Head and Neck 2020-09-12

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

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

Publicatie 12-09-2020


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

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

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

Publicatie 12-09-2020


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

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

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

Publicatie 12-09-2020


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

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

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

Publicatie 11-09-2020


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

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

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

Publicatie 11-09-2020


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

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Untreated head and neck cancer: Natural history and associated factors

\nPaul Zolkind, \nJake J. Lee, \nRyan S. Jackson, \nPatrik Pipkorn, \nSean T. Massa\n

Publicatie 11-09-2020


AbstractBackgroundThis study aims to provide modern estimates of survival for untreated head and neck cancer (HNC) and to identify patient‐ and tumor‐specific factors associated with not receiving definitive treatment.MethodsAdults with mucosal HNC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Median overall survival of untreated patients was calculated and stratified by site and stage. Cause‐specific survival and factors associated with no treatment were investigated with advanced statistics.ResultsThe study cohort included 6477 patients who received no treatment. Overall, untreated patients had a median survival of 12 months, with significant variability by site and stage. Multivariable analysis identified advanced age, black race, unmarried status, and lack of private insurance as associated with no treatment.ConclusionsSurvival of HNC without treatment is dismal, yet substantial variation exists by tumor site and stage. Higher rates of no treatment among the poor and racial minorities are potentially driven by disparities in care availability and provision.

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Impact of greater auricular nerve sacrifice during parotidectomy on quality of life

\nFlora Yan, \nVincent M. Desiato, \nShaun A. Nguyen, \nEric J. Lentsch\n

Publicatie 09-09-2020


AbstractBackgroundGreater auricular nerve (GAN) sacrifice can alter sensation; however, the impact on quality of life (QoL) is unclear.ObjectiveThe aim of this study was to evaluate patients QoL following GAN sacrifice versus preservation.MethodsPatients who underwent parotidectomy from 2010 to 2019 at a single institution completed two QoL surveys. Results between GAN‐sacrificed versus preserved cohorts and short (≤ 1 year) versus long‐term (> 1 year) follow‐up were compared.ResultsOf 404 patients, 67 with known GAN status completed the surveys. GAN‐sacrificed patients more frequently experienced sensation loss of the lobule and concha than GAN‐preserved patients (P = .042 and P = .041, respectively). Interference with daily activities or amount of regained sensation was not different based on GAN status. Short‐term follow‐up patients had a higher number of symptoms and affected areas than long‐term follow‐up patients (P = .014 and P = .002, respectively).ConclusionGAN sacrifice leads to sensation loss of the lobule and concha; however, it does not significantly impair QoL.

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

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

Publicatie 08-09-2020


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

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Radiotherapy in the management of glottic squamous cell carcinoma

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

Publicatie 08-09-2020


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

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Access to preventive care services and stage at diagnosis in head and neck cancer

\nDouglas R. Farquhar, \nNicholas R. Lenze, \nMaheer M. Masood, \nKimon Divaris, \nJason Tasoulas, \nJeffrey Blumberg, \nCatherine Lumley, \nSamip Patel, \nTrevor Hackman, \nMark C. Weissler, \nWendell Yarbrough, \nAdam M. Zanation, \nAndrew F. Olshan\n

Publicatie 08-09-2020


AbstractBackgroundDecreased access to preventive care services has been proposed as a mechanism for the association between low socioeconomic status (SES) and advanced stage at diagnosis in patients with head and neck squamous cell carcinoma (HNSCC).MethodsRetrospective analysis of patients diagnosed with HNSCC in North Carolina between 2002 and 2006.ResultsA total of 1108 patients with HNSCC were included in the study. In the multivariable analysis, use of annual routine dental services (OR 0.7, 95% CI 0.5‐0.9) and colonoscopy in the past 10 years (OR 0.7, 95% CI 0.5‐0.9) were associated with lower odds of advanced T stage at diagnosis. Having no insurance (OR 1.8, 95% CI 1.1‐2.9), an income <$20 000 (OR 1.6 95% CI 1.03‐2.6), and >10 pack‐years tobacco use (OR 1.5, 95% CI 1.04‐2.2) were associated with advanced T stage at diagnosis.ConclusionUse of preventive care services and SES independently predict stage at diagnosis in HNSCC.

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Expanded exposure and detailed anatomic analysis of the superior orbital fissure: Implications for endonasal and transorbital approaches

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

Publicatie 08-09-2020


AbstractThis study aimed to ascertain the maximal exposure of the superior orbital fissure (SOF) afforded by combining endonasal and transorbital endoscopic approaches. Six cadaveric specimens (12 sides) were dissected using endonasal and transorbital endoscopic approaches to access the SOF. The order of the approaches was alternated in each specimen (eg, starting with an endonasal approach in one side followed by a transorbital exposure and reversing the order on the contralateral side). Maximal exposure of the SOF and its contents for individual and combined approaches were explored. The endonasal corridor provided adequate access to the inferomedial 1/3 of the SOF and including the proximal segments of cranial nerves (CN) III, V1 and VI. A transorbital approach was superior accessing the superolateral 2/3s of the SOF, including the superior ophthalmic vein, lacrimal nerve, and distal segment of the CN VI at the lateral aspect; the nasociliary nerve and divisions of CN III centrally; and the frontal nerve and CN IV at the dorsal aspect of levator palpebrae superioris. This study suggests that a combined endonasal and transorbital exposure of the SOF may be advantageous to address lesions in this challenging region.

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Association of multimodal analgesia with perioperative safety and opioid use following head and neck microvascular reconstruction

\nNavdeep R. Sayal, \nOleg Militsakh, \nSarah Aurit, \nJohn Hufnagle, \nLester Hubble, \nWilliam Lydiatt, \nDaniel Lydiatt, \nRobert Lindau, \nAndrew Coughlin, \nAngela Osmolak, \nAru Panwar\n

Publicatie 08-09-2020


AbstractBackgroundThis study examines the association of multimodal analgesia (MMA) protocol for head and neck microvascular reconstruction with postoperative safety and opioid use.MethodsRetrospective, intention‐to‐treat analysis of 226 patients undergoing head and neck microvascular reconstruction between January 1, 2014 and August 30, 2018 at a tertiary‐care hospital following MMA protocol implementation. Multivariable models examined outcomes of interest.ResultsThere were no differences between groups in frequency of bleeding, return to operating room, complete flap loss, readmissions, wound complications, and 30‐day mortality. Patients in MMA protocol experienced reduced likelihood of partial flap loss (OR 0.18, confidence interval 0.04‐0.91), meaningful reduction in postoperative opioid use (cumulative inpatient morphine equivalents 64 vs 141 mg; P < .001, daily morphine equivalents 8 vs 22 mg/d; P < .001; and 22.5% lower frequency of opioid prescription at discharge 55.6% vs 78.1%; P = .001).ConclusionsIn patients undergoing head and neck microvascular reconstruction, MMA is safe and associated with reduced postoperative opioid use.

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Stereotactic body radiotherapy as primary treatment for elderly and medically inoperable patients with head and neck cancer

\nEmile Gogineni, \nZaker Rana, \nPrashant Vempati, \nJessie Karten, \nAnurag Sharma, \nPeter Taylor, \nLucio Pereira, \nDouglas Frank, \nDoru Paul, \nNagashree Seetharamu, \nMaged Ghaly\n

Publicatie 08-09-2020


AbstractBackgroundPatients with head and neck cancer (HNC) who are not candidates for definitive treatment represent an increasing challenge, with limited data to guide management. Conventional local therapies such as surgery and chemoradiation can significantly impact quality of life (QoL). There has been limited data published using stereotactic body radiotherapy (SBRT) as primary treatment in previously unirradiated patients. We hypothesize that SBRT provides high rates of control while limiting toxicity.MethodsA total of 66 medically unfit previously unirradiated patients with HNC were treated with SBRT, consisting of 35‐40 Gy to gross tumor volume and 30 Gy to clinical target volume in five fractions.ResultsMedian age was 80 years. Local control (LC) and overall survival (OS) at 1 year were 73% and 64%. Two patients experienced grade 3 toxicity.ConclusionSBRT shows acceptable outcomes with relatively low toxicity in previously unirradiated patients with HNC who are medically unfit for conventional treatment. SBRT may provide an aggressive local therapy with high rates of LC and OS while maintaining QoL.

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Pathology protocol increases lymph node yield in neck dissection for oral cavity squamous cell carcinoma

\nAndrew J. Holcomb, \nMollie Perryman, \nSara Goodwin, \nJoseph Penn, \nMark R. Villwock, \nAndrés M. Bur, \nYelizaveta Shnayder, \nTerance T. Tsue, \nJanet Woodroof, \nKiran Kakarala\n

Publicatie 08-09-2020


AbstractBackgroundLymph node yield (LNY) is a proposed quality indicator in neck dissection for oral cavity squamous cell carcinoma (OCSCC).MethodsRetrospective series including 190 patients with OCSCC undergoing neck dissection between 2016 and 2018. A change in pathologic grossing protocol was initiated during the study period to assess residual adipose tissue. A generalized linear model was used to assess the impact of multiple variables on LNY.ResultsMean LNY was 28.59 (SD = 17.65). The protocol identified a mean of 10.32 lymph nodes per case. Multivariable analysis identified associations between LNY and use of the pathology protocol (P = .02), number of dissected lymph node levels (P < .001), presence of pathologic lymph nodes (P = .002), body mass index (P = .02), prior neck surgery (P = .001), and prior neck radiation (P = .001).ConclusionsAssessment of residual adipose tissue within neck dissection specimens improves accuracy of LNY. LNY in neck dissection is influenced by multiple factors including methods of pathologic assessment.

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Regulatory role of transcription factor HBP1 in anticancer efficacy of EGFR inhibitor erlotinib in HNSCC

\nChien‐Yi Chan, \nChin‐Ming Chang, \nYuan‐Hong Chen, \nJim Jinn‐Chyuan Sheu, \nTzu‐Yuan Lin, \nChun‐Yin Huang\n

Publicatie 08-09-2020


AbstractBackgroundEpidermal growth factor receptor (EGFR) is often hyperactivated in head and neck squamous cell carcinoma (HNSCC); however, its downstream mediators are not fully identified. Here, we investigate the role of transcription factor HBP1 in the anticancer efficacy of EGFR inhibitor erlotinib in HNSCC.MethodsThe effect of erlotinib and HBP1 on cell proliferation and invasion was examined by flow cytometric analysis and a Matrigel invasion assay, respectively. Oral tumor specimens were used to evaluate the association between the expression level of EGFR and HBP1, and metastatic potential.ResultsErlotinib caused cell growth arrest in the G1 phase and sluggish invasion with a concomitant increase in HBP1 and p27 expression. The erlotinib effect was attenuated upon HBP1 knockdown. Analysis of oral tumor specimens revealed that the low HBP1/high EGFR status can predict metastatic potential.ConclusionsOur data support HBP1 as a crucial mediator of EGFR‐targeting inhibitors in HNSCC.

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Safety parameters of ferromagnetic device during thyroid surgery: Porcine model using continuous neuromonitoring

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

Publicatie 08-09-2020


AbstractBackgroundThe ferromagnetic (FM) device is a new surgical energy modality. This study investigated dynamic recurrent laryngeal nerve (RLN) electromyographic (EMG) data to define safety parameters for using FM devices in thyroidectomy.MethodsReal‐time EMG tracings obtained under continuous neuromonitoring were recorded from 24 RLNs (12 piglets). In the activation study, FM devices were activated at varying distances from the RLN. In the cooling study, FM devices were cooled for varying time intervals, or muscle touch maneuver was performed, before contact with the RLN.ResultsDuring the FMwand/FMsealer activation, no adverse EMG events occurred at distances of 2 mm or longer. The cooling study revealed no adverse EMG events after 1‐second (FMwand) or 3‐second (FMsealer) intervals or after muscle touch maneuver.ConclusionsAn FM device should be activated at a distance of 2 mm from the RLN and should be adequately cooled before further contact with the RLN. Surgeons can avoid RLN injury by observing standard procedures for using FM devices.

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Trends in parotidectomy over 30\u2009years in an Australian tertiary care center

\nNarayana Subramaniam, \nKan Gao, \nRuta Gupta, \nJonathan Robert Clark, \nTsu‐Hui (Hubert) Low\n

Publicatie 08-09-2020


AbstractBackgroundNomenclature, classification, and management of parotid tumors are constantly evolving; this study was performed to identify temporal trends in histology and facial nerve sacrifice in parotidectomy during a 30‐year period (1987‐2018).MethodsRetrospective analysis of patients treated in a single tertiary‐care institution during this time period was performed with analysis of temporal trends.ResultsTwo thousand eight hundred and fifty‐seven parotidectomies were performed; pleomorphic adenoma was the most common histology (34.3%), followed by skin cancer metastases (32.3%). Significant trends noted were increasing age (P < .001), fewer parotidectomies for inflammatory lesions (P < .001), reduced incidence of mucoepidermoid carcinoma (P = .048), increasing incidence of parotidectomy for cutaneous malignancies (P < .001), and reduced facial nerve sacrifice (P = .034).ConclusionIn this contemporary series of parotid pathology, metastatic cutaneous malignancies accounted for a third of cases. Despite reducing facial nerve sacrifice in parotid disease, it is still required in approximately 15% of malignancy and needs to be discussed with all patients preoperatively.

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Clinical utility of apparent diffusion coefficient and diffusion‐weighted magnetic resonance imaging for resectability assessment of head and neck tumors with skull base invasion

\nTakenori Ogawa, \nIkuho Kojima, \nShun Wakamori, \nTakuya Yoshida, \nTakaki Murata, \nMaya Sakamoto, \nAkira Ohkoshi, \nAyako Nakanome, \nHidenori Endo, \nToshiki Endo, \nHajime Usubuchi, \nYukio Katori\n

Publicatie 08-09-2020


AbstractBackgroundThe usefulness of apparent diffusion coefficient (ADC) and diffusion‐weighted magnetic resonance imaging (DWI) in the detection of malignant tumors has been reported. The purpose of this study is to clarify the role of ADC and DWI for diagnosis of skull base tumors.MethodsA total of 27 patients with head and neck tumors with skull base invasions undergoing skull base surgery were enrolled in this study. Pathological findings of dural invasion and bone invasion were compared with the diagnostic imaging.ResultsAdvanced magnetic resonance imaging techniques revealed that ADC values in regions of pathological bone and dural invasions were significantly lower than in regions of no invasion. The area under the curve of ADC in bone invasions and dural invasions were 0.957 and 0.894, respectively.ConclusionsOur findings indicate that ADC and DWI are useful tools for the diagnosis of head and neck tumors with skull base invasion.

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Evaluation of natural growth rate and recommended age for shaving procedure by volumetric analysis of craniofacial fibrous dysplasia

\nJin‐Woo Park, \nJae Hoon Jung, \nSun‐June Park, \nSo Young Lim\n

Publicatie 08-09-2020


AbstractBackgroundWe evaluated the preoperative natural growth pattern of craniofacial fibrous dysplasia and postoperative volume changes in patients undergoing shaving procedures.MethodsThirty‐three patients who underwent serial computed tomography (CT) preoperatively and/or postoperatively were identified. The natural tumor growth rate was assessed using preoperative CT scans. The postoperative tumor regrowth rates and relevant variables were analyzed.ResultsThe preoperative tumor growth rates were significantly lower in patients aged ≥ 16 years than in those aged < 16 years (P < .001). The postoperative tumor regrowth rates were significantly greater when a shaving operation was performed at age < 16 years than at age ≥ 16 years (P = .04). In patients with clinical recurrence, the postoperative remnant tumor volume was inversely correlated with the tumor regrowth rate.ConclusionsThe tumor growth rate of craniofacial fibrous dysplasia significantly decreased after age 16. This should be considered when conducting functional and aesthetic assessments in planning for the shaving of craniofacial fibrous dysplasia.

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The contralateral based submental island flap for reconstruction of tongue and floor of mouth defects: Reliability and oncological outcome

\nAyman A. Amin, \nOmer M. Jamali, \nAhmed S. Ibrahim, \nMohamed A. Rifaat, \nMohamed H. Zedan\n

Publicatie 08-09-2020


AbstractBackgroundSubmental artery island flap (SIF) is a viable alternative to free flaps for selected oral‐cavity defects, however, concerns about its oncologic safety still exists. A novel harvesting technique and its outcome is described in here.MethodsThis is a prospective study for patients with lateralized oral tongue and/or floor of mouth (FOM) cancers who undergone reconstruction using pedicled SIF based on contralateral submental vessels (CSIF) following resection.ResultsForty‐one patients were included. Twenty‐four patients had T2, 13 had T3, and 4 had T1 tumors. The largest flap skin paddle was 15 × 9 cm. One patient sustained complete and five sustained partial flap loss. Three patients developed tongue tethering. Median follow‐up was 13.6 months. Locoregional recurrence occurred in 11 patients (26.8%); 6 oral‐cavity recurrences (14.6%), 6 ipsilateral, and 1 contralateral neck recurrences (2.4%).ConclusionCSIF is a reliable flap that addresses the oncologic controversy and overcomes the disadvantages of ipsilateral flap.

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Thermal imaging for microvascular free tissue transfer monitoring: Feasibility study using a low cost, commercially available mobile phone imaging system

\nAnnika Meyer, \nScott Roof, \nMingyang L. Gray, \nCaleb J. Fan, \nBrittany Barber, \nBrett A. Miles, \nMarita Teng, \nEric Genden, \nJoshua D. Rosenberg\n

Publicatie 08-09-2020


AbstractBackgroundThe use of infrared thermography to evaluate the perfusion of tissue flaps have been studied. This study aims to evaluate the utility of thermal imaging for flap monitoring with a low‐cost, readily available smartphone imaging device.MethodsAdult subjects who underwent head and neck reconstruction using a microvascular free flap with a cutaneous paddle were recruited. Thermal images were taken of the free flap before, during and after anastomosis. Thermal images were analyzed by measuring the average flap temperature minus the average surrounding tissue temperature (dT).ResultsTwenty‐one patients were enrolled. The mean dT for flaps intraoperatively prior to anastomosis was −11.47 °F. For 20 patients, dT averaged between −0.30 to 0.12 °F. One flap was inadequately perfused and dT was found to be −4.35 °F.ConclusionsLow cost, mobile smartphone devices such as the thermal camera may provide an objective method of monitoring microvascular free flaps.Level of evidence2 Prospective Cohort Study.

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Evaluation and validation of Physiological and Operative Severity Score for the enumeration of mortality and morbidity and Portsmouth‐POSSUM scores in predicting morbidity and mortality in patients undergoing head and neck cancer surgeries

\nNupur Karan, \nSuhail Siddiqui, \nKailash S. Sharma, \nGouri H. Pantvaidya, \nJigeeshu V. Divatia, \nAtul P. Kulkarni\n

Publicatie 08-09-2020


AbstractBackgroundIdentification of risk factors for perioperative complications helps in the prognostication. We wanted to determine whether Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth‐POSSUM (P‐POSSUM) can be used in patients undergoing head and neck oncosurgery.MethodsWe conducted a retrospective analysis of 1265 patients after they had major head and neck oncosurgeries. Demographic, surgical and outcome data was collected. We separately analyzed data for patients who had undergone cancer surgery for oral cavity, pharynx, and larynx. We calculated the POSSUM and P‐POSSUM scores.ResultsPOSSUM scoring system had moderate discrimination (AUC = 0.61) and good calibration (P = .36) for the entire study cohort and in the subgroup. Since there were no deaths in the entire cohort, we were not able to check predictive ability of the scores, for mortality.ConclusionsWe found that POSSUM had moderate discrimination and good calibration for morbidity prediction in head and neck cancer surgeries, as well as for the selected subgroup.

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Outcomes after radiation therapy for T2N0/stage II glottic squamous cell carcinoma

\nKarine A. Al Feghali, \nBassem Y. Youssef, \nAbdallah S. R. Mohamed, \nLara Hilal, \nBlaine D. Smith, \nIbrahim Abu‐Gheida, \nGeorges Farha, \nG. Brandon Gunn, \nJack Phan, \nJan Lewin, \nApurva Thekdi, \nWilliam H. Morrison, \nAdam S. Garden, \nClifton David Fuller, \nDavid I. Rosenthal\n

Publicatie 08-09-2020


AbstractBackgroundWe report outcomes for patients with T2N0M0 glottic squamous cell carcinoma (SCC) treated with radiation therapy (RT).MethodsPatients who received definitive RT for T2 glottic SCC from 2000 through 2013 were retrospectively reviewed.ResultsOne hundred and thirteen patients were analyzed (median follow‐up time 91 months; 85 patients received three‐dimensional conformal radiotherapy 3D‐CRT and 28 received intensity‐modulated radiation therapy IMRT). Fractionation was conventional (58%) or altered (42%); 20 patients (18%) received concurrent chemotherapy. Five‐year local control was 83% for the 3D‐CRT vs 81% for the IMRT group (P = .76). The ultimate locoregional control at 5 years was 100% for IMRT vs 91% for 3D‐CRT (P = .1). The 5‐year overall survival (OS) was 78% for 3D‐CRT vs 81% for IMRT (P = .83). On multivariate analysis, younger age was the only independent predictor of improved OS (P = .0002).ConclusionsOncologic and survival outcomes were excellent for patients with T2N0 glottic cancer. Patients treated with IMRT and 3D‐CRT had no statistically significant differences in all investigated endpoints.

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Respiratory droplet generation and dispersal during nasoendoscopy and upper respiratory swab testing

\nVanessa Y. J. Tan, \nEdward Z. Y. Zhang, \nDan Daniel, \nAnton Sadovoy, \nNeville W. Y. Teo, \nKimberley L. Kiong, \nS. T. Toh, \nHeng‐Wai Yuen\n

Publicatie 08-09-2020


AbstractRespiratory particle generation and dispersal during nasoendoscopy and swab testing is studied with high‐speed video and laser light illumination. Video analysis reveals droplet formation in three manoeuvres during nasoendoscopy ‐ sneezing, vocalization, and nasal decongestion spray. A capillary bridge of mucus can be seen when a nasoendoscope exits wet nares. No droplet formation is seen during oral and nasopharyngeal swab testing. We outline the following recommendations: pull the face mask down partially and keep the mouth covered, only allowing nasal access during nasoendoscopy; avoid nasal sprays if possible; if nasal sprays are used, procedurists should be in full personal protective equipment prior to using the spray; withdrawal of swabs and scopes should be performed in a slow and controlled fashion to reduce potential dispersion of droplets when the capillary bridge of mucus breaks up.

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Transoral robotic selective neck dissection for papillary thyroid carcinoma: Dissection of Levels III and IV

\nKyung Tae, \nKeon‐Ho Kim\n

Publicatie 08-09-2020


AbstractWe present the operative procedure of transoral robotic selective neck dissection for papillary thyroid carcinoma. A 28‐year‐old woman, diagnosed with papillary thyroid carcinoma and lymph node metastasis at right level IV, underwent total thyroidectomy, central neck dissection, and selective neck dissection involving levels III and IV via the transoral robotic approach. A 1.5‐2‐cm central incision was made near the base of the lower lip frenulum, and two lateral incisions were made close to the oral commissure. An additional right axillary port was made to place a third robotic instrument for counter‐traction. The operation was completed successfully without conversion to the conventional transcervical approach. The working space and surgical view were enough to perform selective neck dissection of levels III and IV. There were no major postoperative complications. Transoral robotic selective neck dissection of levels III and IV is feasible and safe in selected patients.

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Tympanum reconstruction using a sternocleidomastoid flap in patients with lateral skull base lesions: surgical technique and clinical report

\nGuodong Feng, \nXingmei Wei, \nHuiying Sun, \nZhuhua Zhang, \nXu Tian, \nYang Zhao, \nSurita Aodeng, \nYalin Zhou, \nZhiqiang Gao\n

Publicatie 08-09-2020


AbstractBackgroundDuring surgical treatment of lesions involving the skull base, conductive hearing is often sacrificed due to tympanum destruction. This study aimed to develop a method for tympanum reconstruction using a sternocleidomastoid (SCM) flap to preserve conductive hearing during lateral skull base surgery.MethodsThis study included five patients with lateral skull base lesions who underwent surgery including tympanum reconstruction with an SCM flap between July 2015 and November 2017.ResultsThree patients seen with facial nerve schwannoma, and two had paraganglioma of the head and neck. All patients inferior and posterior tympanic walls were resected; the tympanum and ossicular chain were reconstructed with an SCM flap and prosthesis. The mean postoperative air‐bone gap was 14 dB. No lesion recurrences were observed until the last follow‐up.ConclusionThe SCM flap is effective in preserving conductive hearing through reconstruction of the inferior and posterior tympanic walls in lateral skull base surgery.

Pubmed PDF Web

Evaluation of lymph node ratio and lymph node yield as prognosticators of locoregional recurrence in p16‐associated oropharyngeal squamous cell carcinoma

\nMargaret Nurimba, \nWilliam Hines, \nUttam Sinha, \nAnna Mathew, \nNiels Kokot, \nMark Swanson\n

Publicatie 08-09-2020


AbstractBackgroundThe prognostic value of lymph node yield (LNY) and lymph node ratio (LNR), or the ratio of number of metastatic LNs to total number dissected, has not been well established in p16‐associated oropharyngeal squamous cell carcinoma (OPSCC).MethodsThis retrospective cohort study evaluated locoregional disease‐free survival (LRDFS) in 82 patients with p16+ OPSCC who underwent neck dissection at a single institution from 2009 to 2017. LNR and LNY cutoffs were estimated using time‐dependent receiver operator characteristic (ROC) curves. Prognostic significance of these cutoffs was compared with Eighth Edition AJCC Nodal Staging.ResultsAn increased LNR ≥ 0.129 was associated with worse 2‐year LRDFS (66.9% vs 96.8%, P = .005). LNY was not significantly associated with LRDFS (P = .304). An LNR‐based risk model was a better prognosticator than Eighth Edition AJCC Nodal Staging (Harrells C, 0.9065 vs 0.7668).ConclusionsLNR has good prognostic utility in predicting LRDFS in p16+ OPSCC, but further evaluation of this measure is warranted.

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Added value of metastatic cervical lymph node group V in nodal staging of nasopharyngeal cancer

\nJiraporn Setakornnukul, \nKullathorn Thephamongkhol, \nPanid Chaysiri\n

Publicatie 08-09-2020


AbstractBackgroundPrognostic significance of posterior cervical lymph node metastasis in nasopharyngeal cancer is largely unknown. This study aims to determine the added prognostic significance of cervical lymph node group V to the standard American Joint Committee on Cancer (AJCC) staging system (eighth edition AJCC) of nasopharyngeal patients with cancer treated with intensity‐modulated radiation therapy (IMRT) in terms of overall survival (OS), distant metastatic‐free survival (DMFS), and disease‐free survival (DFS).Methods and MaterialsA retrospective cohort of 199 consecutively diagnosed nasopharyngeal patients with cancer treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) in the era of IMRT in a large university hospital in endemic area of Southeast Asia. Pre‐treatment imaging studies were thoroughly re‐evaluated and re‐staged by a board‐certified radiologist using radiographic criteria for cervical lymph node metastasis. T and N classifications were reclassified according to the eighth AJCC staging system. Group V (Va and Vb) cervical node was evaluated for its added prognostic significance. Coxs proportional hazard model was used to retrieve hazard ratio (HR), 95% confidence interval and P value for N classification. Harrells C‐statistic (concordance index) was used for test of discrimination and internal validation was calculated by bootstrap method.ResultsThis study demonstrated greater separation of OS with HR of 6.75 (95%CI 1.94‐23.51, P = .003) by using group Vb only as N3 compared to HR of 4.70 (95%CI 1.37‐16.13, P = .014) by using current standard N3 disease (groups IV and Vb). Similarly, N2 with presence of Va shows worsened DFS with HR of 8.70 (95%CI 1.08‐69.67, P = .042) compared to N2 without Va with HR of 5.93 (95%CI 0.76‐46.00, P = .089). After incorporating cervical group V into nodal staging, the HR and 95%CI among each group was better separated than the eighth AJCC staging system but without significant improvement in C‐index.ConclusionCervical lymph node group V is a potentially added prognostic factor to standard TNM staging.

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Neutrophil‐to‐lymphocyte ratio as a prognostic indicator for overall and cancer‐specific survival in squamous cell carcinoma of the head and neck

\nRocco M. Ferrandino, \nScott Roof, \nJonathan Garneau, \nYarah Haidar, \nSusan E. Bates, \nYeun‐Hee A. Park, \nJoshua M. Bauml, \nEric M. Genden, \nBrett Miles, \nKeith Sigel\n

Publicatie 08-09-2020


AbstractBackgroundNeutrophil‐to‐lymphocyte ratio (NLR) is a biomarker that is correlated with systemic inflammation and poor prognosis in solid tumors. We investigated the value of NLR in predicting survival in a large population of head and neck cancer patients in the United States.MethodsWe performed a retrospective cohort study of Veterans Affairs patients with head and neck squamous cell carcinoma (HNSCC) diagnosed between January 2000 and December 2017. We compared 5‐year overall survival and cancer‐specific survival for different NLR tertiles using cox proportional hazards modeling with adjustment for covariates.ResultsThe primary cohort consisted of 14 644 subjects of which 99% were male. Relative to patients with NLRs in the lower tertile, patients with NLRs in the top tertile had an 71% increased hazard of all‐cause mortality (P < .001) and 44% increased hazard of cancer‐specific mortality (P < .001) at 5 years.ConclusionsElevated NLR in HNSCC confers a poor prognosis.

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Weighted lymph node ratio: New tool in the assessment of postoperative staging of the neck dissection in HPV‐negative head and neck squamous cell carcinoma patients

\nXavier León, \nEduard Neumann, \nAlfons Gutiérrez, \nJacinto García, \nMontserrat López, \nMiquel Quer\n

Publicatie 08-09-2020


AbstractBackgoundThe objective of this study is to assess a new parameter, the weighted lymph node ratio (WLNR), which incorporates prognostic information regarding the number of metastatic nodes with extracapsular spread and the lymph node yield for pN0 patients to the lymph node ratio.MethodsWe studied retrospectively 1118 patients with head and neck squamous cell carcinoma (HNSCC) treated with a neck dissection.ResultsWe obtained a classification with four categories based on the WLNR values. WLNR classification had a higher prognostic discrimination capacity and a more homogeneous distribution in the number of patients included in each of the categories than the pTNM classification.ConclusionThe WLNR improved the predictive capacity of the eighth edition of the pTNM classification and it can be a useful tool in the assessment of the postoperative staging of the neck dissections in HNSCC patients.

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Impact of the COVID‐19 pandemic on Otolaryngology trainee education

\nTheresa Guo, \nKimberley L. Kiong, \nChristopher M. K. L. Yao, \nMelina Windon, \nDenna Zebda, \nYelda Jozaghi, \nXiao Zhao, \nAmy C. Hessel, \nEhab Y. Hanna\n

Publicatie 08-09-2020


AbstractBackgroundThe COVID‐19 pandemic has reduced clinical volume with a negative impact on trainee education.MethodsSurvey study of Otolaryngology trainees in North America, during the COVID‐19 pandemic in April 2020.ResultsOf 216 respondents who accessed the survey, 175 (83%) completed the survey. Respondents reported a universal decrease in clinical activities (98.3%). Among participants who felt their program utilized technology well, there were significantly decreased concerns to receiving adequate educational knowledge (29.6% vs 65.2%, P = .003). However, 68% of trainees still expressed concern in ability to receive adequate surgical training. In addition, 54.7% of senior trainees felt that the pandemic had a negative impact on their ability to secure a job or fellowship after training.ConclusionsTrainees universally felt a negative impact due to the COVID‐19 pandemic. Use of technology was able to alleviate some concerns in gaining adequate educational knowledge, but decreased surgical training remained the most prevalent concern.

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"Two‐year follow‐up of a randomized phase III clinical trial of nivolumab vs. the investigators choice of therapy in the Asian population for recurrent or metastatic squamous cell carcinoma of the head and neck (CheckMate 141)"

\nChia‐Jui Yen, \nNaomi Kiyota, \nNobuhiro Hanai, \nShunji Takahashi, \nTomoya Yokota, \nShigemichi Iwae, \nYasushi Shimizu, \nRuey‐Long Hong, \nMasahiro Goto, \nJin‐Hyoung Kang, \nWing Sum Kenneth Li, \nRobert L. Ferris, \nMaura Gillison, \nToshimitsu Endo, \nVijayvel Jayaprakash, \nMakoto Tahara\n

Publicatie 08-09-2020


AbstractBackgroundThe present study evaluated the 2‐year survival of the Asian population in the CheckMate 141 trial.MethodsThe CheckMate 141 trial included patients with recurrent or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN). In the present study, 34 Asian patients (nivolumab group: 23 patients; investigators choice of therapy IC group: 11 patients) were analyzed.ResultsThe median overall survival (OS) was 12.1 and 6.2 months for the nivolumab and IC groups, respectively. The estimated 2‐year OS rates were 22.7% and 0% for the nivolumab and IC groups, respectively. In the nivolumab group, the patients with any treatment‐related adverse events (TRAEs), including skin‐related disorders, showed better OS than the patients without any TRAEs.ConclusionsNivolumab demonstrated prolonged OS benefits in the Asian population with platinum‐refractory R/M SCCHN and a favorable safety profile. TRAEs, including skin‐related disorders, may be favorable prognostic factors for nivolumab efficacy.Clinical trial registrationNCT02105636.

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What is the hold up?—Mixed‐methods analysis of postoperative radiotherapy delay in head and neck cancer

\nKevin J. Sykes, \nEmily Morrow, \nJoshua B. Smith, \nAndrew J. Holcomb, \nMindi TenNapel, \nChristopher E. Lominska, \nAndrés M. Bur, \nKiran Kakarala\n

Publicatie 08-09-2020


AbstractBackgroundDelays in postoperative radiotherapy (PORT) for head and neck cancer (HNC) increase the risk for recurrence and mortality. The multifactorial nature of delays calls for an in‐depth understanding of potential contributors from the patients and providers perspectives. We sought to identify causes of delays in adjuvant radiotherapy initiation for HNC.MethodsWe performed a mixed‐methods study including patients with HNC care team members. Forty in‐depth interviews were performed (26 patients; 14 care team members). Timing and demographic data were collected from medical records.ResultsMedian time from surgery to radiotherapy initiation was 45 days; 15 participants began after 42 days. Process delays and failure to communicate the urgency and significance of PORT initiation contributes to delays. Patients with a strong social support system experience less delays.ConclusionsAchieving reductions in PORT initiation requires efficient care coordination, improved communication between interdisciplinary teams, and strengthening social support systems for patients with HNC.

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Successful use of a therapeutic trial of graduated volume and dose escalation for postoperative head and neck radiotherapy in a Fanconi anemia patient

\nLuke M Lewis, \nAlice L Tang, \nTrisha M Wise‐Draper, \nKasiani C Myers, \nJoel S Greenberger, \nVinita Takiar\n

Publicatie 08-09-2020


AbstractBackgroundPatients with the heritable disease, Fanconi anemia (FA), have a 500‐fold risk of developing head and neck squamous cell carcinomas (HNSCC). However, the use of conventional cytotoxic agents including radiation therapy and cisplatin‐based chemotherapy is contraindicated in patients with FA due to underlying DNA repair defects.Methods/ResultsWe present a young FA patient with recurrent HNSCC and high‐risk pathologic features treated with a therapeutic trial of chemoradiation. This novel strategy employs a gentle radiation dose and volume escalation with concurrent pembrolizumab. The patient completed the entire course of therapy with no treatment delays or interruptions.ConclusionsThe FA patient population has a clear need for adjuvant treatment regimens given their predilection for HNSCC. A therapeutic trial may allow FA and other radiosensitive patients to trial radiation with the option to terminate treatment before any severe side effects occur and for some to complete a full course of treatment.

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Radiation necrosis of the pharyngeal soft tissue: Unique clinical entity reconstructed with a previously unreported composite brachioradialis and flexor digitorum superficialis radial forearm flap

"\nMonica H. Xing, \nEdward Ansari, \nQuinn F. OMalley, \nAzita Khorsandi, \nMohemmed Nazir Khan, \nMark L. Urken\n"

Publicatie 08-09-2020


AbstractBackgroundThe radial forearm free flap (RFFF) is a versatile flap commonly used in head and neck reconstructive surgery. We describe the use of a composite RFFF that includes muscle for reconstruction of a hostile wound of the posterior pharyngeal wall.MethodsA 54‐year‐old male with a history of recurrent right palatine tonsil HPV+ squamous cell carcinoma developed severe soft tissue necrosis of the posterior pharyngeal wall secondary to reirradiation. The defect was reconstructed with a composite RFFF that included the brachioradialis (BR) muscle and the flexor digitorum superficialis (FDS) muscle.ResultsRestoration of this complex defect was successfully accomplished with minimal donor site functional deficits and satisfactory functional outcomes including decannulation and resumption of oral intake.ConclusionThis composite RFFF can be effectively used to reconstruct a hostile wound of the posterior pharyngeal wall. Incorporation of muscle in the reconstruction of complex wounds with soft tissue necrosis is beneficial.

Pubmed PDF Web

Reply to the Letter to the Editor regarding “Significance and management of incidentally diagnosed metastatic papillary thyroid carcinoma in cervical lymph nodes in neck dissection specimens”

\nJatin Shah\n

Publicatie 08-09-2020


Pubmed PDF Web

Incidental identification of cervical nodal metastases from papillary thyroid carcinoma: Experiences related to esophageal cancer surgery

\nMasayuki Urabe, \nMasaki Ueno, \nHarushi Udagawa\n

Publicatie 08-09-2020


Pubmed PDF Web

Induction chemotherapy followed by radiotherapy for N3 head and neck squamous cell carcinoma—Useful treatment option with a caveat

\nAdhara Chakraborty, \nShivakumar Thiagarajan\n

Publicatie 08-09-2020


Pubmed PDF Web

Response to comments HN‐20‐1003 “Induction chemotherapy followed by radiotherapy for N3 head and neck squamous cell carcinoma: useful treatment option with a caveat”

\nChengrun Du, \nYungan Tao\n

Publicatie 08-09-2020


Pubmed PDF Web

Application of salivary noncoding microRNAs for the diagnosis of oral cancers

\nFiona T. Deutsch, \nSamantha J. Khoury, \nJohn B. Sunwoo, \nMichael S. Elliott, \nNham T. Tran\n

Publicatie 08-09-2020


AbstractOral cancer is on the rise globally and survival rates, despite improvements in clinical care, have not significantly improved. Early detection followed by immediate intervention is key to improving patient outcomes. The use of biomarkers has changed the diagnostic landscape for many cancers. For oral cancers, visual inspection followed by a tissue biopsy is standard practice. The discovery of microRNAs as potential biomarkers has attracted clinical interest but several challenges remain. These microRNAs can be found in bodily fluids such as blood and saliva which have been investigated as potential sources of biomarker discovery. As oral cancer is localized within the oral cavity, saliva may contain clinically relevant molecular markers for disease detection. Our review provides an outline of the current advances for the application of salivary microRNAs in oral cancer. We also provide a technical guide for the processing of salivary RNAs to ensure accurate clinical measurement and validation.

Pubmed PDF Web

Issue Information

Publicatie 08-09-2020


Pubmed PDF Web

Cover Image

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

Publicatie 08-09-2020


The cover image is based on the Original Article Safety parameters of ferromagnetic device during thyroid surgery: Porcine model using continuous neuromonitoring by Tzu‐Yen Huang MD et al., https://doi.org/10.1002/hed.26334.

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Cover Image

\nAnnika Meyer, \nScott Roof, \nMingyang L. Gray, \nCaleb J. Fan, \nBrittany Barber, \nBrett A. Miles, \nMarita Teng, \nEric Genden, \nJoshua D. Rosenberg\n

Publicatie 08-09-2020


The cover image is based on the Original Article Thermal imaging for microvascular free tissue transfer monitoring: Feasibility study using a low cost, commercially available mobile phone imaging system by Annika Meyer MD et al., https://doi.org/10.1002/hed.26350.

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Comparison of core needle biopsy and fine‐needle aspiration in diagnosis of ma lignant salivary gland neoplasm: Systematic review and meta‐analysis

\nJungheum Cho, \nJunghoon Kim, \nJi Sung Lee, \nChoong Guen Chee, \nYoungjune Kim, \nSang Il Choi\n

Publicatie 08-09-2020


AbstractBackgroundIn this meta‐analysis, we compared the risk of obtaining nondiagnostic results and the diagnostic accuracy for detection of salivary gland malignancy between core needle biopsy (CNB) and fine‐needle aspiration (FNA).MethodsAll published English‐language studies comparing CNB and FNA diagnostic accuracy for salivary gland masses through December 2019 were searched. Pooled risk ratios (RRs) of nondiagnostic results, sensitivities, and specificities of CNB and FNA for salivary gland malignancy diagnosis were determined. Complication rates were compared.ResultsSix studies (1924 procedures) were quantitatively analyzed. CNB yielded significantly fewer nondiagnostic results (P < .001) and had significantly higher pooled sensitivity (P < .001) and specificity (P = .002) than FNA for differentiating malignant and benign salivary gland neoplasms. Hematoma occurred in 0.3% of CNB, while no complication occurred in FNA procedures.ConclusionCNB yielded fewer nondiagnostic results and had superior diagnostic performance compared with FNA for detecting salivary gland malignancies.

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Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by HPV status

\nEva Stein, \nNicholas R. Lenze, \nWendell G. Yarbrough, \nD. Neil Hayes, \nAngela Mazul, \nSiddharth Sheth\n

Publicatie 08-09-2020


AbstractBackgroundThere is a well documented racial disparity in overall survival for oropharyngeal squamous cell carcinoma (OPSCC); however, it is unknown to what extent this disparity varies by HPV‐status.MethodsA literature search was conducted through December 2019 using Ovid Medline, Cochrane Library, Embase, Scopus, and Clinicaltrials.gov. PRISMA guidelines were followed. A meta‐analysis was conducted using random effects models to obtain pooled hazard ratios (HRs).ResultsOf 649 studies initially identified, 20 studies met criteria for the narrative review. There were four studies evaluating survival by race in HPV‐positive OPSCC and five studies in HPV‐negative OPSCC suitable for pooling. The pooled HR associated with black race was 1.10 (95% CI 0.96‐1.23) among patients with HPV‐positive (n = 23 608) and 1.50 (95% CI 1.12‐1.88) among patients with HPV‐negative (n = 12 112). There was notable heterogeneity (I2 = 83%) and publication bias among the HPV‐negative OPSCC studies.ConclusionsThe racial disparity in OPSCC survival persists for HPV‐negative disease and is nonsignificant for HPV‐positive disease. Unmeasured differences in socioeconomic status and access to care may contribute to this disparity.

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Case for staged thyroidectomy

\nOhad Ronen, \nK. Thomas Robbins, \nKerry D. Olsen, \nAshok R. Shaha, \nGregory W. Randolph, \nIain J. Nixon, \nMark E. Zafereo, \nDana M. Hartl, \nLuiz P. Kowalski, \nJuan P. Rodrigo, \nAndrés Coca‐Pelaz, \nAntti A. Mäkitie, \nVincent Vander Poorten, \nAlvaro Sanabria, \nPeter Angelos, \nAlessandra Rinaldo, \nAlfio Ferlito\n

Publicatie 08-09-2020


AbstractRecent modifications in the management of well‐differentiated thyroid cancer have resulted in significant alterations in clinical approach. Utilizing a series of preoperative and postoperative risk factors involving both the patient and the disease pathology, we offer the term “staged thyroidectomy” to help organize these risk factors for patients and the endocrine team to optimize management. This approach is intended to incorporate our latest nuanced understanding of certain endocrine pathology and may serve to optimize patient outcomes.

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Diabetes mellitus in major head and neck cancer surgery: Systematic review and meta‐analysis

\nMathew P. Caputo, \nSepehr Shabani, \nRahul Mhaskar, \nCaitlin McMullen, \nTapan A. Padhya, \nMatthew J. Mifsud\n

Publicatie 08-09-2020


AbstractBackgroundDiabetes mellitus (DM) is a risk factor for surgical complications and a common comorbidity in the setting of head and neck (H&N) cancer. Our objective was to determine if DM is associated with increased rates of H&N cancer surgery complications.MethodsWe conducted a search of Pubmed, Embase, and the national clinical trials database focusing on H&N cancer surgery or free flap reconstruction and diabetes. Two reviewers screened studies by title/abstract and then full text. We then collected data using a pre‐made template. Meta‐analysis was performed using Revman 5.3.ResultsOf the 272 results from Pubmed and 559 from Embase, we selected 16 studies for inclusion. Meta‐analysis revealed DM was associated with increased rates of flap failure (risk ratio RR = 1.83 95% confidence interval CI, 1.18‐2.85; P = .007) and local complications (RR = 1.87 95% CI, 1.24‐2.80; P < .00001).ConclusionAlthough DM is associated with increased risk of flap failure and local H&N cancer surgery complications, further research is required to optimize care in this population.

Pubmed PDF Web

Core needle biopsy for diagnosing lymphoma in cervical lymphadenopathy: Meta‐analysis

\nAnton Warshavsky, \nRoni Rosen, \nChava Perry, \nNidal Muhanna, \nOmer J. Ungar, \nNarin Nard Carmel‐Neiderman, \nDan M. Fliss, \nGilad Horowitz\n

Publicatie 08-09-2020


AbstractBackgroundThe diagnostic yield of core needle biopsies (CNB) in cervical lymphadenopathy for lymphoma diagnosis is controversial. The aim of this study was to calculate the accuracy of cervical CNB in diagnosing lymphoma.MethodsWe conducted a meta‐analysis of all studies on patients presenting with cervical lymphadenopathy and referred to CNB. Patients with a diagnosis other than lymphoma were excluded. All cases diagnosed with lymphoma sufficient to guide treatment based on CNB outcome were considered accurate (actionable) results. A separate meta‐analysis was performed for various lymphoma subtypes.ResultsThree prospective and 19 retrospective studies, comprising 1120 patients, met the inclusion criteria. The rate of actionable lymphoma diagnoses following CNB ranged from 30% to 96.3%, with a random‐effects model of 82.45% (95% confidence interval CI =0.76‐0.88) and a fixed‐effects model of 78.3% (95% CI =0.75‐0.80).ConclusionCNB for cervical lymphadenopathy in lymphoma cases is relatively accurate in guiding treatment.

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Risk stratification in oral squamous cell carcinoma using staging of the eighth American Joint Committee on Cancer: Systematic review and meta‐analysis

\nAlhadi Almangush, \nMatti Pirinen, \nOmar Youssef, \nAntti A. Mäkitie, \nIlmo Leivo\n

Publicatie 08-09-2020


AbstractThe eighth edition of the American Joint Committee on Cancer (AJCC8) staging manual has major changes in oral squamous cell carcinoma (OSCC). We searched PubMed, OvidMedline, Scopus, and Web of Science for studies that examined the performance of AJCC8 in OSCC. A total of 40 808 patients were included in the studies of our meta‐analysis. A hazard ratio (HR) of 1.87 (95%CI 1.78‐1.96) was seen for stage II, 2.65 (95%CI 2.51‐2.80) for stage III, 3.46 (95%CI 3.31‐3.61) for stage IVa, and 7.09 (95%CI 4.85‐10.36) for stage IVb. A similar gradual increase in risk was noted for the N classification. For the T classification, however, there was a less clear variation in risk between T3 and T4. AJCC8 provides a good risk stratification for OSCC. Future research should examine the proposals introduced in the published studies to further improve the performance of AJCC8.

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Prevalence of human papillomavirus in oral epithelial dysplasia: Systematic review and meta‐analysis

\nCecilie Dovey de la Cour, \nCecilie Dyg Sperling, \nFederica Belmonte, \nStina Syrjänen, \nFreija Verdoodt, \nSusanne Krüger Kjaer\n

Publicatie 08-09-2020


AbstractThe purpose of this systematic review and meta‐analysis was to estimate the overall and type‐specific prevalence of human papillomavirus (HPV) DNA in oral epithelial dysplasia and assess p16INK4a overexpression in relation to HPV‐status. A systematic literature search identified 31 eligible studies (832 cases) evaluating the presence of HPV DNA in oral epithelial dysplasia cases by PCR. Of these, six studies evaluated p16INK4a overexpression in relation to HPV‐status. The overall pooled prevalence of HPV DNA in oral epithelial dysplasia was 27.2% (95% CI: 17.6‐38.1). We observed substantial interstudy heterogeneity, which could not be explained by differences in continent, tissue type, or severity of epithelial dysplasia. HPV16 was the predominant genotype detected. Moreover, 62.2% of HPV positive and 17.8% of HPV negative oral epithelial dysplasia samples stained intensively positive for p16INK4a. This meta‐analysis found that 27% of oral epithelial dysplasia harbor HPV DNA. Whether this represents a transient infection or has a carcinogenic role is unknown.

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Prevalence of PD‐L1 expression in head and neck squamous precancerous lesions: a systematic review and meta‐analysis

\nIlaria Girolami, \nLiron Pantanowitz, \nEnrico Munari, \nMaurizio Martini, \nRiccardo Nocini, \nNicola Bisi, \nGabriele Molteni, \nDaniele Marchioni, \nClaudio Ghimenton, \nMatteo Brunelli, \nAlbino Eccher\n

Publicatie 08-09-2020


AbstractBackgroundStudies concerning programmed death‐ligand 1 (PD‐L1) expression in precancerous lesions of head and neck (HN) region have shown variable results.MethodsWe systematically reviewed the published evidence on PD‐L1 expression in HN precancerous lesions.ResultsOf 1058 original articles, 14 were included in systematic review and 9 in meta‐analysis. The pooled estimate of PD‐L1 expression was 48.25% (confidence interval CI 21.07‐75.98, I2 98%, tau2 0.18). PD‐L1 expression appeared to be more frequent in precancerous lesions than in normal mucosa (risk ratio RR 1.65, CI 0.65‐4.03, I2 91%, tau2 0.82) and less frequent than in invasive squamous cell carcinoma (RR 0.68, CI 0.43‐1.08, I2 91%, tau2 0.22).ConclusionsPD‐L1 expression could reflect a point of balance between host immune response and cancer escape ability. High heterogeneity and moderate quality suggest that further studies with larger sample size and more rigorous case selection will allow more precise assessment of PD‐L1 expression in HN precancerous lesions.

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

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

Publicatie 05-09-2020


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

Pubmed PDF Web

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

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

Publicatie 05-09-2020


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

Pubmed PDF Web

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

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

Publicatie 05-09-2020


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

\nKyung Tae\n

Publicatie 05-09-2020


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

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

Publicatie 04-09-2020


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

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

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

Publicatie 03-09-2020


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

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

Publicatie 03-09-2020


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

\nGuan‐Jiang Huang, \nBei‐Bei Yang\n

Publicatie 01-09-2020


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

\nXiaodong Zhu\n

Publicatie 01-09-2020


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

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

Publicatie 31-08-2020


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

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

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

Publicatie 31-08-2020


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

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

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

Publicatie 30-08-2020


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

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Use of intraoperative neural monitoring for prognostication of recovery of vocal mobility and reduction of permanent vocal paralysis after thyroidectomy

\nGerard Thong, \nCatherine Brophy, \nPatrick Sheahan\n

Publicatie 30-08-2020


AbstractIntroductionThe benefits of intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) on post‐thyroidectomy vocal cord palsy (VCP) rates are contentious. We wished to study impact of IONM on permanent VCP after thyroidectomy.MethodsRetrospective review of prospective series of 1011 (1539 nerves‐at‐risk) patients undergoing thyroidectomy without (418, group 1) and with (583, group 2) IONM.ResultsThere were three recognized nerve injuries in group 1, vs one in group 2 (P = .3). There were no differences in overall VCP rates. However, patients in group 2 with immediate postoperative VCP had higher likelihood of full recovery than patients in group 1 (55 of 56 vs 23 of 29 patients, P = .01), and lower incidence of total permanent VCP (2 of 917 vs 9 of 647 patients, P = .01).ConclusionAmong patients with immediate postoperative VCP after thyroidectomy, IONM is associated with a higher likelihood of regaining normal vocal function. This may be related to better identification of RLN branching in IONM cases.

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Prognostic nomogram for adenoid cystic carcinoma in different anatomic sites

\nXiaoli Mu, \nYan Li, \nLing He, \nHui Guan, \nJingjing Wang, \nZhigong Wei, \nYan He, \nZheran Liu, \nRuidan Li, \nXingchen Peng\n

Publicatie 30-08-2020


AbstractBackgroundAdenoid cystic carcinoma (ACC) is a relatively uncommon tumor. The existing prediction model is limited to the head and neck. We aim to construct a prognostic nomogram combined with the clinical features and treatment options of ACC to predict the disease‐specific survival (DSS) of patients diagnosed with ACC in different anatomic sites.MethodsA novel predictive model was constructed using 1285 patients with ACC from the Surveillance, Epidemiology, and End Results (SEER) registry between 2010 and 2015. The performance of this model was externally validated using 118 patients with ACC in the West China Hospital, Sichuan University between 2010 and 2017.ResultsThe prognostic model demonstrated that age, primary site, lymph node metastasis, distant metastasis, radiotherapy and surgery were independent factors for DSS. The validation of the model using an external cohort proved its reliability.ConclusionThe developed novel predictive model is shown to provide accurate and efficient predictive information for patients with ACC for different anatomic sites.

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Decline in circulating viral and human tumor markers after resection of head and neck carcinoma

\nErin M. Lopez, \nApril Michelle Tanner, \nEugenie Du, \nSamip N. Patel, \nJared Weiss, \nMark C. Weissler, \nTrevor Hackman, \nGaorav P. Gupta, \nJose Zevallos, \nSandra Elmore, \nRenee Betancourt, \nLeigh Thorne, \nSiddharth Sheth, \nMargaret L. Gulley\n

Publicatie 28-08-2020


AbstractBackgroundDNA sequencing panels can simultaneously quantify human and viral tumor markers in blood. We explored changes in levels of plasma tumor markers following surgical resection of head and neck carcinoma.MethodsIn preresection and postresection plasmas, targeted DNA sequencing quantified variants in 28 human cancer genes and levels of oncogenic pathogens (human papillomavirus HPV, Epstein‐Barr virus EBV, Helicobacter pylori) from 21 patients with head and neck squamous cell carcinoma.ResultsPreresection, 11 of 21 patients (52%) had detectable tumor markers in plasma, most commonly TP53 mutation or HPV genome. Several days postresection, levels fell to undetectable in 8 of 10 evaluable patients, while two high‐stage patients retained circulating tumor markers.ConclusionsModern sequencing technology can simultaneously quantify human gene variants and oncogenic viral genomes in plasma. Falling levels of cancer‐specific markers upon resection can help identify viral and human markers to track at subsequent timepoints as a means to evaluate efficacy of interventions.

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

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

Publicatie 27-08-2020


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

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

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

Publicatie 27-08-2020


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

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Image‐guided robotic radiosurgery for glomus jugulare tumors—Multicenter experience and review of the literature

\nFelix Ehret, \nMarkus Kufeld, \nChristoph Fürweger, \nAlfred Haidenberger, \nChristian Schichor, \nRalph Lehrke, \nSusanne Fichte, \nCarolin Senger, \nMartin Bleif, \nDaniel Rueß, \nMaximilian Ruge, \nJörg‐Christian Tonn, \nAlexander Muacevic, \nJohn‐Martin Hempel\n

Publicatie 27-08-2020


AbstractBackgroundGlomus jugulare tumors (GJTs) are challenging to treat due to their vascularization and location. This analysis evaluates the effectiveness and safety of image‐guided robotic radiosurgery (RRS) for GJTs in a multicenter study and reviews the existing radiosurgical literature.MethodsWe analyzed outcome data from 101 patients to evaluate local control (LC), changes in pretreatment deficits, and toxicity. Moreover, radiosurgical studies for GJTs have been reviewed.ResultsAfter a median follow‐up of 35 months, the overall LC was 99%. Eighty‐eight patients were treated with a single dose, 13 received up to 5 fractions. The median tumor volume was 5.6 cc; the median treatment dose for single‐session treatments is 16 Gy, and for multisession treatments is 21 Gy. Fifty‐six percentage of patients experienced symptom improvement or recovered entirely.ConclusionsRRS is an effective primary and secondary treatment option for GJTs. The available literature suggests that radiosurgery is a treatment option for most GJTs.

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

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

Publicatie 27-08-2020


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

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Factors impacting successful salvage of the failing free flap

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

Publicatie 26-08-2020


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

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

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

Publicatie 25-08-2020


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

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

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

Publicatie 25-08-2020


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

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

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

Publicatie 25-08-2020


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

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

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

Publicatie 24-08-2020


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

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

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

Publicatie 23-08-2020


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

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

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

Publicatie 22-08-2020


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

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

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

Publicatie 21-08-2020


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

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Panendoscopy during follow‐up in laryngeal carcinoma patients after radiotherapy

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

Publicatie 21-08-2020


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

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

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

Publicatie 21-08-2020


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

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

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

Publicatie 19-08-2020


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

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

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

Publicatie 19-08-2020


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

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

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

Publicatie 19-08-2020


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

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

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

Publicatie 19-08-2020


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

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

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

Publicatie 18-08-2020


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

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

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

Publicatie 18-08-2020


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

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Curative‐intent radiotherapy for glottic carcinoma in situ

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

Publicatie 17-08-2020


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

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

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

Publicatie 17-08-2020


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

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Updates in the evidence‐based management of cutaneous melanoma

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

Publicatie 16-08-2020


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

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

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

Publicatie 13-08-2020


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

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Soft tissue deposits: Surrogate marker for distant metastasis?

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

Publicatie 13-08-2020


Pubmed PDF Web

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

\nAkshat Malik, \nSudhir Nair\n

Publicatie 13-08-2020


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

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

Publicatie 09-08-2020


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

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

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

Publicatie 09-08-2020


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

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

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

Publicatie 07-08-2020


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

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

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

Publicatie 06-08-2020


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

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Cosmetic outcomes following transoral versus transcervical thyroidectomy

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

Publicatie 06-08-2020


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

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

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

Publicatie 06-08-2020


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

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

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

Publicatie 06-08-2020


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

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

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

Publicatie 06-08-2020


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

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

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

Publicatie 02-08-2020


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

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

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

Publicatie 01-08-2020


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

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