Head and Neck

Head and Neck

Changing functional status within 6 months posttreatment is prognostic of overall survival in patients with head and neck cancer: NRG Oncology Study

22-08-2019 – Ronald C. Eldridge, Stephanie L. Pugh, Andy Trotti, Kenneth Hu, Sharon Spencer, Sue Yom, David Rosenthal, Nancy Read, Anand Desai, Elizabeth Gore, George Shenouda, Mark V. Mishra, Deborah Bruner, Canhua Xiao

Journal Article

Abstract
Background
Is posttreatment functional status prognostic of overall survival in patients with head and neck cancer (HNC).
Methods
In an HNC clinical trial, 495 patients had two posttreatment functional assessments measuring diet, public eating, and speech within 6 months. Patients were grouped by impairment (highly, moderately, modestly, or not impaired) and determined if they improved, declined, or did not change from the first assessment to the second. Multivariable Cox models estimated overall mortality.
Results
Across all three scales, the change in posttreatment patient function strongly predicted overall survival. In diet, patients who declined to highly impaired had three times the mortality of patients who were not impaired at both assessments (hazard ratio HR = 3.60; 95% confidence interval, 2.02‐6.42). For patients improving from highly impaired, mortality was statistically similar to patients with no impairment (HR = 1.38; 95% CI, 0.82‐2.31).
Conclusions
Posttreatment functional status is a strong prognostic marker of survival in patients with HNC.

Evaluation of oral tegafur‐uracil as metronomic therapy following concurrent chemoradiotherapy in patients with non‐distant metastatic TNM stage IV nasopharyngeal carcinoma

22-08-2019 – Jia‐Hong Chen, Wen‐Yen Huang, Ching‐Liang Ho, Tsu‐Yi Chao, Jih‐Chin Lee

Journal Article

Abstract
Background
The study was aimed to evaluate the impact of accumulated oral tegafur‐uracil (UFUR) as maintenance chemotherapy on overall survival (OS) and disease‐free survival (DFS) rates after concurrent chemoradiotherapy (CCRT) for complete remission (CR) in non‐distant metastatic TNM stage IV nasopharyngeal carcinoma (NPC).
Methods
Data were retrospectively analyzed from a database of patients with non‐distant metastatic TNM stage IV NPC, composed of those who underwent CCRT for CR from January 2010 through December 2017.
Results
Thirty‐three patients were treated with CCRT (the non‐UFUR group), and the other 37 patients were treated with the same regimen, followed by additional oral UFUR (the UFUR group). Importantly, the 5‐year OS rates were 91.89% in the UFUR group and 57.58% in the non‐UFUR group (P = .004).
Conclusions
Adding UFUR to CCRT was found to significantly improve the DFS and OS rates of patients with non‐distant metastatic TNM stage IV NPC. The authors cautiously suggest UFUR as possible maintenance therapy following CCRT.

Salvage surgery for recurrent larynx cancer

21-08-2019 – Ximena Mimica, Martin Hanson, Snehal G. Patel, Marlena McGill, Sean McBride, Nancy Lee, Lara A. Dunn, Jennifer R. Cracchiolo, Jatin P. Shah, Richard J. Wong, Ian Ganly, Marc A. Cohen

Journal Article

Abstract
Background
Despite advances in treatment, the recurrence rates for laryngeal cancer range from 16% to 40%.
Methods
Patients with recurrent laryngeal cancer treated at Memorial Sloan Kettering (MSK) from 1999 to 2016 were reviewed. Survival outcomes were analyzed.
Results
Of 241 patients, 88% were male; the median age was 67 years; 71% had primary glottic tumors. At initial treatment, 72% of patients were seen with early stage disease; primary treatment was radiation (68%), chemoradiation (29%), and surgery (3%). The most common salvage surgery was total laryngectomy (74%). Forty‐seven percentage were upstaged at salvage surgery. The 2‐ and 5‐year disease‐specific survival (DSS) was 74% and 57%, respectively. Patients with c
T4 disease treated with nonsurgical primary management had a 0% 5‐year DSS. Independent predictors of DSS were tumor location, perineural invasion, margin, and stage.
Conclusions
Salvage surgery results in acceptable oncologic outcomes. Stage, disease site, perineural invasion, and margins are associated with inferior DSS.

Patterns of local recurrence after curative resection and reconstruction for oropharyngeal and oral cancers: Implications for postoperative radiotherapy target volumes

20-08-2019 – Yeona Cho, Hong In Yoon, Ik Jae Lee, Jun Won Kim, Chang Geol Lee, Eun Chang Choi, Se‐Heon Kim, Ki Chang Keum

Journal Article

Abstract
Background
We aimed to determine the patterns of local recurrence after curative resection and reconstruction for oropharyngeal and oral cancers.
Methods
One hundred‐fourteen patients with oropharyngeal and oral cancers underwent resection and reconstruction. The local recurrences were classified as “intra‐flap” (the recurrent tumor was located in the flap tissue), “marginal” (≤5 mm from the flap anastomosis), and “outside” (in the original tissue and >5 mm from the anastomosis) recurrences.
Results
Twenty‐seven patients (23.7%) experienced local recurrence, while 32 (28.1%) experienced regional, and nine (7.9%) recurred distantly. Among those who showed local recurrence, one developed “outside” recurrence and the remaining 26 developed “marginal” recurrences. Age >60 years and lymph node metastasis were associated with poor disease‐free survival and overall survival (OS), while the perineural invasion was related to poor locoregional failure‐free survival and OS.
Conclusion
Most recurrences developed at the anastomosis marginal site, while none developed in the flap tissue.

A surgical approach to schwannomas originating from the esophageal branch of the recurrent laryngeal nerve: Pictorial essay

20-08-2019 – Kenya Kobayashi, Yoshihumi Matsumoto, Fumihiko Matsumoto, Tetsufumi Sato, Taisuke Mori, Takaaki Tsuchida, Go Omura, Satoko Matsumura, Atsuo Ikeda, Azusa Sakai, Kotaro Eguchi, Seiichi Yoshimoto

Journal Article

Abstract
Background
Schwannoma originating from the esophageal branch of the recurrent laryngeal nerve is clinically rare event. The best approach to preoperative pathological diagnosis, surgery, and airway management for this submucosal tumor in the tracheal membranous portion remains controversial.
Methods and Results
A 69‐year‐old man had developed dyspnea for 6 months. Transnasal endoscopy revealed a submucosal tumor in the tracheal membranous portion, obstructing the airway. CT revealed that the tumor was located between the trachea and esophagus. Needle biopsy using ultrasonic bronchoscope diagnosed the submucosal tumor as schwannoma. Intercapsular resection was performed by a transtracheal approach under local anesthesia. The tumor was completely resected and the patients symptoms completely improved.
Conclusions
We report the treatment of a rare schwannoma originating from the esophageal branch of the recurrent laryngeal nerve. A needle biopsy using an ultrasonic bronchoscope was successfully used for diagnosis. Intercapsular resection by a transtracheal approach was effective.

Factors driving frequent attendance at emergency departments for patients with head and neck cancer

18-08-2019 – Aidan L. Tan, Narayanan Gopalakrishna Iyer, Natascha Putri, Nivedita Nadkarni, Thakshayeni Skanthakumar, Ting Hway Wong, Gerald Ci An Tay

Journal Article

Abstract
Background
Patients with head and neck cancer have a higher risk of emergency department (ED) frequent attender (FA). We hypothesized that FAs present with issues different from non‐FAs.
Methods
A retrospective cohort study was conducted on Singapore residents with head and neck cancers using de‐identified registry merged with electronic medical record data. A competing risk regression analysis was performed to identify factors associated with FA. Aggregated primary diagnoses were compared for patients with and without FA risk factors.
Results
Thirteen percent of patients with head and neck cancer were FAs. FA risk factors were Charlson comorbidity index (3+), and socioeconomic status (SES). FAs had a higher proportion of respiratory infections. The spectrum of diagnosis was similar for patients with low and high SES. Current smokers had a greater proportion of respiratory complaints, relative to never smokers.
Conclusion
Patients with greater comorbidity scores or higher SES were more likely to be FA. FAs were more likely to present with respiratory complaints, likely related to cancer treatment, or smoking status.

Gender disparities are present in academic rank and leadership positions despite overall equivalence in research productivity indices among senior members of American Head and Neck Society (AHNS) Fellowship Faculty

16-08-2019 – Meghan E. Garstka, Gregory W. Randolph, Antoine B. Haddad, Cherie‐Ann O. Nathan, Kareem Ibraheem, Mahmoud Farag, Neal Deot, Hania Adib, Marcus Hoof, Kaley French, Mary T. Killackey, Emad Kandil

Journal Article

Abstract
Background
This study aims to examine potential disparities in scholarly performance based on sex, academic rank, leadership positions, and regional distribution of faculty in accredited Head and Neck Surgery fellowships in the United States.
Methods
Online faculty listings for 37 accredited fellowships were organized according to academic rank, leadership position, sex, and institutional location. Academic productivity was measured with three bibliometric indices: h‐index, m‐index, and the weighted relative citation ratio.
Results
A total of 732 faculty members were included, of which 153 (21%) were female. Fifty‐eight males (89.2%) held leadership positions, compared to seven females (10.8%). There was no significant difference in overall productivity between male and female senior faculty. There were regional differences in productivity by sex.
Conclusions
Females are underrepresented in senior faculty and within three common leadership positions, although scholarly productivity for male and female senior faculty and for those in leadership positions is similar.

Absence of disruptive TP53 mutations in high‐risk human papillomavirus‐driven neck squamous cell carcinoma of unknown primary

15-08-2019 – Paolo Boscolo‐Rizzo, Lea Schroeder, Valeria Sacchetto, Dana Holzinger, Maria Cristina Da Mosto, Giancarlo Tirelli, Elisa Dal Cin, Monica Mantovani, Anna Menegaldo, Annarosa Del Mistro, Salvatore Romeo, Angelo Paolo Dei Tos, Monia Niero, Stefania Rigo, Gerhard Dyckhoff, Jochen Hess, Laia Alemany, Miquel Quer, Xavier León, Jerry Polesel, Michael Pawlita, Roberta Bertorelle

Journal Article

Abstract
Background
To enforce the evidence for causality between high‐risk human papillomavirus (hr
HPV) infections and neck squamous cell carcinoma from unknown primary (NSCCUP) and provide biological basis for treatment de‐intensification, we searched for TP53 mutations in association with HPV status.
Methods
TP53 mutations were searched for by amplification of exons 4 to 10.
Results
Of the 70 NSCCUP, 27 (39%) harbored HPV infection. TP53 sequencing resulted in the identification of 19 patients harboring single mutations including 16 disruptive alterations (84%). The association of TP53 mutations and HPV could be evaluated in 48 NSCCUP including those with disruptive mutation in any exon (n = 16) and those without mutations but with complete sequence of exons 4 to 9 (n = 32): no disruptive mutations were found in the 17 HPV‐driven NSCCUP but in 16 of the 31 non‐HPV‐driven NSCCUP (P = .0002).
Conclusion
In a fraction of cases, NSCCUP is an HPV‐driven entity harboring wild‐type TP53 gene or nondisruptive TP53 mutations. HPV‐driven NSCCUP might benefit from treatment de‐intensification.

Serious immune‐related adverse events in patients with head and neck cancer after checkpoint blockade: Systematic review

15-08-2019 – Mohsin Shah, Mona K. Jomaa, Renata Ferrarotto, Sai‐Ching J. Yeung, Ehab Y. Hanna, Cielito C. Reyes‐Gibby

Journal Article, Review

Abstract
Background
Immune checkpoint inhibitors confer significant clinical benefit by bolstering immune‐system activity, however, they also produce a spectrum of immune‐related adverse events (ir
AEs). Rapid recognition and timely treatment of these patients is essential for improved outcomes.
Methods
We conducted a systematic review of English‐language articles in MEDLINE, EMBASE, Web of Science, PubMed, and Cochrane CENTRAL databases on patients with head and neck cancer treated with immune checkpoint inhibitors who developed treatment‐related adverse events.
Results
Of 1715 unique citations, 11 studies met inclusion criteria. Eight patients with serious ir
AEs were reported from case reports and case series. Overall, 46 treatment‐related AEs were identified from the pooled 791 patients with at least 12 having potential relevance to ir
AEs. The most frequent AEs observed in patients receiving PD‐1 inhibitors involved the endocrine, cutaneous, and gastrointestinal systems.
Conclusions
Characterizing ir
AEs in longitudinal studies is needed for developing strategies for their prompt recognition and management.

The impact of treatment package time on locoregional control for HPV+ oropharyngeal squamous cell carcinoma treated with surgery and postoperative (chemo)radiation

14-08-2019 – “Hann‐Hsiang Chao, Caitlin A. Schonewolf, Erik X. Tan, Samuel Swisher‐McClure, Alireza F. Ghiam, Gregory S. Weinstein, Bert W. OMalley, Ara A. Chalian, Christopher H. Rassekh, Jason G. Newman, Roger B. Cohen, Joshua M. Bauml, Charu Aggarwal, Alexander Lin, John N. Lukens”

Journal Article

Abstract
Background
For patients with head and neck squamous cell carcinoma (SCC) undergoing surgery followed by postoperative radiotherapy (PORT), time from surgery to completion of adjuvant therapy, “package time” impacts locoregional control (LRC). However, the significance of package time in HPV+ oropharyngeal SCC (OPSCC) is unknown.
Methods
We examined patients undergoing TORS resection with PORT for HPV+ OPSCC from January 2010 to December 2015 with ≥18 months follow‐up (n = 267). A cutoff of 15 weeks was used to delineate patients into short and long package time groups. LRC loss was defined as any recurrence after surgery.
Results
Prolonged package time >15 weeks was associated with inferior LRC in this HPV+ OPSCC cohort, driven primarily by interval from surgery to PORT initiation. Multivariate analysis showed that package time and T classification are both independently associated with LRC.
Conclusions
Among HPV+ OPSCC, prolongation of package time appears to compromise LRC, but not survival.

Level of plasma catecholamine predicts surgical outcomes of carotid body tumors: Retrospective cohort study

13-08-2019 – Huanrui Hu, Jichun Zhao, Zhoupeng Wu, Bin Huang

Journal Article

Abstract
Backgrounds
Carotid body tumors (CBTs) are rare neoplasms and some of them produce catecholamine. Although operations for catecholamine‐producing CBTs are safe, the relationship between prognosis and endocrine function has not been analyzed before.
Methods
Patients diagnosed with CBTs in our department between 2009 and 2018 were analyzed. Plasma catecholamine was examined as a variable of surgical outcomes and prognosis by using statistical methods.
Results
Patients who suffered CBTs and underwent operations were divided into two groups according to their plasma catecholamine. Patients in the normal group had more or heavier surgical complications, such as neurological complications (P = .008) and blood loss (P = .03), than those in the high group. However, overall survival, local recurrence, and remote metastasis were not varied significantly in both groups.
Conclusions
A high level of plasma catecholamine was a predictor for the improved operative outcomes of CBTs. Hence, nonfunctional CBTs had further short‐term surgical complications.

Nonrecurrent laryngeal nerve in thyroid surgery: Frequency, anatomical variations according to a new classification and surgery consideration

13-08-2019 – Van Quang Le, Quoc Duy Ngo, Xuan Quy Ngo

Journal Article

Abstract
Background
The nonrecurrent laryngeal nerve (NRLN) is a rare embryologically derived variant of the RLN. We aimed to identify the proportion of NRLN (during thyroidectomy), classify clinical NRLN types, and recommend some surgical considerations.
Method
In this prospective study, from May 2017 to September 2018, our hospital carried out 2158 thyroid operations. We reported the NRLN rate and distinguished NRLN into four types.
Results
Overall, NRLN had an incidence rate of 0.74% (16 out of 2158 total thyroid surgeries). We did not detect any patient with left‐sided NRLN. The traveling patterns of the nerves could be classified as descending (12.5%), vertical (25%), ascending (37.5%), or V‐shaped (25%).
Conclusion
The NRLN is a rare variation of the RLN. From our experience, we recommend the guidelines will help surgeons to avoid NRLN injury.

Survival of oral tongue squamous cell carcinoma in young adults

13-08-2019 – Jamie R. Oliver, S. Peter Wu, Clifford M. Chang, Dylan F. Roden, Binhuan Wang, Kenneth S. Hu, David Schreiber, Babak Givi

Journal Article

Abstract
Background
Small cohort studies have suggested oral tongue squamous cell carcinoma (OTSCC) could be associated with worse prognosis in individuals younger than 40.
Methods
We compared the survival of all OTSCC cases in the National Cancer Database under 40 years old with those older than 40, excluding patients over 70. Cox regression and propensity score matched (PSM) survival analyses were performed.
Results
A total of 22 930 OTSCC patients were identified. The under 40 group consisted of 2566 (9.9%) cases; 20664 were 40 to 70 (90.1%). Most were male (13 713, 59.8%), stage I‐II (12 754, 72.4%), and treated by surgery alone (13 973, 63.2%). Survival in patients under 40 was higher (79.6% vs 69.5%, P < .001). In PSM analysis (n = 2928) controlling for all 10 significant factors in multivariate regression, patients under 40 had a 9% higher 5‐year survival (77.1% vs 68.2%, P < .001).
Conclusion
Contrary to the prior reports, younger patients with OTSCC did not have worse survival in the National Cancer Database.

Impact of body mass index on post‐thyroidectomy morbidity

13-08-2019 – Claire Blanchard, Sahar Bannani, François Pattou, Laurent Brunaud, Antoine Hamy, Niki Christou, Muriel Mathonnet, Marcel Dahan, Jean‐Michel Prades, Gérard Landecy, Henri‐Pierre Dernis, Fréderic Sebag, Emmanuel Babin, Alain Bizon, Jean‐Christophe Lifante, Frank Jegoux, Christelle Volteau, Cécile Caillard, Valery‐Pierre Riche, Éric Mirallié

Journal Article

Abstract
Background
The impact of obesity on total thyroidectomy (TT) morbidity (recurrent laryngeal nerve palsy and hypocalcaemia) remains largely unknown.
Methods
In a prospective study (NCT01551914), patients were divided into five groups according to their body mass index (BMI): underweight, normal weight, overweight, obese, and severely obese. Preoperative and postoperative serum calcium was measured. Recurrent laryngeal nerve (RLN) function was evaluated before discharge, and if abnormal, at 6 months.
Results
In total 1310 patients were included. Baseline characteristics were similar across BMI groups except for age and sex. Postoperative hypocalcaemia was more frequent in underweight compared to obese patients but the difference was not statistically significant in multivariate analysis. There was no difference between groups in terms of definitive hypocalcaemia, transient and definitive RLN palsy, and postoperative pain.
Conclusion
Obesity does not increase intraoperative and postoperative morbidity of TT, despite a longer duration of the procedure.

Dual‐phase CT angiography for presurgical planning in patients with vessel‐depleted neck

13-08-2019 – Eugenie Du, Sagar Patel, Benjamin Huang, Samip N. Patel

Journal Article

Abstract
Background
Microvascular reconstruction in vessel‐depleted necks is challenging due to limited availability of recipient vessels. We examine the utility of dual‐phase CT angiography (CTA), which delineates both arteries and veins, for preoperative planning in such difficult cases.
Methods
Retrospective chart review of a single surgeon from July 2013 to July 2017 in a tertiary referral center was performed. Patient characteristics, operative details, and surgical outcomes were examined.
Results
Thirteen patients met inclusion criteria. The operative plan was changed to a local flap for one patient as a result of imaging; free tissue transfer was performed for the remaining cases with 100% flap survival rate. Average operative time and ischemia time were 524 ± 110 minutes and 153 ± 47 minutes, respectively.
Conclusions
Dual‐phase CTA can evaluate potential venous and arterial recipient vessel and guide surgical explorations. As such, it may aid in presurgical planning for microvascular free tissue transfer in vessel‐depleted necks.

Ipsilateral neck radiotherapy in N2b well‐lateralized tonsil cancer – Approach with caution

13-08-2019 – David Maskell, Hannah Buckley, Katherine Sission, Tom Roques, Konstantinos Geropantas

Journal Article

Abstract
Background
Treatment of the uninvolved neck in well‐lateralized tonsillar squamous cell carcinoma is controversial. We became concerned after a number of contralateral neck recurrences (CNRs) in patients receiving ipsilateral radiotherapy (RT).
Methods
This is a single center retrospective series including patients with well‐lateralized tonsillar cancer treated with ipsilateral neck RT between 2004 and 2011.
Results
We identified 53 patients treated with ipsilateral neck RT during the study period. The rate of CNR was 7.5% (4 of 53). All four patients had p16‐positive, T1, N2b, M0 tumors. The subgroup of patients with N2b disease (28 of 53) had a CNR of 14.3%. We subsequently switched to treat patients with N2b with bilateral neck RT. We analyzed the outcomes of 23 patients with N2b treated with bilateral neck intensity‐modulated RT (IMRT) and observed no CNRs.
Conclusions
We observed a higher than expected rate of CNR in the N2b population. Bilateral neck IMRT for these patients represents a safe alternative.

Comparison of postoperative voice outcomes after postauricular facelift robotic hemithyroidectomy and conventional transcervical hemithyroidectomy

13-08-2019 – Chang M. Song, Min S. Kim, Dong W. Lee, Yong B. Ji, Jung H. Park, Dong S. Kim, Kyung Tae

Journal Article

Abstract
Background
The purpose of this study was to determine whether postauricular robotic and conventional hemithyroidectomy result in significantly different voice outcomes.
Methods
We prospectively compared the voice handicap index (VHI)‐10 and acoustic parameters of a postauricular facelift robotic group and a conventional group preoperatively, 1 week, 1 month, and 6 months after surgery.
Results
Forty‐two patients in the postauricular group and 68 patients in the conventional group completed the VHI‐10 questionnaire and acoustic analysis. The postoperative VHI‐10 scores were not significantly different between the two groups. In female patients, the highest frequency was higher and the frequency range was wider in the postauricular group compared to the conventional group postoperatively until 1 month after surgery.
Conclusion
Postauricular facelift robotic thyroidectomy has advantages over conventional thyroidectomy in terms of postoperative voice pitch.

High‐grade radiologic extra‐nodal extension predicts distant metastasis in stage II nasopharyngeal carcinoma

13-08-2019 – Yujun Hu, Tianzhu Lu, Shao Hui Huang, Shaojun Lin, Yunbin Chen, Yanhong Fang, Han Zhou, Yiping Chen, Jingfeng Zong, Yu Zhang, Ying Chen, Jianji Pan, Youping Xiao, Qiaojuan Guo

Journal Article

Abstract
Background
To investigate the prognostic value of radiologic extra‐nodal extension (r
ENE) in stage II nasopharyngeal carcinoma (NPC).
Methods
Stage II NPC patients with N1 category (n = 365) were enrolled and divided into three groups according to the situation of r
ENE: without r
ENE, suspected r
ENE, and confirmed r
ENE (grades: A, infiltration into surrounding fat; B, matted nodes; C, infiltration into adjacent structures).
Results
Only high‐grade r
ENE (including matted nodes and infiltration into adjacent structures) could significantly influence the survival outcomes, patients with high‐grade r
ENE had significantly poorer survival than those without, with the 7‐year distant metastasis‐free survival and overall survival demonstrated to be 78.5% vs 93.0% (P < .001) and 81.9% vs 89.9% (P = .05), respectively. High‐grade r
ENE, as defined in our study, is a stable criterion, with high intra‐rater and inter‐rater consistency.
Conclusion
High‐grade r
ENE was an evaluable predictor that could help with the selection of stage II patients with high risk of distant metastasis.

A nomogram to estimate the risk of developing distant metastases in parotid cancer

13-08-2019 – Luca Giovanni Locatello, Angelo Cannavicci, Chiara Bruno, Giandomenico Maggiore, Vincenzo Napoleone, Oreste Gallo

Journal Article

Abstract
Background
Parotid cancer (PC) is a heterogeneous group of malignant tumors whose management mainly focuses on locoregional control. However, distant metastases (DM) can represent the most common cause of treatment failure. We have defined the predictors and developed a model that can predict a single patients risk to develop DM.
Methods
We have analyzed our institutional database of 259 patients with PC and use it to develop a nomogram. C‐index and calibration curves were used to assess performance of our model.
Results
DM appeared in 18.9% of patients. Age, c
T, p
N, perineural invasion, and adenoid cystic carcinoma were significantly associated with distant failure.
Conclusions
We here present the first model to identify patients with PC at high risk of DM. Such tool can be of great value in managing these rare cancers in terms of a more precise prognosis and follow‐up while waiting for better systemic therapies to come in the future.

Outcomes of dental and craniofacial osseointegrated implantation in head and neck cancer patients

13-08-2019 – Phillip Moore, Damien Grinsell, Bernard Lyons, Ian Hewson

Journal Article

Abstract
Background
Treatment of head and neck cancer may result in disfiguring and debilitating anatomical changes. Osseointegrated implants may be used in these patients to facilitate attachment of implant‐retained dentures or cosmetic prostheses.
Methods
A retrospective audit was performed, reviewing the treatment of patients who received dental or craniofacial osseointegrated implants during treatment of head and neck cancer.
Results
One hundred sixty implants were inserted in 54 patients with oral, nasal, orbital, or auricular defects. Overall, 85% of implants were successful after mean follow‐up of 25.7 months. The brand of implant used was shown to impart a statistically significant implant survival difference, and orbital implants had poorer survival compared to nonorbital implants. There was a statistical insignificant implant survival advantage in both nonsmokers and patients who did not undergo radiotherapy.
Conclusions
Dental and craniofacial osseointegrated implants may be reliably used in patients with head and neck cancer. However, further research is required to clarify the role of smoking in osseointegrated implant failure.

Second primary tumors in patients with a head and neck paraganglioma

13-08-2019 – Kevin J. Contrera, Valeda Yong, Chandana A. Reddy, Eren Berber, Robert R. Lorenz

Journal Article

Abstract
Background
There are conflicting recommendations and possibly overuse of imaging for surveillance of second primary tumors for patients with a history of head and neck paraganglioma.
Methods
Retrospective cohort study of 234 adults with head and neck paragangliomas (1990‐2010) followed for a mean of 7.5 ± 8.4 years.
Results
The rate of second paraganglioma was 1.7% after 5 years and 5.1% after 10 years, yielding an incidence of 6.65 per 1000 person‐years. Only 1.3% of patients (2.59 per 1000 person‐years) ever had a second paraganglioma in the chest, abdomen, or pelvis. Patients with a hereditary paraganglioma (hazard ratio HR = 4.84, 95% confidence interval CI: 1.52‐15.43) or carotid body tumor (HR = 3.55, 95% CI: 1.15‐10.99) were at greater risk.
Conclusions
The incidence rate of a second primary paragangliomas is low but increases with hereditary disease. These results question the utility of repeated imaging outside of the neck to screen for second paragangliomas.

Parotidectomy by an endoscopic‐assisted postauricular‐groove approach

13-08-2019 – Tiancheng Li, Yuhe Liu, Quangui Wang, Yong Qin, Weihua Gao, Qian Li, Erik Schiferle, Shuifang Xiao

Journal Article

Abstract
Background
To investigate the feasibility of an endoscopic‐assisted postauricular‐groove approach parotidectomy and to evaluate the advantages and limitations of such an approach.
Methods
A total of 72 patients with parotid gland tumors underwent a parotidectomy procedure between January 2014 and January 2016. Of the aforementioned patients, 15 were treated by a postauricular‐groove approach (group I), whereas the remaining 57 were treated by the Blair “S” incision (group II).
Results
Difference in visual analogue scale score for aesthetic outcome (0 vs 3) and median intraoperative blood loss (30 vs 50 m
L) was statistically significant. Operation time and transient facial nerve paralysis were comparable. No recurrence of tumors was found in either group.
Conclusion
The endoscopic‐assisted postauricular‐groove approach for limited parotid tumor resection offers several advantages over the conventional “S” incision parotidectomy. In addition, it is arguably safer and results in a superior aesthetic outcome.

Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study

13-08-2019 – Jonathan Hanna, Elliot Morse, Philip R. Brauer, Benjamin Judson, Saral Mehra

Journal Article

Abstract
Background
Purpose of the study is to assess nationwide margin performance in oropharynx transoral robotic surgery (TORS).
Methods
Retrospective review of the National Cancer Database.
Results
Two thousand six hundred sixty‐one patients were included. The national positive margin rate (PMR) was 16.9%. High‐volume facilities had a lower PMR than low‐volume facilities (12.7% vs 21.9%; P < .001). Patients with disease of the tonsil had a lower PMR (15.7%) than base‐of‐the‐tongue (18.2%; P = .14). PMR increased with T classification (T1 = 13.0%, T2 = 17.1%, T3 = 28.2%, T4a = 45.9%, T4b = 58.3%; P < .001). On multivariable regression, factors associated with margin status included only lymph‐vascular invasion (1.631.13‐2.36; P = .01), high volume (0.570.36‐0.92; P = .005), and T classification (as compared to T1, T2: 1.501.03‐2.18, T3: 3.111.77‐5.46, T4a: 7.032.95‐16.75, T4b: 6.721.26‐35.93; P < .001).
Conclusions
National PMR is 16.9%, substantially higher than reported in high‐volume TORS centers. There is a linear association between positive margins and T classification, with T3 and T4 PMRs exceeding 28%. High‐volume facilities are half as likely to yield positive margins compared to low‐volume facilities. There was no association between human papilloma virus status, tumor subsite, or academic facility status and positive margins.

Assessment of quality and consistency of monoclonal antibodies for CB1 and CB2 in head and neck squamous cell carcinoma

13-08-2019 – Kelly E. Daniels, Adam J. Luginbuhl, Stacey K. Mardekian, David M. Cognetti, Joseph M. Curry, Andrew P. South

Journal Article

Abstract
Background
Marijuana has numerous roles as an agonist in the endocannabinoid signaling system (ESS). This study evaluated monoclonal antibodies across experimental techniques to establish a framework for studying ESS receptors, CB1 and CB2.
Methods
Tissue from five patients with head and neck cancer were used to generate cell lines and formalin‐fixed paraffin‐embedded (FFPE) sections, which were analyzed by western blot (WB), immunohistochemistry (IHC), and immunofluorescence (IF). Subgroup analysis was performed on FFPE sections from 8 marijuana users and 10 controls by IHC. Results were compared across methods for consistency.
Results
In all patients, WB and IF were CB1 positive, whereas IHC was negative. Select samples were CB2 positive by WB, but failed IF and IHC applications. In subgroup analysis, 1 of 8 users and 3 of 10 nonusers were CB1 positive.
Conclusions
Interpretation of CB1/CB2 antibody data should be performed cautiously and confirmation of findings across multiple experimental methods is recommended.

Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout

13-08-2019 – Christian Jacobi, Constanze Gahleitner, Henning Bier, Andreas Knopf

Journal Article

Abstract
Background
Carotid blowout syndrome (CBS) is a rare but life‐threatening complication of head and neck squamous cell carcinoma (HNSCC). Chemoradiation (CRT) may make CBS more likely, but so far no longitudinal analysis of different treatment strategies has been conducted.
Methods
In the present study, 1072 patients with HNSCC were divided into groups depending on whether they had experienced CBS. Disease‐related data were analyzed using chi‐square test, Fisher exact test, and Students t test. Survival rates were calculated using Kaplan‐Meier test, log‐rank test, and the Cox regression analysis for forward selection.
Results
Thirty‐six patients suffering from CBS demonstrated significantly advanced T status (P = .001) and UICC stage (P = .004) when compared with unaltered counterparts. After adjustment for UICC stage, OS was comparable in both groups, whereas the mean recurrence‐free survival (RFS) rate was better in unaltered patients (67 vs 24 months; P < .0001). Cox regression for forward selection revealed local recurrence (hazard ratio HR, 1.9; P < .0001), T status (HR, 1.9; P = .03), and CRT (HR, 2.0; P < .0001) as independent risk factors for mortality related to CBS.
Conclusion
CBS is a rare event in patients with HNSCC demonstrating reduced OS/RFS. Advanced T status, C/RT, and the recurrence of local tumors increase the risk of CBS‐associated death.

A cadaveric study quantifying the anatomical landmarks of the facial artery and its parapharyngeal branches for safe transoral surgery

13-08-2019 – Aziza Mohamed, Vinidh Paleri, Ajith George

Journal Article

Abstract
Background
Hemorrhage remains a major potential risk when performing any form of transoral surgery. This is the first study to focus on the location of the facial artery “bulb” (Fa
B) and its tonsillar branches within the parapharyngeal space (PPS) from the perspective of the transoral surgeon.
Method
A total of 44 hemi‐sections were dissected via the transoral approach with endoscopic assistance: 26 from fresh‐frozen specimens and 18 formalin‐fixed hemi‐sections. The distance from the superior apex of the Fa
B to the pterygoid hamulus (PH) was recorded, and the arterial branching variations described.
Results
The average distance from the PH to the Fa
B was 4.17 ± 0.4 cm. In 90.9% of cases, the two tonsillar artery branches passed between styloglossus muscle (SGM) and stylopharyngeus muscle (SPM).
Conclusion
Understanding the Fa
B location and its branching patterns offers the surgeon confidence dissecting in the PPS transorally.

Completion surgery after extracapsular dissection of low‐grade parotid gland malignant tumors

13-08-2019 – Konstantinos Mantsopoulos, Sarina Mueller, Miguel Goncalves, Michael Koch, Heinrich Iro

Journal Article

Abstract
Background
The aim of the study was to compare the oncological and functional outcome between extracapsular dissection and completion surgery on the one hand and sole extracapsular dissection on the other hand in small low‐grade malignant parotid tumors.
Methods
The records of all patients treated for T1‐T2 low‐grade malignant tumors of the parotid gland primarily by means of extracapsular dissection between 2006 and 2015 were studied retrospectively.
Results
Forty patients with T1‐T2 low‐grade parotid malignancies were detected. Our study showed outstanding oncological outcomes in both patient groups, the facial nerve function being significantly better after sole extracapsular dissection in the direct postoperative phase, with no differences between the groups in the long term.
Conclusions
Our study showed very encouraging preliminary results following primary extracapsular dissection as the sole surgical therapy for carefully selected low‐stage, low‐grade, inferiorly located lesions in patients with high compliance.

The role of CIP2A as a therapeutic target of rapamycin in radioresistant head and neck cancer with TP53 mutation

13-08-2019 – Song Hee Kim, Won Hyeok Lee, Daseul Seong, Jae Hee An, Hyoung Uk Je, Hae Yun Nam, Sang Yoon Kim, Seong Who Kim, Myung Woul Han

Journal Article

Abstract
Background
CIP2A may activate multiple oncogenic proteins and promote the proliferation of various cancer cells.
Methods
We investigated that the role of CIP2A in radioresistant head and neck cancer (HNC) cell line with TP53 mutation and the effect of the rapamycin on the response of HN31 with TP53 mutation cells to irradiation related to CIP2A expression.
Results
CIP2A expression was stimulated by p53 mutation and critical for the inhibition of senescence induction in response to radiation. The treatment with radiation alone neither induced cytotoxicity in HN31 cells nor completely suppressed the activation of CIP2A. However, the combination of radiation and rapamycin increase the radiosensitivity through the induction of senescence with downregulation of CIP2A expression both in vivo and in vitro.
Conclusion
Our results suggest that CIP2A may serve as a therapeutic target of rapamycin through induction of senescence in radioresistant HNC with TP53 mutation.

Projected oropharyngeal carcinoma incidence among middle‐aged US men

13-08-2019 – Li Xu, Kristina R. Dahlstrom, David R. Lairson, Erich M. Sturgis

Journal Article

Abstract
Background
The incidence of oropharyngeal cancer (OPC) is rapidly increasing. This study aimed to describe the temporal trends and projection of OPC incidence.
Methods
Incidence data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and trends were calculated using the joinpoint regression model.
Results
The incidence of OPC in the US population significantly increased by 1.94% (95% confidence interval CI, 1.65%‐2.23%) per year from 2000 to 2015. OPC was projected to increase continuously over the next 30 years, with more than half of projected new OPC cases being found in non‐Hispanic white men aged 55‐69 years. By 2045, OPC will become the third most common cancer in 55‐69‐year‐old non‐Hispanic white men in the United States.
Conclusions
The incidence of OPC is expected to increase substantially in the US population, particularly among middle‐aged non‐Hispanic white men. Our projections may have implications for policy makers.

Ultrasound can help to indirectly predict contact of parotid tumors to the facial nerve, correct intraglandular localization, and appropriate surgical technique

13-08-2019 – Georgios Psychogios, Holger Rueger, Monika Jering, Eleni Tsoures, Julian Künzel, Johannes Zenk

Journal Article

Abstract
Background
The purpose of this prospective study is to evaluate the role of ultrasound in benign parotid tumor surgery, particularly by helping to identify the tumor location and its relationship to the facial nerve (FN) and by predicting the appropriate surgical approach.
Methods
Fifty patients underwent preoperative ultrasound. The course of the FN was indirectly defined, and the following predictions were made: contact of the tumor with the FN, the necessity for intraoperative nerve exposure, localization in the correct parotid lobe, and choice of the appropriate surgical technique.
Results
Contact of parotid tumors with the FN was determined with an accuracy of 96%. The need for intraoperative nerve exposure was incorrectly determined only once. The appropriate surgical technique was correctly predicted in 98% of the patients.
Conclusions
Ultrasound is helpful for indirectly predicting the relationship between parotid tumors and the FN. The retromandibular vein is the most important landmark.

Prevalence and clinical and psychological correlates of high fear of cancer recurrence in patients newly diagnosed with head and neck cancer

13-08-2019 – Spela Mirosevic, Belinda Thewes, Carla van Herpen, Johannes Kaanders, Thijs Merkx, Gerry Humphris, Robert J. Baatenburg de Jong, Johannes A. Langendijk, C. René Leemans, Chris H. J. Terhaard, Irma M. Verdonck‐de Leeuw, Robert Takes, Judith Prins, the NET‐QUBIC Consortium

Journal Article

Abstract
Background
Patients with head and neck cancer (HNC) are vulnerable to fear of cancer recurrence (FCR) and psychiatric morbidity. We investigated the prevalence of high FCR and demographic, clinical, psychological, and psychiatric factors associated with high FCR prior to the start of the treatment.
Methods
In a cross‐sectional substudy of the large ongoing prospective NET‐QUBIC study questionnaires and psychiatric interviews of 216 patients newly diagnosed with HNC were analyzed.
Results
High FCR was observed in 52.8% of patients and among those 21.1% also had a lifetime history of selected anxiety or major depressive disorder. FCR was not related to any clinical characteristics; however, younger age, higher anxiety symptoms, introversion, greater needs for support regarding sexuality, and being an exsmoker were significantly associated with higher FCR.
Conclusion
Factors associated with high FCR provide us with a better conceptual understanding of FCR in patients newly diagnosed with HNC.

Efficacy of combined surgery and 125I seed brachytherapy for treatment of primary mucoepidermoid carcinoma of the parotid gland

13-08-2019 – Zhi‐Yuan Wu, Wen‐Jie Wu, Lei Zheng, Ming‐Wei Huang, Yan Shi, Xiao‐Ming Lv, Shu‐Ming Liu, Jian‐Guo Zhang, Jie Zhang

Journal Article

Abstract
Background
This study aimed to determine the effectiveness and safety of surgery combined with postoperative 125I seed brachytherapy for treatment of primary mucoepidermoid carcinoma (MEC) of the parotid gland.
Methods
Retrospective analysis of data of patients with MEC (n = 108) treated with surgery plus postoperative 125I seed brachytherapy between 2004 and 2016. Overall survival (OS), disease‐free survival (DFS), local control rate (LCR), distant metastasis, and radiation‐associated toxicities were analyzed, and factors affecting outcomes were evaluated.
Results
The 5‐ and 10‐year OS were 98.8% and 95.8%, respectively. The DFS and LCR at 5 and 10 years were all 91.4%. Age ≥ 60 years (hazard ratio HR = 6.86, 95% confidence interval CI: 1.54‐30.55) and T4 disease (HR = 7.15, 95% CI: 1.40‐36.52) were poor prognostic factors. Acute radiation‐associated toxicities were minor.
Conclusion
Surgery plus 125I seed brachytherapy appears to be an effective treatment for parotid gland MEC, capable of providing satisfactory outcomes with few complications.

Impact of smoking cessation on clinical outcomes in patients with head and neck squamous cell carcinoma receiving curative chemoradiotherapy: A prospective study

13-08-2019 – Jenny Ling‐Yu Chen, Chia‐Wei Shen, Chia‐Chun Wang, Yu‐Sen Huang, Jo‐Pai Chen, Chien‐Hsieh Chiang, Yu‐Li Lin, Sung‐Hsin Kuo, Chun‐Wei Wang

Journal Article

Abstract
Background
We hypothesized that patients with head and neck squamous cell carcinoma (HNSCC) with smoking cessation during curative chemoradiotherapy (CRT) had fewer complications and lower tumor progression risks.
Methods
Sixty‐three patients with nonmetastatic HNSCC who were smokers at diagnosis (carbon monoxide CO breath concentrations ≥3 ppm) and underwent curative CRT were prospectively enrolled. Successful smoking cessation throughout CRT was confirmed by CO breath concentrations <3 ppm at CRT completion.
Results
Forty‐one patients (65%) successfully discontinued smoking throughout CRT. With a median 33‐month follow‐up, patients with successful smoking cessation during CRT had significantly fewer, greater, and lower probabilities of grade ≥3 acute toxicities (P = .01), progression‐free survival (P = .03), and permanent gastrostomy or tracheostomy (P = .04), respectively, than those continuing smoking throughout CRT. In multivariate analysis, successful smoking cessation during CRT significantly reduced tumor progression risks (hazard ratio: 0.4, P = .05).
Conclusion
Smoking cessation during curative CRT reduced treatment‐related toxicities and tumor progression risks in patients with HNSCC.

Outcomes following head neck free flap reconstruction requiring interposition vein graft or vascular bridge flap

13-08-2019 – Giuseppe Di Taranto, Shih‐Heng Chen, Rossella Elia, Ngamcherd Sitpahul, Jeffrey C. Y. Chan, Luigi Losco, Emanuele Cigna, Diego Ribuffo, Hung‐Chi Chen

Journal Article

Abstract
Background
Interposition vein grafts (IVG) and vascular bridge flaps (VBF) have been exploited as vascular conduit in challenging head and neck reconstructions.
Methods
A retrospective review was conducted on 6025 flaps. The effect of patients characteristics and length of IVG on flap compromise and loss were analyzed. Comparison between IVG and VBF was performed.
Results
The flap compromise and loss rates for the overall group were 8.2% and 3.2%, respectively. An IVG was used in 309 free flaps. The average length of the vein grafts was 6.9 ± 4.2 cm. An unplanned return to the operation room occurred in 32 cases (10.4%) and failure of the flap in 12 patients (3.9%). Binary logistic regression found a significant association between flap compromise and loss rates and length of IVG, hypertension, prior radiation, and neck dissection. In the multiple regression model, length of IVG and prior radiation significantly influenced the outcomes. Thirty‐nine patients underwent reconstruction with a long IVG (>10 cm). Twenty‐six patients underwent surgical reconstruction with radial forearm flap as a VBF. The rate of flap compromise was higher in the group with a long IVG (P = .01).
Conclusions
In head and neck free flap reconstruction, the length of IVGs and history of radiotherapy are associated with flap compromise and loss. In case of long distance between the pedicle and the recipient site, the use of a VBF bridge should be considered as a safe alternative.

Combined analysis of miRNA‐181a with phase angle derived from bioelectrical impedance predicts radiotherapy‐induced changes in body composition and survival of male patients with head and neck cancer

13-08-2019 – Tomasz Powrózek, Anna Brzozowska, Marcin Mazurek, Radosław Mlak, Grzegorz Sobieszek, Teresa Małecka‐Massalska

Journal Article

Abstract
Background
Nutritional deficits developing as an effect of applied radiotherapy (RTH) negatively affect patients quality of life, survival, and therapy outcomes. We demonstrated novel approach to prediction of RTH‐induced changes in body composition of patients with head and neck cancer using phase angle (PA) derived from bioelectrical impedance in combination with mi
RNA‐181a expression.
Results
Patients with simultaneous presence of low PA and high mi
RNA expression were at a significantly higher risk of decreasing the fat‐free mass index (FFMI) <14.9 kg/m2 (odds ratio OR = 5.14; P = .02), FFM < 44.7 kg (OR = 6.20; P = .04), and lean mass (OR = 10.0; P = .04) during the therapy period. Receiver operating curve analysis allowed to predict changes in FFMI, lean mass, and FFM with area under the curve calculation over 0.700. The simultaneous presence of high mi
RNA and low PA negatively affected patients survival (OR = 5.12; P = .02).
Conclusion
Evaluation of PA in combination with mi
RNA demonstrates higher diagnostic accuracy and predictive value for detecting RTH‐induced changes in body composition of patients with cancer.

Association between blood pressure and postoperative hematomas in the patients undergoing head and neck cancer reconstruction

13-08-2019 – Kuan‐Ying Wang, Kuo‐Chung Yang, Fang‐Yi Su, Yu‐Ching Chen, Yu‐Hsuan Hsieh, Shiao‐Lin Huang, Wen‐Chung Liu

Journal Article

Abstract
Background
Postoperative hematoma is one of the most common complications of free flap reconstruction and compromises the perfusion of pedicles and perforators. Therefore, we reviewed our patients to analyze the associated risk factors.
Method
This study involved a retrospective chart review from 2014 to 2016. We identified the patients undergoing free flap reconstructions for head and neck cancer. Patients with postoperative hematoma requiring surgical intervention were included.
Result
We enlisted 289 patients undergoing head and neck reconstructions. Eighteen patients (6.2%) had postoperative hematomas of which 12 hematomas occurred within the first 3 days and 9 in the first 24 hours. Elevated systolic blood pressure increased the risk of hematoma formation, but hematoma was not associated with higher failure rate. Tachycardia was observed in the patients with hematoma.
Conclusions
Transient elevated blood pressure increased the risk of hematoma. We suggest controlling systolic blood pressure below 150 mm Hg for prevention of hematoma.

Efficacy of posttreatment radioiodine scanning in patients with differentiated thyroid cancer

13-08-2019 – “Shorook Naara, Kamel Mahameed, Moran Amit, Jacob T. Cohen, Michal Weiler‐Sagie, Igor Albitskiy, Ziv Gil, Salem Billan”

Journal Article

Abstract
Background
Differentiated thyroid cancers often require radioiodine treatment followed by posttreatment scan. We aimed in this study to assess the utility of the posttreatment radioiodine scan in this population.
Methods
An analysis of patients who received radioiodine treatment at Rambam Campus, during 2006‐2013. Scans showing remnant normal thyroid tissue were considered as normal. Positive uptake was defined as uptake in the lateral neck or distant sites.
Results
A total of 455 patients were analyzed, 68% had T1‐T2 and 28% had positive lymph nodes. Positive uptake in the lateral neck was recorded in 52 (11.4%) and in distant sites in 41 (9%) patients. Tracheal invasion, esophageal invasion, nerve invasion, and N1b classification were associated with a positive scan (P < .05). A positive radioactive iodine scan was not related to poor prognosis.
Conclusions
Posttreatment scans are positive in only 20% of patients. Locally invasive tumor and positive nodes are associated with positive scans.

Efficacy of indocyanine green fluorescence in predicting parathyroid vascularization during thyroid surgery

13-08-2019 – Alexander C. Razavi, Kareem Ibraheem, Antoine Haddad, Lachin Saparova, Hosam Shalaby, Mohamed Abdelgawad, Emad Kandil

Journal Article

Abstract
Background
We examined the value of indocyanine green (ICG) fluorescence angiography in predicting parathyroid vascularization following thyroid and central compartment surgeries.
Methods
Data were prospectively collected on adult patients undergoing thyroid and/or central compartment surgeries. Outcomes were compared in surgeries performed with and without ICG use. ICG scoring was used to quantify the vascularity of parathyroid glands.
Results
One hundred eleven patients were included; 43 (38.7%) patients underwent ICG injections. There was no significant difference in mean parathyroid hormone (PTH) changes at the end of surgery (29.24 vs 23.48 pg/m
L, P = .38), symptomatic hypocalcemia (7.9% vs 3.9%, P = .37), or length of stay (1.095 ± 0.22 vs 0.912 ± 0.07 days, P = .51) between surgeries performed with and without ICG. The average vascularization score among individuals undergoing ICG angiography was 2.89 out of a maximum of 8 points.
Conclusion
Low‐flow ICG patterns are not associated with postoperative PTH changes or transient hypocalcemia and may lead to unnecessary parathyroid autotransplantation.

Primary organ preservation vs total laryngectomy for T4a larynx cancer

13-08-2019 – Justin Oh, Eitan Prisman, Robert Olson, Eric Berthelet, Jonn Wu, Eric Tran, Brendan Bakos, Rojin Kaviani, Sarah Nicole Hamilton

Journal Article

Abstract
Background
There is a lack of consensus regarding the management of T4a larynx cancer. We evaluated the outcomes of organ preservation and laryngectomy for T4a laryngeal cancer.
Methods
Retrospective analysis of patients with T4a larynx cancer at BC Cancer from 1984 to 2014 was performed. Outcomes in patients treated with surgery alone (Sx) (n = 47), surgery with adjuvant radiotherapy (Sx/RT) (n = 94), radiation alone (RT) (n = 152), and radiation with concurrent chemoradiotherapy (chemo
RT) (n = 36) were compared.
Results
The 5‐year overall survival (OS) was 40% for chemo
RT, 34% for RT, 23% for Sx, and 45% for Sx/RT. On multivariate analysis (MVA), Sx/RT (hazard ratio HR, 0.66; 95% confidence interval CI, 0.48‐0.91) and chemo
RT (HR, 0.44; 95% CI, 0.26‐0.72) were associated with better OS than RT alone (P = .001). Sx had similar OS compared to RT (HR, 1.17; 95% CI, 0.82‐1.68).
Conclusions
Chemo
RT and Sx/RT were associated with better OS compared to single modality treatment. Chemo
RT may be considered as an option for T4a larynx cancer.

Novel technique for the direct closure of the radial forearm flap donor site defect with a local bilobed flap

13-08-2019 – Mubarak Ahmed Mashrah, Yan Lingjian, Thomas Peter Handley, Chaobin Pan, Chen Weiliang

Journal Article

Abstract
Background
The donor site defect remains the major disadvantage of the radial forearm free flap (RFFF). The purpose of this case series was to evaluate the effectiveness and safety of a local bilobed flap in direct closure of the RFFF donor site defect.
Methods
Between February 2017 and July 2017, a prospective study was designed with 13 patients who had undergone RFFF reconstruction of the oral cavity. The primary purpose was to assess the effectiveness and safety of a bilobed flap closure of the RFFF donor site with primary healing. The late endpoint was to evaluate functional morbidity of the donor hand by comparing preoperative and postoperative outcomes.
Results
The donor site defect healed primarily in 12 of the 13 patients. A small area of skin necrosis (4%) developed in one patient, which was managed conservatively and healed by secondary intention. A significant reduction of wrist extension (mean difference MD = 2.64°, P = .01) and grip strength (MD = 3.68 kg, P = .04) was observed between preoperative and postoperative measurements. No statistically significant difference was observed regarding flexion, radial deviation, ulnar deviation, supination, pronation and pinch strength (P > .05).
Conclusions
The bilobed flap is a reliable and effective method for closure of a RFFF donor site defect, ≤5 cm in greatest length. The advantages are excellent regional skin color match and avoidance of a second donor site and its inherent complications.

Exploratory analysis of prognostic factors for lenvatinib in radioiodine‐refractory differentiated thyroid cancer

13-08-2019 – Chiaki Suzuki, Naomi Kiyota, Yoshinori Imamura, Hideaki Goto, Hirotaka Suto, Naoko Chayahara, Masanori Toyoda, Yasuhiro Ito, Akihiro Miya, Akira Miyauchi, Naoki Otsuki, Ken‐ichi Nibu, Hironobu Minami

Journal Article

Abstract
Background
Multitarget kinase inhibitors (m‐TKI), including lenvatinib, are now available as treatment options for radioiodine‐refractory differentiated thyroid cancer (RR‐DTC). However, the optimal timing of treatment initiation with m‐TKI in these patients remains to be defined.
Methods
We retrospectively reviewed the clinical records of 30 consecutive patients with RR‐DTC. The relationship between clinical characteristics was evaluated, including tumor growth parameters at pretreatment/post‐treatment and efficacy of lenvatinib.
Results
A total of 26 patients with RR‐DTC treated with lenvatinib were evaluable for response and eligible for analysis. From the results of multivariate analysis, baseline tumor size and tumor‐related symptoms were independent negative prognostic factors for overall survival (OS) and progression‐free survival (PFS). Pretreatment tumor growth parameters were not prognostic for either PFS or OS.
Conclusions
Patients with RR‐DTC with a high tumor burden and tumor‐related symptoms had significantly worse prognosis. Greater tumor reduction after starting lenvatinib may lead to better prognosis, irrespective of pretreatment high tumor growth rate.

Recategorization of tumor stage in patients with node‐negative oral tongue cancer: Impact of the eighth edition American Joint Committee staging system

13-08-2019 – Rushil R. Dang, Muhammad M. Qureshi, Steven J. Caldroney, Andrew R. Salama, Minh Tam Truong

Journal Article

Abstract
Background
To evaluate recategorization of p
T1‐3N0 oral tongue cancer, from seventh to eighth editions of the American Joint Committee on Cancer (AJCC) staging classification, and impact on overall survival (OS).
Methods
Using the National Cancer Database, 1277 patients were categorized using tumor size and depth of invasion with seventh and eighth AJCC staging systems and evaluated for OS.
Results
Tumor‐category was unchanged in 82.9% and upstaged in 17.1% patients with eighth AJCC. The 3‐year OS was 85.3%, 76.6%, and 77.0% with seventh AJCC compared to 87.1%, 75.1%, and 81% with eighth AJCC, for patients with p
T1N0, p
T2N0, and p
T3N0 disease, respectively. Improved discrimination of p
T1N0 vs p
T2N0 for OS on multivariate analysis was seen for eighth AJCC (hazard ratio HR = 1.43, 95% confidence interval CI: 1.03‐1.98, P = .03) but not for patients with p
T3N0, with seventh AJCC (HR = 1.02, 95% CI:0.53‐1.98, P = .95), and eighth AJCC (HR = 0.86, 95% CI: 0.52‐1.42, P = .55).
Conclusion
Eighth edition AJCC staging leads to improved discrimination of OS between p
T1N0 and p
T2N0 but not for patients with p
T3N0.

Detecting recurrent head and neck cancer using electronic nose technology: A feasibility study

13-08-2019 – Rens M. G. E. Goor, Joey C. A. Hardy, Michel R. A. Hooren, Bernd Kremer, Kenneth W. Kross

Journal Article

Abstract
Background
The aim of this feasibility study was to assess the diagnostic performance of an electronic nose (e‐nose) as a noninvasive diagnostic tool in detecting locoregional recurrent and/or second (or third) primary head and neck squamous cell carcinoma (HNSCC) after curative treatment.
Methods
Using an e‐nose (Aeonose, The e
Nose Company, Zutphen, The Netherlands), breath samples were collected from patients after curative treatment of an HNSCC with a locoregional recurrence or second (or third) primary tumor (N = 20) and from patients without evidence of recurrent disease (N = 20). Analyses were performed utilizing artificial neural networking based on patterns of volatile organic compounds.
Results
A diagnostic accuracy of 83% was observed in differentiating follow‐up patients with locoregional recurrent or second (or third) primary HNSCC from those without evidence of disease.
Conclusion
This study has demonstrated the feasibility of using an e‐nose to detect locoregional recurrent and/or second (or third) primary HNSCC.

Preoperative anemia displays a dose‐dependent effect on complications in head and neck oncologic surgery

13-08-2019 – Nicholas B. Abt, Constantine Tarabanis, Ashley L. Miller, Sidharth V. Puram, Mark A. Varvares

Journal Article

Abstract
Introduction
Anemias effect on head and neck surgical complications is unknown.
Methods
Head and neck cancer operations were acquired from the 2006 to 2013 American College of Surgeons National Surgical Quality Improvement Program databases. Anemia was defined as <39% or <36% hematocrit in men and women, respectively. Multivariable logistic regression analyses were performed.
Results
Major head and neck surgery patients had a 44.2% anemia incidence (n = 527 of 1193). Anemic patients had increased complication rates (27.1%) and mortality (2.1%) vs non‐anemic patients at 19.8% (P = .003) and 0.5% (P = .009), respectively. There was a significant difference in morbidity odds with hematocrit >27% (odds ratio OR = 1.09) vs <27% (OR = 4.22). Complication odds were further increased with hematocrit between 24% and 27% (OR = 8.94). There were increased rates of wound dehiscence (6.6% vs 2.7%, P < .001), pneumonia (8.5% vs 4.7%, P = .006), and myocardial infarction (1.7% vs 0.3%, P = .01) in anemic vs non‐anemic patients.
Conclusion
Anemia was associated with increased morbidity at hematocrit <27%. An inverse dose‐dependent effect of decreasing hematocrit was observed for overall morbidity.

Prognostic impact of tumor growth velocity in head and neck squamous cell carcinoma treated by radiotherapy: A pilot study

13-08-2019 – Gilles Delahaut, Stéphane Témam, Jérôme Ambroise, Yungan Tao, Francois Janot, Sébastien Van der Vorst

Journal Article

Abstract
Background
When a patient is seen with a newly diagnosed oropharyngeal squamous cell carcinoma, it remains unclear to the treating physicians how fast the tumor growth rate is.
Methods
From patients with oropharynx squamous cell carcinoma treated by radiotherapy, the investigators selected comparable diagnostic CT‐scan (Di
CT) and radiotherapy planning CT‐scan (Rt
CT). Tumor and pathological lymph node volumes were measured in order to calculate tumor progression.
Results
From the selection of 19 patients, the mean absolute tumor progression rate was 0.23 ± 0.2 cm3/d and mean relative progression rate was 1.84 ± 1.64%/d. Mean tumor doubling time is 286 days (range 7‐1282 days), demonstrating a wide range of tumor growth pattern. Significant tumor progression (>20%) between Di
CT and Rt
CT was shown in 73% of patients, and 53% of the patients were seen a tumor progression of >50% within a mean waiting time of 42.1 days. Kaplan‐Meier curves showed a non‐significative link between fast progression tumors (>1%/d) and higher risk of recurrence (HR: 2.2; P = .23).
Conclusions
Tumor progression can be assessed based on Di
CT and Rt
CT. Treatment delay should be avoided at all cost. Different growth patterns were evidenced. For the fast‐growing tumors subgroup, pejorative clinical outcomes were suggested. Prospective studies are needed to confirm a link between fast‐growing tumors and higher risk for recurrence.

Simultaneous tracheal and esophageal reconstruction for thyroid cancer involving trachea and esophagus using a free bipaddled posterior tibial artery perforator flap

13-08-2019 – Jun Liu, Jianjun Ren, Dan Lv, Ji Wang, Di Deng, Linke Li, Haiyang Wang, Fei Chen

Journal Article

Abstract
Background
Simultaneous tracheal and esophageal reconstruction after tumor resection is a great challenge. Here we present an innovative operative technique to simultaneously reconstruct tracheal and esophageal defects, in which a free posterior tibial artery perforator flap was made into a free bipaddled flap to cover both tracheal and esophageal defects.
Methods
A free bipaddled posterior tibial artery perforator flap was utilized to conduct simultaneous tracheal and esophageal reconstruction for a 72‐year‐old female patient with papillary thyroid carcinoma and massive trachea and esophagus invasion, who underwent radical resection.
Results
Satisfactory breathing and swallowing functions were gained independent of nasal feeding and tracheotomy. Voice was still hoarse due to tumor invasion of left recurrent laryngeal nerve. During a period of 2‐year follow‐up, no sign of tumor recurrence was observed.
Conclusion
A free bipaddled posterior tibial artery perforator flap could be a decent choice for simultaneous reconstruction of large tracheal and esophageal defects.

Objective and quantifiable measuring mechanism for assessing flap pliability: Our experience with 92 patients

13-08-2019 – Jhonatan Elia, Ayal Hassidim, Allan Billig, Katya Chapchay, Chieh‐Tsai Wu, Shao‐Yu Hung, David Chon‐Fok Cheong, Chung‐Kan Tsao

Journal Article

Abstract
Background
Pliability describes a flaps ability to bend under spatial limitations, yet a quantifiable measurement for this flexibility does not exist.
Methods
Between January 2015 and January 2017, we applied a novel measuring mechanism to two free flaps for head and neck reconstruction. We allocated a flap pliability score (FPS) to these flaps and observed correlations to common variables.
Results
Forty profunda artery perforator (PAP) and 52 anterolateral thigh (ALT) flaps were allotted a score depending on how pliable they performed on our test. Proximal PAP and distal ALT were more pliable than their respective opposite ends. Other interesting conclusions regarding these flaps were also made.
Conclusions
With our technique, pliability of the proximal and distal ends of PAP and ALT flaps was ascertained. Herein, we describe an innovative measuring mechanism via which we can allocate a FPS to any flap and thus obtain information regarding how suitable they are for a given recipient site.

Prognostic markers in salivary gland cancer and their impact on survival

13-08-2019 – Mateusz Szewczyk, Andrzej Marszałek, Jacek Sygut, Paweł Golusiński, Wojciech Golusiński

Journal Article

Abstract
Background
The role of molecular markers in salivary gland carcinoma (SGC) is not well understood. We evaluated molecular marker expression and their prognostic value.
Methods
Immunohistochemical analysis of 124 tumor specimens was performed to determine expression of androgen (AR), estrogen (ER), and progesterone (PR) receptors and epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), programmed death ligand 1 receptor (PD‐L1), and PD‐L1 in tumor‐infiltrating mononuclear cell (TIMC). Survival outcomes (disease‐free survival DFS and overall survival OS), p
T and N classification, margin status, and treatment failure were assessed.
Results
Most patients (78; 62.9%) had early‐stage SGC. AR positivity and EGFR positivity were detected in 21.0% and 78.6%, respectively, of tumors. AR positivity and PD‐L1 negativity were associated with locally advanced disease. PD‐L1‐negativity was associated with higher recurrence (38.5% vs 0%; P < .001) and worse DFS. OS and DFS were worse in patients with AR+ or HER2+ disease.
Conclusions
Several molecular markers—AR and HER2 positivity and PD‐L1 negativity—were associated with worse clinical outcomes. Prospective, multi‐institutional trials are needed to determine the prognostic value of these markers.

Risk stratification of fine‐needle aspiration cytology of parotid neoplasms based on the Milan system—Experience from a tertiary center in Asia

13-08-2019 – Kevin C. C. Choy, Manish M. Bundele, Hao Li, Ernest W. Fu, Nandini C. L. Rao, Ming Yann Lim

Journal Article

Abstract
Background
The recently described Milan system provides a unified way of categorizing salivary gland fine‐needle aspiration (FNA) cytology. We aim to use this system to stratify risk of malignancy in parotid FNAs.
Methods
In this retrospective case series, 376 FNAs were preoperatively performed for 573 parotidectomies over 14 years.
Results
Risk of malignancy on FNA is as follows: nondiagnostic 14.5%, non‐neoplastic 26.7%, atypia of undetermined significance 29.3%, benign neoplasm 2.7%, neoplasm of uncertain malignant potential 19.1%, suspicious for malignancy 87.5%, and malignant 100%. The specific diagnoses of pleomorphic adenoma and Warthin tumor on FNA have high positive predictive value of 97.5% and 96.6%, respectively. Multivariate regression associates smaller size of lesion with a nondiagnostic or indeterminate result. Seniority of operator is associated with a lower likelihood of a nondiagnostic result.
Conclusions
This large Asian series validates the Milan system as a valuable tool in stratifying malignancy risk of parotid FNAs.

Effective, same‐day preoperative embolization and surgical resection of carotid body tumors

13-08-2019 – Kartsunori Katagiri, Kiyoto Shiga, Aya Ikeda, Daisuke Saito, Shin‐ichi Oikawa, Kodai Tshuchida, Jun Miyaguchi, Akio Tamura, Tatsuhiko Nakasato, Shigeru Ehara, Kazuyuki Ishida

Journal Article

Abstract
Background
The aim of this study was to evaluate the efficacy of the procedure by analyzing the blood loss and duration of carotid body tumor (CBT) surgery following same‐day preoperative embolization.
Methods
We reviewed the medical records of subjects retrospectively. Fifteen patients with 16 CBTs were enrolled in this study. Our same‐day procedure comprises preoperative embolization of the feeding arteries in the morning followed by surgery within 3 hours after the embolization is completed.
Results
The mean operative time and the mean amount of blood loss were 138 minutes and 29.3 m
L, respectively. The tumor volume after embolization was markedly reduced and the mean reduction rate was 50%. We found that 13 CBTs had more than three feeding arteries. Almost all the postoperative complications, mainly cranial nerve paralyzes, resolved within months after surgery.
Conclusion
Our same‐day procedure is a safer and superior alternative to traditional CBT surgery, having good outcomes.

Transoral laser microsurgery for treatment of oropharyngeal cancer in 368 patients

13-08-2019 – Bernhard G. Weiss, Friedrich Ihler, Mahalia Zoe Anczykowski, Mattis Bertlich, Julia Kitz, Wolfgang Steiner, Martin Canis, Mark Jakob

Journal Article

Abstract
Background
Oncological and functional outcome of transoral laser microsurgery (TLM) for primary treatment of oropharyngeal cancer was examined using a multimodal treatment concept.
Methods
A total of 368 patients with oropharyngeal squamous cell carcinoma (p
T1‐4, p
N0‐2, M0) underwent TLM +/− neck dissection (85%), +/− (chemo)radiotherapy (57%). The majority of patients had advanced stage III and IVa disease (79%).
Results
Five‐year Kaplan‐Meier estimates for local control were 83.5% for p
T1, 74.1% for p
T2, 77.3% for p
T3, and 76.0% for p
T4a tumors. Five‐year estimates of overall, disease‐specific, and recurrence‐free survival for stage I were 76.0%, 92.8%, and 69.1%; for stage II 71.1%, 85.7%, and 49.6%; for stage III 61.7%, 72.5%, and 58.8%; and for stage IVa 57.3%, 73.7%, and 63.9%, respectively. Postoperative (chemo)radiotherapy improved the outcome for advanced disease. p16‐positive tumors had superior survival estimates. Overall, 93.5% maintained regular oral nutrition without feeding tube dependency.
Conclusion
Primary TLM in multimodal concepts of treatment offers good oncologic outcome even for advanced‐stage oropharyngeal cancer.

Clinical and functional outcomes after total laryngectomy and laryngopharyngectomy: Analysis by tumor subsite, salvage status, and extent of resection

13-08-2019 – Christopher J. Perdoni, Griffin D. Santarelli, Elliot Y. Koo, Daniel W. Karakla, Matthew J. Bak

Journal Article

Abstract
Background
Outcomes following surgical intervention for laryngeal and hypopharyngeal tumors are dependent on several factors. In the present study, we sought to determine whether tumor subsite, salvage status, and extent of resection influenced postoperative outcomes.
Methods
Retrospective review of 107 patients at a single institution who underwent total laryngectomy or partial/total laryngopharyngectomy.
Results
Hypopharyngeal subsite and total laryngopharyngectomy subgroups had inferior speech and swallow outcomes compared to their respective cohorts (P < .05). Salvage patients had inferior 3‐year overall survival (P < .05) and swallow outcomes (P < .001). Previously radiated patients had increased fistula rates (29.9% vs 10%, P = .02), and the use of tissue coverage in salvage total laryngectomy had a protective effect on fistula formation (10% vs 37%, P = .04).
Conclusions
By stratifying patients across multiple subgroups, we provide a detailed narrative in surgical outcomes that can be incorporated into treatment planning. Further prospective studies are needed to compare surgical outcomes to those of organ preservation therapy.

Patterns of care and survival impact of adjuvant chemoradiotherapy for oropharyngeal cancer with intermediate‐risk features

13-08-2019 – Alexander N. Goel, Sophia Sangar, Laith Mukdad, Chase M. Heaton, William R. Ryan, Marilene B. Wang, Jennifer L. Long, Maie A. St. John

Journal Article

Abstract
Background
Survival outcomes for adjuvant chemoradiotherapy (a
CRT) and adjuvant radiotherapy (a
RT) were compared in patients with oropharyngeal squamous cell carcinoma (OPSCC) with intermediate‐risk features.
Methods
We identified 2164 patients with OPSCC in the National Cancer Database without positive margins or extracapsular extension and with at least one intermediate‐risk feature: p
T3‐T4 disease, ≥two positive lymph nodes, level IV/V nodal disease, and/or lymphovascular invasion. We assessed predictors of a
CRT use and covariables impacting overall survival.
Resultsa
CRT was commonly used for both human papillomavirus (HPV)‐positive (62.0%) and HPV‐negative (64.3%) patients with OPSCC. Higher N stage, level IV/V neck disease, and younger age strongly predicted a
CRT utilization. There was no significant survival benefit associated with a
CRT vs a
RT in HPV‐positive (hazard ratio HR, 0.93; 95% confidence interval CI, 0.62‐1.38; P = .71) or HPV‐negative (HR, 0.75; 95% CI, 0.51‐1.10; P = .15) disease.
Conclusions
Despite high rates of utilization, a
CRT is not associated with better survival vs a
RT for OPSCC with intermediate‐risk features, including HPV‐negative tumors.

Improved accuracy of hemimandibular reconstructions involving the condyle by utilizing hydroformed reconstruction plates rather than hand‐bent stock plates

13-08-2019 – Hui Shan Ong, Jian Nan Liu, Abdelrehem Ahmed, Xing Zhou Qu, Kenneth Wan, Dong Ping Xie, Chen Ping Zhang

Journal Article

Abstract
Background
Computer‐aided design/computer‐aided manufacturing (CAD/CAM) surgical templates allow precise mandibular reconstructive surgery. However, their clinical accuracy is limited by manual plate bending. Digitally hydroformed plates maintain a digital workstream in virtual planning.
Methods
Twelve patients with Browns class IIc mandibular defects were randomized into two groups: group I (experimental), the reconstruction plate was digitally hydroformed, and group II (control), surgeries were performed CAD/CAM guided with the reconstruction plate manually prebent. The linear and angular deviations of reconstruction outcomes were compared to surgical simulation in both groups.
Results
The mean linear and angular deviations of middle and posterior segments were 2.14 ± 0.79 mm, 3.71 ± 0.95 mm, 8.73° ± 1.91°, and 9.06° ± 0.96° in group I and 4.31 ± 0.78 mm, 6.74 ± 1.40 mm, 16.35° ± 0.72°, and 31.48° ± 3.38° in group II, respectively. Measurements in group I were significantly lower than group II (P < .005).
Conclusion
Digital hydroforming for plate prebent is a reliable method that helps improving the clinical accuracy of CAD/CAM‐guided mandibular reconstruction surgery.

Endoscopic transoral parathyroidectomy: Initial experience

13-08-2019 – Luis‐Mauricio Hurtado‐López, Sandra‐Haydee Gutiérrez‐Román, Erich Basurto‐Kuba, Kuauhyama Luna‐Ortiz

Journal Article

Abstract
Background
We evaluate our initial experience of transoral vestibular approach parathyroidectomy (TOEPVA) for the treatment of primary hyperparathyroidism.
Methods
We conducted a prospective study of patients with single parathyroid adenoma, using TOEPVA to perform the parathyroidectomy. The variables we analyzed were size, volume, and location of the adenoma, bleeding, identification, and preservation of the recurrent laryngeal nerve, injury to the mental nerve, and the effective cure rate, using measures of central tendency.
Results
Our study included 21 women, with an average age of 43 years. The recurrent laryngeal nerve and mental nerve suffered no permanent damage, the average size of the adenoma was 26.6 mm, and a volume of 3.95 m
L. We were able to identify the adenoma and cure the hyperparathyroidism in 20 of the patients (95.2%).
Conclusions
TOEPVA is viable and safe in who wish to avoid the cervical scar resulting for the patient with primary hyperparathyroidism.

Segmental tracheal resection (nine rings) and reconstruction for carcinoma showing thymus‐like differentiation (CASTLE) of the thyroid

13-08-2019 – Justin Tran, Mark Zafereo

Journal Article

Abstract
Background
Tumors invading the trachea are rare, and although literature often suggests five tracheal rings as the maximum limit of tracheal resection with primary closure, longer tracheal resections and primary closure are possible in many patients. One such locally invasive tumor with propensity for tracheal invasion is carcinoma showing thymic‐like differentiation (CASTLE) of the thyroid.
Methods
A 53‐year‐old woman presents with a 2‐year history of hoarseness, newly diagnosed right vocal cord paralysis, and a thyroid mass with significant tracheal and esophageal muscularis invasion. Pathology suggests CASTLE. Segmental nine‐ring tracheal resection with primary closure is illustrated, demonstrating important tracheal reconstructive techniques.
Results
At the completion of total thyroidectomy and central compartment dissection (not illustrated), the area of tracheoesophageal tumor involvement is isolated. First, the disease is sharply dissected from the tracheal wall and esophagus, excising 4 cm of esophageal muscularis. Next, a plane is established between the membranous trachea and esophagus. The intact left recurrent laryngeal nerve is released from the left tracheoesophageal groove. Substernal thoracic tracheal attachments are released, and a suprahyoid muscle release is performed. Tracheal rings 1 through 9 are resected en bloc, and circumferential tracheal closure is illustrated, with careful attention to technique of tracheal closure and management of the endotracheal tube. Finally, given the degree of tracheoesophageal resection and indication for postoperative radiation therapy, a pectoralis muscle flap is rotated over the trachea and esophagus.
Conclusion
To our knowledge, this is the first video demonstration of a segmental resection and reconstruction of a CASTLE of the thyroid in the peer‐reviewed literature. Unique to this case is the significant length of tracheal resection with primary closure, as well as demonstration of concurrent esophageal muscularis resection. Resection and reconstruction of longer segments of cervical trachea require stepwise surgical technique to safely preserve recurrent laryngeal nerve (s), while releasing the larynx and thoracic trachea to minimize tension on the tracheal closure.

Transoral silastic medialization for unilateral vocal fold paralysis

13-08-2019 – Ihab Atallah, MK Manjunath, Paul F. Castellanos

Journal Article

Abstract
Background
Medialization laryngoplasty has historically been performed through an external approach. The aim of our work is to demonstrate the feasibility of silastic vocal fold medialization transorally.
Methods
Patients with unilateral vocal fold paralysis requiring medialization laryngoplasty were included in this report. Silastic medialization was done through a transoral approach. A supraglottic laryngotomy is performed followed by dissection and tunneling in the paraglottic space. Silastic implant is inserted into the tunnel to medialize the vocal fold and the ipsilateral arytenoid. The laryngotomy is tightly closed by endoscopic sutures.
Results
A consecutive series of 22 patients are reported. All patients had dysphonia with significant glottic insufficiency. After endoscopic silastic medialization, voice and swallowing were significantly improved (P < .001). No postoperative complications or implant extrusion occurred in our series.
Conclusion
Silastic vocal fold medialization can be safely and effectively performed through a transoral approach with good results on voice and swallowing.

Trimodality therapy for oropharyngeal cancer in the TORS era: Is there a cohort that may benefit?

13-08-2019 – Matthew Gallitto, Kunal Sindhu, Isaac Wasserman, Brian De, Vishal Gupta, Brett A. Miles, Eric M. Genden, Marshall Posner, Krzysztof Misiukiewicz, Richard L. Bakst

Journal Article

Abstract
Background
With increasing adoption of transoral robotic surgery (TORS) for oropharyngeal cancer (OPC), more patients may receive trimodality therapy. We sought to investigate outcomes and toxicities in this cohort.
Methods
A retrospective study of patients with OPC treated with trimodality therapy at a tertiary‐care hospital, comparing those receiving bilateral vs unilateral neck radiation.
Results
Four hundred thirty‐six patients underwent TORS, 17% receiving adjuvant chemoradiation. Of the 46 patients completing adjuvant treatment in‐house, contralateral neck was spared in 20%. There were no significant differences in survival, and patient‐reported outcomes in salivary function, mood, and anxiety were superior in those patients receiving unilateral neck radiation and directly correlated with mean dose to local structures.
Conclusions
Surgery for OPC offers the potential for reduction in radiation volumes by omitting the contralateral neck in those who may have required definitive chemoradiation. Even in patients receiving concurrent chemotherapy, unilateral neck radiation has a favorable toxicity profile without compromising survival.

Predictive value of the milking patency test when performing the arterial microanastomosis in head and neck surgery

13-08-2019 – Fabien Podeur, Benjamin Peyrachon, Lara Nokovitch, Maria Adèle Dammacco, Quentin Qassemyar, Sophie Deneuve

Journal Article

Abstract
Background
The milking patency test (MPT) is widely used to assess the patency of microanastomosis, despite it being proven to be a traumatic test.
Methods
We performed microanastomoses with intentional two‐wall stitches and asked senior microsurgeons to evaluate the permeability of the anastomoses by looking first at the results of the MPT, then according to artery pulsation.
Results
Microsurgeons were all accurate in evaluating normal or clamped anastomoses. But in anastomoses with defects, the MPT was considered normal 94%, 85%, and 73%. MPT has a positive predictive value of 100% but with a negative predictive value of 27.5%. Observation of the artery pulsation distal to the anastomosis gave similar results.
Conclusions
Our experiment shows that the two‐wall stitches on arterial anastomoses are hardly detected by an MPT. The observed pulsation of the artery gives the same results and could be used instead, without damaging the vessels.

Utilization of rehabilitation services in patients with head and neck cancer in the United States: A SEER‐Medicare analysis

13-08-2019 – Jennifer R. Wang, Zhannat Nurgalieva, Shuangshuang Fu, Samantha Tam, Hui Zhao, Sharon H. Giordano, Katherine A. Hutcheson, Carol M. Lewis

Journal Article

Abstract
Background
Head and neck cancer (HNC) and its treatment lead to functional impairments. Rehabilitation by speech‐language pathology (SLP) and occupational/physical therapy (OT/PT) can decrease morbidity.
Methods
The Surveillance, Epidemiology and End Results–Medicare data for patients with HNC diagnosed between 2002 and 2011 was utilized to evaluate posttreatment rehabilitation.
Results
In 16 194 patients, the overall utilization rate was 20.7% for SLP and 26.2% for OT/PT services. Treatment modality was significantly associated rehabilitation utilization. Compared to patients treated with primary surgery, those treated with primary radiotherapy had significantly lower odds of OT/PT utilization. Patients treated with surgery plus adjuvant treatment and primary concurrent chemoradiation had higher odds of SLP utilization compared to patients treated with surgery alone.
Conclusions
Rehabilitation services appeared to be underutilized by patients with HNC in the United States and vary with treatment modality. There is a need to improve integration of rehabilitation services into the HNC care continuum.
Summary
Rehabilitation services are underutilized by patients with HNC during posttreatment surveillance in the United States. Treatment modality significantly impacts rehabilitation utilization patterns.

An innovative reconstruction procedure of total nasal resurfacing with a bipedicled propeller perforator flap

13-08-2019 – Guillaume de Bonnecaze, Benoit Chaput

Journal Article

Abstract
Background
A forehead frontal flap is the treatment of choice for complex nasal defects. However, in patients with contra indications for such frontal flaps, few alternatives are available.
Methods
We developed a three‐stage, nasal reconstruction procedure using a bipedicled, propeller perforator flap based on the modiolus perforators. Here, we describe the flap, the harvesting thereof, and the 6‐month outcomes after placement.
Results
The flap did not exhibit any sign of necrosis or congestion. Six months after reconstruction, the patient had not suffered any esthetic or functional sequela.
Conclusion
Although the indications for our new flap are less numerous than those for a frontal flap, our flap is a useful alternative when frontal flap placement is not feasible (or the patient refuses such a flap) and when placement of a free flap is too risky.

Prognostic value of radiographically defined extranodal extension in human papillomavirus‐associated locally advanced oropharyngeal carcinoma

13-08-2019 – Sibo Tian, Matthew J. Ferris, Jeffrey M. Switchenko, Kelly R. Magliocca, Richard J. Cassidy, Jaymin Jhaveri, Ashley H. Aiken, Kristen L. Baugnon, Patricia A. Hudgins, Ayse T. K. Kendi, Mihir R. Patel, Nabil F. Saba, Walter J. Curran, Jonathan J. Beitler

Journal Article

Abstract
Background
Pathologic extranodal extension (ENE) has traditionally guided the management of head and neck cancers. The prognostic value of radiographic ENE (r
ENE) in human papillomavirus (HPV)‐associated oropharyngeal squamous cell carcinoma (HPV + OPX) is uncertain.
Methods
Patients with HPV + OPX with adequate pretreatment radiographic nodal evaluation from a single institution were analyzed. r
ENE status was determined by neuroradiologists at time of diagnosis. Distant metastasis‐free survival (DMFS), overall survival (OS), and locoregional recurrence‐free survival (LRFS) were estimated using Kaplan‐Meier methods. Cox proportional hazards models were fit to assess the impact of r
ENE on survival endpoints.
Results
Hundred sixty‐eight patients with OPX + squamous cell carcinomas diagnosed between April 2008 and December 2014 were included for analysis with median follow‐up of 3.3 years. Eighty‐eight percent of patients received concurrent chemoradiotherapy. r
ENE was not prognostic; its presence in patients with HPV + OPX did not significantly impact OS, LRFS, or DMFS.
Conclusions
In patients with HPV + OPX, r
ENE was not significantly associated with OS, LRFS, or DMFS.

Comparative transcriptome analysis of sinonasal inverted papilloma and associated squamous cell carcinoma: Out‐HOXing developmental genes

13-08-2019 – Diana Bell, Achim H. Bell, Michael E. Kupferman, Victor G. Prieto, Randal S. Weber, Ehab Y. Hanna

Journal Article

Abstract
Background
Sinonasal papilloma has a tendency toward local destruction, recurrence, and malignant transformation. This study aimed to unravel mechanisms in the malignant transformation of sinonasal papillomas using RNA‐seq.
Methods
The cohort consisted of 37 consecutive patients; tumor histology included a continuum spectrum (sinonasal papillomas/dysplastic/carcinomas‐in‐situ/invasive squamous cell carcinomas). These were microdissected and RNA was subjected to whole‐transcriptome shotgun sequencing.
Results
RNA‐seq and pathway analysis showed that the highest expressed genes/potential drivers were development‐ and differentiation‐related genes. The protein expression of six highly upregulated genes (HOXA9, EN1, DUX4, CA9, CD1a, and CK5/6) validated the RNA‐seq results. HOXA9 and CA9 were found to be expressed in most of the carcinoma samples but were largely negative in papillomas; all of the CA9‐negative carcinomas were recurrent.
Conclusions
We conclude that sinonasal carcinomas arising from papillomas are mainly defined by overexpressed developmental/homeobox genes, which provide the potential for transformation/plasticity, along with differentiation and proliferation behavior of neoplastic cells. Our results support HOXA9 and CA9 as biomarkers for carcinomas, with CA9 emerging as a predictive marker of recurrence.

Prediction of survival with combining quantitative 18F‐FDG PET/CT and DW‐MRI parameters in sinonasal malignancies

13-08-2019 – Kerem Ozturk, Mehmet Gencturk, Emiro Caicedo‐Granados, Faqian Li, Zuzan Cayci

Journal Article

Abstract
Background
We aimed to establish the prognostic value of 18F‐fluoro‐deoxy‐glucose positron emission/CT (18F‐FDG PET/CT) and diffusion‐weighted (DW) MRI in determining overall survival (OS), progression‐free survival (PFS), and distant metastasis‐free survival (DMFS) of sinonasal malignancies.
Methods
Sixty‐eight patients with sinonasal cancer who underwent both pretreatment 18F‐FDG PET/CT scan and head‐neck MRI from January 2009 through August 2017 were retrospectively reviewed. Kaplan‐Meier survival analysis of 18F‐FDG PET/CT and DW‐MRI parameters were performed for OS, PFS, and DMFS.
Results
Cox regression analysis determined that all the quantitative 18F‐FDG PET/CT and DW‐MRI parameters were independently correlated with PFS, DMFS, and OS (P < .05). After controlling for imaging variables, perineural invasion (P = .02) and ill‐defined margin (P = .02) were found to be significantly correlated with shorter OS; while the perineural invasion was significantly correlated with shorter PFS (P = .02).
Conclusions
The pretreatment DW‐MRI and 18F‐FDG PET/CT parameters could be substantial surrogate markers for sinonasal malignancies.

“The image‐guided operating room—Utility and impact on surgeons performance in the head and neck surgery”

13-08-2019 – Nidal Muhanna, Catriona M. Douglas, Michael J. Daly, Harley H. L. Chan, Robert Weersink, Jimmy Qiu, Jason Townson, John R. Almeida, David Goldstein, Ralph Gilbert, Eugene Yu, Walter Kucharczyk, David A. Jaffray, Jonathan C. Irish

Journal Article

Abstract
Background
The image‐guided operating room (OR) is an emerging standard for dealing with complex cases in many surgical disciplines including neurosurgery, thoracic surgery, maxillofacial trauma, and orthopedic surgery. Its use in head and neck oncological surgery is not well established. The primary aim of this study was to assess the image quality of cone‐beam CT (CBCT) under real clinical conditions. The secondary aim was to assess the effect on surgical performance and decision making.
Methods
Intraoperative 3D imaging was performed using a CBCT capable C‐Arm mounted on a multi‐axis robot (Siemens Zeego) in the image‐guided OR. All patients had immediate preoperative imaging taken with further intraoperative imaging performed as required. Ten initial patients, comprising 28 intraoperative scans, were used for questionnaire‐based image reviews conducted with experienced head and neck clinicians. Scans were assessed for aspects of both image quality and clinical utility, on separate 5‐point Likert scales (1‐5).
Results
The median rating for bony detail was 4 out of 5. Vascular detail was increased (P < 10−8) from 1 to 3 with the use of IV contrast (region of interest CT# was 284 HU SD, 47 HU). Images were rated as 4 for freedom from artifact. Soft tissue definition was 2, with no significant improvement (P = .2) with the addition of IV iodinated contrast. Surgeons rated the greatest clinical utility (4) for the CBCT when assessing postreconstruction imaging of a complex case.
Conclusions
The image quality of CBCT in the image‐guided OR is good for bony detail and complex oncological reconstructions in the head and neck setting but probably has limited benefit for intraoperative soft tissue delineation. Future studies must also focus on clinical outcomes to help demonstrate the value of the image‐guided OR.

Apoptotic signaling in salivary mucoepidermoid carcinoma

13-08-2019 – Gabriela M. Silva, Victoria Saavedra, Renata C. F. Ianez, Elen A. Sousa, Ágatha N. Gomes, Natalie Kelner, Maria A. Nagai, Luiz P. Kowalski, Fernando A. Soares, Silvia V. Lourenço, Cláudia M. Coutinho‐Camillo

Journal Article

Abstract
Background
Mucoepidermoid carcinoma is the most common malignant tumor of salivary glands. Apoptosis plays an important role in organogenesis of glandular structures, and aberrations of apoptotic mechanisms is associated with a wide array of pathologic conditions.
Methods
The immunoexpression of proteins associated with apoptosis and proliferation was evaluated in 40 mucoepidermoid carcinoma cases.
Results
Par‐4, Survivin, MUC1, PHLDA1, Fas, and Ki‐67 were predominantly expressed in mucoepidermoid carcinoma. Fas
L was rarely expressed, and Caspase‐3 expression was observed in almost 50% of the cases. SPARC expression was associated with low‐grade tumors, and Ki‐67 expression was associated with lymph node metastasis. Expression of Fas and decreased expression of Ki‐67 and Caspase‐3 were associated with better overall cancer‐specific survival rates.
Conclusions
The association of SPARC and Ki‐67 expression with pathological features and the association of Fas, Caspase‐3, and Ki‐67 with survival probabilities suggest that these proteins may be useful prognostic markers for mucoepidermoid carcinoma.

Upregulated long noncoding RNA ENST00000470447.1 inhibits cell migration and invasion and predicts better disease‐free survival of oral cancer

13-08-2019 – Fa Chen, Lingjun Yan, Jing Wang, Lisong Lin, Yu Qiu, Zhijian Hu, Junfeng Wu, Xiaodan Bao, Liangkun Lin, Rui Wang, Lin Cai, Fengqiong Liu, Baochang He

Journal Article

Abstract
Background
The aim of the present study was to assess the long noncoding RNA (lnc
RNA) expression profile of oral cancer and clarify the biological functions and clinical value of a novel lnc
RNA ENST00000470447.1.
Method
Microarray assay was used to explore lnc
RNA expression profiles in three paired oral cancer and adjacent normal tissue samples. The expression of targeted lnc
RNA (ENST00000545372.1, ENST00000470447.1, and ENST00000412353.1) was validated by quantitative real‐time polymerase chain reaction. Then we evaluated the biological and clinical roles of ENST00000470447.1 in oral cancer by in vitro assays and multivariable Cox regression analysis.
Results
Lnc
RNAs were aberrantly expressed in oral cancer tissues. The expression levels of ENST00000470447.1 and ENST00000412353.1 in oral cancer tissues were significantly lower than those in matched adjacent noncancerous tissues (P < .001). in vitro assays indicated that overexpression of ENST00000470447.1 significantly inhibited the proliferation, migration, and invasion ability of Tca‐8113 cells, whereas promoted the apoptosis of Tca‐8113 cells. Furthermore, ENST00000470447.1 expression was significantly correlated with tumor differentiation (P = .030). Cox regression analyses demonstrated that high ENST00000470447.1 expression was associated with better disease‐free survival for patients with oral cancer (hazard ratio: 0.25, 95% CI: 0.06‐0.95; P = .041).
Conclusion
Our findings suggest that ENST00000470447.1 can be served as a potential novel marker for recurrence and metastasis prediction of patients with oral cancer, which may provide a potential therapeutic target for oral cancer.

Adjunctive Chinese herbal medicine therapy for nasopharyngeal carcinoma: Clinical evidence and experimental validation

13-08-2019 – Ying‐Chyi Song, Kuo‐Feng Hung, Kai‐Li Liang, Jen‐Huai Chiang, Hui‐Chi Huang, Hui‐Ju Lee, Mei‐Yao Wu, Sheng‐Jie Yu, Hsin‐Yi Lo, Tin‐Yun Ho, Hung‐Rong Yen

Journal Article

Abstract
Background
To investigate the benefits of adjunctive Chinese herbal medicine (CHM) for patients with nasopharyngeal carcinoma (NPC).
Methods
We included all patients diagnosed with NPC during 1997‐2009 and followed until 2011 in Taiwan. We used 1:1 frequency matching by age, sex, comorbidity, conventional treatment, and index year to compare the CHM users and non‐CHM users (n = 2542 each). The prescribed CHM was further investigated with regard to its cytotoxicity.
Results
Compared with non‐CHM users, adjunctive CHM users had a lower hazard ratio of mortality risk, and a better survival probability. Gan‐Lu‐Yin (GLY) was the most commonly prescribed CHM, and it reduced cell viability, inhibited tumor proliferation, and induced apoptosis through the poly (ADP‐ribose) polymerase and caspase‐3‐dependent pathway in human NPC TW01 cells. Oral administration of GLY retarded NPC‐TW01 tumor growth in the xenograft nude mouse model.
Conclusion
Real‐world data and laboratory experiments implied that adjunctive CHM might be beneficial for NPC patients.

Induction of cell fusion/apoptosis in anaplastic thyroid carcinoma in orthotopic mouse model by urokinase‐specific oncolytic Sendai virus

13-08-2019 – Yoshihiro Miyagawa, Koji Araki, Taku Yamashita, Shingo Tanaka, Yuya Tanaka, Masayuki Tomifuji, Yasuji Ueda, Yoshikazu Yonemitsu, Hideaki Shimada, Akihiro Shiotani

Journal Article

Abstract
Background
This study was designed to assess the therapeutic effect of urokinase‐targeted recombinant oncolytic Sendai virus, termed “Bio
Knife,” on anaplastic thyroid carcinoma (ATC).
Methods
Urokinase activity was investigated in human ATC cell lines, and Bio
Knife cytotoxicity against the cell lines was evaluated in vitro. Orthotopic mouse models of ATC were treated with three intratumoral injections of Bio
Knife, control virus, or phosphate‐buffered saline (PBS) and were observed daily until >20% weight loss occurred.
Results
All three ATC cell lines showed a high level of urokinase activity. Bio
Knife induced urokinase‐dependent cell fusion and cytotoxicity in all cell lines. Orthotopic models treated with Bio
Knife showed significantly prolonged survival compared with models treated with control virus or PBS (Bio
Knife 41.6 ± 15.0, control virus 17.0 ± 2.9, PBS 17.7 ± 6.3 days).
Conclusions
Bio
Knife exerted therapeutic effects in orthotopic ATC mouse models. Thus, Bio
Knife represents a possible treatment option for ATC.

The significance of tumor budding in oral cancer survival and its relevance to the eighth edition of the American Joint Committee on Cancer staging system

13-08-2019 – Yi‐Yun Ho, Tzu‐Ying Wu, Han‐Chieh Cheng, Cheng‐Chieh Yang, Cheng‐Hsien Wu

Journal Article

Abstract
Background
To explore the clinicopathological significance of tumor budding (TB) on oral squamous cell carcinoma (OSCC) prognosis.
Methods
Data of 200 patients with OSCC were retrieved from the cancer registration database in Taipei Veterans General Hospital. Clinicopathological characteristics and survival relevant to TB were analyzed.
Results
The data showed that TB was predominant in the tongue and floor of the mouth in younger patients with OSCC and correlated with several pathological factors, such as perineural invasion and lymphovascular invasion. Patients with TB have significantly lower recurrence‐free survival (P ≤ .0001). TB was significantly associated with lymph node metastasis in patients with early cancer stage (P = .042). Multivariate analysis demonstrated extranodal extension and TB as independent predictors of lymph node recurrence (adjusted hazard ratio = 9.90 and 3.89, respectively).
Conclusion
TB is a significant predictor of tumor aggression with locoregional failure even in the revised 8th American Joint Committee on Cancer staging system.

Prediction of pharyngocutaneous fistula and survival after salvage laryngectomy for laryngohypopharyngeal carcinoma

13-08-2019 – Yong Han Kim, Jong‐Lyel Roh, Seung‐Ho Choi, Soon Yuhl Nam, Sang Yoon Kim

Journal Article

Abstract
Background
This study examined the risk factors of pharyngocutaneous fistula development and poor survival after salvage laryngectomy.
Methods
Binary logistic regression analyses were carried out to analyze the relationship between post‐salvage fistula development and variables. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate prognostic factors associated with disease‐free survival (DFS) and overall survival (OS) after salvage laryngectomy.
Results
Multivariate analyses showed that previous radiotherapy and pre‐salvage tracheostomy were the independent variables predictive of post‐salvage fistula development (all P < .05). The 5‐year DFS and OS rates were 58.8% and 45.9%, respectively. Multivariate analyses showed that nodal positivity at salvage remained the independent factor predictive of both DFS (hazard ratio HR 2.83, P = .002) and OS (HR 2.22, P = .006).
Conclusions
Fistula development after salvage laryngectomy might be predicted by a history of radiotherapy or tracheostomy. Post‐salvage survival is associated with nodal positivity at salvage.
Condensed Abstract
This study examined the risk factors of pharyngocutaneous fistula development and survival in 103 patients who underwent salvage laryngectomy. Previous radiotherapy and tracheostomy were the independent variables predictive of post‐salvage fistula development, and nodal positivity at salvage was the independent factor predictive of both disease‐free survival and overall survival.

The molecular landscape of the University of Michigan laryngeal squamous cell carcinoma cell line panel

13-08-2019 – Jacqueline E. Mann, Aditi Kulkarni, Andrew C. Birkeland, Judy Kafelghazal, Julia Eisenberg, Brittany M. Jewell, Megan L. Ludwig, Matthew E. Spector, Hui Jiang, Thomas E. Carey, J. Chad Brenner

Journal Article

Abstract
Background
Laryngeal squamous cell carcinomas (LSCCs) have a high risk of recurrence and poor prognosis. Patient‐derived cancer cell lines remain important preclinical models for advancement of new therapeutic strategies, and comprehensive characterization of these models is vital in the precision medicine era.
Methods
We performed exome and transcriptome sequencing as well as copy number analysis of a panel of LSCC‐derived cell lines that were established at the University of Michigan and are used in laboratories worldwide.
Results
We observed a complex array of alterations consistent with those reported in The Cancer Genome Atlas head and neck squamous cell carcinoma project, including aberrations in PIK3CA, EGFR, CDKN2A, TP53, and NOTCH family and FAT1 genes. A detailed analysis of FAT family genes and associated pathways showed disruptions to these genes in most cell lines.
Conclusions
The molecular profiles we have generated indicate that as a whole, this panel recapitulates the molecular diversity observed in patients and will serve as useful guides in selecting cell lines for preclinical modeling.

Radiation‐induced sensitivity of tissue‐resident mesenchymal stem cells in the head and neck region

13-08-2019 – Jennifer L. Spiegel, Mario Hambrecht, Vera Kohlbauer, Frank Haubner, Friedrich Ihler, Martin Canis, Arndt F. Schilling, Kai O. Böker, Ralf Dressel, Katrin Streckfuss‐Bömeke, Mark Jakob

Journal Article

Abstract
Background
Tissue‐resident mesenchymal stem cells (MSCs) possess the ability to migrate to areas of inflammation and promote the regeneration of damaged tissue. However, it remains unclear how radiation influences this capacity of MSC in the head and neck region.
Methods
Two types of MSCs of the head and neck region (mucosa m
MSC and parotid gland p
MSC) were isolated, cultured and exposed to single radiation dosages of 2 Gy/day up to 10 days. Effects on morphology, colony forming ability, apoptosis, chemokine receptor expression, cytokine secretion, and cell migration were analyzed.
Results
Although MSC preserved MSC‐specific regenerative abilities and immunomodulatory properties following irradiation in our in vitro model, we found a deleterious impact on colony forming ability, especially in p
MSC.
Conclusions
MSC exhibited robustness and activation upon radiation for the support of tissue regeneration, but lost their potential to replicate, thus possibly leading to depletion of the local MSC‐pool after irradiation

A novel approach to neurologic function sparing surgical management of vagal schwannomas: Continuous intraoperative nerve monitoring of the laryngeal adductor reflex

13-08-2019 – Mykayla L. Sandler, John R. Sims, Catherine Sinclair, Rebecca Ho, Lauren E. Yue, Maria J. Téllez, Sedat Ulkatan, Azita S. Khorsandi, Margaret Brandwein‐Weber, Mark L. Urken

Case Reports

Abstract
Background
Vagal schwannomas are rare, benign tumors of the head and neck. Nerve damage during surgical resection is associated with significant morbidity. A new technique of continuous intraoperative nerve monitoring (IONM) that allows for real‐time intraoperative feedback has recently been used for thyroid and cervical spine surgeries but has not previously been used in vagal schwannoma surgery.
Methods
Case series of three patients who underwent vagal schwannoma excision utilizing this novel IONM technique. The recurrent laryngeal and vagus nerves were monitored via the laryngeal adductor reflex (LAR) using an electromyographic endotracheal tube.
Results
Three patients with suspected vagal schwannomas were treated surgically using the intracapsular enucleation approach with a combination of intermittent IONM and continuous IONM of the LAR.
Conclusion
This combination of continuous and intermittent IONM can be used to preserve vagal laryngeal innervation and function and may represent the future standard of care for vagal schwannoma excision.

Brain and frontal‐bone metastasis from nasopharyngeal carcinoma: Case report and literature review

13-08-2019 – Zhen Su, Xiaolong Cao, Guorong Zou

Case Reports

Abstract
Background
Metastases to the bones, lungs, and liver are common in patients with nasopharyngeal carcinoma (NPC) but not to the brain and frontal bone (B + FB).
Methods
We describe a patient with NPC with B + FB metastasis. He received two cycles of palliative chemotherapy (gemcitabine and cisplatin) and then radiotherapy (60 Gy) for B + FB metastasis. A literature review of previous cases was also undertaken.
Results
Follow‐up 6 months after completion of chemotherapy and radiotherapy showed that our patient experienced a complete response without signs of NPC progression.
Conclusions
B + FB metastases from NPC are uncommon. Our case highlights the diagnostic and treatment difficulties clinicians face when dealing with patients with uncommon sites of metastasis. Optimal adjuvant therapy followed by local radiotherapy might elicit long survival in patients with NPC with uncommon sites of metastasis.

In reply to McDowell et al

13-08-2019 – David Maskell, Hannah Buckley, Katherine Sisson, Tom Roques, Dinos Geropantas

Letter

Comment on “Ipsilateral neck radiotherapy in N2b well‐lateralized tonsil cancer—Approach with caution”

13-08-2019 – Lachlan McDowell, June Corry

Letter

nnInfections of the ear, nose, throat, and sinuses. u200aBy nMarlene L. Durandn, nDaniel G. Deschlern. Springer, New York City, NY. 2018. $199.00 US. 404 ppn

13-08-2019 – Jonathan S. Choi, Benjamin D. Lovin

Transoral parathyroidectomy—Why make a simple operation complicated? A surgical fantasy

13-08-2019 – Ashok R. Shaha

Editorial

The effect of depth of invasion on node negative tongue cancer staging

13-08-2019 – William Lydiatt

Editorial

Issue Information

13-08-2019 –

Front Cover

13-08-2019 –

The cover image is based on the Original Article Parotidectomy by an endoscopic‐assisted postauricular‐groove approach, by Tiancheng Li et al., https://doi.org/10.1002/hed.25720.

Inside Front Cover

13-08-2019 –

The cover image is based on the Original Article Induction of cell fusion/apoptosis in anaplastic thyroid carcinoma in orthotopic mouse model by urokinase‐specific oncolytic Sendai virus, by Yoshihiro Miyagawa et al., https://doi.org/10.1002/hed.25769.

Inside Back Cover

13-08-2019 –

The cover image is based on the Original Article Efficacy of posttreatment radioiodine scanning in patients with differentiated thyroid cancer, by Shorook Naara et al., https://doi.org/10.1002/hed.25833. Cover Image © Nofar Rada.

Outside Back Cover

13-08-2019 –

The cover image is based on the Original Article Novel technique for the direct closure of the radial forearm flap donor site defect with a local bilobed flap by Mubarak Ahmed Mashrah et al., https://doi.org/10.1002/hed.25839.

Late effects of chemo and radiation treatment on dental structures of childhood cancer survivors. A systematic review and meta‐analysis

13-08-2019 – Kyriaki Seremidi, Dimitrios Kloukos, Argy Polychronopoulou, Antonis Kattamis, Katerina Kavvadia

Journal Article, Review

Abstract
Background
This systematic review summarizes the prevalence of dental defects after chemo and radiation therapy and correlates the findings with specific characteristics of each treatment modality.
Methods
Database search was performed for studies reporting dental late effects of chemo and radiation therapy. After data extraction and risk of bias assessment, prevalence of crown and root defects was assessed. Correlations between each defect and the characteristics of the antineoplastic treatment were performed.
Results
Sixteen nonrandomized studies were included, yielding a total of 1300 patients with a mean age at diagnosis of 4.5 years. Results reported that root defects were more common than crown defects. The most common root defect was impaired root growth and microdontia the most common crown defect. Age, radiation dose and field were statistically associated with higher prevalence of dental defects.
Conclusion
Defects were associated with combination of chemotherapy and radiotherapy, as used in current therapeutic antineoplastic modalities.

Predictive value of CCND1/cyclin D1 alterations in the malignant transformation of potentially malignant head and neck disorders: Systematic review and meta‐analysis

13-08-2019 – Pablo Ramos‐García, Miguel Ángel González‐Moles, Ángela Ayén, Lucía González‐Ruiz, José Antonio Gil‐Montoya, Isabel Ruiz‐Ávila

Journal Article, Review

Abstract
Background
To evaluate published evidence on the predictive value of CCND1 amplification/cyclin D1 overexpression as malignant transformation risk markers in potentially malignant disorders (PMDs) of the head and neck.
Material and Methods
We searched PubMed, Embase, Web of Science, and Scopus for studies published before June 2018. We conducted a meta‐analysis to quantify the impact of CCND1/cyclin D1 amplification/overexpression on malignant transformation of head and neck PMDs.
Results
Nine studies met inclusion criteria. Quantitative evaluation indicated strong statistically significant association between CCND1/cyclin D1 amplification/overexpression and the progression of head and neck PMD to head and neck squamous cell carcinoma (risk ratio RR = 2.04, 95% confidence interval CI = 1.37‐3.03, P < .001, and RR = 2.27, 95% CI = 1.32‐3.91, P = .003, respectively). We observed moderate heterogeneity among studies (I2 = 40.7%), and we cannot rule out small‐study effects such as publication bias. The oral cavity subgroup showed the strongest association between CCND1/cyclin D1 amplification/overexpression and progression to cancer.
Conclusion
CCND1/cyclin D1 amplification/overexpression is important to predict the malignant transformation risk of head and neck PMDs, especially oral PMDs.

Controversies in free tissue transfer for head and neck cancer: A review of the literature

13-08-2019 – Marianne Abouyared, Andrew P. Katz, Liliana Ein, Jill Ketner, Zoukaa Sargi, Elizabeth Nicolli, Jason M. Leibowitz

Journal Article, Review

Abstract
Background
Microvascular free tissue transfer provides superior functional outcomes when reconstructing head and neck cancer defects. Careful patient selection and surgical planning is necessary to ensure success, as many preoperative, intraoperative, and postoperative patient and technical factors may affect outcome.
Aims
To provide a concise, yet thorough, review of the current literature regarding free flap patient selection and management for the patient with head and neck.
Materials and Methods
PubMed and Cochrane databases were queried for publications pertaining to free tissue transfer management and outcomes.
Results
Malnutrition and tobacco use are modifiable patient factors that negatively impact surgical outcomes. The use of postoperative antiplatelet medications and perioperative antibiotics for greater than 24 hours have not been shown to improve outcomes, although the use of clindamycin alone has been shown to have a higher risk of flap failure. Liberal blood transfusion should be avoided due to higher risk of wound infection and medical complications.
Discussion
There is a wide range of beliefs regarding proper management of patients undergoing free tissue transfer. While there is some data to support these practices, much of the data is conflicting and common practices are often continued out of habit or dogma.
Conclusion
Free flap reconstruction remains a highly successful surgery overall despite as many different approaches to patient care as there are free flap surgeons. Close patient monitoring remains a cornerstone of surgical success.

Systematic review of international guidelines for perioperative antibiotic prophylaxis in Head & Neck Surgery. A YO‐IFOS Head & Neck Study Group Position Paper

13-08-2019 – Carlos Miguel Chiesa‐Estomba, Jérome R. Lechien, Nicolas Fakhry, Antoine Melkane, Christian Calvo‐Henriquez, Daniele de Siati, Jose Angel Gonzalez‐Garcia, Johannes Jacobus Fagan, Tareck Ayad

Journal Article, Review

Abstract
Background
Surgical site infection (SSI) is defined as an infection that occurs after a surgical incision or organ manipulation during surgery. The frequency reported for clean head and neck surgical procedures without antimicrobial prophylaxis is <1%. In contrast, infection rates in patients undergoing complicated cancer surgery are high, ranging from 24% to 87% of patients without antimicrobial prophylaxis.
Methods
Guidelines and recommendations about the use of antibiotics in head and neck surgery from 2004 to 2019 were reviewed.
Results
Four guidelines from Oceania, 5 from South America, 5 from North America, 2 from the United Kingdom, 11 from Europe, 1 from Africa, 1 from the Middle East, and 3 from Asia were included. A total of 118 papers were included for analysis and recommendation.
Conclusion
Antibiotic prophylaxis can decrease the incidence of SSI. However, the risks associated with antibiotic exposure and the risk of antibiotic resistance need to be taken into consideration.

Prevalence of trismus in patients with head and neck cancer: A systematic review with meta‐analysis

13-08-2019 – Amber L. Watters, Shane Cope, Meir N. Keller, Mariela Padilla, Reyes Enciso

Journal Article, Review

Abstract
Background
The purpose of this systematic review and meta‐analysis was to determine the prevalence of trismus in patients with head and neck cancer.
Methods
Four electronic databases were searched: Cochrane Library, MEDLINE, EMBASE, and Web of Science up to April 2018. Level of evidence was assessed based on Oxford Centre for Evidence‐based Medicine. Publications were restricted to prospective cohort studies (n = 15), randomized clinical trials (n = 3), and cross‐sectional studies (n = 5) reporting on trismus as mouth maximum opening less than or equal to 35 mm in the English language.
Results
A total of 636 abstracts were reviewed for inclusion. Twenty‐three studies were included in qualitative analysis and 15 studies in meta‐analysis. The results included 2786 patients with head and neck cancer treated with surgery, radiotherapy, and/or chemotherapy either alone or in combination. Based on meta‐analyses, the weighted average prevalence of trismus increased from 17.3% at baseline (95% confidence interval CI, 10.8%‐26.5%) to a peak of 44.1% at 6 months (95% CI, 36.7%‐51.8%) and decreased to 32.1% at 12 months (95% CI, 27.2%‐37.4%) and continued in average 32.6% at 3‐10 years (95% CI, 22.0%‐45.3%).
Conclusions
Having a primary site of the oral cavity or oropharynx was associated with a higher risk for developing trismus based on individual studies. Prospective cohort studies or randomized controlled trials with multiple objective trismus measurements, evaluation of disease characteristics, and treatment variables are needed to further investigate the prevalence of trismus secondary to head and neck cancer treatment.

Positive survival trend in metastatic head and neck cutaneous squamous cell carcinoma over four‐decades: Multicenter study

12-08-2019 – Shaheen Hasmat, Ardalan Ebrahimi, Peter P. Luk, Tsu‐Hui (Hubert) Low, Lachlan McDowell, Matthew J. R. Magarey, Michael Veness, Ruta Gupta, Jonathan Clark

Journal Article

Abstract
Background
This study assessed changes over time of survival of head and neck cutaneous squamous cell carcinoma (HNc
SCC) with lymph node metastases.
Methods
A multicenter analysis of 1301 patients with metastatic HNc
SCC treated between 1980 and 2017. Differences in disease‐specific survival (DSS) and overall survival (OS) by decade were assessed using multivariate Cox regression.
Results
Over the study period, we noted an increase in the proportion of patients aged over 80 years (3.9%‐31.7%; P < .001) and immunosuppression (1.9%‐9.9%; P = .03). After adjusting for number and size of metastatic nodes, extranodal extension, perineural invasion, immunosuppression, treatment, and institution, there was a reduction in risk of cancer‐related mortality from 0.47 in 1990‐1999 (P = .04) to 0.30 in 2000‐2009 (P < .001) when compared to 1980‐1989. This remained stable at 0.30 in 2010‐2017 (P = .001). OS remained stable after 1990.
Conclusion
Despite an aging and more frequently immunosuppressed population, fewer patients are dying from metastatic HNc
SCC.

“Surgical approaches for infratemporal fossa tumor resection: Fifteen years experience of a single center”

12-08-2019 – Daniel Yafit, Irit Duek, Sara Abu‐Ghanem, Omer J. Ungar, Anat Wengier, Helena Moshe‐Levyn, Ravit Yanko‐Arzi, Arik Zaretski, Nevo Margalit, Avraham Abergel, Nidal Muhanna, Dan M. Fliss

Journal Article

Abstract
Background
The aims of this study were to report our centers experience with infratemporal fossa (ITF) tumors, to review the treatment modalities and outcomes.
Methods
Data of patients that underwent resection of ITF tumors in a single tertiary referral medical center were collected and analyzed.
Results
Sixty‐three patients were included. Sarcoma was the most common pathology (18; 29%). The most common surgical approach was the preauricular‐orbitozygomatic approach (24; 38%), followed by endoscopic, craniofacial resection, and combined approaches. Forty‐seven patients (75%) required reconstruction, 23 (49%) involving free tissue transfer. Thirty‐five patients (76%) with malignant lesions required adjuvant therapy consisting of radiotherapy, chemotherapy, or both. Thirty‐three patients suffered from complications related to surgery or adjuvant therapy. The three‐ and five‐years survival rates for malignancy were 82% and 66%, respectively.
Conclusion
Complete surgical resection of ITF involving tumors is feasible, providing good long‐term survival. Multidisciplinary approach is the key for success.

Effects of jaw exercise intervention timing on outcomes following oral and oropharyngeal cancer surgery: Pilot study

12-08-2019 – Mykayla L. Sandler, Cathy L. Lazarus, Meng Ru, Kayvon F. Sharif, Lauren E. Yue, Martha J. Griffin, Ilya Likhterov, Raymond L. Chai, Daniel Buchbinder, Mark L. Urken, Cindy Ganz

Journal Article

Abstract
Background
Common in head and neck cancer patients, trismus can make speech and swallowing difficult and can compromise quality of life (QOL). Jaw range of motion exercise therapy may prevent or treat trismus in surgical patients. While the importance of these exercises is well‐documented, there is little literature regarding the optimal timing of exercise initiation.
Methods
A prospective pilot study investigated the effects of early vs late jaw exercise intervention on postoperative jaw opening and QOL measures, which were examined descriptively.
Results
Timing of exercise intervention was not found to significantly impact the measured outcomes. However, provisional, descriptive findings showed that jaw opening was significantly associated with multiple QOL measures, with greater jaw opening associated with improved QOL. For certain QOL measures, this positive association was stronger at earlier time points than at later time points.
Conclusions
The exploratory findings of this pilot study support further research into possible benefits of early jaw exercise intervention.

Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists

12-08-2019 – Amarbir S. Gill, Michael Kinzinger, Arnaud F. Bewley, D. Gregory Farwell, Michael G. Moore

Journal Article

Abstract
Background
Physician practice patterns regarding diagnosis and management of malnutrition in the head and neck cancer patient population are not well studied.
Methods
A 17‐question survey was distributed to 1392 members of the American Head and Neck Society (AHNS). The impact of hospital type, fellowship training, experience, and specialty was assessed.
Results
Among AHNS members, there were 124 total respondents (9% response rate), including both otolaryngologists and radiation oncologists. Respondents strongly agreed (90%) that malnutrition negatively impacts patient outcomes. The majority (63%) felt comfortable screening for malnutrition, but 13% reported no routine assessment of malnutrition; 57% were unfamiliar with relevant guidelines. Barriers to screening included lack of familiarity with screening tools/guidelines, lack of time, and lack of access to dietitian.
Conclusion
Although there was a strong consensus among respondents that the identification and management of malnutrition among head and neck cancer patients is critical, familiarity with relevant guidelines was poor.

Elective neck dissection in patients with radio‐recurrent and radio‐residual squamous cell carcinoma of the larynx undergoing salvage total laryngectomy: Systematic review and meta‐analysis

10-08-2019 – Daniel J. Lin, Alyson Lam, Laura Warner, Vinidh Paleri

Journal Article, Review

Abstract
Background
Approximately 30% of nonsurgically treated patients with laryngeal squamous cell carcinoma will suffer recurrence, and many will be clinically N0; the indication for elective neck dissection (END) remains uncertain. We aimed to determine whether END is indicated during salvage laryngectomy.
Methods
Systematic review and meta‐analysis.
Results
A total of 1141 patients were identified from 17 studies. Occult nodal positivity was 13.7% (106/775) confidence interval (CI) 11.3%‐16.1%; higher in supraglottic than glottic disease (17.8%, CI 10.3%‐25.3% vs 12%, CI 7.1%‐16.9%, P = .18). No significant difference existed between END vs observation in 5‐year disease free survival (odds ratio OR = 0.76, CI = 0.49‐1.17, P = .21, I2 = 10%) and overall survival (OS; OR = 0.96, CI = 0.65‐1.41, P = .82, I2 = 54%).
Conclusions
No significant survival advantage was found for END vs observation. Individual studies trended towards improved survival with END in supraglottic and locally advanced tumors. These factors should be considered when deciding on END in salvage laryngectomy.

Response to Bittner et al.: Polyethylene glycol fusion associated with antioxidants: A new promise in the treatment of traumatic paralysis

10-08-2019 – Raquel Salomone

Letter

Salomone et al did not induce PEG‐fusion repair of severed rat facial nerves

09-08-2019 – George Bittner, Cameron Ghergherehchi, Michelle Mikesh, Dale Sengelaub, Richard Trevino, Jamie Shores

Letter

Impact of internal mammary artery perforator propeller flap in neck resurfacing and fistula closure after salvage larynx cancer surgery: Our experience

09-08-2019 – Giovanni Almadori, Eugenio De Corso, Giuseppe Visconti, Aurora Almadori, Giovanni Di Cintio, Dario A. Mele, Stefano Settimi, Gaetano Paludetti, Marzia Salgarello

Journal Article

Abstract
Background
Salvage total laryngectomy (TL) and laryngopharyngectomy (LP) after chemoradiotherapy may produce disfiguring defects with severe complications that require complex reconstructions.
Methods
Between January 2012 and December 2018, we enrolled 25 patients who underwent internal mammary artery perforator (IMAP) flap reconstruction after salvage TL or LP. We performed retrospective review of clinical charts to collect information such as history, timing of reconstruction, type of defect, follow‐up, donor and recipient site complications, and overall flap survival (OFS) rate. Three years overall survival (OS), relapse‐free survival (RFS), and disease‐specific survival (DSS) were calculated.
Results
The OFS rate was 95%. One partial flap necrosis was recorded. No donor‐site complications were found. The mean follow‐up was 18 months. Three years OS was 44%, RFS was 47%, and DSS was 54%.
Conclusions
IMAP flap appears to be safe, versatile, and easy to harvest, with minimal donor site morbidity. It is a reliable option in Head&Neck reconstruction, in salvage surgery as well.

Treatment modality and outcomes in larynx cancer patients: A sex‐based evaluation

07-08-2019 – Hong Li, Eva Yujia Li, Alexandra Eva Kejner

Journal Article

Abstract
Background
To evaluate the differences in treatment modality and outcomes between male and female patients with laryngeal squamous cell carcinoma (SCC) in the United States.
Methods
Data were extracted from the Surveillance, Epidemiology, and End Results Database for patients with laryngeal SCC (2004‐2013). Overall survival (OS), disease specific survival (DSS), and multivariate analyses were conducted.
Results
Among women, supraglottic cancers were the most prevalent (61.2%); whereas the majority of men developed glottic cancers (64.2%; P < .001). Women with T4 disease were more likely to undergo primary radiation (56.8% vs 45.3%; P < .001) and less likely to undergo open surgery were than men (37.1% vs 48.2%; P < .001). Women had significantly better OS in glottic and supraglottic cancers, and comparable survival in subglottic cancer. Sex remained an independent prognostic factor for both DSS and OS.
Conclusion
Sex is an independent prognostic factor for DSS and OS in patients with laryngeal SCC.

Temporal myofascial segmentation for multilayer reconstruction of middle cranial fossa floor after extradural subtemporal approach to the clival and paraclival region

07-08-2019 – Filippo Gagliardi, Martina Piloni, Michele Bailo, Cristian Gragnaniello, Gianluca Nocera, Nicola Boari, Alfio Spina, Anthony J. Caputy, Pietro Mortini

Journal Article

Abstract
Background
Skull‐base reconstruction represents a concern after resection of middle fossa (MF) tumors by the extradural subtemporal transzygomatic approach (ESTZ). Regional pedicled flaps appear to be the best option. This study describes a technique for temporal myofascial segmentation to harvest a multilayered vascularized flap for MF reconstruction, which might preserve temporal muscle (TM) function and its blood supply.
Methods
The technique to harvest a combined segmented temporal myofascial flap (CSTMF) is described. The flap consists in a temporal fascial (TFF) and a muscle flap (TMF), composed by TM anterior‐medial bundle (AMB).
Results
CSTMF provides wide coverage of dural lining, through the TFF, and of dead‐space, through the TMF. The possibility to tailor TMF according to the need, anatomically preserving the blood supply, enables to significantly increase its volume.
Conclusion
CSTMF represents an effective option as regional multilayered pedicled flap for MF reconstruction, potentially preserving TM function and minimizing the cosmetic impact.

Significance and management of incidentally diagnosed metastatic papillary thyroid carcinoma in cervical lymph nodes in neck dissection specimens

07-08-2019 – Magis Mandapathil, Paul Lennon, Ian Ganly, Snehal G. Patel, Jatin P. Shah

Journal Article

Abstract
Background
The management of patients with incidentally discovered metastatic thyroid cancer in cervical lymph nodes in neck dissection specimens for other pathologies is unclear.
Methods
Retrospective review of neck dissection specimens for nonthyroid malignancy during a 30‐year period was undertaken to identify incidental metastatic papillary thyroid cancer (PTC).
Results
Twenty‐six patients had an incidental finding of PTC in lymph node(s) in neck dissection specimens. Subsequent ultrasound of the thyroid showed nodules in 20 patients. Eleven (42%) underwent total thyroidectomy, 1 (4%) had a lobectomy, and 14 (54%) were kept under active surveillance only. At a median follow‐up of 48 months (range 10‐189 months), all patients who had undergone surgery and those under surveillance were free of PTC recurrence.
Conclusion
Evaluation for detection of a primary thyroid tumor is essential in all patients with incidentally discovered metastatic PTC. Decision regarding surgery or surveillance is dependent on clinical and radiological tumor features and patient factors.

Perioperative risk factors for post‐thyroidectomy hematoma: Significance of pain and ketorolac usage

07-08-2019 – Minhyung Lee, Jihye Rhee, Yoonjoong Kim, Young Ho Jung, Soon‐Hyun Ahn, Woo‐Jin Jeong

Journal Article

Abstract
Background
Post‐thyroidectomy hematoma (PH) is uncommon but may be a life‐threatening complication. We explored perioperative risk factors for PH, with emphasis on perioperative hemodynamics, pain, and medications.
Methods
A retrospective case‐control study was performed with matching for age, sex, and type of operation. Univariate and multivariate analyses were performed to identify independent risk factors.
Results
In 1780 thyroid surgeries, 22 cases of PH were detected (1.24%). Antithrombotic agent usage, numeric rating scale (NRS) of postoperative pain, and two or more doses of ketorolac postoperatively significantly differed between the two groups. Multiple regression analysis revealed all three variables were significant risk factors for PH (odds ratio = 55.23, 10.48, and 22.58, respectively). Perioperative hemodynamics did not affect PH.
Conclusions
Antithrombotic agent usage, postoperative pain, and two or more doses of ketorolac postoperatively were identified as independent risk factors for PH. Proper pain control and judicious usage of ketorolac are recommended.

Evaluation of the efficacy of lipotransfer to manage radiation‐induced fibrosis and volume defects in head and neck oncology

07-08-2019 – Michelle F. Griffin, Jelovac Drago, Aurora Almadori, Nicholas Kalavrezos, Peter E. Butler

Journal Article

Abstract
Background
Multimodality treatment for head and neck cancer leads to substantial functional and esthetic impairment mainly manifested as radiation‐induced skin fibrosis (RIF) in combination with volumetric defects and reduction in neck mobility. This study assessed the impact of lipotransfer as part of secondary surgical procedure(s) in patients treated for head and neck malignancies.
Methods
Retrospective analysis was performed between 2005 and 2016. All patients with a history of head and neck malignancy, multimodal treatment including at least surgery or radiotherapy, and at least 2‐year disease‐free survival were included. Thirty‐eight patients (22 men, 16 women) matched the inclusion criteria.
Results
Thirty seven (97%) reported esthetic and functional improvements in their RIF and volumetric defect at follow‐up of 32 months. Major improvement in esthetic and functional outcome was reported by 24 (63%) patients and surgeons and minor by 13 patients and surgeons (34%) without causing any complications. Lipotransfer was also found to significantly improve patients psychological health postoperatively as showed by significant improvements in Derriford Appearance Scale (DAS24), Short Form Health Survey (SF‐36), and University of Washington Quality of Life Questionnaire (UW‐QOL V4) scores (P < .001).
Conclusions
Lipotransfer is effective for volume restoration and treating scar and RIF from head and neck defects.

Could the infiltration of the thyroarytenoid muscle define the pT2 glottic carcinoma?

05-08-2019 – Marco Lionello, Andy Bertolin, Ennio Nardello, Luciano Giacomelli, Fabio Canal, Giuseppe Rizzotto, Gino Marioni, Marco Lucioni

Journal Article

Abstract
Background
The involvement of the thyroarytenoid (TA) muscle by glottic cancer may be related to an impaired vocal cord mobility, which is classified as c
T2 disease. The primary endpoint was to evaluate the prognostic significance of TA muscle involvement in early glottic cancer treated with transoral laser microsurgery (TLM).
Methods
A review was conducted on a cohort of 209 patients consecutively treated with TLM for early glottic carcinoma. Univariate analysis was used to examine the prognostic meaning of clinical and pathological parameters.
Results
The statistical analysis showed that TA muscle infiltration correlated significantly with a worse prognosis in terms of recurrence rate and disease‐free survival, and this was confirmed even in the subcohort with p
T1a glottic cancer.
Conclusions
Our preliminary findings suggest that it could be considered as a criterion for upstaging a glottic cancer from p
T1 to p
T2.

Postoperative infection predicts poor survival in locoregionally advanced oral cancer

05-08-2019 – Marco A. Mascarella, Jayson Lee Azzi, Sabrina Daniela Silva, Alex Mlynarek, Veronique‐Isabelle Forest, Michael Hier, Keith Richardson, Nader Sadeghi

Journal Article

Abstract
Background
We ascertain the association of postoperative infection on survival in patients with locoregionally advanced oral cavity squamous cell carcinoma (OCSCC).
Methods
A retrospective study of patients with stage III/IVA OCSCC undergoing curative‐intent surgery was performed. Postoperative infection was considered within 30 days after surgery. Kaplan‐Meier survival curves were used to compare overall survival (OS) in patients with postoperative infection. Cox regression and propensity‐score matching were used to adjust for confounders.
Results
Fifty‐four of 114 patients had a postoperative infection. The 5‐year OS in patients with a postoperative infection (24.1%) was lower than those without (65.2%; P < .0001). Postoperative infection was a negative predictor of OS after adjusting for patient, antibiotic, pathologic, and operative factors; the adjusted hazard ratio for OS was 2.54 (95% confidence interval, 1.27‐5.09).
Conclusion
Postoperative infection is a strong negative predictor of OS in patients with OCSCC undergoing ablative surgery.

In response: Tailored approach for recurrent laryngeal nerve dissection according to different endoscopic endocrine surgery

05-08-2019 – Luis‐Mauricio Hurtado‐Lopez, Erich Basurto‐Kuba

Letter

Tailored approach for recurrent laryngeal nerve dissection according to different endoscopic endocrine surgery

05-08-2019 – Paolo Miccoli, Gianlorenzo Dionigi

Letter

Surgical consensus guidelines on sentinel node biopsy in patients with oral cancer

05-08-2019 – Mark McGurk

Letter

Letter to the editor‐in‐chief of Head and Neck

05-08-2019 – Domenico Rubello, Girolamo Tartaglione, Renato Valdes Olmos, Francesco Giammarile

Letter

Predicting radiation dosimetric distribution in different regions of the jaw in patients receiving radiotherapy for squamous cell carcinoma of the tonsil

05-08-2019 – Chiaojung Jillian Tsai, Nipun Verma, Adepitan A. Owosho, Patrick Hilden, Jonathan Leeman, SaeHee Yom, Joseph M. Huryn, Nancy Y. Lee, Cherry L. Estilo

Journal Article

Abstract
Background
Radiotherapy (RT), the main treatment for patients with head and neck cancer, can lead to dental complications.
Methods
We identified 244 patients with squamous cell carcinoma of the tonsil treated with RT from 2004 to 2013. For each patient, we contoured the 10 tooth‐bearing regions and calculated the radiation dose (gray, Gy) to each region. From this data set, we built two predictive models to determine the expected maximum radiation dose, one for the non‐molar regions and another for the molar regions.
Results
For the non‐molars, the final model included location, T‐classification, and overall stage, with a median absolute prediction error of 7.0 Gy. For the molars, the final model included location, T‐classification, overall stage, and treatment year, with a median absolute error of 6.0 Gy.
Conclusions
Our current model offers a good estimation of the maximum radiation dose delivered to different regions of the jaw; future work will independently validate these models.

Transoral robotic surgery for head and neck malignancies: Imaging features in presurgical workup

01-08-2019 – Benjamin Y.M. Kwan, Nazir Mohammed Khan, John R. Almeida, David Goldstein, Vinidh Paleri, Reza Forghani, Eugene Yu

Journal Article, Review

Abstract
The objective of this article was to review the indications for transoral robotic surgery (TORS) in head and neck malignancies. The role of imaging in patient selection will be specifically reviewed. TORS is a recently developed technique that allows minimally invasive surgeries to be performed in the head and neck. TORS has a role in the de‐escalation of oropharyngeal cancers, which allows for lower doses of chemoradiation therapy (this is a technique currently in clinical trials). Additionally, this technique allows for less invasive surgery and decreases associated complications. TORS can also be performed at other subsites. Cross‐sectional imaging has a prominent role to help identify suitable candidates for this type of surgery. This article will review important anatomy and staging related to TORS. Additionally, the key imaging features for patient selection (indications and contraindications) will be presented along with case illustrations.

Microscopic tumor invasion of contralateral mucosa in cancer involving unilateral septum

01-08-2019 – Gurston Nyquist, Chandala Chitguppi, Allison Keane, Erin Reilly, Ian Koszewski, Mehri Mollaee, Sanjeet Rangarajan, Mindy Rabinowitz, Marc Rosen, Madalina Tuluc

Journal Article

Abstract
Background
Preservation of contralateral mucosa with microscopic tumor invasion in unilateral septal involvement increases the recurrence risk. The purpose of this study was to analyze the risk of invasion of contralateral mucosa in unilateral septal involvement of cancer and to risk stratify patients.
Methods
Retrospective chart review of patients with histologically proven malignancy with unilateral septal involvement and absence of gross septal tumor involvement on the contralateral side were included.
Results
Among 40 patients, majority (55%) belonged to sixth and seventh decade. The most common type was squamous cell carcinoma (63%). Approximately one‐fourth (23%) showed microscopic contralateral invasion. Females (OR 12; 95% CI 2.01‐71.35) and patients with septal bone invasion (OR 28.5; CI 3.35‐242.0) had a higher risk of developing contralateral mucosal invasion.
Conclusion
Complete resection of contralateral mucosa is preferred in areas along the bony septum. When complete resection is not performed, intraoperative frozen section is strongly recommended.

Phase II trial with axitinib in recurrent and/or metastatic salivary gland cancers of the upper aerodigestive tract

29-07-2019 – Laura D. Locati, Stefano Cavalieri, Cristiana Bergamini, Carlo Resteghini, Salvatore Alfieri, Giuseppina Calareso, Paolo Bossi, Federica Perrone, Elena Tamborini, Pasquale Quattrone, Roberta Granata, Donata Galbiati, Francesca Platini, Ester Orlandi, Luigi Mariani, Lisa Licitra

Journal Article

Abstract
Background
Patients with prognosis recurrent/metastatic (R/M) salivary gland carcinomas (SGCs) are poor. Activity of axitinib was demonstrated in adenoid cystic carcinoma (ACC). We tested axitinib in a larger cohort of R/M SGCs including non‐ACC.
Methods
Axitinib was administered at 10 mg daily (dose escalation allowed) until progression or unacceptable toxicity. Null hypothesis would be rejected if more than 3 of 26 responses were observed.
Results
Twenty‐six patients (50% were male; 6 ACC, 20 non‐ACC) were treated. Response rate was 8% (2 partial responses), 13 stable disease (>6 months in 7 patients) and 11 disease progression. Median progression‐free survival and overall survival were 5.5 and 26.2 months, respectively. All patients had at least one adverse event: stomatitis (69%), fatigue (58%) and hypertension (54%) were the most frequent.
Conclusions
This trial did not meet its primary endpoint hence axitinib should not be considered for further investigations in SGCs. Safety profile was in line with the scientific literature.

Long‐term outcome of re‐irradiation for recurrent or second primary head and neck cancer: A multi‐institutional study of AIRO—Head and Neck working group

29-07-2019 – “Ester Orlandi, Pierluigi Bonomo, Letizia Ferella, Elisa DAngelo, Marta Maddalo, Daniela Alterio, Gabriele Infante, Almalina Bacigalupo, Angela Argenone, Nicola Alessandro Iacovelli, Isacco Desideri, Bruno Meduri, Luca Triggiani, Stefania Volpe, Liliana Belgioia, Francesco Dionisi, Domenico Attilio Romanello, Carlo Fallai, Rosalba Miceli”

Journal Article

Abstract
Background
To report the long‐term outcome of patients undergoing re‐irradiation (re‐RT) for a recurrent or second primary head and neck cancer (RSPHNCs) in seven Italian tertiary centers, while testing the Multi‐Institution Reirradation (MIRI) recursive partitioning analysis (RPA) recently published.
Methods
We retrospectively analyzed 159 patients. Prognostic factors for overall survival (OS) selected by a random forest model were included in a multivariable Cox analysis. To externally validate MIRI RPA, we estimated the Kaplan‐Meier group‐stratified OS curves for the whole population.
Results
Five‐year OS was 43.5% (median follow‐up: 49.9 months). Nasopharyngeal site, no organ dysfunction, and re‐RT volume <36 cm3 were independent factors for better OS. By applying the MIRI RPA to our cohort, a Harrell C‐Index of 0.526 was found indicating poor discriminative ability.
Conclusion
Our data reinforce the survival benefit of Re‐RT for selected patients with RSPHNC. MIRI RPA was not validated in our population.

MicroRNA expression patterns in oral squamous cell carcinoma: hsa‐mir‐99b‐3p and hsa‐mir‐100‐5p as novel prognostic markers for oral cancer

29-07-2019 – Mark Jakob, Lena M. Mattes, Stefan Küffer, Kristian Unger, Julia Hess, Mattis Bertlich, Frank Haubner, Friedrich Ihler, Martin Canis, Bernhard G. Weiss, Julia Kitz

Journal Article

Abstract
Background
Micro
RNAs (mi
RNA) recently evolved as potential cancer biomarkers. Therefore, the aim of the present study was to evaluate the prognostic impact of eight mi
RNAs connected to oral squamous cell carcinoma (OSCC).
Method
Expression levels of hsa‐mir‐21‐5p, hsa‐mir‐29b‐3p, hsa‐mir‐31‐5p, hsa‐mir‐99a‐5p, hsa‐mir‐99b‐3p, hsa‐mir‐100‐5p, hsa‐mir‐143‐3p and hsa‐mir‐155‐5p were analyzed in tumor tissue (n = 36) and healthy oral mucosal tissue (n = 17) and correlated with clinical variables. Results of the study cohort were validated in an OSCC cohort of The Cancer Genome Atlas.
Results
Increased hsa‐mir‐99b‐3p expression level showed a tendency toward advanced tumor stages, and high levels of hsa‐mir‐100‐5p expression were associated with extracapsular extension. While a high expression level of hsa‐mir‐99b‐3p was associated with better survival, a high expression level of hsa‐mir‐100‐5p was correlated with a poorer survival in the study cohort.
Conclusion
Our results indicate that hsa‐mir‐99b‐3p and hsa‐mir‐100‐5p may serve as novel prognostic biomarkers in OSCC.

Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT—A study by the HKNPCSG

27-07-2019 – Wai‐Tong Ng, Edwin C.Y. Wong, Alice K.W. Cheung, James C.H. Chow, Darren M.C. Poon, Jessica W.Y. Lai, Chi‐Leung Chiang, Horace C.W. Choi, Tin‐Ching Chau, Victor H.F. Lee, Anne W.M. Lee, Anthony H.P. Tam, Kwok‐Hung Au

Journal Article

Abstract
Background
This study evaluates the contemporary care for patients with locally recurrent nasopharyngeal carcinoma after failure of the primary course of intensity modulated radiotherapy.
Methods
Eligible patients were identified through the Hong Kong Cancer Registry database. Patterns of care and treatment outcomes were analyzed.
Results
Two hundred seventy‐two patients with locally recurrent tumors were identified. Of them, 30.9% received surgery, whereas 35.7% received re‐irradiation (re‐RT). The 5‐year overall survival (OS) for the whole group was 30.2%. Old age and advanced r
T classification were adverse prognostic factors, whereas surgery (mainly in resectable recurrence) was associated with favorable survival outcome. The 5‐year OS rates for patients who received surgery and re‐RT were 56.3% and 21.8%, respectively.
Conclusions
Early detection of resectable recurrence is of paramount importance as surgery for resectable tumors offers the potential to achieve excellent outcomes. Re‐RT could be considered in selected patients with unresectable disease and favorable prognostic features.

Comparison of hypocalcemia rates between LigaSure and clamp‐and‐tie hemostatic technique in total thyroidectomies

26-07-2019 – Feng‐Yu Chiang, Kang Dae Lee, Kyung Tae, Ralph P. Tufano, Che‐Wei Wu, I‐Cheng Lu, Pi‐Ying Chang, Yi‐Chu Lin, Tzu‐Yen Huang

Journal Article

Abstract
Background
Postoperative hypocalcemia (PH) is a serious complication after total thyroidectomy. This study aimed to compare PH rates between Liga
Sure Small Jaw (LSJ) and clamp‐and‐tie hemostatic technique in patients undergoing total thyroidectomy.
Methods
Four hundred twenty patients were divided into two groups: group L (210 patients) performed with LSJ and group C (210 patients) with clamp‐and‐tie technique. Serum ionized calcium (i
Ca) was measured before and 12, 24, 48, 72 hours after surgery. PH was defined as i
Ca lower than 4.2 mg/d
L in at least two measurements.
Results
There was no significant difference between groups in sex, age, extent of surgery, pathology, and the strategy of intraoperative management of parathyroid glands (PG). The PH rate was significantly lower in group L compared to group C (22.9% vs 32.4%, P = .03).
Conclusions
Compared to clamp‐and‐tie technique, Liga
Sure is superior to decrease PH rate after total thyroidectomy.

Superficial temporal vessels, both anterograde and retrograde limbs, are viable recipient vessels for recurrent head and neck reconstruction in patients with frozen neck

26-07-2019 – Siti Radhziah Sudirman, Hsiang‐Shun Shih, Jill Chia‐Jung Chen, Kuan‐Ming Feng, Seng‐Feng Jeng

Journal Article

Abstract
Background
Reconstruction of recurrent head and neck malignancy especially in the presence of a frozen neck is challenging. The superficial temporal vessels would be ideal as recipient vessels because they lie out of the previous surgical and radiation field.
Methods
We conducted a retrospective case‐control study based on our database between January 2013 and June 2016. A total of 581 primary cases were selected as controls. The 60 test group patients had (a) recurrent head and neck reconstruction, (b) previous surgery and irradiation, (c) frozen neck, and (d) superficial temporal vessels as recipients.
Results
There was no significant difference between vascular compromise rates of superficial temporal vessels (anterograde and retrograde limbs) and controls (P > .05). Flap success rate of the test and control group is comparable, 95% vs 98% respectively.
Conclusion
Superficial temporal vessels, both anterograde and retrograde, should be the first consideration for recurrent intraoral, facial, and scalp reconstruction with frozen necks.

Tongue reconstruction: Rebuilding mobile three‐dimensional structures from immobile two‐dimensional substrates, a fresh cadaver study

26-07-2019 – R Michael Baskin, Hadi Seikaly, Raja Sawhney, Deepa Danan, Martha Burt, Sherif Idris, Mohamed Shama, Brian Boyce, Peter T. Dziegielewski

Journal Article

Abstract
Objective
To determine the two‐dimensional (2D) characteristics of flaps necessary to create three‐dimensional (3D) tongue anatomy.
Methods
Dissection of 11 fresh, nonpreserved human cadavers was performed. Six defects in each were created: total tongue, total oral tongue, hemiglossectomy, oral hemiglossectomy, total base of tongue, and hemi‐base of tongue. The resections were debulked to create flat, 2D mucosal flaps. The dimensions and shapes of these flaps were determined.
Results
Each specimen showed consistent dimensions and geometry between cadavers. The total tongue was pear‐shaped, the total oral tongue was egg‐shaped, the oral hemi‐tongue was bullet‐shaped, the hemi‐tongue resembled a dagger, the total base of tongue was rectangular, and the hemi‐base of tongue was hour‐glass shaped.
Conclusion
Typical dimensions and shapes of common tongue defects were determined. It is conceivable that customizing reconstructive flaps based on these data will increase the accuracy of neo‐tongue reconstruction, and thus, improve functional outcomes.

Predicting individualized mortality probabilities for patients with squamous cell carcinoma of the maxilla: Novel models with clinical and histopathological predictors

26-07-2019 – Fons J. B. Slieker, Remco de Bree, Ellen M. Van Cann

Journal Article

Abstract
Background
The aim of this article was to develop prediction models that calculate postoperative 2‐ and 5‐year mortality probabilities of patients with squamous cell carcinoma of the maxilla (MSCC).
Methods
Data were collected from the medical records of patients who had been operated between 2000 and 2015 for MSCC. Potential clinical and histopathological predictors were identified. Confounding‐(un)adjusted multivariate Cox and logistic regression models were computed with stepwise backward selection. Internal validation was performed to assess calibration and discriminatory ability.
Results
Ninety‐five patients with MSCC were included. Two‐year follow‐up was complete, and 85 patients had 5‐year follow‐up. Age, neck treatment, surgical margins, bone invasion, spindle growth, and vasoinvasive growth were associated with mortality. Models were adjusted for confounding with Charlsons comorbidities index. C‐indexes were .841 and .770 respectively, and .838 and .749 after bootstrapping.
Conclusion
The MSCC‐specific mortality probability can be calculated with new prediction models.

Myotomy of sternocleidomastoid muscle as a secondary procedure in laryngectomized patients

26-07-2019 – Giovanni Paolo Santoro, Paolo Luparello, Maria Silvia Lazio, Lara Valentina Comini, Federica Martelli, Angelo Cannavicci

Journal Article

Abstract
Background
The application of specific devices to seal the tracheal stoma in laryngectomized patients is critical for optimal pulmonary and phonatory rehabilitation. Indeed, an excessive stomal depth is one of the main causes of rehabilitation failure. In this context, division of the sternal heads of the sternocleidomastoid muscle (SCM) is a common technique, usually performed during the laryngectomy.
Methods
We perform a myotomy of the sternal head of the SCM in deep and narrow tracheal stoma as a secondary procedure under local anesthesia, and here we describe the surgical steps of this procedure.
Results
The medium depth of the stoma is reduced, and no procedure‐specific complications have been observed. Postoperative morphological features show a flattening of the peristomal area, and all patients have begun regular use of appropriate patches and filters.
Conclusions
Secondary section of SCM is a safe, simple, and effective procedure in total laryngectomies with deep and narrow stoma.

Early oral cavity cancer: The prognostic factors and impact of adjuvant radiation on survival

24-07-2019 – Suhas K. Rajappa, Udip Maheshwari, Dharma Ram, Venkata P. B. Koyyala, Ghanashyam Mandal, Sumit Goyal, Rajeev Kumar, Ajay K. Dewan

Journal Article

Abstract
Background
Early oral cavity cancer has good prognosis but recurrence in them is still not uncommon. There is no general consensus on the prognostic factors and adjuvant therapy that would have a significant impact on survival.
Methods
A retrospective analysis of early oral cavity cancer patients during the time period 2009‐2017. The data regarding demographics, histopathological features, and recurrence patterns were collected and analyzed.
Results
Depth of invasion (DOI) was the most important prognostic factor among all the factors analyzed. Further analysis showed that addition of adjuvant radiotherapy for patients with DOI >5 mm did not show survival benefits (P = .73). Another subset analysis of patients with DOI >10 mm also did not show any survival advantage with adjuvant therapy P = .24.
Conclusion
There is no benefit of adding adjuvant RT in patients with DOI > 5 mm or in patients who were upstaged to T3 based only on DOI.

Head and neck cancer during pregnancy

22-07-2019 – Jennifer Le Guevelou, Sabrina Lebars, Emmanuel Kammerer, Ludovic de Gabory, Sebastien Vergez, François Janot, Bertrand Baujat, Christian Righini, Franck Jegoux, Xavier Dufour, Jean‐Claude Merol, Olivier Mauvais, Audrey Lasne‐Cardon, Lise Selleret, Juliette Thariat

Journal Article, Review

Abstract
Background
The incidence of cancer during pregnancy is low but is slightly increasing. Data on incidence and etiology of head and neck (HN) cancers in pregnant women are rare. We evaluated the frequency, tumor type, associated factors, and specific biomarkers in HN cancers occurring in pregnant (and peripartum) women.
Methods
A systematic literature search was performed on PubMed, for any HN tumor site occurring in pregnant women.
Results
Sixty cases of HN cancers occurring during pregnancy were identified. Most of them were oral cavity cancers. Relationships with oncogenic viruses, hormonal disturbance, and shift in maternal immunity profile were identified.
Conclusion
Carcinogenesis of HN cancers in pregnant women may be led by different cancer type–specific hallmarks. Relevance of these etiological factors with respect to treatments and birth control recommendations is being investigated by the REFCOR in an ambispective study.

Very late xerostomia, dysphagia, and neck fibrosis after head and neck radiotherapy

22-07-2019 – Margot Baudelet, Leen Van den Steen, Peter Tomassen, Katrien Bonte, Philippe Deron, Wouter Huvenne, Sylvie Rottey, Wilfried De Neve, Nora Sundahl, Gwen Van Nuffelen, Fréderic Duprez

Journal Article

Abstract
Background
Acute and late toxicity after intensity‐modulated radiotherapy (IMRT) for head and neck cancer (HNC) impacts on patient quality of life; yet, very late toxicity data remain scarce. This study assessed dysphagia, xerostomia, and neck fibrosis 3‐8 years after IMRT.
Methods
A retrospective analysis using generalized estimated equations was performed on 60 patients with HNC treated with fractionated IMRT between 2000 and 2015 who had a follow‐up ≥8 years. Toxicity was scored using LENT‐SOMA scales.
Results
A trend towards a nonlinear global time effect (P = .05) was noted for dysphagia with a decrease during the 5 years post‐treatment and an increase thereafter. A significant decrease in xerostomia (P = .001) and an increase in neck fibrosis (P = .04) was observed until 8 years.
Conclusions
Dysphagia, xerostomia, and neck fibrosis do not appear stable over time and remain highly prevalent in the very late follow‐up. Our findings support the need for prospective trials investigating very late toxicity in patients with HNC.

Hallmarks of cancer: Tumor budding as a sign of invasion and metastasis in head and neck cancer

22-07-2019 – Antti A. Mäkitie, Alhadi Almangush, Juan P. Rodrigo, Alfio Ferlito, Ilmo Leivo

Journal Article, Review

Abstract
Invasion and metastasis are hallmarks of cancer. The concept of tumor budding at tumor‐host interface has been documented in many carcinomas. A growing body of evidence indicates that tumor budding is a sign of invasion and early step for metastasis of many epithelial cancers including head and neck squamous cell carcinoma (HNSCC). In addition, recent research has underlined the importance of tumor budding as a promising prognosticator in HNSCC. This review summarizes the findings regarding tumor budding in HNSCC and focuses on the role of tumor budding in invasion and metastasis. Also, we highlight the prognostic significance of tumor budding in HNSCC and its potential for improving clinical decision making in terms of recommending optimal individualized treatment for this patient population.

Recurrence factors in pediatric ameloblastoma: Clinical features and a new classification system

19-07-2019 – Rong Yang, Yu Tang, Xu Zhang, Zheqi Liu, Sandhya Gokavarapu, Chengzhong Lin, Zhenhu Ren, Yongmei Zhou, Wei Cao, Tong Ji

Journal Article

Abstract
Background
Ameloblastomas of jaw in the pediatric population are a rare clinical entity and have not been well addressed in the literatures. The present retrospective study analyzed the risk factors associated with recurrence of pediatric ameloblastomas.
Methods
Cases of primary pediatric ameloblastomas seen in a tertiary hospital between 2005 and 2015 were analyzed to identify the clinical factors associated with recurrence.
Results
There were a total of 104 cases of primary pediatric ameloblastomas. The overall mean maximum tumor diameter was 4.11 ± 1.339 cm. The receiver operating characteristic curve and the Youden Index showed an optimal cutoff point of 4.95 cm to accurately predict recurrence. Bone cortex/soft tissue invasion were associated with tumor recurrence (P < .001).
Conclusions
The maximum tumor diameter, root resorption, and bone cortex/soft tissue invasion were risk factors for recurrence of pediatric ameloblastomas. The new classification system may serve as a predictor of recurrence in pediatric ameloblastomas.

In regards to Orlandi et al HED‐19‐0487

17-07-2019 – Roi Dagan, Curtis Bryant

Letter

Could the extreme conformality achieved with proton therapy in paranasal sinuses cancers accidentally results in a high rate of leptomeningeal progression?

17-07-2019 – Ester Orlandi, Nicola A. Iacovelli, Anna Cavallo, Carlo Resteghini, Lorenza Gandola, Lisa Licitra, Paolo Bossi

Letter

Endoglin (CD105) expression in neurofibromatosis type 2 vestibular schwannoma

16-07-2019 – “Gino Marioni, Lorenzo Nicolè, Diego Cazzador, Chiara Pavone, Domenico DAvella, Alessandro Martini, Antonio Mazzoni, Elisabetta Zanoletti”

Journal Article

Abstract
Background
Neurofibromatosis type 2 (NF2) is an autosomal dominant, multiple neoplasia syndrome characterized by bilateral vestibular schwannomas (VSs). Endoglin is a proliferation‐associated protein expressed in angiogenic endothelial cells. The aim of this study was to investigate endoglin expression in a series of NF2‐associated VSs, as compared with a group of sporadic VSs.
Methods
Using image analysis, vessel cross‐sectional area (AA) and density (VD) were calculated from CD105 expression in 7 NF2‐associated VSs and 14 size‐matched sporadic VSs.
Results
There were no significant differences between NF2‐associated VSs and sporadic cases in terms of AA (P = .28), or VD (P = .39). A positive correlation emerged between tumor growth rate (measured on contrast‐enhanced MRI) and VD in the cohort of NF2‐associated VSs (rho = 0.95, P = .05).
Conclusions
Further investigations are needed to ascertain the feasibility of (a) measuring circulating endoglin levels to monitor tumor growth rate and (b) targeting tumor neoangiogenesis with anti‐endoglin approaches in NF2‐associated VS.

Prognosis of nasopharyngeal carcinoma with insufficient radical dose to the primary site in the intensity‐modulated radiotherapy era

16-07-2019 – Tianzhu Lu, Xingyun Xie, Qiaojuan Guo, Shenghua Zhan, Cheng Lin, Shaojun Lin, Yu Zhang, Jingfeng Zong, Jianji Pan

Journal Article

Abstract
Background
It was reported that reduced radiotherapy is feasible for children with nasopharyngeal carcinoma (NPC) and papilloma virus‐positive oropharyngeal cancer. Therefore, we performed this study to explore the prognosis of reduced‐dose radiation in adult with NPC.
Methods
Between 2004 and 2013, we retrospectively analyzed 19 patients histologically diagnosed with NPC, who received <66 Gy radiation therapy. Ten patients receiving <54 Gy to the primary site were group A. Nine patients receiving ≥54 Gy were group B.
Results
Thirteen patients received induction chemotherapy (IC) for two or three cycles. In group A, the 5‐year overall survival (OS) was 50.0%. For group B, the 5‐year OS, locoregional relapse‐free survival, progression‐free survival, and distant metastasis‐free survival were 88.9%, 100.0%, 88.9%, and 88.9%. Group B had a better prognosis than group A on OS (88.9% vs 50.0%, P = .03).
Conclusion
Patients receiving ≥54 Gy but <66 Gy with IC achieved good local control and long‐term survival.

Temporomandibular disorder in head and neck cancer patients undergoing radiotherapy: Clinical findings and patient‐reported symptoms

16-07-2019 – Nina Pauli, Christina Mejersjö, Bodil Fagerberg‐Mohlin, Caterina Finizia

Journal Article

Abstract
Background
The aim of this study was to investigate how common temporomandibular disorder (TMD) symptoms are among head and neck cancer (HNC) patients before and after oncological treatment.
Methods
Eighty‐nine patients with HNC receiving radiotherapy were enrolled in the study. Patients were examined before radiotherapy and at 6 and 12 months after radiotherapy to evaluate the function and tenderness of the temporomandibular jaw and the muscles of mastication as well as the patient‐reported symptoms.
Results
At 6 months after radiotherapy, there was a large increase in the number of patients reporting problems with opening their mouth, fatigue, stiffness, and pain of the jaw. Sixty‐eight percent of the patients had symptoms of TMD before oncological treatment and 94% and 81% had symptoms at the 6‐ and 12‐month follow‐up, respectively.
Conclusion
The signs and symptoms of TMD escalate after radiotherapy, with symptoms peaking at 6 months after radiotherapy. Most commonly, patients suffer from restricted mouth opening, stiffness, fatigue, and pain of the jaw.

Comprehensive management of HPV‐related squamous cell carcinoma of the head and neck of unknown primary

13-07-2019 – Elie Rassy, Piero Nicolai, Nicholas Pavlidis

Journal Article, Review

Abstract
Background
Human papillomavirus (HPV)‐related squamous cell carcinoma of unknown primary (SCCUP) is currently rising in incidence but lacks a validated management approach.
Aims
This paper reviews the clinical presentation, diagnosis, and treatment of HPV‐related SCCUP.
Materials and Methods
The Medline/Pubmed database was searched by using the following keywords “CUP”, “cancer of unknown primary”, “HPV”, “human papilloma virus”, and “head and neck”. The references of the publications of interest were also screened for relevant papers.
Results
The clinical assessment of HPV‐related SCCUP includes a complete clinical examination, an endoscopic evaluation with white‐light and narrow band imaging, and radiologic assessment using morphologic and metabolic imaging. If the diagnosis remains unconfirmed, endoscopic examination under anesthesia with tonsillectomy ± base of tongue mucosectomy is performed. The therapeutic rationale aims to eradicate the involved lymph nodes and potential primary tumor with a sequence of chemoradiotherapy and neck dissection.
Discussion
As a general approach, p16‐negative SCCUP are truly HPV negative, whereas p16‐positive specimens require confirmation with HPV in situ hybridization or polymerase chain reaction to confirm HPV infection. If a cervical metastasis is considered HPV positive, the primary lesion is likely in the oropharynx, and further diagnostic interventions such as tonsillectomy seems to be mandatory. Whether the optimal treatment is neck dissection followed by adjuvant radiotherapy or concomitant chemoradiotherapy (CRT) (in case of extranodal extension or advanced lymph node stages) or definitive CRT followed by neck dissection (in case of positive 18F‐FDG‐PET/CT) remains a matter of debate. Solid scientific evidence supporting treatment de‐escalation in HPV‐related SCCUP is lacking, and the results of ongoing trials are at the brink of reporting.
Conclusion
Currently, the treatment of patients with HPV‐related SCCUP should not differ from the standard treatment of other SCCUP patients and is similarly based on the staging of the disease and general condition of the patient.

Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy

12-07-2019 – Xuemei Li, Jidan Zhou, Ci Chu, Qian You, Renming Zhong, Zhiyong Rao, Wen Hu

Journal Article

Abstract
Background
The aim of this study is to assess the effect of home enteral nutrition (HEN) on the myelosuppression of patients with nasopharyngeal cancer (NPC) during the course of concurrent chemoradiotherapy (CCRT).
Methods
A total of 18 outpatients with NPC administered oral nutritional supplementation intervention at home during the course of CCRT were designated as the HEN group, whereas 36 patients with NPC who had previously completed CCRT were retrospectively included as the control group. Patient Generated Subjective Global Assessment, body mass index (BMI), and blood test were evaluated prior to CCRT. During the course of CCRT, blood test was assessed every 2 weeks.
Results
In male patients, hemoglobin (HB) and red blood cell were decreased (P < .05) in both HEN and control group after CCRT, whereas white blood cell (WBC) started to decrease since week 2 of CCRT in the control group but maintained in the HEN group which was significantly higher than the control (5.05 ± 1.29 vs 3.77 ± 1.5, P < .05). In female patients, HB and WBC were reduced in control group during CCRT, whereas these indicators also maintained in the HEN group. Surprisingly, all patients with lower BMI (<24 kg/m2) had a significant increase in platelet (PLT) after CCRT (200.78 ± 58.03 vs 253.00 ± 69.82, P < .05), while had steady HB and WBC values in the HEN group. At the end of CCRT, WBC and PLT of the HEN group were both higher than those in the control group (5.21 ± 1.07 vs 3.37 ± 1.52), (253.00 ± 69.82 vs 165.57 ± 59.56) (P < .05 for both). Our findings suggest that HEN is effective in preventing myelosuppression during CCRT for patients with NPC.
Conclusion
Our findings suggest that HEN is effective in preventing myelosuppression during CCRT for patients with NPC.

Quality of care and short and long‐term outcomes of oropharyngeal cancer care in the elderly

11-07-2019 – Christine G. Gourin, Robert J. Herbert, Harry Quon, Carole Fakhry, Ana P. Kiess, David W. Eisele, Kevin D. Frick

Journal Article

Abstract
Objective
To examine associations between quality, short‐term and long‐term treatment‐related outcomes, and costs in elderly patients treated for oropharyngeal squamous cell cancer (OPSCC).
Methods
We retrospectively evaluated Surveillance, Epidemiology, and End Results (SEER)‐Medicare data from 666 patients diagnosed with OPSCC from 2004 to 2007 using multivariate regression and survival analysis. Quality indicators were derived from guidelines for recommended care and performance measures.
Results
Higher quality care was associated with lower risk of death in patients with dysphagia (hazard ratio HR = 0.44 0.32‐0.60), weight loss (HR = 0.42 0.28‐0.62), gastrostomy (HR = 0.47 0.33‐0.68), airway obstruction (HR = 0.41 0.27‐0.62), tracheostomy (HR = 0.17 0.05‐0.67), and pneumonia (HR = 0.53 0.33‐0.85). There were no significant differences in mean incremental costs associated with airway and swallowing impairment for patients receiving higher quality care.
Conclusions
Higher quality OPSCC care was associated with improved survival in elderly patients with airway and swallowing impairment. These data suggest that greater adherence to evidence‐based guidelines has favorable implications for long‐term outcomes.

Timing of surgery and adjuvant radiation therapy for sinonasal malignancies: Effect of surgical approach

11-07-2019 – Roy Xiao, Rohan R. Joshi, Qasim Husain, Jennifer R. Cracchiolo, Nancy Lee, Jillian Tsai, Yao Yu, Linda Chen, Jung J. Kang, Sean McBride, Nadeem Riaz, Benjamin R. Roman, Ian Ganly, Viviane Tabar, Stacey T. Gray, Marc A. Cohen

Journal Article

Abstract
Background
Timely postoperative radiation therapy (RT) within 50 days of surgery for head and neck cancers provides a survival advantage.
Methods
Using the National Cancer Database, we performed a propensity score‐matched analysis comparing patients undergoing open or endoscopic surgery for squamous cell carcinoma (SCC) of the nasal cavity and paranasal sinuses from 2010 to 2015.
Results
Among 168 pairs, patients undergoing endoscopic surgery had shorter time to surgery (24.2 vs 36.7 days, P < .001) and shorter postoperative time to RT (PTTR, 51.2 vs 58.4 days, P = .02). On multivariable linear regression, endoscopic surgery predicted shorter PTTR (β = −7.6, P = .01). Using the Kaplan‐Meier method, patients in the longest PTTR quartile had decreased overall survival (OS; Q1 vs Q4, 3‐year OS 76.5% vs 53.3%, P = .007), a durable finding when adjusted for covariates (Q1 vs Q4, HR 0.50, P = .008).
Conclusions
Patients undergoing endoscopic surgery for sinonasal SCC experience shorter PTTR. Shorter PTTR is associated with extended OS.

Transoral robotic retropharyngeal lymph node dissection in a recurrent head and neck carcinoma

11-07-2019 – Gerardo Petruzzi, Jacopo Zocchi, Silvia Moretto, Barbara Pichi, Giovanni Cristalli, Giuseppe Mercante, Giuseppe Spriano, Armando De Virgilio, Raul Pellini

Journal Article

Abstract
Background
A step‐by‐step demonstration of the transoral robotic surgical approach (TORS) used in retropharyngeal node dissection (RND) in a recurrent head and neck carcinoma.
Methods
Clinical human study of TORS RND via en bloc resection using a da
Vinci Si system (Intuitive Surgical, Inc., Sunnyvale, California).
Results
A da
Vinci Si system provided sufficient access, reach, and visualization to perform TORS‐RND. Access and exposure were achieved with a Feyh‐Kastenbauer (FK) retractor (Gyrus Medical Inc., Tuttlingen, Germany). Two surgical instruments and one 3D camera arm can be deployed with minimal collision or restriction of arm movement.
Conclusions
Routine transcervical, transparotid, and transmandibular RNDs can provoke potentially serious surgical morbidities and complications. This study demonstrates the technical feasibility of TORS RND in a 68‐year‐old man.

VEGFR‐2 is downregulated in sestamibi‐negative parathyroid adenomas

10-07-2019 – Boban M. Erovic, David P. Goldstein, Sylvia L. Asa, Stefan Janik, Ozgur Mete, Jonathan C. Irish

Journal Article

Abstract
Background
The purpose of this study was to determine the expression profile of several biomarkers in sestamibi‐positive (n = 23) and sestamibi‐negative (n = 6) parathyroid adenomas.
Methods
A tissue microarray of parathyroid adenomas from 29 patients was constructed and slides were stained for several proteins involved in angiogenesis, inflammation, cell adhesion, cell cycle, apoptosis, and with markers of the sonic hedgehog, m
TOR, Forkhead box O and WNT signal transduction pathways. Protein expression was determined using an image‐analysis software (Spectrum Plus©, 38 Aperio).
Results
Protein expression analysis revealed that the vascular endothelial growth factor receptor 2 (VEGFR2) score was significantly higher in the sestamibi‐positive cohort compared to sestamibi‐negative adenomas (P = .038). Other proteins were not differentially expressed between sestamibi‐positive and sestamibi‐negative adenomas.
Conclusion
It is hypothesized that VEGFR‐2 overexpression in parathyroid adenomas increases vascular permeability resulting in a higher uptake of sestamibi.

18Fluorodeoxyglucose‐positron emission tomography/Ct computer‐assisted biopsies for suspected persistent or recurrent malignant skull base disease

03-09-2018 – Patrick Dubach, Thiago Oliveira–Santos, Stefan Weber, Nicolas Gerber, Andreas Dietz, Marco Caversaccio

ABSTRACTBackground
Fluorodeoxyglucose (FDG)‐positron emission tomography (PET)/CT is increasingly used for the evaluation of regional or distant metastasis in head and neck oncology. However, positive PET findings lack specificity, which is especially challenging for localized disease at the skull base.
Methods
An optically tracked navigation system for multimodal image‐guided biopsies was tested to evaluate PET‐positive skull base lesions between 2009 and 2013.
Results
FDG‐PET/CT navigated biopsies of patients with suspected persistence or recurrence of carcinoma (sinonasal, n = 3; nasopharyngeal, n = 1; adenocarcinoma, n = 2; and carcinoma of unknown primary origin, n = 1) have been safely performed. Histology confirmed local persistent or recurrent malignant disease (n = 5), radio‐osteonecrosis (n = 1), and super‐infection (n = 1).
Conclusion
In the follow‐up of patients with tumors, FDG‐PET/CT‐navigated biopsies are a valid tool to evaluate PET‐positive skull base lesions. This is an especially useful technique if functional anomalous areas in FDG‐PET/CT do not cause structural alterations in MRI/CT, and if endoscopic visualization is impossible because of posttreatment alterations. © 2014 Wiley Periodicals, Inc. Head Neck, 2014