Impact of nodal metastasis on survival was analyzed using Cox univariable and multivariable regression.ResultsWe identified 2627 patients from 2004 to 2015. Positive CLNs were identified in 1433 (54.5%), and 542 (20.6%) had >10 CLN+. Overall survival was 94.5% and 89.6% at 3 and 5 years. Patients with 11 to 20 CLN+ had significantly worse survival than patients with 1 to 10 CLN+ in univariable and multivariable analyses (HR = 3.56 (2.31‐5.50) vs 2.26 (1.60‐3.20); P < .0001). The ratio of positive to dissected CLN was associated with overall survival.ConclusionsHigher burden of nodal disease is associated with worse survival in MTC. The number of positive nodes could be a valuable prognosticator in addition to the current staging system.

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Impact of early oral hydration on pharyngocutaneous fistula following total laryngectomy

\nOvie Edafe\n

Publicatie 26-10-2020


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Reply to the Letter to the Editor regarding “Early oral hydration protects against pharyngocutaneous fistula after total laryngectomy or total pharyngolaryngectomy”

\nMatthieu Le Flem, \nLaure Santini, \nCarole Boulze, \nAbdallah Alshukry, \nAntoine Giovanni, \nPatrick Dessi, \nNicolas Fakhry\n

Publicatie 26-10-2020


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Need for long‐term follow‐up in sinonasal inverted papilloma: A Single‐institution experience

\nGregori H. A. Binz, \nMichael B. Soyka, \nDavid Holzmann, \nChristian M. Meerwein\n

Publicatie 26-10-2020


AbstractBackgroundMost studies on sinonasal inverted papillomas (SNIPs) regarding risk factors for recurrence, recurrence rates (RRs) and malignant transformation are biased by a significant proportion of revision cases.MethodsRetrospective study on patients with consecutive, treatment‐naïve SNIPs at a tertiary referral center between 1999 and 2019.ResultsOverall, RR was 9.8% (10 of 102 patients), with 2 of 10 recurrences (20%) occurring after more than 5 years. Histopathological workup revealed synchronous malignancy in 2 of 102 patients (2%). Subgroup analysis revealed a significantly higher RR for SNIPs involving the frontal sinus (26.3% vs 6.0%, P = .02). No SNIPs primarily originating from the frontal sinus were observed.ConclusionOverall, RR of treatment‐naïve SNIPs is comparably low; however, long‐term follow‐up is mandatory due to late recurrences. Secondary involvement of the frontal sinus was identified as risk factor for recurrence. No SNIPs primarily originating from frontal sinus were observed.

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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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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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