Head and Neck 2022-09-27

The effect of adjuvant radiotherapy on clinical outcomes in early major salivary gland cancer

Wei‐Ju Hong, Shih‐Lun Chang, Chia‐Jen Tsai, Hung‐Chang Wu, Yi‐Chen Chen, Ching‐Chieh Yang, Chung‐Han Ho

Publication date 27-09-2022


Abstract Background This study investigated the effects of adjuvant radiotherapy on outcomes in early-stage major salivary gland cancers.
MethodsA total of 655 patients were identified, including 355 (54.2%) received adjuvant radiotherapy and 300 (45.8%) had surgery alone. The effect of adjuvant radiotherapy on 5-year locoregional recurrence and disease-specific survival (DSS) was calculated using the Kaplan–Meier method, Wilcoxon rank sum test, and Cox proportional hazards model.
Results There were no significant differences in locoregional recurrence and DSS between patients receiving adjuvant radiotherapy and those not in both univariate and multivariable analysis. Although patients with positive margin status had a higher locoregional recurrence and those with moderate/poor differentiation had a worse DSS, stratified analysis still indicated there were no protective effects from the use of adjuvant radiotherapy.
Conclusions The use of adjuvant radiation therapy was not associated with improved locoregional recurrence and DSS, even for those with high-risk histopathological factors.

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The computer‐aided design margin: Ex vivo 3D specimen mapping to improve communication between surgeons and pathologists

Kayvon F. Sharif, James S. Lewis, Kim A. Ely, Mitra Mehrad, Sumit Pruthi, James L. Netterville, Sarah L. Rohde, Alexander Langerman, Kyle Mannion, Robert J. Sinard, Eben L. Rosenthal, Michael C. Topf

Publication date 26-09-2022


Abstract Background Numerous challenges exist in determining surgical margin status. Communication between surgeons and pathologists is crucial for specimen orientation and accurate margin assessment.
MethodsA prospective study to determine feasibility of incorporating three-dimensional (3D) scanning into surgical pathology workflow was performed. A structured-light 3D scanner captured the photorealistic surface topography of fresh surgical specimens. Computer-aided design (CAD) software was used to document sites of margin sampling and sectioning. Surveys were distributed among faculty and staff stakeholders to assess feasibility.
ResultsA series of 40 cases were 3D-scanned. Median image acquisition time was 8 min. The majority of respondents agreed that the experimental 3D system helped achieve clearer communication. 3D specimen maps assisted in the communication of a focally positive or close margin in 4 of 17 cases.
Conclusions Routine 3D scanning and specimen mapping is feasible and represents an innovative approach to intraoperative and final pathology documentation, margin analysis, and surgeon–pathologist communication.

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Magnetic resonance imaging‐based radiomics model for predicting radiation‐induced temporal lobe injury in nasopharyngeal carcinoma after intensity‐modulated radiotherapy

Dan Bao, Yanfeng Zhao, Zhou Liu, Haijun Xu, Ya Zhang, Meng Yuan, Lin Li, Meng Lin, Xinming Zhao, Dehong Luo

Publication date 26-09-2022


Abstract Background To develop a model based on magnetic resonance imaging (MRI) radiomics and clinical features for predicting radiation-induced temporal lobe injury (RTLI) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).
Methods Two hundred and sixteen patients with NPC were retrospectively included. Radiomics features were extracted and selected. The logistic regression analysis was performed for prediction models construction. The area under the receiver operating characteristic curve (AUC) was calculated for performance evaluation.
Results Three radiomics features were selected to construct the radiomics signature (AUC of 0.94 and 0.92). The clinical-radiomics model, integrating radiomics signature with T classification, achieved higher predictive performance in the training and validation cohorts (AUC of 0.95 and 0.93), as well as improved accuracy of the classification of RTLI outcomes (net reclassification improvement: 0.711; 95% CI: 0.57–0.86; p < 0.001).
Conclusions The clinical-radiomics model and radiomics signature both showed great performance in predicting RTLI in patients with NPC.

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Low postoperative lymphocyte count increases risk of progression in human papillomavirus associated oropharyngeal cancer

Linda X. Yin, David M. Routman, Courtney N. Day, William S. Harmsen, Travis Haller, Kathleen Bartemes, Daniel L. Price, Eric J. Moore, Robert L. Foote, Michelle Neben‐Wittich, Ashish V. Chintakuntlawar, Daniel J. Ma, Katharine A. Price, Kathryn M. Van Abel

Publication date 21-09-2022


Abstract Background We aim to explore the prognostic role of absolute lymphocyte count (ALC) before, during, and after treatment on oncologic outcomes in human papillomavirus associated oropharyngeal cancer (HPV(+)OPSCC).
Methods Retrospective cohort at a tertiary center, 2006–2018. Multivariable Cox regressions were used to determine the effect of ALC on risk of progression. Univariate linear regression was performed to determine clinical factors associated with lower ALC.
Results All 197 patients underwent primary surgery. Mean (SD) ALC nadirs (×109 cells/L) were: baseline (N = 149): 1.69 (0.56); postoperative (N = 126): 1.58 (0.59); post-RT (N = 141): 0.68 (0.35) and long-term (N = 105): 0.88 (0.37). Lower baseline ALC nadir was associated with worse overall survival (HR 3.85, 95%CI: 1.03–14.29, p = 0.04). Lower postoperative ALC nadir was associated with higher risk of progression (HR 2.63, 95%CI: 1.04–6.67, p = 0.04).
Conclusions Lower baseline ALC is associated with worse survival, whereas lower postoperative ALC is associated with increased risk of progression in surgically treated HPV(+)OPSCC.
Level of Evidence3

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Occult metastasis to the superficial level VI lymph nodes in papillary thyroid carcinoma

Ha Na Lee, Chang Myeon Song, Yong Bae Ji, Jae Kyung Myung, Young‐Jun Lee, Kyung Tae

Publication date 21-09-2022


Abstract Background This study aimed to evaluate the incidence and risk factors of occult metastasis to superficial level VI, defined as the space anterior to the strap muscles, including the lymph nodes between the sternocleidomastoid and sternohyoid muscles and suprasternal space lymph nodes.
Methods We studied 129 patients with papillary thyroid carcinoma who underwent thyroidectomy and neck dissection, including superficial level VI dissection.
Results Of the 129 patients, 62 (48%) had lymph nodes in the harvested specimens of superficial level VI, and the mean number of lymph nodes retrieved was 1.9 ± 1.2. Occult metastasis to superficial level VI occurred in four patients (3.1%). No significant risk factors of superficial level VI occult metastasis were noted in multivariate analysis.
Conclusions Occult metastasis to superficial level VI was rare in patients with papillary thyroid carcinoma. Therefore, prophylactic dissection of superficial level VI may not be necessary for primary papillary thyroid carcinoma.

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Neuropathic pain prevalence and risk factors in head and neck cancer survivors

Raniv D. Rojo, Jenny L. Ren, Demis N. Lipe, Hoda Badr, Sanjay Shete, Ehab Y. Hanna, Cielito C. Reyes‐Gibby

Publication date 21-09-2022


Abstract Background Neuropathic pain (NP) is a debilitating symptom among head and neck cancer (HNC) survivors although few large studies report its prevalence and associated risk factors.
MethodsA cross-sectional survey assessing demographic, behavioral, and clinical risk factors for NP. NP was assessed using the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS).
Results Forty-five percent (227/505) reported having pain including 13.7% (69/505) who were positive for S-LANSS. Reported pain sites were in the regions of the head and oral cavity (46.2%) and neck and throat (41.5%). Despite a higher self-reported use of analgesic medication (NP+ = 41.2%; NP− = 27.4%; p = 0.020) and alternative pain therapies (NP+ = 19.1%; NP− = 8.4%; p = 0.009), severe pain was more prevalent among those with NP (N+ = 23.2%; NP− = 13.3%; p = 0.004). Adjusted for opioid medications, ethnicity/race, age, surgery, depression, and comorbidities were risk factors for NP.
ConclusionNP remains prevalent in HNC survivors highlighting the importance of routine pain surveillance.

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Two stage, hybrid endovascular and open surgical approach to treat difficult carotid body tumors

Gustavo Fink‐Josephi, Luis Mauricio Hurtado‐López, Aldo Francisco Hernández‐Valencia, Jesús Antonio Higuera‐Calleja, Guadalupe Guerrero‐Avendaño

Publication date 21-09-2022


Abstract Objective Present the feasibility, applicability, clinical effectiveness, and results of complicated Shamblin II or III carotid body tumors treated with a two-stage hybrid surgical approach.
Materials and Methods Retrospective, observational, cross-sectional, descriptive study of the successful treatment of 16 cases of difficult Shamblin II or III carotid body tumors, consisting of a two-stage surgical approach. We conducted a retrospective, observational, cross-sectional, descriptive study of a series of patients with complicated Shamblin II or III carotid body tumors, which we treated with a two-stage hybrid surgical procedure, in which we first placed a carotid endoprosthesis and 45 days later performed surgical resection of the tumor, following our originally published technique. This study was conducted from February, 2007 to November, 2019, in a third level care centre.
Results We treated 16 patients with a mean age of 50.5 years. All resided at more than 2000 meters above sea level. In all 16 a complete resection was performed. The average duration of surgery was 103.9 min, the average intraoperative bleeding was 69 ml. There were three cases of neuropraxia. The ansa cervicalis nerve had to be sectioned in three cases and there was permanent upper laryngeal nerve injury in two cases. There were no permanent cerebrovascular injuries from placement of the endoprostheses. One patient developed transient cerebral ischaemia (TIA) with no long-term sequelae. There were two cases of asymptomatic late occlusion of the endoprostheses. The average initial volume of the tumors was 54.4 cc. The average tumor volume 35 days after implant of the endoprosthesis was 30.9 cc.
Symptoms Presence of tumors in the neck in all cases and two cases of dysphagia.
Conclusion This two-stage hybrid technique allowed for the complete resection of difficult Shamblin II or III carotid body tumors, with one case of TIA and two with permanent upper laryngeal nerve injuries and without mortality.

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Return to work in patients with head and neck cancer: Systematic review and meta‐analysis

Justin Yu, Justin Smith, Ravi Marwah, Oskar Edkins

Publication date 19-09-2022


Abstract Background The aim of this review was to determine the prevalence of return to work (RTW) amongst head and neck cancer (HNC) survivors and to determine its impact on quality of life (QoL).
MethodsA literature search was conducted in Pub Med, Scopus, Embase and CINAHL in March 2021. Articles were included if they reported the number of patients with HNC receiving definitive treatment who were working at the time of diagnosis and returned to work.
Results There were 21 articles deemed eligible for inclusion. Meta-analysis suggested that 67% of patients with HNC who were employed at diagnosis RTW (95% CI 62%–73%, I2 = 97.53%). Patients who RTW were demonstrated to have lower levels of anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale.
Conclusions Return to work is an important clinical outcome which must be considered in the survivorship care of patients with HNC.

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Tracheostomy dependence following “organ preservation” (chemo)radiation protocol for laryngeal and hypopharyngeal cancers

Clare Jing Jing Batchelor, Stephanie Patricia Flukes

Publication date 19-09-2022


Abstract Background Patients receiving primary (chemo)radiotherapy for laryngeal or hypopharyngeal cancer risk developing severe laryngeal dysfunction and becoming tracheostomy dependent, detracting from the benefits of organ preservation. We aim to describe the airway outcomes for this cohort and identify risk factors for developing tracheostomy dependence.
Methods Patients with laryngeal or hypopharyngeal cancer who were recommended for and underwent primary (chemo)radiotherapy over a 6-year period were identified from a tertiary hospital Head and Neck cancer database. Patient, tumor, and treatment details were collected and analyzed.
Results Of 166 patients, 18.7% (N = 31) required tracheostomy insertion. Advanced tumor classification was the only significant predictor (p < 0.00001). Successful decannulation was observed in 12.9% (N = 4). Decannulation was observably less successful with advanced tumors, bilateral vocal cord immobility, tracheostomies inserted under emergency conditions.
Conclusion We quantified tracheostomy insertion rates and dependence in patients undergoing “organ-preserving” (chemo)radiotherapy, to assist in the pre-treatment counseling of patients opting for this approach.

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Radiomics based on magnetic resonance imaging for preoperative prediction of lymph node metastasis in head and neck cancer: Machine learning study

Yuepeng Wang, Taihui Yu, Zehong Yang, Yuwei Zhou, Ziqin Kang, Yan Wang, Zhiquan Huang

Publication date 17-09-2022


Abstract Background In this study, we use machine learning techniques to develop an efficient preoperative magnetic resonance imaging (MRI) radiomics approach for evaluation of cervical lymph node (CLN) status.
Methods After collecting all patients MRI images, we used CLN radiomic features, the apparent diffusion coefficients (ADC) from diffusion-weighted imaging (DWI), and lymph node short diameter of the CLN to build MRI model to predict the status of the CLN.
Results One hundred and twenty cases met inclusion criteria. The MRI model including the radiomic features, ADC, and lymph node size of the CLN achieved better performance for CLN status prediction with the area under the receiver operating characteristic (ROC) curve (AUC) of 0.83.
Conclusions The multiomic signature of MRI radiomics, ADC, and lymph node size of CLNs has high predictive value for the status of CLNs. This model has provided scientific value to the surgeon regarding cervical lymph nodes before surgery.

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Analysis of the accuracy of computer‐assisted DCIA flap mandibular reconstruction applying a novel approach based on geometric morphometrics

David Steybe, Philipp Poxleitner, Marc C. Metzger, Rainer Schmelzeisen, Maximilian F. Russe, Marc Anton Fuessinger, Leonard S. Brandenburg, Pit J. Voss, Stefan Schlager

Publication date 17-09-2022


Abstract Background This study evaluated the accuracy of computer-assisted surgery (CAS)–driven DCIA (deep circumflex iliac artery) flap mandibular reconstruction by traditional morphometric methods and geometric morphometric methods (GMM).
Methods Reconstruction accuracy was evaluated by measuring distances and angles between bilateral anatomical landmarks. Additionally, the average length of displacements vectors between landmarks was computed to evaluate factors assumed to influence reconstruction accuracy. Principal component analysis (PCA) was applied to unveil main modes of dislocation.
Results High reconstruction accuracy could be demonstrated for a sample consisting of 26 patients. The effect of the number of segments and length of defect on reconstruction accuracy were close to the commonly used significance threshold (p = 0.062/0.060). PCA demonstrated displacement to result mainly from sagittal and transversal shifts.
ConclusionsCAS is a viable approach to achieve high accuracy in mandibular reconstruction and GMM can facilitate the evaluation of factors influencing reconstruction accuracy and unveil main modes of dislocation in this context.

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Development of the remote 100 ml water swallow test versus clinical assessment in patients with head and neck cancer: Do they agree?

Laura‐Jayne Watson, Sarah H. Woodman, Deborah Ganderton, Kate A. Hutcheson, Shirley Pringle, Joanne M. Patterson

Publication date 16-09-2022


Abstract Background The 100 ml water swallow test (WST) is a validated swallow assessment used in head and neck cancer (HNC). We aimed to determine the level of agreement when completing the 100 ml WST via clinician-graded video-testing or patient self-testing compared to standard face-to-face assessment (FTF).
Methods Convenience sampling from four UK centers.
Inclusion criteria: patients with HNC treated with any modality prior to, or within 5 years of treatment. Participants were recruited to complete the 100 ml WST by video-testing or self-testing and compared with FTF.
Results Sixty-three patients were recruited; 1 was unable to perform the task; 30 in video-testing; and 32 in self-testing. There was no difference in swallow capacity (p = 0.424) and volume (p = 0.363) for the video-testing or the self-testing swallow capacity (p = 0.777) and volume (p = 0.445).
Conclusions This study demonstrates that video-testing and self-testing are reliable methods of completing the 100 ml WST for this sample of patients with HNC.

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Systemic conditions associated with increased risk to develop oral squamous cell carcinoma: Systematic review and meta‐analysis

Erison Santana Dos Santos, Maria Eduarda Pérez‐de‐Oliveira, Ana Gabriela Costa Normando, Luiz Alcino Monteiro Gueiros, Silvia Regina Rogatto, Pablo Agustin Vargas, Márcio Ajudarte Lopes, Eliete Neves Silva Guerra, Adriana Franco Paes Leme, Alan Roger Santos‐Silva

Publication date 16-09-2022


Abstract This study aimed to map systemic alterations predisposing to oral squamous cell carcinoma (OSCC) onset. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Five databases were used to access (1) reports of OSCC co-occurring in patients with systemic conditions, (2) prevalence of OSCC among these patients, and (3) clinicopathological profiles. Data from more than 1 million patients worldwide showed that Fanconis anemia, xeroderma pigmentosum, dyskeratosis congenital, chronic fatigue syndrome, and patients post bone marrow transplantation (BMT) present increased risk for OSCC development. The overall prevalence of OSCC in syndromic patients and post-BMT were 0.65% (95% CI = 0.13–3.11, p < 0.01) and 5.83% (95% CI = 0.00–30.90, p < 0.01), respectively. The certainty of the evidence was moderate. This study demonstrated that some systemic conditions predispose to OSCC. These results present an impact on the screening of OSCC in systemically compromised patients.

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The T‐shaped FST pharyngoplasty step‐by‐step closure technique

Gerardo Petruzzi, Danilo Di Giorgio, Federico Leone, Barbara Pichi, Flaminia Campo, Armando De Virgilio, Valentino Valentini, Raul Pellini

Publication date 15-09-2022


Abstract Pharyngocutaneous fistula is one of the most common and serious complications associated with total laryngectomy. Numerous studies tried to evaluate causative and predisposing factors associated with this complication, but data are considerably variable and there is still no international consensus. Incidence rate varies considerably between studies, with reported rates from 3% to 65%. This 4K video presents our T-shaped four-step technique (FST) for closing the pharyngeal mucosa after total laryngectomy in a step-by-step manner. All sutures were performed by braided absorbable 3/0 26 mm 1/2c (Vicryl plus 3.0; Ethicon, Somerville, NJ, USA). Recordings were performed using a Karl Storz 4K 3D VITOM® exoscope (Karl Storz SE & Co. KG, Tuttlingen, Germany). We have been described this technique through a high-definition video, showing each step, and tips from the authors. Our T-shaped pharyngoplasty closure technique can be divided into four steps: 1. “Key Stitches”; 2. “Area Refinement Stitches”; 3. “Modified Connell Suture”; 4. “Modified Purse String Suture.” Our T-shaped FST closure technique proved to be an effective and reproducible method, which we feel could be the preferred choice for primary pharyngoplasty closure.

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Epidemiology and treatment outcomes of cutaneous squamous cell carcinoma extending to the temporal bone

Michael J. C. Schachtel, Mitesh Gandhi, James J. Bowman, Sandro V. Porceddu, Benedict J. Panizza

Publication date 09-09-2022


Abstract Background Accurate epidemiological and outcomes data regarding cutaneous squamous cell carcinoma (cSCC) extending to the temporal bone is lacking.
Methods Retrospective analysis of 167 Australian patients with primary and peri-temporal bone cSCC.
ResultscSCC extending from secondary subsites (93.4%) was 14 times more frequent than primary temporal bone SCC (6.6%). For patients who underwent curative surgery ± post-operative radiotherapy (n = 146, 87.4%), 5-year disease-free survival, locoregional recurrence-free survival, disease-specific survival, and overall survival was 53.0%, 59.4%, 67.9%, and 44.7%, respectively. External ear and pre-auricular tumors, salvage surgery, tumor size (≥40 mm medial-lateral), nodal disease, and involved margins were negative predictors of survival in multivariable analysis.
Conclusion In regions of high sun exposure, cSCCs extending to the temporal bone are more common than primary cancers. Outcomes are improved with clear margins, justifying the need for radical resection. Further research regarding pre-auricular cancers is required given poorer associated survival outcomes.

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Preclinical feasibility of robot‐assisted sentinel lymph node biopsy using multi‐modality magnetic and fluorescence guidance in the head and neck

Giri Krishnan, Aidan Cousins, Nguyen Pham, Valentina Milanova, Melanie Nelson, Shridhar Krishnan, Nynke S. Berg, Anil Shetty, Eben L. Rosenthal, Peter‐John Wormald, Benjamin Thierry, Andrew Foreman, Suren Krishnan

Publication date 08-09-2022


Abstract Background Sentinel lymph node biopsy (SLNB) is a staging procedure dependent on accurate mapping of draining lymphatics via tracers. Robot-assisted SLNB enables access to multiple neck levels with a single incision and intraoperative fluorescence guidance to the SLN.
Methods Lymphatic mapping in swine was done using a magnetic tracer and fluorescent dye, injected into the tongue. MRI preoperatively mapped lymphatic spread of the magnetic tracer. Dissection was performed using a da Vinci Xi robot guided by fluorescence-imaging of the dye.
Results Robot-assisted SLNB was successfully performed in all animals (n = 5). A novel MRI protocol differentiated SLNs (n = 6) from lower echelon nodes (n = 11) based on flow progression. Fluorescence imaging provided valuable intraoperative guidance and correlated with magnetic-positive nodes.
Conclusions This study demonstrates preclinical feasibility of a robot-assisted approach to SLNB using magnetic and fluorescent tracers in the head and neck, enabling both preoperative mapping and intraoperative guidance.

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Characterizing critical predictors of an academic career following head and neck fellowship in otolaryngology

Neeraj V. Suresh, Mary Jue Xu, Jacob Harris, Eesha Balar, Louis‐Xavier Barrette, Kevin T. Chorath, Alvaro G. Moreira, Karthik Rajasekaran

Publication date 08-09-2022


Abstract Background Historically, graduating head and neck (HN) fellows outpace available academic HN positions, resulting in a highly competitive job market. We identified factors that associate with full-time academic HN positions post-HN fellowship.
Methods Graduates of American Head and Neck Society (AHNS)-accredited fellowships from 2005 to 2017 (n = 356) were extracted from the AHNS website.
Results From 2015 to 2017, the supply–demand mismatch for academic HN jobs improved. Of the 57.3% (n = 204) of graduating HN fellows who entered academia, 64% (n = 130) trained at just 10 fellowship institutions, 47% (n = 94) attended OHNS residency at an NIH top 40 funded institution, and 54% (n = 111) attended OHNS residency at an AHNS-accredited institution offering HN fellowship. After multivariate regression, number of manuscripts (OR = 1.14; p = 0.01) was significantly associated with initial academic job post-fellowship.
Conclusion The recent improvement in supply–demand mismatch for academic jobs is promising for future HN fellows interested in academia.

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Delayed tracheal rupture following transoral endoscopic thyroidectomy vestibular approach: Case report and review of the literature

Yu‐jing Weng, Ben‐ling Hu, Jiang Jiang, Lei Min, Qing Ai, De‐biao Chen, Wei‐chun Chen, Zhi‐heng Huang

Publication date 07-09-2022


Abstract Background Although the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been proven to be a safe procedure for select patients, as it is a novel approach, all associated complications require adequate attention.
Methods We presented a 49-year old woman who underwent TOETVA developed delayed tracheal rupture 1 week after surgery. An extensive search of literature was carried out using Pub Med, Embase, and Web of Science for studies reporting tracheal injury following endoscopic thyroidectomy.
Results Thirteen cases of endoscopic thyroidectomy were analyzed, including eight cases of TOETVA. Tracheal injury occurred during various procedures, including accidental dissection, surgical needle puncture, Hegar dilation and trocar placement, and thermal injury by the energy device.
Conclusions Tracheal injury following TOETVA is an underreported complication that can be induced by various factors. Thermal injury to the trachea is more likely to cause a delayed rupture. Careful blunt dissection and standardized use of energy devices are suggested.

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Epstein–Barr virus‐associated leiomyosarcoma of the larynx in an adult patient with human immunodeficiency virus infection: Case report and review of the literature

Jian‐Di Jin, Zhe Chen, Zai‐Zai Cao, Shui‐Hong Zhou, Xiu‐Ming Zhang, Hong‐Tian Yao

Publication date 07-09-2022


Abstract We investigated the clinical features, treatment, and prognosis of laryngeal leiomyosarcoma (LLMS) and Epstein–Barr virus-associated (EBV-associated) LMS. We report a case of EBV-associated LLMS in an adult patient with HIV infection. We also conducted a review of the English-language literature on LLMS and EBV-associated leiomyosarcoma. To the best of our knowledge, 62 cases of LLMS and EBV-associated leiomyosarcoma have been reported to date. Of patients with LLS, 18.9% had distant metastases and 17.0% had local recurrence. The overall 5-year survival rate was 64.0%. Distant metastases affected the survival of patients with LLMS (p = 0.04). EBV-positive patients had a low survival rate (p = 0.01). Among patients with EBV-associated LMS, 8.2% had distant metastases and recurrence and the overall 5-year survival rate was 50.0%. EBV-associated LLMS is rare. The EBV infection might be a poor prognostic factor of LLMS.

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Correlation between radiologic and pathologic extranodal extension in HPV‐associated oropharyngeal cancer: Systematic review

Tristan Morey, John‐Charles Hodge, Cindy Stern, Suren Krishnan, Andrew Foreman

Publication date 07-09-2022


Abstract Pretreatment determination of extranodal extension (ENE) has significant clinical implications in human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Unfortunately there is no gold-standard imaging modality for radiological assessment of ENE in HPV+ OPSCC, leading to subjective assessments and complex decision making concerning ENE. A systematic review of diagnostic test accuracy was therefore undertaken, with five databases systemically searched to evaluate the diagnostic performance of an imaging modality for detection of ENE in HPV+ OPSCC. A meta-analysis was conducted on four CT studies using a random-effects model. While a narrative synthesis was provided for the studies using PET/CT and “CT and MRI.” Out of 1772 hits, six studies were included in the review. Meta-analysis on four CT studies showed CT had an overall sensitivity of 77% and specificity of 60%. PET/CT had a sensitivity of 37.5% and specificity of 97%. “CT and MRI” had a sensitivity of 62% and specificity of 78%. Further diagnostic studies involving CT, PET/CT and MRI are ultimately required.

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Three‐dimensional exoscope‐assisted single‐stage tracheal resection

Francesca Pirola, Giuseppe Mercante, Elena Russo, Caterina Giannitto, Luca Malvezzi, Fabio Ferreli, Giuseppe Spriano, Umberto Cariboni, Armando De Virgilio

Publication date 06-09-2022


Abstract The three-dimensional (3D) 4K exoscope is a surgical tool recently introduced in numerous fields of otolaryngology, such as microvascular surgery, otology, and laryngology. However, other surgical fields may also benefit from this technology. In this case, a single-stage tracheal resection was planned with the aid of the 3D 4K exoscope, in a 75-year-old female with post-tracheostomy tracheal stenosis. High-quality magnification of the surgical field was obtained, with facilitated skeletonization of the laryngotracheal axis. The exoscope provided greater involvement in surgery and allowed more interactions among all operating room personnel and learners, as they could access the same field of view of the first surgeon, as well as perceiving depth of the surgical field with 3D technology. The exoscope represents a valid application in open surgery performed for laryngotracheal stenosis, with advantages of enhancing training and education, allowing precise surgical dissection, and reducing risks of iatrogenic damage to surrounding structures.

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Utilizing 3D head and neck specimen scanning for intraoperative margin discussions: Proof of concept of our novel approach

Michael P. Saturno, Margaret Brandwein‐Weber, Lily Greenberg, Alex Silberzweig, Daniel Buchbinder, Eric M. Dowling, Mohemmed N. Khan, Raymond Chai, Mark L. Urken

Publication date 06-09-2022


Abstract Background The current standard of documenting and communicating frozen section margin results is inefficient. We present a novel method of generating 3D digital models of gross tumor specimens to more clearly visualize histopathological margin results.
Methods Fifty-five head and neck specimens were scanned and virtually “inked” using 3D software. These 3D specimen maps were displayed in the operating room to provide the surgeon with a real-time specimen-to-defect relationship by which further resections could be guided.
Results Margin results were reported within an average of 34 min using the proposed workflow. The scanner rendered accurate models of specimens that exceeded 3.0 × 3.0 × 3.0 cm. Critical specimen features to consider were size, color, textural complexity, and the presence of discernible anatomic landmarks.
Conclusions Optical 3D scanning technology can improve the quality of head and neck margin documentation and the efficiency with which results are communicated between the pathologist and surgeon.

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Superiority of metastatic lymph node ratio over number of node metastases and TNM/AJCC N classification in predicting cancer‐specific survival in medullary thyroid cancer

Andreas Machens, Kerstin Lorenz, Frank Weber, Henning Dralle

Publication date 06-09-2022


Abstract Background In medullary thyroid cancer (MTC), it is unclear which nodal classification system, metastatic lymph node ratio (MLNR), number of node metastases, or TNM/AJCC N classification, predicts cancer-specific survival best.
Methods Kaplan–Maier analysis of cancer-specific survival after operation at a tertiary center.
Results Included were 505 MTC patients. The spread of the survival curves was greatest after stratification by MLNR (in 0.20 increments), followed by number of node metastases (in 10-node and 20-node increments) and TNM/AJCC classification (N0, N1a, N1b). After collapsing overlapping survival curves, all adjacent curves (MLNRs ≤0.20 vs. 0.21–0.60 vs. >0.60; 0 vs. 1–20 vs. >20 node metastases; and TNM/AJCC N classification N0/N1a vs. N1b) significantly differed between each other.
Conclusions In MTC, MLNR, reflecting intensity of lymphatic spread, predicts cancer-specific survival better than number of node metastases or TNM/AJCC N classification. The applicability of these findings to patients with limited neck dissection requires more research.

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Functional and biomechanical assessment of the hand following ulnar forearm free flap transfer: Prospective self‐controlled study

Maged Ali Al‐Aroomi, Mubarak Ahmed Mashrah, Zhongzheng Qi, Changfu Sun, Weiyi Duan

Publication date 05-09-2022


Abstract Background There is a shortage of well-designed self-controlled studies evaluating hand biomechanics following ulnar forearm flap (UFF) harvest. This study was conducted to evaluate objective and subjective functional outcomes of the donors hand following UFF harvest.
Methods All patients undergoing UFF were included for analysis. Grip strength, wrist movement, forearm supination and pronation, pinch strengths, sensation to light touch and temperature, and hand dexterity were assessed preoperatively and at 1, 3, and 6 months postoperatively. In addition, DASH score (disabilities of the arm, shoulder, and hand score) and Patient and Observer Scar Assessment Scale (POSAS) were analyzed.
ResultsA total of 18 patients were enrolled. A significant reduction in grip strength for donors hand was observed between preoperative and postoperative 1 and 3 months (mean difference = 14 kg, 7.38 kg, respectively, p = 0.000 for all). A similar trend was observed for pinch strength and range of motion (p < 0.05). Three months after surgery, there is still a significant reduction in tip pinch, tripod pinch, wrist extension, and supination. All biomechanics outcomes returned to preoperative baseline at 6 months after surgery. No patients suffered significant changes in sensation to light touch, temperature, and numbness by 6 months. There was a significant increase in DASH score by 3.37 points 6 months after operation (p = 0.000). The POSAS score indicates satisfaction with the appearance of the donor site.
ConclusionsUFF is a safe and reliable option for oral cavity reconstruction with minimum donor site morbidities, mainly when cosmesis is paramount. Furthermore, objective hand biomechanics ultimately returns to its preoperative state within 6 months after surgery.

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Long‐term outcomes of high dose carbon‐ion radiation therapy for unresectable upper cervical (C1‐2) chordoma

Shuri Aoki, Masashi Koto, Hiroaki Ikawa, Reiko Imai, Omatsu Tokuhiko, Makoto Shinoto, Hirotoshi Takiyama, Shigeru Yamada, Hiroshi Tsuji

Publication date 05-09-2022


Abstract Background Chordoma is a rare, locally invasive neoplasm of the axial skeleton. Complete resection is often difficult, especially for the upper-cervical (C1-2) spine. We evaluated the efficacy and safety of carbon-ion radiotherapy (CIRT) for unresectable C1-2 chordoma.
Methods Patients with C1-2 chordoma treated with definitive CIRT (60.8 Gy RBE in 16 fractions) were retrospectively analyzed. We evaluated OS, LC, PFS, and toxicity.
Results Nineteen eligible patients all completed the planned course of CIRT. With the median follow-up 68 months (range: 29–144), median OS was 126 months (range: 36-NA). Five-year OS, LC, and PFS were 68.4% (95% CI, 42.8%–84.4%), 75.2% (46.1%–90.0%), and 64.1% (36.3%–82.3%), respectively. Regarding acute toxicity of grade ≥3, there was only one grade 3 mucositis. Late toxicity included radiation-induced myelitis (grade 3 in 1 patient; 5.3%), and compression fractures (n = 5; 26.3%).
Conclusions High-dose CIRT is a promising treatment option for unresectable upper cervical chordoma.

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Presentation and outcomes of patients with clinically T1‐2, N0 parotid mucoepidermoid carcinoma: The roles of elective neck dissection and adjuvant radiotherapy

Zaid Al‐Qurayshi, Christopher Blake Sullivan, Derek B. Allison, Marisa R. Buchakjian

Publication date 05-09-2022


Abstract Objectives Examine the role of elective neck dissection (END) and adjuvant radiotherapy (RT) in early-stage clinically N0 parotid mucoepidermoid carcinoma (MEC).
Methods The study is a retrospective analysis of the National Cancer Database, 2004–2016. The study population included adult patients with MEC who underwent parotidectomy.
ResultsA total of 1233 patients were included. Histopathology demonstrated well, moderately, and poorly differentiated MEC 47.12%, 39.98%, and 12.90% of the time, respectively. END was performed in 78.67% of patients, resulting in nodal upstaging in 4.43% and identification of extracapsular extension (ECE) in 0.72%. RT was utilized in 67.33% of patients with advanced pathological features. Neither END nor RT improved overall survival separately (p < 0.05) or combined (adjusted HR: 1.19, 95%CI: 0.52, 2.70, p = 0.68).
Conclusion This study provides an epidemiological perspective regarding patients with clinically T1-2, N0 MEC. There was no observed survival advantage with END and RT.

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Exploring the impact of metabolic imaging in head and neck cancer treatment

Diana Raquel Dias Domingues, Michelle M. Leech

Publication date 05-09-2022


Abstract Background Target volume delineation is performed with anatomical imaging for head and neck cancer. Molecular imaging allows the recognition of specific tumor regions. Its inclusion in the pathway could lead to changes in delineation and resultant treatment plans.
MethodsPRISMA methodology was adhered to when selecting the articles for analysis and only full articles were quality assessed.
Results Seventeen articles were included. Gross tumor volume (GTV) primary, GTV nodal, and other target volumes were evaluated. Positron emission tomography/computerized tomography (PET/CT) produced smaller primary GTVs, although not with diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI) or PET/MRI. The impact of these image modalities on GTV nodal did not display any consistency. Additionally, there was considerable heterogeneity in metrics comparing delineations. Four studies included appraised the dosimetric impact of the changes in target volume delineation.
Conclusion Quantifying the impact of molecular imaging is difficult, due to heterogeneity in reporting metrics in molecular imaging modalities and a paucity of detail regarding delineation method and guideline adherence.

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Voice and communication after open partial horizontal laryngectomies: A cross‐sectional outcome study

Marco Fantini, Erika Crosetti, Nicole Pizzorni, Andrea Elio Sprio, Andy Bertolin, Giuseppe Rizzotto, Antonio Schindler, Giovanni Succo

Publication date 05-09-2022


Abstract Objective The present study evaluates voice and communication after open partial horizontal laryngectomies (OPHLs), according to surgery and patient-related variables.
Methods Fifty-eight patients were included: 18 type I OPHL, 20 type II OPHL and 20 type III OPHL. Acoustic, aerodynamic, endoscopic, perceptual and self-assessment analyses were carried out. Surgery-related variables and patient-related variables were considered for the analysis.
Results Type I OPHL revealed the best phonatory outcomes. Type II and type III OPHL showed similar and poor results, with a highly deteriorated voice quality. A significant difference in MTP was found for patients who had both arytenoids/cricoarytenoid units preserved. Age and time from surgery showed significant correlations with voice quality after OPHLs.
Conclusions Voice and communication outcomes after OPHLs are heterogeneous and might be influenced by several factors. Knowing variables with a substantial impact on phonatory outcomes may help clinicians in the preoperative decision-making process and the postoperative rehabilitative program.

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Prognostic value of computed tomography scan detection of cartilage invasion in advanced laryngeal cancer treated with primary total laryngectomy

Maxwell Y. Lee, Jonathan Lee, Sarah Stock, Mario Belfiglio, Brian Matia, Shlomo Koyfman, Nikhil P. Joshi, Brian B. Burkey, Eric Lamarre, Brandon Prendes, Joseph Scharpf, Robert R. Lorenz, Neil M. Woody, David J. Adelstein, Jessica L. Geiger, Deborah J. Chute, Jamie A. Ku

Publication date 05-09-2022


Abstract Background We sought to determine whether detection of cartilage invasion (CI) by computed tomography predicts oncologic outcomes after primary total laryngectomy.
Methods Retrospective cohort study comparing oncologic outcomes between radiologic versus pathologic diagnosis.
Results Assessment of clear CI versus gestalt CI resulted in 84% versus 48% specificity, 90.9% versus 80.3% positive predictive value (PPV), 60.6% versus 80.3% sensitivity, 44.7% versus 48% negative predictive value (NPV), respectively. Disease-free survival (DFS) was similar between cT4a and cT3/cT2 patients (p = 0.87). DFS trended towards superiority among pT3/pT2 versus pT4a patients (p = 0.18). DFS was similar among patients with CI on radiologist gestalt versus no CI (p = 0.94). Histologically confirmed CI was associated with a hazard ratio (HR) of 1.46 (p = 0.27), gestalt CI 1.13 (p = 0.70), and clear CI 1.61 (p = 0.10) for DFS.
Conclusion Gestalt determination of CI results in high sensitivity but low specificity, while clear determination of CI results in moderate sensitivity and high specificity.

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Endonasal access to the lateral poststyloid space: Far lateral extension of an endoscopic endonasal corridor

Lifeng Li, Nyall R. London, Leslie R. Kim, Daniel M. Prevedello, Ricardo L. Carrau

Publication date 05-09-2022


Abstract The styloid process constitutes the posterolateral boundary for an endonasal exposure of the infratemporal fossa. This study aims to explore the feasibility of a far-lateral extension to the lateral poststyloid space via an endonasal corridor. An endonasal dissection was performed on six cadaveric specimens (12 sides). Following an endoscopic endonasal access to the parapharyngeal space, the styloid process and the tympanic portion of the temporal bone were removed to reveal the jugular bulb and the extratemporal facial nerve. Distances from the anterior nasal spine to the relevant landmarks were measured using a surgical navigation device. Through an endonasal corridor, only the anteroinferior aspect of the jugular bulb was exposed. Conversely, the extratemporal facial nerve could be sufficiently exposed, and the deep temporal nerve could be transposed to the stylomastoid foramen. The average horizontal distances from the nasal spine to the posterior tract of V3, styloid process, and facial nerve were 79.33 ± 3.41, 97.10 ± 4.74, and 104.77 ± 4.42 mm, respectively. Access to the lateral poststyloid space via an endonasal corridor is feasible, potentially providing an alternative approach to address select lesions extending to this region. The deep temporal nerve has a similar diameter to that of the facial nerve; thus, providing potential reinnervation of the facial nerve.

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Performance of the Neck Imaging Reporting and Data System as applied by general neuroradiologists to predict recurrence of head and neck cancers

Jonathan Lee, Dagan Kaht, Syed Ali, Scott Johnson, Jennifer Bullen, Christopher Karakasis, Eric Lamarre, Jessica Geiger, Shlomo Koyfman, Sarah Stock

Publication date 05-09-2022


Abstract Background The Neck Imaging Reporting and Data System (NI-RADS) is used to assess imaging after head and neck cancer treatment. We evaluated NI-RADS with general neuroradiologists rather than with head and neck subspecialists.
Methods Computed tomography and magnetic resonance imaging examinations with/without positron emission tomography from May 2018 to September 2020 were retrospectively identified. NI-RADS scores at the primary site and lymph nodes were provided by 21 neuroradiologists. Recurrence status was based on clinical and imaging findings. Area under the curve (AUC) was used to assess accuracy.
Results We assessed 608 scans from 464 patients. For NI-RADS categories 1, 2, and 3, primary site recurrence rates were 5%, 29%, and 65% with AUC of 0.765, while lymph node recurrence rates were 3%, 10%, and 80% with AUC of 0.820.
ConclusionsNI-RADS as used by general neuroradiologists is effective in separating head and neck cancers into discrete categories for predicting recurrent disease.

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Characteristics and outcomes of young patients with laryngeal cancer: National hospital‐based retrospective cohort analysis

Alex Yang, Priscilla Tanamal, Kathleen Tibbetts, Baran Sumer, James‐Michael Blackwell, Kelly Schostag, David Sher, Andrew Day

Publication date 05-09-2022


Abstract Background The relative incidence of laryngeal cancer is rising in young patients, yet their characteristics, risk factors, and outcomes relative to older patients are poorly understood.
Methods Retrospective cohort analysis of the National Cancer Database from 2006 to 2015.
Results Among 25 029 total patients, 923 (3.7%) were young (<45 years old) and 3266 underwent tumor HPV testing. Compared to older patients, a greater proportion of young patients were female (30.3%, 23.3%; p < 0.001) and seen with high-risk HPV-positive tumors (29.9%, 12.4%; p < 0.001). In subset analyses of young patients, females with higher income (≥$38 000) exhibited a decreased risk of overall mortality compared to all other sex-income subcategories (adjusted hazard ratio aHR: 0.43, 95% confidence interval CI: 0.25–0.72). In subset analyses of patients of all ages with known tumor HPV status, patients with high-risk HPV-positive tumors exhibited a reduced risk of all-cause mortality (aHR: 0.74, 95%CI: 0.60–0.92, p = 0.007).
Conclusion The interdependent associations between age, sex, tumor HPV status, and income on laryngeal cancer outcomes warrant further investigation.

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Disparities in the impact of the AJCC 8th edition staging system on differentiated thyroid cancer outcomes

Juan A. Santamaria‐Barria, Amanda N. Graff‐Baker, Shu‐Ching Chang, Adam Khader, Anthony J. Scholer, Mary Garland‐Kledzik, Melanie Goldfarb

Publication date 05-09-2022


Abstract Background The impact of AJCC8 among self-reported racial/ethnic groups on differentiated thyroid cancer (DTC) outcomes is unknown.
Methods Multivariate-regression evaluated the association between AJCC7 to AJCC8 stage change and race/ethnicity in patients with DTC in the NCDB. Cox-proportional-regression evaluated whether AJCC7 to AJCC8 stage change affects overall survival (OS) differently based on reported race/ethnicity.
Results After adjusting for confounders, Hispanics and Asian-Pacific-Islanders (APIs) were 27% and 12% less likely to be down-staged compared to white-non-Hispanics (WNHs) (p < 0.001); black-non-Hispanics (BNHs) had no significant down-staging difference. Down-staged patients had an increased risk of death compared to patients with unchanged staging, regardless of race/ethnicity. However, based on two-way interaction, the magnitude of this negative change on survival from down-staging was only different between WNHs (HR = 2.64) and BNHs (HR = 1.77), (p = 0.04).
Conclusions Outcome disparities persist among self-reported racial/ethnic groups with AJCC8. Down-staged patients across all racial/ethnic groups had decreased survival compared to those with unchanged stage, with the least impact in BNHs.

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Exposure to alcohol and overall survival in head and neck cancer: A regional cohort study

Alexander Denissoff, Teemu Huusko, Sami Ventelä, Solja Niemelä, Johannes Routila

Publication date 05-09-2022


Abstract Background There is a paucity of knowledge regarding the association of alcohol use with overall survival (OS) of patients with head and neck squamous cell carcinoma (HNSCC).
Methods All 1033 patients treated for new HNSCC in Southwest Finland regional referral center of Turku University Hospital in 2005–2015. Cox regression analysis was used. Tumor TNM classification, age at baseline and tobacco smoking status were assessed as potential confounders.
ResultsA history of severe harmful alcohol use with major somatic complications (HR: 1.41; 95%CI: 1.06–1.87; p = 0.017) as well as current use of at least 10 units per week (HR: 1.44, 95%CI: 1.16–1.78; p = 0.001) were associated with OS.
Conclusions Alcohol consumption of 10–20 units/week, often regarded as moderate use, was found to increase risk of mortality independent of other prognostic variables. Systematic screening of risk level alcohol use and prognostic evaluation of alcohol brief intervention strategies is highly recommended.

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Development of a novel signature derived from single cell RNA‐sequencing for preoperative prediction of lymph node metastasis in head and neck squamous cell carcinoma

Yibin Dai, Ziyu Wang, Enshi Yan, Jin Li, Han Ge, Na Xiao, Jie Cheng, Pengfei Diao

Publication date 05-09-2022


Abstract Background Lymph node metastasis (LNM) is considered as an adverse prognostic indicator for cancer patients. Preoperative knowledge of LNM is valuable for pretreatment decision making. Here, we sought to develop and validate an LNM signature for preoperative prediction of LNM in patients with head and neck squamous cell carcinoma (HNSCC).
Methods By studying single cell RNA-sequencing data (scRNA-seq), differentially expressed mRNA were selected and analyzed through univariate logistic regression and least absolute shrinkage and selection operator (LASSO) to identify an LNM signature. Multivariate logistic regression was utilized to establish an LNM nomogram incorporating LNM signature and T-classification.
Results The LNM signature was significantly associated with lymph node status and prognosis. The LNM signature and LNM nomogram displayed a robust predictive effect.
Conclusion Our study reveals that LNM signature is a powerful biomarker for preoperative prediction of LNM in patients with HNSCC, which may be effective to realize individualized outcome prediction.

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African American race as a risk factor associated with a second primary lung cancer after initial primary head and neck cancer

Yusra F. Shao, Seongho Kim, John D. Cramer, Dina Farhat, Jeffrey Hotaling, Syed Naweed Raza, George Yoo, Ho‐sheng Lin, Harold Kim, Ammar Sukari, Misako Nagasaka

Publication date 05-09-2022


Abstract Background Initial primary head and neck cancer (IPHNC) is associated with second primary lung cancer (SPLC). We studied this association in a population with a high proportion of African American (AA) patients.
Methods Patients with IPHNC and SPLC treated between 2000 and 2017 were reviewed for demographic, disease, and treatment-related characteristics and compared to age-and-stage-matched controls without SPLC. Logistic and Cox regression models were used to analyze the relationship of these characteristics with the development of SPLC and overall survival (OS).
Results Eighty-seven patients and controls were compared respectively. AA race was associated with a significantly higher risk of developing SPLC (OR 2.92, 95% CI 1.35–6.66). After correcting for immortal time bias, patients with SPLC had a significantly lower OS when compared with controls (HR 0.248, 95% CI 0.170–0.362).
Conclusions We show that AA race is associated with an increased risk of SPLC after IPHNC; reasons of this increased risk warrant further investigation.

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Feasibility of robotic thyroidectomy via hairline incision using da Vinci single port system: Initial experience with 40 consecutive cases

Tae‐Koon Kim, Minjung Seo, Seol Hoon Park, Jin Il Kim, Soon Joon Kim, Jae Hyun Kim, Yong Han Kim, Myung Woul Han

Publication date 05-09-2022


Abstract Background This study aimed to introduce our robotic technique, which can minimize dissection extent using the da Vinci SP robotic system via hairline incision.
Methods Forty patients underwent robotic thyroidectomy using the da Vinci SP robotic system via a hairline incision between February 2020 and April 2021 at Ulsan University Hospital. All procedures were performed successfully by one surgeon using the SP robotic system.
Results Hemithyroidectomies were performed in 32 patients and total thyroidectomies in eight patients. Central neck dissection was performed in 32 patients. The overall mean operative time was 140.2 ± 50.7 min, and the mean console time was 74.0 ± 42.7 min. All patients were discharged on the second or third day after operation without any complications.
Conclusions Robotic thyroidectomy using the SP robotic system via hairline incision is technically feasible and safe, with a shorter incision length when compared with that of the Xi system.

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Association of low skeletal muscle mass and systemic inflammation with surgical complications and survival after microvascular flap reconstruction in patients with head and neck cancer

Najiba Chargi, Omar Breik, Tymour Forouzanfar, Timothy Martin, Prav Praveen, Matthew Idle, Satyesh Parmar, Remco Bree

Publication date 05-09-2022


Abstract Background Skeletal muscle mass (SMM) and chronic inflammation are associated with postoperative complications and survival.
Methods Patients with head and neck cancer (HNC) undergoing microvascular free flap reconstruction were included. SMM and neutrophil-to-lymphocyte ratio (NLR) were measured and their association with treatment outcomes analyzed.
Results Five hundred and fifty-four patients were included. Predictors for complications were elevated NLR in all flaps (OR 1.5), low SMM in radial forearm flap (OR 2.0), and elevated NLR combined with low SMM in fibula flap surgery (OR 4.3). Patients with solely elevated NLR were at risk for flap-related complications (OR 3.0), severe complications (OR 2.2), and when combined with low SMM for increased length of hospital stays (LOS) (+3.9 days). In early-stage HNC, low SMM (HR 2.3), and combined elevated NLR with low SMM (HR 2.6) were prognostics for decreased overall survival.
ConclusionsSMM and NLR are predictive for poor outcomes in patients with HNC undergoing microvascular reconstruction.

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The robotic‐assisted extended “Sistrunk” approach for tumors of the upper aerodigestive tract with limited transoral access: First description of oncological and functional outcomes

Christian Simon, Avinash Beharry, Vinidh Paleri, Pascaline Dübi, Karma Lambercy, F. Christopher Holsinger, Jelena Todic

Publication date 05-09-2022


Abstract We report on the first clinical experience with the robotic-assisted extended “Sistrunk” approach (RESA) for access to constrained spaces of the upper aerodigestive tract. This prospective case cohort study include six patients that underwent RESA if transoral exposure could not be achieved. Three patients received previous radiation. Patients were postoperatively followed until week 16 for perioperative complications, surgical margins, and functional outcomes. In all patients RESA allowed adequate exposure and resection with negative margins. Three patients who underwent salvage surgery experienced a minor or intermediate grade postoperative bleeding. No patient developed a pharyngocutaneous fistula. Three patients recovered their swallowing to their preoperative status and the remaining three experienced an improvement. All patients experienced complete recovery of their voice. RESA has the potential to provide a new organ preservation approach for head and neck cancer (HNC) not amenable to transoral exposure and thus warrants further prospective clinical studies.

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Deriving prognostic significance from a molecular subtype model of laryngeal carcinoma

Yibo Zhou, Jiahong Wang, Zhongxi Huang, Pinggui Gong, Minqiang Xie

Publication date 05-09-2022


Abstract Background This study explored whether laryngeal carcinoma could be divided into different subtypes based on molecular differences using a molecular subtype-prediction model.
Methods We extracted data from the Cancer Genome Atlas and Gene Expression Omnibus databases and then performed unsupervised cluster analysis to identify discrete molecular subtypes of laryngeal carcinoma. Significance analysis of microarrays was performed to detect differentially expressed genes for each subtype, and gene set enrichment analysis and the Gen CliP3 software were used to label gene functions and identify key pathways.
Results We categorized 126 patients into C1 and C2 molecular subtypes associated with pathologic grade. The C2 subtype appeared more aggressive, with a worse prognosis. The most significant enrichment pathway of the C2 subtype was the Hedgehog pathway, and GLI1 was a core gene.
Conclusions Laryngeal carcinoma can be divided into two subtypes based on differences in molecular expression, which could identify key molecules associated with prognosis.

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Association of post‐treatment longitudinal symptom severity clusters with subsequent survival in oropharyngeal cancer

Ghazal Haddad, Katrina Hueniken, Maria Christine Xu, Scott Bratman, John Almeida, David Goldstein, Shao Hui Huang, Aaron Hansen, Andrew Hope, Anna Spreafico, Wei Xu, Geoffrey Liu

Publication date 05-09-2022


Abstract Background Patients with cancer often experience multiple symptoms concurrently. We identified patient clusters based on longitudinal symptom severity trajectories in oropharyngeal cancer (OPC) and evaluated the potential clinical utility of this approach.
MethodsA retrospective OPC patient cluster analysis using 6 months of symptom severity data from radiotherapy initiation. The clinico-demographic characteristics and overall survival of patients were compared between clusters.
Results We identified four clusters of patients differing in longitudinal symptom severity. Cluster A (n = 168) included patients with the mildest longitudinal symptoms, cluster B (n = 59) and cluster C (n = 63) were intermediate, and cluster D (n = 30) included patients with the worst symptoms. The clusters differed in their HPV status, ECOG performance status, smoking history, drinking history, treatment modality, and 5-year survival. These clusters separated symptom severity trajectories more distinctly than individual clinico-demographic characteristics.
Conclusions Early symptom severity trajectory clustering revealed distinct patient clusters that were prognostic of overall survival.

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Comparative effectiveness and stage‐shift effect of endoscopic exam among newly diagnosed oral cancer patients with different stages in Taiwan

Chi‐Mei Ho, Yi‐Hsun Chen, Wen‐Hung Hsu, Winnie Yen‐Yun Wang, Shyng‐Shiou F. Yuan, I‐Chen Wu, Hui‐Min Hsieh

Publication date 05-09-2022


Abstract Background Patients with oral cancer are at higher risk of developing second primary esophageal cancer (SPEC) and the consensus for screening strategies remains unclear. This study aimed to examine comparative effectiveness and the stage-shift effect of endoscopic exam among patients with oral cancer.
MethodA population-based longitudinal retrospective observational matched case and control cohort study with at least 5 years follow-up was conducted. We identified 45 457 newly diagnosed patients with oral cancer, 2004–2013, and the eligible patient with oral cancer was 39 401. Propensity score matching was used to match comparable groups, and the two groups (screening vs. nonscreening) was 5941, individually. The study primary endpoints were to compare detection of incident SPEC and the stage-shift effect of endoscopic screening between screened and nonscreened incident oral cancer patients. Cox proportional hazard and competing risk models were analyzed. Statistical analyses were conducted in 2020–2021.
Result Detection of incident SPEC in the screened group was significantly higher than in the nonscreened group (hazard ratio: 2.92, 95% confidence interval CI: 2.29–3.72). The stage-shift effect from endoscopic screening was found overall in patients with oral cancer (odds ratio OR: 0.39, 95%CI: 0.21–0.70), in particular in advanced-stage patients (OR: 0.25, 95%CI: 0.11–0.61), but not in early-stage patients (OR: 0.60, 95%CI: 0.26–1.40).
Conclusion This study confirmed that endoscopic screening achieved early detection of SPEC among patients with oral cancer. To improve the screening stage-shift effect, patients with oral cancer are encouraged to undergo routine endoscopic screening.

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Durable response in a patient with recurrent respiratory papillomatosis treated with immune checkpoint blockade

Ke Bai, Scott M. Norberg, Cem Sievers, Tanya Meyer, Jay Friedman, Christian Hinrichs, Clint T. Allen

Publication date 05-09-2022


Abstract Background Immune checkpoint blockade can provide clinical benefit for patients with advanced cancer. Here, we report durable disease control over many years following PD-L1 blockade through induction of a viral antigen-specific T cell response in an adult patient with recurrent respiratory papillomatosis.
Methods Antigen-specific T cell response assays, single cell RNA-sequencing, and RNA-scope was used to study clinical tissues.
Results An HPV6 E2-specific T cell clone restricted to HLA-B*55, present at low frequency in the pre-treatment papilloma, significantly expanded after six doses of PD-L1 blockade and remained present and functional at the site of initial response in the larynx as a tissue resident memory T cell for 4 years. An associated reduction in E2 target gene was observed following treatment.
Conclusions Although demonstrated in a single exceptional responder, these results highlight that immune checkpoint blockade may induce durable, viral antigen-specific immunity of sufficient magnitude to control disease in patients with nonmalignant disorders.

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Reply to Letter to the Editor regarding “Zygomatic implant perforated (ZIP) flap technique: A milestone in rehabilitation of low‐level maxillectomy”

Chris J. Butterworth, Derek Lowe, Simon N. Rogers

Publication date 05-09-2022


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Letter to the Editor: “Zygomatic implant perforated (ZIP) flap technique: A milestone in rehabilitation of low‐level maxillectomy”

Radhika Jain, Sandeep Gurav, Gurkaran Preet Singh

Publication date 05-09-2022


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Stroboscopy and High‐Speed Imaging of the Vocal Function, Second Edition, Peak Woo, Plural Publishing, 2022, 437, Price: $299.95

Barbara Ebersole

Publication date 05-09-2022


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Issue Information

Publication date 05-09-2022


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Sentinel lymph node biopsy in high‐risk cutaneous squamous cell carcinoma of the head and neck: Systematic review and meta‐analysis

Andrea Costantino, Luca Canali, Bianca Maria Festa, Giuseppe Spriano, Giuseppe Mercante, Armando De Virgilio

Publication date 05-09-2022


Abstract The aim of our study was to better define the role of sentinel lymph node biopsy (SLNB) in high-risk cutaneous squamous cell carcinoma of the head and neck (cSCCHN). A systematic review and meta-analysis was performed according to the PRISMA statement. Seven-hundred and five patients were included from 20 studies. The pooled SLN identification rate was 98.8% (95%CI: 97.0–99.8). The median number of SLN excised was 3.6 (n = 371, 95%CI: 2.0–4.4). The pooled SLNB positive rate and cumulative regional recurrence rate (RRR) in negative SLNB were 5.6% (95%CI: 2.6–9.6) and 2.9% (95%CI: 0.5–7.2), respectively. The high SLN identification rate demonstrates SLNB feasibility in cSCCHN. The low SLNB positive rate and the relatively high RRR raise some doubts concerning its clinical utility. Further studies are mandatory to define predictors of lymph node metastases able to better select patients that may benefit from a SLNB.

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Current trends in carotid body tumors: Comprehensive review

Mauricio Gonzalez‐Urquijo, Alejandra Castro‐Varela, Alanna Barrios‐Ruiz, David E. Hinojosa‐Gonzalez, Ana Karen Garza Salas, Erick Ambriz Morales, Mirna González‐González, Mario Alejandro Fabiani

Publication date 05-09-2022


Abstract Background Carotid body tumor (CBT) is a rare neoplasm that has been increasingly studied during the last decades; nevertheless, it continues to be a topic of controversy. This review aims to provide an update on the general features of CBT and particularly review different treatment strategies and primary outcomes.
Methods Data for this literature review were identified by Pub Med, Scopus, and Medline. 93 articles from the initial search were included, as well as 28 relevant studies utilizing the snowballing method; totaling 121 articles about CBT.
Results Main features such as anatomy, embryology, genetics, clinical presentation, and diagnosis of CBT are presented, followed by evidence of different treatment strategies such as radiotherapy, preoperative embolization, vascular resection, and vascular reconstruction. Main complications are also discussed.
Conclusion This review summarizes the most critical aspects regarding CBT. Future studies should compare different treatments to attain the best surgical results with lower morbidity rates.

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Cytologic diagnosis of parotid gland Warthin tumor: Systematic review and meta‐analysis

Roie Fisher, Ohad Ronen

Publication date 05-09-2022


Abstract It is important to define the accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of Warthin tumor (WT). This systematic review and meta-analysis evaluated the accuracy of FNAC in the diagnosis of WT in the parotid gland and WT growth rate. For determination of FNAC accuracy, 17 studies, encompassing 1710 cases, were included. Pulled random model estimates of sensitivity, specificity, PPV, and NPV were 93.7% (95%CI: 92.1, 95.3), 97.9% (95%CI: 97, 98.9), 93.3% (95%CI: 91.5, 95.1), and 97.4% (95%CI: 96.4, 98.4), respectively. FNAC is highly reliable for the diagnosis of WT of the parotid. The high PPV value suggests that patients with a cytological diagnosis of WT of the parotid may be assigned to active surveillance.

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Prevalence and prognostic impact of retropharyngeal lymph nodes metastases in oropharyngeal squamous cell carcinoma: Meta‐analysis of published literature

Giancarlo Tirelli, Nicoletta Gardenal, Enrico Zanelli, Daniele Borsetto, Veronica Phillips, Alberto Vito Marcuzzo, Jonathan Fussey, Jerry Polesel, Paolo Boscolo‐Rizzo

Publication date 05-09-2022


Abstract Background This systematic review and meta-analysis aims to estimate the prevalence and prognostic impact of retropharyngeal lymph node metastases (RLNMs) in oropharyngeal squamous cell carcinoma (OPSCC).
Methods This meta-analysis was conducted according to PRISMA guidelines.
Inclusion criteria: studies with more than 20 patients reporting the prevalence or prognostic impact of RLNMs in OPSCC. Whenever available, data on HPV status and subsites were extracted.
Results Twenty-two articles were included. The overall prevalence of RLNMs in OPSCC was 13%, with no significant differences depending on HPV status. The highest prevalence was observed for posterior pharyngeal wall SCC (24%), followed by soft palate (17%), palatine tonsil (15%), and base of tongue (8%). RLNMs were associated with a significantly higher risk of death (HR:2.54;IC95%1.89–3.41) and progression (HR:2.44;IC95%1.80–3.30).
Conclusions The prevalence of RLNMs in OPSCC was 13%, being higher in tumors of the posterior pharyngeal wall. RLNMs were associated with unfavorable outcomes.

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Systematic review of head and neck lymphedema assessment

Matthew Fadhil, Ravjit Singh, Thomas Havas, Ian Jacobson

Publication date 05-09-2022


Abstract Head and neck lymphedema (HNL) is an increasingly recognized complication of head and neck cancer and its treatment. However, no consensus exists on the “gold-standard” assessment tool for the purposes of diagnosis, classification, or monitoring of HNL. We conducted a systematic review of the literature regarding HNL assessment to determine the optimal method/s of assessment for patients with HNL. A review of publications between January 2000 and September 2021 was undertaken on four electronic databases. Studies were excluded if no clear assessment method of HNL was documented. Sixty-seven articles were included in the study. A wide range of assessment methods for HNL have been reported in the literature. For the purposes of diagnosis and classification of physical findings, computed tomography (CT) appears the most promising tool available for both external and internal HNL. In terms of monitoring, ultrasound appears optimal for external HNL, while a clinician-reported rating scale on laryngoscopy is the gold standard for internal HNL. Patient-reported assessment must be considered alongside objective methods to classify symptom burden and monitor improvement with treatment.

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Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with human papillomavirus‐related squamous cell cancer: Long‐term results

Somiah Siddiq, Sarah Stephen, Daniel Lin, Hannah Fox, Max Robinson, Vinidh Paleri

Publication date 03-09-2022


Abstract Introduction To report the long-term oncological and functional outcomes of en bloc TORS lateral oropharyngectomy to address the close/involved margin following diagnostic tonsillectomy in HPV-related SCC of unknown primary.
Material and methodsA single tertiary center observational cohort over a 4-year period. Primary outcome measures were disease-specific survival (DSS), overall survival (OS), and PSS NOD (Performance Status Scale-Normalcy of Diet) scores.
ResultsTORS specimens did not evidence residual carcinoma in 93% of patients. Of 14 patients, 50% received surgery alone (median follow-up 57 months; range 46–96), the remainder surgery and adjuvant therapy (median follow-up of 58 months; range 51–69) with 100% DSS, OS and no deterioration of PSS NOD scores.
Conclusions Long-term oncological outcomes confirm TORS lateral oropharyngectomy alone is an oncologically safe treatment. Due consideration of this approach is warranted to mitigate against the morbidity of adjuvant radiotherapy treatment in this group of patients.

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Monitoring postoperative ambulation and sleep after head and neck surgery: A feasibility and utility study using wearable devices

Vivek C. Pandrangi, Matthew Jorizzo, Suparna Shah, Jennifer Bruening, Mark K. Wax, Daniel Clayburgh, Peter Andersen, Ryan J. Li

Publication date 02-09-2022


Abstract Background To evaluate use of wearable activity devices to monitor trends in ambulation and sleep after head and neck surgery.
Methods Patients utilized Fitbit devices after surgery. Daily activity and sleep scores, step counts, and total sleep time (TST) were obtained.
Results There were 30 patients within the final cohort. Trends in step counts after specific procedures were identified, and higher subjective activity level correlated with step counts (r = 0.25, 95% CI = 0.07–0.41). Among patients with complete step data (n = 24), POD1 steps ≥200 were associated with reduced length of stay (4.5 ± 1.7 days vs. 7.2 ± 4.0 days, 95% CI = 0.33–5.0). Mean TST was 5.4 ± 2.5 h, TST correlated with subjective sleep scores (r = 0.25, 95% CI = 0.03–0.044), and clinical events associated with sleep–wake transitions on Fitbit devices were identified.
Conclusions Wearable activity devices appear feasible for monitoring trends in postoperative ambulation and sleep. Use of these devices may facilitate postoperative recovery.

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Multi‐institutional review of sinonasal and skull base chondrosarcoma: A 20‐year experience

Jacob G. Eide, Rijul S. Kshirsagar, Jacob C. Harris, Alyssa Civantos, Robert M. Brody, John Y. K. Lee, Michelle Alonso‐Basanta, Jillian W. Lazor, Ali Nabavizadeh, Beverly Y. Wang, Edward C. Kuan, James N. Palmer, Nithin D. Adappa

Publication date 02-09-2022


Abstract Background Chondrosarcomas of the sinonasal cavity and skull base are uncommon malignancies. We sought to provide long-term outcomes at two tertiary care centers.
Methods Patients with chondrosarcoma treated between 2000 and 2021 were included. The primary outcomes were overall survival (OS) and disease-specific survival (DSS).
Results Thirty-eight patients met inclusion criteria. Fourteen patients had sinonasal (36.8%), 7 petroclival (18.4%), and 17 other primary skull base lesions (44.7%). Twenty-eight patients (73.7%) underwent radiation with an average dose of 67.3 ± 15.1 Gy. Eighteen patients (47.4%) required revision surgery for recurrence. 1, 5, and 10-year OS were 97.3%, 93.1%, and 74.7%. DSS at 5- and 10-year survival was 95.7%. Adjuvant radiation was associated with improved OS (HR: 0.12; 95% CI: 0.02–0.75, p = 0.023).
Conclusion We present our experience over the last 20 years treating chondrosarcomas. Favorable survival outcomes can be achieved but recurrence requiring repeat resection is common.

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Intensity‐modulated radiotherapy with planned Gamma Knife radiosurgery boost for head and neck cancer with extensive disease in proximity to critical structures

Joshua C. Farris, Cole R. Steber, Paul J. Black, Michael D. Chan, James D. Ververs, Christina K. Cramer, James D. Browne, Joshua D. Waltonen, Christopher A. Sullivan, Hafiz S. Patwa, Adrian W. Laxton, Stephen B. Tatter, Bart A. Frizzell, Mercedes Porosnicu, Thomas W. Lycan, Kathryn M. Greven, Ryan T. Hughes

Publication date 01-09-2022


Abstract Background To describe intensity-modulated radiotherapy (IMRT) with Gamma Knife Radiosurgery (GKRS) boost for locally advanced head and neck cancer (HNC) with disease near dose-limiting structures.
Methods Patients with HNC treated with IMRT/GKRS as part of a combined modality approach between 2011 and 2021 were reviewed. Local control, overall survival and disease-specific survival were estimated using the Kaplan Meier method.
Results Twenty patients were included. Nineteen patients had T3-4 tumors. Median follow-up was 26.3 months. GKRS site control was 95%. Two patients progressed at the treated primary site, one patient failed at the edge of the GKRS treatment volume, with no perineural or intracranial failure. 2-year OS was 94.7% (95% CI: 85.2%–100%). Concurrent chemotherapy was given in nine patients (45%). One patient (5%) received induction/concurrent chemotherapy. Brain radionecrosis occurred in three patients, one of which was biopsy-proven.
ConclusionsIMRT plus GKRS boost results in excellent disease control near critical structures with minimal toxicity.

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Diagnostic test accuracy of sentinel lymph node biopsy in squamous cell carcinoma of the oropharynx, larynx, and hypopharynx: A systematic review and meta‐analysis

Sven Bosch, Michal Czerwinski, Tim Govers, Robert P. Takes, Remco Bree, Abrahim Al‐Mamgani, Gerjon Hannink, Johannes H. A. M. Kaanders

Publication date 01-09-2022


Abstract The aim of this meta-analysis was to determine the diagnostic test accuracy of sentinel lymph node biopsy (SLNB) in patients with oropharyngeal, laryngeal, and hypopharyngeal squamous cell carcinoma (SCC). For this purpose, MEDLINE, EMBASE, and Web of Science were searched from inception to March 8, 2022. Included were studies evaluating diagnostic test accuracy of SLNB to identify cervical lymph node metastases with elective neck dissection or follow-up as reference. A bivariate generalized linear mixed model approach was used for the meta-analysis. Nineteen studies were eligible, evaluating 377 cases in total. The pooled estimates of sensitivity and negative predictive value were 0.93 (95% CI: 0.86–0.96) and 0.97 (95% CI: 0.94–0.98), respectively. The excellent accuracy of SLNB justifies a place in the diagnostic workup of patients with larynx and pharynx SCC. Randomized trials are required to demonstrate oncologic safety and benefits on treatment related morbidity and quality of life when omitting elective neck treatment based on SLNB.

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Endoscopic pituitary surgery: A national database review

Zaid Al‐Qurayshi, Douglas M. Bennion, Jeremy D. W. Greenlee, Scott M. Graham

Publication date 30-08-2022


Abstract Background Pituitary tumors surgery is increasingly performed via endoscopic transsphenoidal approach (TSP). This study describes outcomes of TSP surgery in the United States.
MethodsA retrospective cross-sectional analysis of adult patients with pituitary adenoma was performed using the Nationwide Readmissions Database, 2010–2015.
ResultsA total of 5891 patients were identified. The average age was 51.29 ± 0.29 years. The risk of postoperative epistaxis, diabetes insipidus, cerebrospinal fluid (CSF) leak, and other general postoperative complications was 0.71%, 10.20%, 8.35%, and 2.37%, respectively.
Independent risk factors of CSF leak included: age <65-year, male, body mass index ≥25, and multiple comorbidities (p < 0.001 each). The prevalence of CSF leak was not associated with hospital TSP volume and teaching status.
Conclusion This study provides a national epidemiological perspective on TSP in the United States. The risk of postoperative CSF leak appears to be associated with intrinsic patient factors rather than resource and expertise availability.

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Elevated preradiotherapy serum lactate dehydrogenase predicts distant metastasis for lymphoepithelial carcinoma of major salivary gland following postoperative radiotherapy

Wenbin Yan, Yang Liu, Chunying Shen, Junlin Yi, Xiaomin Ou, Chaosu Hu

Publication date 24-08-2022


Abstract Background To evaluate the predicting factors associated with distant metastasis (DM) for lymphoepithelial carcinoma of salivary gland (LECSG) following postoperative radiotherapy (PORT).
Methods We retrospectively collected 160 eligible patients from two cancer institutions. The DM rate was evaluated using competing risk method.
Results The median follow-up time was 65.6 months. Elevated preradiotherapy serum LDH (ratio >0.5) (p = 0.006) and N classification (N2-3) (p = 0.001) were independently associated with DM for the LECSG. After the risk stratification, the high-risk subgroup was defined as the patients presented higher risk score (score >0), whereas 5-year cumulative incidence of DM in the high- and low-risk group was 30.9% and 6.0%, respectively (p < 0.001). Moreover, a significantly worse overall survival (OS) was observed in the high-risk patients compared with the low-risk subgroup (5-year OS: 83.9% vs. 97.8%, p = 0.006).
Conclusion Elevated preradiotherapy serum LDH could serve as a predictive factor for DM in the LECSG following PORT.

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Immune‐modified Glasgow prognostic score: A new prognostic marker for head and neck cancer

Kosuke Terazawa, Toshimitsu Ohashi, Hirofumi Shibata, Takuma Ishihara, Takenori Ogawa

Publication date 23-08-2022


Abstract Background The modified Glasgow prognostic score (mGPS) includes C-reactive protein and serum albumin levels and is a useful prognostic tool for malignant tumors. The immune system affects cancer progression and recurrence and treatment response. We hypothesized that increasing the lymphocyte count improves mGPS, and we created a new prognostic marker termed immune-mGPS (imGPS).
Methods This study included 461 patients with head and neck squamous cell carcinoma (HNSCC). The imGPS was calculated as the conventional mGPS with one additional point for a low lymphocyte count (<1250/μL).
Results Addition of the lymphocyte count to mGPS significantly increased the area under the time-dependent receiver operating characteristic curve for overall and progression-free survivals. The added predictive abilities of this tool were supported by improvement in both net reclassification and integrated discrimination.
ConclusionimGPS is a more accurate predictor of clinical outcome in patients with HNSCC than mGPS.

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Development and validation of prognostic nomograms in patients with ascending type of nasopharyngeal carcinoma: A retrospective study based on SEER database

Kai‐Hua Chen, Yu‐Ting Jiang, Rong Zhao, Yong‐Chu Sun, Xiao‐Dong Zhu

Publication date 20-08-2022


Abstract Background Nomograms specifically used to predict the prognosis of ascending type nasopharyngeal carcinoma (NPC) have not been constructed.
Methods Data of ascending type (T3-4N0-1M0) NPC from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015 were extracted.
Results Altogether 862 patients with ascending type NPC were enrolled, including 603 in training cohort and 259 in validation cohort. Age, marital status, pathology, grade, tumor size, T classification, and chemotherapy were the independent prognostic factors for overall survival (OS). Age, marital status, pathology, grade, and chemotherapy were the independent prognostic factors for cancer-specific survival (CSS). In training cohort, the concordance index of the OS and CSS nomograms were 0.694 (95% confidence interval CI, 0.677–0.711) and 0.678 (95%CI, 0.659–0.697), respectively, while those in validation cohort were 0.740 (95%CI, 0.715–0.765) and 0.708 (95%CI, 0.679–0.737), separately.
Conclusion The as-constructed nomograms for ascending type NPC could provide accurate prognostic predictions of OS and CSS.

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Significance of nuclear EGFR and ABCG2 expression in malignant transformation of oral potentially malignant disorders

Marko Tarle, Danko Müller, Marina Raguž, Ivica Lukšić

Publication date 19-08-2022


Abstract Background The purpose of this study was to investigate the expression of nuclear EGFR (nEGFR) and the stem cell marker ABCG2 in oral leukoplakia (OL) and oral erythroplakia (OE) and to assess their significance as prognostic biomarkers for malignant transformation.
Methods In this study we included 50 patients with oral potentially malignant disorders (OPMD), 31 with OL and 19 with OE, in whom we examined the expression of nEGFR and ABCG2 by immunohistochemical methods.
Results Twenty-one (42%) of 50 patients with OL and OE developed oral squamous cell carcinoma (OSCC). The malignant transformation was increased 12,84-fold (95% CI, 2.15–76.44, p = 0.005) in OPMD expressing both ABCG2 and nEGFR. Expression of nEGFR is a strong indicator of malignant transformation, unlike ABCG2 expression, respectively.
Conclusions Determining the co-expression of the biomarkers nEGFR and ABCG2 in OPMD may serve us to determine the risk of malignant transformation in OSCC.

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Early‐stage vocal cord cancer treated with hypofractionated radiotherapy to the larynx with or without concurrent chemotherapy

Alexandra N. Leo, Roi Dagan, Christopher G. Morris, Adam L. Holtzman, Kathryn E. Hitchcock, Curtis M. Bryant, Robert J. Amdur, William M. Mendenhall

Publication date 11-08-2022


Abstract Background We report outcomes among patients with T2 and select T3 glottic squamous cell carcinoma (SCC) treated with radiotherapy.
Methods We reviewed T2 and T3 (only paraglottic space invasion) N0 M0 glottic SCC patients treated with curative-intent hypofractionated larynx radiotherapy, with or without concurrent systemic therapy.
Results Of 71 patients, those who received concurrent chemotherapy (23/71; 32%) had worse prognostic factors, including impaired cord mobility (70% vs. 40%, p = 0.02) and larger median gross tumor volume (3.0 vs. 1.6 cm3, p = 0.003). Over a median follow-up of 3.8 years, 2-year local control among patients with impaired cord mobility appeared higher for those who received chemotherapy (88% vs. 61%, p = 0.12), but the difference was not statistically significant. Acute and late toxicity rates were not higher among patients who received chemotherapy.
Conclusions The addition of concurrent platinum-based chemotherapy to hypofractionated larynx radiotherapy among patients with early-stage glottic SCC with impaired cord mobility appears safe and worthy of additional investigation.

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Distribution of the head and neck surgical oncology workforce in the United States

Abhinav Talwar, Alex J. Gordon, Arnaud F. Bewley, Tanya Fancy, William M. Lydiatt, Donald Weed, Michael G. Moore, Babak Givi

Publication date 09-08-2022


Abstract Background The recent trends in education and geographic distribution of the head and neck surgery workforce have not been studied extensively.
Methods We reviewed publicly available sources to locate all fellowship-trained head and neck surgeons and recent graduates. The number of surgeons in each state was compared against head and neck cancer incidence data from the Centers for Disease Control.
Results The number of graduates increased annually by 1 per 100 000 000 people from 2011–2020. The average number of fellowship-trained surgeons per state was 10 (SD: 12). The average number of new head and neck cancer cases per surgeon was 247 (SD: 135). Ten states (20%) had cases >1 SD above the national average/surgeon, while 3 (6%) had cases >1 SD below the national average.
Conclusion Head and neck surgeons are located in most states, but not uniformly. Most states have approximately average density of surgeons; however, several states are outliers.

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Characterizing the epithelial–mesenchymal transition status of circulating tumor cells in head and neck squamous cell carcinoma

Karl Payne, Jill Brooks, Nikolaos Batis, Graham Taylor, Paul Nankivell, Hisham Mehanna

Publication date 05-08-2022


Abstract Background Circulating tumor cells (CTCs), in particular those undergoing an epithelial–mesenchymal transition (EMT), are a promising source of biomarkers in head and neck squamous cell carcinoma (HNSCC). Our aim was to validate a protocol using microfluidic enrichment (Parsortix platform) with flow-cytometry CTC characterization.
Method Blood samples from 20 treatment naïve HNSCC patients underwent Parsortix enrichment and flow cytometry analysis to quantify CTCs and identify epithelial or EMT subgroups—correlated to clinical outcomes and EMT gene-expression in tumor tissue.
ResultsCTCs were detected in 65% of patients (mean count 4 CTCs/ml). CTCs correlated with advanced disease (p = 0.0121), but not T or N classification. Epithelial or EMT CTCs did not correlate with progression-free or overall survival. Tumor mesenchymal gene-expression did not correlate with CTC EMT expression (p = 0.347).
Discussion Microfluidic enrichment and flow cytometry successfully characterizes EMT CTCs in HNSCC. The lack of association between tumor and CTC EMT profile suggests CTCs may undergo an adaptive EMT in response to stimuli within the circulation.

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Oncologic outcomes of salvage surgery and immune checkpoint inhibitor therapy in recurrent head and neck squamous cell carcinoma: A single‐institution retrospective study

Neeraja Konuthula, Olivia A. Do, Ted Gobillot, Cristina P. Rodriguez, Neal D. Futran, Jeffrey Houlton, Brittany R. Barber

Publication date 05-08-2022


Abstract Background Survival outcomes in recurrent head and neck squamous cell carcinoma (HNSCC) are poor. This study aimed to compare survival outcomes between salvage surgery and immunotherapy in patients with recurrent advanced HNSCC.
Methods Patients with advanced stage (stage III or IV) recurrent HNSCC following treatment with platinum-based chemotherapy were included. Survival was estimated using the Kaplan–Meier method, and Cox regression was used for multivariate logistic regression.
Results Two-year overall survival after salvage surgery was 68.6% and after immunotherapy patients was 24.6%. Multivariate logistic regression showed that salvage surgery was associated with improved survival without statistical significance (hazard ratio HR 0.12, p = 0.25). Subgroup analysis of patients with oral cavity/oropharyngeal cancer noted improved survival with salvage surgery over immunotherapy (HR 0.006, p = 0.01) and decreased survival with neutrophil-to-lymphocyte ratio (NLR) > 5 (HR 6.4, p = 0.02).
Conclusion Our retrospective single-institutional data suggest that resectable advanced stage recurrent HNSCC may have improved survival with salvage surgery in appropriately selected patients, but larger prospective studies are required.

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Prognostic capacity of the transcriptional expression of lactate dehydrogenase A in patients with head and neck squamous cell carcinoma

Silvia Bagué, Xavier León, Ximena Terra, Marylène Lejeune, Mercedes Camacho, Francesc‐Xavier Avilés‐Jurado

Publication date 04-08-2022


Abstract Background To analyze the relationship between the transcriptional expression of lactate dehydrogenase A (LDHA) and the disease control in patients with a head and squamous cell carcinoma (HNSCC).
Methods We determined the transcriptional expression of LDHA in 110 HNSCC patients treated with surgery.
Results Five-year disease-free survival for patients with a high transcriptional expression of LDHA (n = 51) was 39.2% (95% confidence interval CI: 25.3%–53.1%), and for patients with a low expression (n = 59), it was 63.6% (95% CI: 51.1%–76.1%) (p = 0.004). According to the results of a multivariate analysis, patients with a high transcriptional expression of LDHA had a 3.4-fold increased risk of tumor recurrence. Patients with a high transcriptional expression of LDHA tended to show a higher intensity of immunohistochemical expression of LDHA at the tumor cells (p = 0.086).
Conclusion In HNSCC patients treated with surgery, a high transcriptional expression of LDHA was associated with a significant decrease in disease-free survival.

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Posttreatment FDG‐PET/CT Hopkins criteria predict locoregional recurrence after definitive radiotherapy for oropharyngeal squamous cell carcinoma

Jacob A. Miller, Farshad Moradi, Vandana Sundaram, Rachel Liang, Carrie Zhang, Ngan Kim Nguyen, Faisal Akhtar, Yuhan Liu, Yulan Ren, Nima Harandi, Yingjie Weng, Erqi L. Pollom, Alexander Dimitrios Colevas, Vasu Divi, Floyd Christopher Holsinger, Beth M. Beadle, Quynh‐Thu Le, Michael F. Gensheimer

Publication date 03-08-2022


Abstract Background Metabolic response assessment for oropharyngeal squamous cell carcinoma (OPSCC) aids in identifying locoregional persistence/recurrence (LRR). The Hopkins Criteria are a standardized qualitative response assessment system using posttreatment FDG-PET/CT.
Methods We conducted a retrospective cohort study of patients with node-positive OPSCC treated with definitive (chemo)radiotherapy. We assessed Hopkins Criteria performance for LRR, then developed and validated a competing-risks model.
Results Between 2004 and 2018, 259 patients were included with median follow-up of 43 months. The Hopkins Criteria sensitivity, specificity, negative predictive value, and accuracy were 68%, 88%, 95%, and 85%. The 36-month cumulative incidence of LRR was greater with positive scores (45% vs. 5%, HR 12.60, p < 0.001). PET/CTs performed ≤10 weeks after radiotherapy were associated with a four-fold increase in pathologically negative biopsies/surgeries (36% vs. 9%, p = 0.03). The AUC for LRR was 0.89 using a model integrating the Hopkins score.
Conclusions The Hopkins Criteria predict LRR with high accuracy for OPSCC response assessment.

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Salivary bypass tube in total laryngectomy: Systematic review and meta‐analysis

Andrea Costantino, Gian Marco Pace, Bianca Maria Festa, Fabio Ferreli, Luca Malvezzi, Giuseppe Spriano, Giuseppe Mercante, Armando De Virgilio

Publication date 03-08-2022


Abstract The aim of this study is to determine whether the preventive positioning of a salivary bypass tube (SBT) after total laryngectomy (TL) reduces the incidence of postoperative pharyngocutaneous fistula (PCF) and pharyngeal stenosis (PS). This study was conducted in conformity with the PRISMA statement. 1960 patients with a median age of 62.0 years were included. A SBT was placed in 980 (50%) patients (SBT group). The cumulative PCF incidence in the SBT group was 15.8% (95% CI: 9.3–23.6). The measured pooled OR comparing PCF incidence in patients with SBT compared to those without was 0.40 (95% CI: 0.24–0.65). The pooled PS incidence in the SBT group was 12.3% (95% CI: 5.4–21.6). The measured pooled OR comparing PS incidence in patients with SBT compared to those without was 0.43 (95% CI: 0.24–0.65). PCF and PS could be prevented by the intra-operative placement of a SBT.

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Transposition nasolabial flap: A versatile flap for sensate reconstruction of lip defects

Aseem Mishra, Ravi Shankar, Gautam Prakash, Sudeshna Banerjee, Dipti Daga, Krishna Gopal Birmiwal, Neelesh Tiwari, Monika Gupta, Guru Charan Sahu, Abhishek Das

Publication date 03-08-2022


Abstract Introduction Lip reconstruction aims at maintaining the function and aesthetics of the facial subunits. Sensation in the reconstructed lip helps in bolus formation, tactile discrimination, and thermal sensation. In this study, we aim to describe random pattern nasolabial flap for lip reconstruction using various functional parameters.
Methodology This is a retrospective study of 22 patients with carcinoma lip who underwent surgical resection and reconstruction with sensate nasolabial flap. Several clinicopathological parameters were studied. Outcome parameters like oral competence, tactile sensation, thermal sensitivity of reconstructed lip and speech outcomes were evaluated.
ResultA functional outcome with 2–4 mm of two-point discrimination was obtained in 19 patients. All patients had intelligible speech. A mean sulcus depth of 19.59 mm was achieved. One patient had partial flap loss owing to wound infection.
Conclusion Random pattern senate nasolabial flap offers a good functional outcome by maintaining the tactile and thermal sensitivity.

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Needs assessment in head and neck surgical oncology training: A qualitative study of expert opinions

Babak Givi, Alex J. Gordon, Yoon Soo Park, William M. Lydiatt, Ara Tekian

Publication date 03-08-2022


Abstract Background Few studies have investigated the needs of head and neck surgery trainees and areas for improvement of fellowship programs.
Methods We conducted a qualitative study by interviewing a nationally representative sample of program directors and national leaders in head and neck surgery. We asked about the current state and strengths of training; and areas for further improvement. All interviews were independently coded and analyzed by two reviewers.
Results All experts (100%) believed that the current training provides a strong foundation and furthermore, a standardized curriculum is beneficial. Multidisciplinary training (80%), participation in tumor boards (75%), and a syllabus (60%) were the most frequently mentioned components. Most believed that a formal certification process would be beneficial (73%), though there was no consensus on the format.
Conclusion Experts in head and neck surgery are generally in favor of a standardized curriculum. Further discussions of a formal certification process might be warranted.

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Overexpression of circFNDC3B promotes the progression of oral tongue squamous cell carcinoma through the miR‐1322/MED1 axis

Xiao Chen, Deyu Kong, Jun Deng, Fei Mo, Jin Liang

Publication date 02-08-2022


Abstract Background The potential role of circFNDC3B in regulating oral tongue squamous cell carcinoma development (OTSCC) remains unknown.
Methods The level of circFNDC3B in OTSCC tissues or cell lines was measured and its function in vitro and in vivo was analyzed. Interactions among circFNDC3B, miR-1322, and MED1 were verified by luciferase reporter and RNA pull-down assays.
Results The level of circFNDC3B in tissues or cell lines of OTSCC was higher than that in control groups. siRNA-mediated circFNDC3B inhibition resulted in weakened proliferation, migration, and invasion, which was reversed by miR-1322. Overexpression of MED1 in OTSCC cells partially reversed the tumor suppression functions of si-circFNDC3B or miR-1322 mimics in vitro. circFNDC3B overexpression dramatically promoted tumor growth in vivo. circFNDC3B directly bound with miR-1322 and consequently promoted the MED1 expression in OTSCC cells.
Conclusions The circFNDC3B/miR-1322/MED1 axis participates in OTSCC progression, which may provide novel therapeutic targets for OTSCC.

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The diagnostic yield of head and neck imaging in symptomatic patients with a normal clinical examination

Michael Goodfellow, Christian Lim, Harry Tustin, Youssef Mentias, Helen Cocks

Publication date 02-08-2022


Abstract Aim Nationally, concern has been raised about the overuse of diagnostic testing. In patients with unilateral otalgia and no history of Head and Neck Cancer (HNC), 1% had a malignancy detected on imaging that was not detected on clinical examination.
Methods We performed a retrospective review of “MRI soft tissue neck” scans performed at our hospital from May 2020 to May 2021. Patients were excluded if their scan was not ordered for HNC symptoms. Previous HNC patients undergoing follow-up imaging were also included.
Results In total, 326 scan requests were analyzed. Of the 132 patients without clinical features of overt disease, only one received a new diagnosis of HNC. This patient had previously had a HNC and was undergoing routine follow-up imaging.
Conclusion Our data demonstrate that performing MRI scans in symptomatic patients with a normal examination, FNE, and no history of HNC does not benefit the diagnosis or management of these patients.

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Extracapsular dissection by the sternocleidomastoid muscle–parotid space approach reduces the risks of postparotidectomy sialocele and salivary fistula

Lin Lan, Diancan Wang, Ruohan Ma, Wei Wang

Publication date 01-08-2022


Abstract Background Postoperative sialoceles and fistulas are frequent surgical complications of parotid tumor resection. Extracapsular dissection by the sternocleidomastoid muscle–parotid space approach (ECD-SMPSA) is a minimally invasive technique. To our knowledge, the characteristics of sialoceles and fistulas secondary to ECD-SMPSA have not been reported.
Methods This prospective study enrolled 52 patients who underwent ECD-SMPSA without sialocele/fistula prevention measures. Postoperative sialoceles and fistulas were evaluated during 2 months of follow-up.
Results Among the 52 patients, only one male patient developed a mild sialocele. No salivary fistulas occurred. The overall rate of sialocele/fistula formation was 1.92%.
Conclusions When treating clinically benign tumors that involve the sternocleidomastoid muscle–parotid space, ECD-SMPSA may prevent postoperative formation of sialoceles and salivary fistulas.

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Impact of a prognostic model for overall survival on the decision‐making process in a head and neck cancer multidisciplinary consultation meeting

Maarten C. Dorr, Arta Hoesseini, Aniel Sewnaik, José A. Hardillo, Robert J. Baatenburg de Jong, Marinella P. J. Offerman

Publication date 30-07-2022


Abstract Background Multidisciplinary decision-making in head and neck cancer care is complex and requires a tradeoff between prolonging survival and optimizing quality of life. To support prognostication and decision-making in head and neck cancer care, an individualized prognostic model for overall survival (OncologIQ) is available.
Methods By quantitative and qualitative research we have studied user value of OncologIQ and its impact on the decision-making process in a multidisciplinary consultation meeting.
Results Healthcare professionals experienced added value upon using prognostic estimates of survival from OncologIQ in half (47.5%) of the measurements. Significant impact on the decision making process was seen when OncologIQ was used for older patients, patients having a WHO performance score ≥ 2, or high tumor stage.
Conclusions The prognostic model OncologIQ enables patient-centered decision-making in a multidisciplinary consultation meeting and was mostly valued in complex patients.

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Case volume regionalization and volume‐based outcome differences in cutaneous head and neck melanoma

Kelsey M. Roman, Sina J. Torabi, Khodayar Goshtasbi, Edward C. Kuan, Tjoson Tjoa, Yarah M. Haidar

Publication date 29-07-2022


Abstract Background Hospital volume has emerged as a prognostic factor in oncology but is not currently known whether volume is associated with improved outcomes for cutaneous head and neck (HN) melanoma.
MethodsA total of 556 079 cutaneous melanoma cases reported by the 2004–2016 National Cancer Database were separated into two cohorts (HN and non-HN) and facilities within each cohort were classified by case volume. Analysis employed chi-square, analysis of variance, Kaplan–Meier, and Cox proportional hazards models.
Results Only 41 facilities (3.1% of 1326) treating HN melanoma and 50 facilities (3.7% of 1344) treating non-HN melanoma were classified as high-volume facilities (HVFs). The estimated 5-year overall survival (OS) was 62.7% (standard error SE: 0.4%) for patients with HN at low-volume facilities (LVFs), 69.3% (SE: 0.4%) at IVFs, and 71.8% (SE 0.4%) at HVFs (p < 0.001). Differences in OS remained significant between HVFs versus LVFs after adjusting for confounders.
Conclusion Volume is independently associated with OS and improved surgical outcomes for HN melanoma.

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Facial nerve palsy: Narrative review on the importance of the eye and its assessment

Shaheen Hasmat, Tsu‐Hui ( Hubert) Low, Joseph R. Dusseldorp, Payal Mukherjee, Jonathan R. Clark

Publication date 27-07-2022


Abstract New solutions are emerging that address specific facial regions in facial nerve palsy (FNP). However the most dreaded consequence of FNP is paralytic lagophthalmos threatening the eye. A way to prioritize these regions is thus required. A review of the literature is conduced to capture the current concepts in evaluating FNP. Overall, patients are assessed from three perspectives: from the clinicians perspective using validated clinician-based grading instruments, from patients perspective based on FNP-specific patient-reported outcome measures, and from the perspective of the layperson. The existing tools however provide limited information regarding the relative importance of different regions of the face. The eye appears to be an area of great concern for the patient where most surgical therapies are directed at. Addressing ocular problems in FNP carry a high priority but this is not clearly reflected by the standard systems.

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Curative high‐dose reirradiation for patients with recurrent head and neck squamous cell carcinoma using IMRT or proton therapy: Outcomes and analysis of patterns of failure

Arnaud Beddok, Caroline Saint‐Martin, Samar Krhili, Catherine Ala Eddine, Laurence Champion, Anne Chilles, Farid Goudjil, Sofia Zefkili, Malika Amessis, Dominique Peurien, Olivier Choussy, Christophe Tourneau, Remi Dendale, Irene Buvat, Gilles Créhange, Valentin Calugaru

Publication date 25-07-2022


Abstract Purpose To analyze outcomes of patients treated with curative reirradiation (reRT), with intensity-modulated radiation therapy (IMRT) or proton therapy (PT) for recurrent head and neck squamous cell carcinoma (HNSCC).
Materials Among the 55 patients reirradiated for head and neck cancer from 30/08/2012 to 08/04/2019, 23 had HNSCC and received IMRT (52.2%) or PT (47.8%) at a median maximum dose to the CTV of 66 Gy.
Results After a median follow-up of 41.3 months, 18 patients developed a locoregional recurrence (LR), of which eight (44.4%) occurred within the previously reirradiated volume. Two-year locoregional failure-free survival and overall survival were 18.3%95%CI:7.1%–47.1% and 42.5%95%CI:26.2%–69.1%, respectively. Disease-free survival was significantly longer in the PT group (p = 0.031). Main late grade ≥2 toxicities were dysphagia and trismus.
Conclusion Curative reRT in HNSCC is possible for selected cases, but the LR rate in the irradiated field and the risk of toxicity grade ≥2 remain high.

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Endoscopic trans‐lateral oropharyngeal wall approach to the petrous apex and the petroclival region

Lifeng Li, Hongbo Xu, Nyall R. London, Ricardo L. Carrau, Yonggang Jin, Xiaohong Chen

Publication date 22-07-2022


Abstract BackgroundA trans-lateral oropharyngeal wall approach (TLOWA) to the petrous apex has not been previously defined. This study aims to assess the feasibility of a TLOWA for surgical access to the petrous apex and the petroclival region.
Methods An endoscopic TLOWA for exposure of the petrous apex and petroclival region was performed on five cadaveric specimens (10 sides). Associated anatomical landmarks were defined, and the strategies for maximal exposure of the internal carotid artery (ICA) were explored.
Results Via a TLOWA, the parapharyngeal ICA was widely exposed in all 10 sides. Following transection of the Eustachian tube, the inferior petrous apex and petroclival region could be sufficiently exposed. After drilling the anteroinferior bony canal, the horizontal petrous ICA, foramen lacerum, and the paraclival ICA could be adequately revealed.
Conclusion The TLOWA may provide an alternative corridor for access to the petrous apex and the petroclival region. The parapharyngeal, petrous, lower paraclival ICAs, and the foramen lacerum could be adequately exposed via the TLOWA.

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Loss of exosomal miR‐34c‐5p in cancer‐associated fibroblast for the maintenance of stem‐like phenotypes of laryngeal cancer cells

Mei Wang, Ciwang Zhuoma, Xiaojin Liu, Qiang Huang, Guoyu Cai, Ge Sang, Liang Zhou, Huaidong Du, Chunping Wu

Publication date 22-07-2022


Abstract Background Cancer-associated fibroblasts (CAFs) reconstitute cancer stemness. This study aims to investigate whether the loss of CAF-derived exosomal miR-34c-5p contributes to the maintenance of stem-like properties of laryngeal squamous cell carcinoma (LSCC).
Methods Exosomes from primarily cultured CAFs and paired normal fibroblasts (NFs) were collected and identified. The differential expression of exosomal miR-34c-5p between CAFs and NFs was detected by next-generation sequencing. In vitro and in vivo assays were performed to examine the effects of miR-34c-5p on the maintenance of stem-like properties.
Results MiR-34c-5p expression is significantly reduced in CAF-derived exosomes. In vitro and in vivo assays revealed that exosomal miR-34c-5p can regulate the stem-like properties of LSCC cells, such as proliferation, invasion, sphere and plate colony formation, chemoresistance, tumorigenicity in nude mice, as well as the expression of cancer stem cell genes.
Conclusions Loss of miR-34c-5p in CAF-derived exosomes contributes to the maintenance of stem-like phenotypes of LSCC.

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Transoral robotic excision of thyroglossal duct cyst using vestibular and sublingual incisions

Kyung Tae, Hee Ryung Kim

Publication date 20-07-2022


Abstract With the extension of remote-access head and neck surgery to improve postoperative cosmetic outcomes, a robotic or endoscopic procedure was developed to excise thyroglossal duct cysts (TGDCs). Here, we present the operative procedure of a novel transoral robot-assisted Sistrunk operation using oral vestibular and sublingual incisions in a 21-year-old woman with TGDC. A 1.5-cm central vestibular incision and two lateral vestibular incisions were made. In addition, a midline vertical sublingual incision was made to cut the hyoid bone via the sublingual route. The surgery was successfully completed without conversion to the conventional transcervical approach. Our technique using three vestibular incisions and a sublingual incision was more efficient in performing the Sistrunk operation than frenulotomy or endoscopic vestibular approaches. In conclusion, the transoral robotic Sistrunk operation using three vestibular incisions and a sublingual incision is feasible and safe and yields excellent postoperative cosmesis.

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Interventions for head and neck cancer survivors: Systematic review

Danielle N. Margalit, Talya Salz, Rebecca Venchiarutti, Kristi Milley, Mairead McNamara, Sophie Chima, Jamieson Wong, Paige Druce, Larissa Nekhlyudov

Publication date 18-07-2022


Abstract Background Interventions for head/neck cancer (HNC) survivors may not address their cancer-related and general health needs.
Methods Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided this systematic review of studies from 2000 to 2021 of interventions targeting cancer survivors treated with curative-intent, using MEDLINE, Embase, Emcare, and PsycINFO. Interventions were categorized into domains of the Quality of Cancer Survivorship Care Framework to characterize the scope and quality of interventions.
Results We identified 28 studies for inclusion: 13 randomized and 15 non-randomized. Most targeted surveillance/management of physical effects (n = 24) including 13 that also targeted psychosocial effects. Four studies addressed prevention/surveillance for recurrence/new cancers, one addressed health promotion/disease prevention, and one addressed chronic medical conditions. Most studies (n = 27) had medium-high risk of bias.
Conclusions There are few high-quality studies addressing HNC survivorship. Future rigorously designed studies should address broader areas of care, including chronic disease management and health promotion/disease prevention.

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Outcomes of curative treatment for head and neck squamous cell carcinoma in very elderly adults ≥80\u2009years old

Traeden Wilson, Lindsay Fleischer, Shivam Patel, Anil Bhatnagar, Nadir Ahmad, Gregory Kubicek

Publication date 13-07-2022


Abstract Background Head and neck cancer treatment can be difficult and advancing age is associated with greater frailty. It is unclear if curative treatment for very elderly patients is beneficial. This study compared outcomes to curative treatment in patients ≥80 aged with HNSCC to patients aged 70–79.
Methods Retrospective study of 114 patients diagnosed with HNSCC. Overall survival (OS), Disease-Free Survival (DFS), and local-regional control (LRC) were compared and adjusted for confounders.
Results Patients aged 70–79 had a higher median OS (35 months 95% CI, 19.58–50.42) compared with patients aged ≥80 (19 months 11.72–26.28; p = 0.008) but similar DFS and LRC. KPS < 90 was the stand-alone independent prognostic factor for OS (HR = 2.14 1.05–4.38).
Conclusion Very elderly HNSCC patients (aged ≥80) can have favorable outcomes with curative therapy and advanced chronological age alone should not prohibit patients from receiving treatment. Performance status may be a greater predictor of survival outcome than age alone.
Level of Evidence Level III.

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Survival and prognosis of metastatic head and neck adenoid cystic carcinoma

Di Zhang, Yue Chai, Yuce Wei, Fei Qi, Mei Dong

Publication date 13-07-2022


Abstract Background To investigate the clinical characteristics, treatment, and prognosis of patients with metastatic head and neck adenoid cystic carcinoma (HNACC).
Method The clinical data of metastatic HNACC from 1999 to 2020 at the National Cancer Center of China were retrospectively collected.
Results One hundred seventy-four patients with metastatic HNACC were enrolled and median overall survival (OS) was 45.6 months. Univariate analysis indicated that smoking history, disease-free interval (DFI), number and sites of metastases, and systemic therapy were associated with OS. In the multivariate analysis, non-smokers, DFI ≥3 years, and lung metastasis were prognostic factors. Local therapy for localized disease could prolong survival in patients with both recurrent and metastatic disease.
Conclusion No smoking history, DFI ≥3 years, and lung metastasis were favorable prognostic factors. Local therapy for metastases could not provide survival benefits, but local therapy for localized disease may prolong survival. Whether initial systemic therapy could improve prognosis needs further exploration.

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Acute toxicity in patients treated with concurrent chemoradiotherapy with proton versus intensity‐modulated radiation therapy for nonmetastatic head and neck cancers

Kristine N. Kim, Joanna Harton, Nandita Mitra, John N. Lukens, Alexander Lin, Isabella Amaniera, Abigail Doucette, Peter Gabriel, Brian Baumann, James Metz, Andrzej Wojcieszynski

Publication date 13-07-2022


Abstract Background We evaluated if proton therapy is associated with decreased acute toxicities compared to intensity-modulated radiation therapy (IMRT) in patients receiving concurrent chemoradiotherapy for head and neck cancers.
Methods We analyzed 580 patients with nonmetastatic head and neck cancers. Primary endpoint was any 90-day grade ≥3 toxicity, prospectively collected and graded per CTCAEv4. Modified Poisson regression models were used.
Results Ninety-five patients received proton and 485 IMRT. The proton group had more HPV-positive tumors (65.6 vs. 58.0%, p = 0.049), postoperative treatment (76.8 vs. 62.1%, p = 0.008), unilateral neck treatment (18.9 vs. 6.6%, p < 0.001) and significantly lower doses to organs-at-risk compared to IMRT group. Adjusted for patient and treatment characteristics, the proton group had decreased grade 2 dysgeusia (RR0.67, 95%CI 0.53–0.84, p = 0.004) and a trend toward lower grade ≥3 toxicities (RR0.60, 95%CI 0.41–0.88, p = 0.06).
Conclusions Proton therapy was associated with significantly reduced grade 2 dysgeusia and nonstatistically significant decrease in acute grade ≥3 toxicities compared to IMRT.

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Prognostic role of baseline 18F‐FDG pet/CT in squamous cell carcinoma of the paranasal sinuses

Francesco Dondi, Nadia Pasinetti, Andrea Guerini, Cesare Piazza, Davide Mattavelli, Paolo Bossi, Alfredo Berruti, Marco Ravanelli, Davide Farina, Domenico Albano, Giorgio Treglia, Francesco Bertagna

Publication date 12-07-2022


Abstract Background To retrospectively investigate the prognostic role of baseline 18F-FDG PET/CT in squamous cell carcinoma (SCC) of the paranasal sinuses.
Methods Clinical features and PET/CT semiquantitative parameters of 49 patients were collected. Anova and Kruskall–Wallis tests were used to assess the relationship between these parameters. Kaplan–Meier, univariate, and multivariate analysis were performed to search for independent prognostic factors for progression free (PFS) and overall survival (OS).
Results Mean PFS was 29.95 months (SD 29.36) with relapse/progression of disease occurring in 18 patients; mean OS was 33.40 (SD 27.78) months with death occurring in 15 patients. Presence of nodal metastasis (14 subjects) was correlated with standardize uptake value (SUV) max, SUVmean, SUV/blood-pool ratio, SUV/liver ratio, metabolic tumor volume, and total lesion glycolysis. SUVmax, SUVmean, and presence of nodal metastasis resulted as independent prognostic factors for OS.
Conclusion18F-FDG PET/CT semiquantitative parameters confirmed their prognostic role for SCC of paranasal sinuses.

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Exploration of anatomical landmarks for performing an endoscopic transoral nasopharyngectomy

Lifeng Li, Hongbo Xu, Yonggang Jin, Xiaohong Chen, Ricardo L. Carrau, Nyall R. London

Publication date 12-07-2022


Abstract Background Performing a nasopharyngectomy via a transoral approach has been reported; however, defining landmarks to facilitate this approach has not been addressed. This study aims to explore anatomical landmarks to aid in performing a nasopharyngectomy via the transoral corridor.
Methods An endoscopic transoral nasopharyngectomy was performed on six cadaveric specimens (12 sides). Related anatomical landmarks were defined, and the strategy to preserve the parapharyngeal internal carotid artery (pICA) was explored.
Results An endoscopic transoral nasopharyngectomy was successfully achieved in all 12 sides. Utilizing the pterygoid hamulus as a landmark, the cartilaginous ET and attachments could be adequately exposed. Identification of the pICA is a prerequisite prior to Eustachian tube (ET) transection. The sphenoidal spine and the petrotympanic fissure could be sufficiently revealed in all 12 sides, which aided in transection of the cartilaginous ET without pICA injury. The ET and the prevertebral contents could be adequately removed via the transoral corridor.
Conclusion The pterygoid hamulus, sphenoidal spine and petrotympanic fissure serve as reliable landmarks for performing a transoral nasopharyngectomy. Identification of the pICA is a prerequisite prior to transection of the ET to avoid pICA injury.

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Augmenting inter‐rater concordance of radiologic extranodal extension in HPV‐positive oropharyngeal carcinoma: A multicenter study

"Frank Hoebers, Eugene Yu, Brian OSullivan, Alida A. Postma, Walter M. Palm, Eric Bartlett, Jonathan Lee, Sarah Stock, Shlomo Koyfman, Jie Su, Wei Xu, Shao Hui Huang"

Publication date 29-06-2022


Abstract Objectives To assess intra- and inter-institutional concordance and identify methods to increase precision in radiologic extranodal extension (rENE) ascertainment in HPV+ oropharyngeal carcinoma.
Methods Six radiologists, blinded to clinical outcomes, from three centers assessed rENE in two phases: Phase-I (20 cases) utilized each individuals a priori appreciation of the literature. Phase-II (30 additional cases) was performed after deliberating experience and consolidating operating definitions. Intra- and inter-institutional Kappa were calculated at >50% and >75% certainty levels, respectively.
Results The Phase-I intra-institutional kappa was 0.76, 0.32, and 0.44 at >50% certainty and improved to 0.89, 0.61, and 0.66 at >75% certainty. Inter-institutional Fleiss kappa also improved with higher certainty (from 0.40 to 0.57, p = 0.039).  The Phase-II inter-rater kappa was significantly higher than Phase-I at the same certainty level (both p < 0.001).
ConclusionA learning curve exists for rENE assessment. Strategies to augment reliability include high certainty for declaration, consolidated operating definitions, and sharing experience among radiologists.

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Magnetic resonance imaging‐based radiogenomics analysis for predicting prognosis and gene expression profile in advanced nasopharyngeal carcinoma

Publication date 22-12-2021


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