Health, Medicine

Head & Neck

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Relevance of BRAF and NRAS mutations in the primary tumor and metastases of papillary thyroid carcinomas

‎Yesterday, ‎14 ‎Ιουνίου ‎2016, ‏‎6:01:15 μμ | Marisa Cañadas-Garre, Patricia Becerra-Massare, Antonia Moreno Casares, Miguel Ángel Calleja–Hernández, José Manuel Llamas-Elvira

Abstract

Background

Multifocality of papillary thyroid carcinoma (PTC) is common. BRAF and NRAS mutations are the most frequent genetic alterations in PTC. The purpose of this study was to determine the distribution and relevance of BRAFT1799A and NRAS mutations in PTC.

Methods

BRAFT1799A and NRAS mutations were evaluated in 195 intrathyroid or metastatic foci from 29 patients with multifocal PTC.

Results

BRAFT1799A mutation was positive in 46.7% of the 59 intrathyroid and 136 metastatic foci (91/195 foci). Heterogeneous BRAF pattern was observed in 51.7% patients (15/29 patients). Irrespective of BRAF status at diagnosis (thyroid or nodes), all patients with recurrent PTC presented BRAF-mutated metastases during follow-up. All foci were negative for NRAS mutations.

Conclusion

BRAF but not NRAS mutations were heterogeneously distributed among primary tumor, nodal sites, and recurrent disease. The BRAF status of metastases generated during the follow-up can differ from the status of foci at diagnosis. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Impaired vocal cord mobility in T2N0 glottic carcinoma: Suboptimal local control with Radiation alone

‎Yesterday, ‎14 ‎Ιουνίου ‎2016, ‏‎6:01:12 μμ | Priyanka Bhateja, Matthew C. Ward, Grant H. Hunter, John F. Greskovich, Chandana A. Reddy, Tobenna I. Nwizu, Eric Lamarre, Brian B. Burkey, David J. Adelstein, Shlomo A. Koyfman

Abstract

Background

T2 glottic cancer with impaired vocal cord mobility (T2b) is known to have higher local failure rates when compared with T2 cancers without impaired cord mobility (T2a) treated with radiotherapy (RT) alone.

Methods

In this retrospective review, we identified and compared the local control rates of 3 groups: T2aN0 treated with RT; T2bN0 treated with RT; and T2b-3N0-2 treated with chemoradiotherapy (CRT).

Results

The 3-year local control rate was 95.1% for T2aN0, 73.2% for T2bN0 treated with RT, and 91.5% for the CRT group (p = .01). On univariate analysis, T2bN0 disease versus T2aN0 treated with RT alone (p = .03) was significantly associated with inferior local control.

Conclusion

Patients with glottic cancer with impaired vocal cord mobility (T2b) have a high rate of local failure with RT alone. The addition of concurrent chemotherapy should be considered for patients highly motivated toward larynx preservation and willing to accept the potential toxicity. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Neoadjuvant chemotherapy and transoral surgery as a definitive treatment for oropharyngeal cancer: A feasible novel approach

‎Yesterday, ‎14 ‎Ιουνίου ‎2016, ‏‎6:00:55 μμ | Nader Sadeghi, Ning-Wei Li, M. Reza Taheri, Samantha Easley, Robert S. Siegel

Abstract

Background

The purpose of this study was to present our evaluation of the outcome of oropharyngeal cancer managed with neoadjuvant chemotherapy and transoral surgery (TOS) with neck dissection as definitive treatment.

Methods

This is a case series of 17 patients with advanced oropharyngeal cancer who were treated with neoadjuvant chemotherapy followed by TOS. The treatment details and oncologic outcome are reported. The volumetric response of the tumor to neoadjuvant chemotherapy is evaluated and validated by histopathology.

Results

Seventeen patients with TNM stages III and IV oropharyngeal cancer constitute this series for survival analysis. On a median and mean follow-up of 31 and 40 months, respectively, 16 of the 17 patients were alive without recurrence. Disease-specific survival (DSS) and overall survival (OS) at 3 years were 94.1%.

Conclusion

Adjuvant chemotherapy followed by TOS and neck dissection is a feasible and efficacious novel therapeutic approach for definitive management of moderately advanced oropharyngeal cancer, reserving radiotherapy (RT) for salvage or adverse features. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Excessive intravenous fluid therapy in head and neck cancer surgery

‎Yesterday, ‎14 ‎Ιουνίου ‎2016, ‏‎6:00:34 μμ | Eeva Haapio, Ilpo Kinnunen, Juhani K.E. Airaksinen, Heikki Irjala, Tuomas Kiviniemi

ABSTRACT

Background

The purpose of this retrospective study was to present our assessment of modifiable perioperative factors for major cardiac and cerebrovascular events (MACCE).

Methods

This study included an unselected cohort of patients with head and neck cancer (n = 456) treated in Turku University Hospital between 1999 and 2008.

Results

Perioperative and postoperative univariate predictors of MACCE at 30-day follow-up were: total amount of fluids (during 24 hours) over 4000 mL, any red blood cell (RBC) infusion, treatment in the intensive care unit (ICU), tracheostomy, and microvascular reconstruction surgery. Median time from operation to MACCE was 3 days. Patients receiving >4000 mL of fluids had MACCE more often compared with those receiving <4000 mL (10.8% vs 2.4%; p < .001, respectively). Moreover, every RBC unit transfused or every liter of fluid administered over 4000 mL/24h increased the risk of MACCE 18% per unit/liter, respectively.

Conclusion

Patients with head and neck cancer receiving excessive intravenous fluid administration perioperatively and postoperatively are at high risk for cardiac complications, especially heart failure. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Value of fine-needle aspiration in evaluating large thyroid nodules

‎Yesterday, ‎14 ‎Ιουνίου ‎2016, ‏‎6:00:29 μμ | Thibaut Raguin, Olivier Schneegans, Jean-François Rodier, Pierre-Philippe Volkmar, Eric Sauleau, Christian Debry, Guillaume Debonnecaze, Jean-Pierre Ghnassia, Agnès Dupret-Bories

ABSTRACT

Background

The American Thyroid Association (ATA) recommends using ultrasound-guided fine-needle aspiration (FNA) in order to evaluate supracentimetric and suspect thyroid nodules. The purpose of this study was to evaluate the effective use of FNA before surgery for nodules over 3 cm in diameter.

Methods

In this retrospective study, we analyzed the results of ultrasound-guided FNA and postoperative histological analysis in 843 nodules >3 cm.

Results

The FNA was informative in 42.6%. The correlation with the final histological analysis was 94.8% for benign nodules and 71.0% for malignant nodules. The FNA had a positive predictive value of 71%, a specificity of 97%, a sensitivity of 56%, and a 4.7% rate of false-negative results.

Conclusion

Because there is a nonnegligible FNA risk of error, notably allowing the evolution of a cancer in 1 of 20 cases, the FNA data should not delay surgical intervention for potentially suspect nodules >3 cm in diameter. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Improved local and regional control with radiotherapy for Merkel cell carcinoma of the head and neck

‎Yesterday, ‎14 ‎Ιουνίου ‎2016, ‏‎6:00:27 μμ | Tobin Strom, Arash O. Naghavi, Jane L. Messina, Sungjune Kim, Javier F. Torres–Roca, Jeffery Russell, Vernon K. Sondak, Tapan A. Padhya, Andy M. Trotti, Jimmy J. Caudell, Louis B. Harrison

Abstract

Background

We hypothesized that radiotherapy (RT) would improve both local and regional control with Merkel cell carcinoma of the head and neck.

Methods

A single-institution institutional review board-approved study was performed including 113 patients with nonmetastatic Merkel cell carcinoma of the head and neck. Postoperative RT was delivered to the primary tumor bed (71.7% cases) ± draining lymphatics (33.3% RT cases).

Results

Postoperative local RT was associated with improved local control (3-year actuarial local control 89.4% vs 68.1%; p = .005; Cox hazard ratio [HR] 0.18; 95% confidence interval [CI] = 0.06–0.55; p = .002). Similarly, regional RT was associated with improved regional control (3-year actuarial regional control 95.0% vs 66.7%; p = .008; Cox HR = 0.09; 95% CI = 0.01–0.69; p = .02). Regional RT played an important role for both clinical node-negative patients (3-year regional control 100% vs 44.7%; p = .03) and clinical/pathological node-positive patients (3-year regional control 90.9% vs 55.6%; p = .047).

Conclusion

Local RT was beneficial for all patients with Merkel cell carcinoma of the head and neck, whereas regional RT was beneficial for clinical node-negative and clinical/pathological node-positive patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Issue Information – Contents

‎Πέμπτη, ‎9 ‎Ιουνίου ‎2016, ‏‎12:58:13 μμ

Cover Image

‎Πέμπτη, ‎9 ‎Ιουνίου ‎2016, ‏‎12:58:12 μμ
Thumbnail image of graphical abstract

The cover image, by Chung-Hwan Baek et al., is based on the Case Report (Online Only) Exponentially growing osteosarcoma of mandible with acromegaly, DOI: 10.1002/hed.24394.

Recurrent laryngeal nerve injury in thyroid surgery: Clinical pathways and resources consumption

‎Δευτέρα, ‎6 ‎Ιουνίου ‎2016, ‏‎7:25:40 πμ | Cesare Carlo Ferrari, Stefano Rausei, Francesco Amico, Luigi Boni, Feng-Yu Chiang, Che-Wei Wu, Hoon Yub Kim, Gianlorenzo Dionigi

Abstract

Background

The impact of recurrent laryngeal nerve (RLN) injury management in thyroid surgery seems to be relevant to patients, National Healthcare System (NHS), and society.

Methods

We studied resource consumption in the management of patients with RLN injury versus noninjured patients investigating 3 perspectives (patients, NHS, and society) in 5 clinical pathways.

Results

Direct medical costs supported by the NHS range from a minimum of euro (€) 79.46 to a maximum of € 3261.95. From the patient’s perspective, the direct medical costs supported by the patient increased from a minimum of € 3.60 to a maximum of € 499.45. Productivity losses were accounted in € 156 per day per patient. From the NHS perspective, the percentage increase ranged from 43.25% to 98.14%. From the patient’s perspective, it ranged from 51.52% to 80.60%.

Conclusion

The analysis shows a significant economic impact of RLN injury management, which varies depending on the damage, duration, and severity. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Effect of surgical intervention on circulating tumor cells in patients with squamous cell carcinoma of the head and neck using a negative enrichment technology

‎Δευτέρα, ‎6 ‎Ιουνίου ‎2016, ‏‎7:25:32 πμ | Kris R. Jatana, Priya Balasubramanian, Kyle P. McMullen, Jas C. Lang, Theodoros N. Teknos, Jeffrey J. Chalmers

ABSTRACT

Background

The purpose of this study was to investigate the impact of surgical intervention on detection of circulating tumor cells (CTCs) in patients with squamous cell carcinoma of the head and neck (SCCHN.)

Methods

We utilized a negative depletion technique to identify cytokeratin (CK)-positive CTCs. The numbers of CTCs immediately before and after surgical resection were compared.

Results

Seventy-six blood samples from 38 patients with SCCHN were examined. Seventy-nine percent of the patients had CTCs detected before and after surgery. A total of 7.89% had no CTCs before surgery, yet had CTCs identified after surgery. Overall, 60.5% of patients had an increased number of CTCs/mL after surgery with a mean increase of 6.63-fold. A statistically significant increase in CTCs was seen after surgery (p = .02).

Conclusion

The timing of sample collection in patients with SCCHN who have surgical intervention can potentially impact the number of CTCs identified. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Sacrificing the buccal branch of the facial nerve during parotidectomy

‎Τετάρτη, ‎1 ‎Ιουνίου ‎2016, ‏‎6:35:34 μμ | Muthuswamy Dhiwakar, Zubair A. Khan

Abstract

Background

The need for and consequence of sacrificing the buccal branch of the facial nerve during parotidectomy is unknown. We sought to determine the indication, frequency, and functional outcome of buccal branch sacrifice.

Methods

We conducted a prospective study of all cases of parotidectomy at a tertiary referral center.

Results

Of 100 consecutive cases of parotidectomy, the buccal branch was sacrificed in 23 cases. This subgroup was more likely to have anterior or deep lesions (p < .001), retrograde facial nerve dissection (p = .037), and immediate postoperative upper and lower facial weakness (p = .051 and .002, respectively). However, if the temporozygomatic and cervicomandibular branches were anatomically preserved, full facial (including buccal) function was restored.

Conclusion

Deep or anterior lesions may warrant sacrifice of the buccal branch for adequate access and excision. However, this does not result in long-term impairment of facial function. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Adverse effect of smoking on prognosis in human papillomavirus-associated oropharyngeal carcinoma

‎Τετάρτη, ‎1 ‎Ιουνίου ‎2016, ‏‎6:35:29 μμ | Carmen P. Liskamp, Geert O. Janssens, Johan Bussink, Willem J. Melchers, Johannes H. Kaanders, Cornelia G. Verhoef

Abstract

Background

The purpose of this retrospective study was to identify prognostic factors in a cohort of patients with oropharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT).

Methods

Medical records of 142 patients treated with (chemo)radiotherapy between September 2005 and September 2011 were reviewed and the human papillomavirus (HPV) status was determined by polymerase chain reaction (PCR) analysis. Potential prognostic factors for 3-year locoregional control and overall survival (OS) were evaluated.

Results

HPV-positive patients (n = 82) had locoregional control and OS of 78% and 79%, respectively. Significant prognostic factors on multivariate analysis were smoking (p = .03) for locoregional control and OS, and comorbidity (p = .04) for OS. Further stratification was done according to smoking behavior in HPV-positive patients. Locoregional control in current smokers was 67% compared to 86% in never smokers and former smokers, respectively (p = .02).

Conclusion

Smoking was the only modifiable prognostic factor in HPV-positive patients. Therefore, active stop-smoking programs must be integrated in the routine management of patients to maximize treatment results. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Oncologic outcomes of patients with positive margins after laser cordectomy for T1 and T2 glottic squamous cell carcinoma

‎Τετάρτη, ‎1 ‎Ιουνίου ‎2016, ‏‎6:35:24 μμ | Quentin Charbonnier, Anne-Sophie Thisse, Laurent Sleghem, François Mouawad, Dominique Chevalier, Cyril Page, Geoffrey Mortuaire

Abstract

Background

The oncologic impact of surgical margins after transoral laser microsurgery (TLM) for T1 and T2 glottic carcinoma is controversial. The purpose of this study was to assess the prognostic value of margin status in terms of local control.

Methods

Records of 266 patients treated from 1990 to 2013 were evaluated. Patients with previous cordectomy or without preoperative CT scan were excluded from the study.

Results

A total 110 patients (85 T1a, 8 T1b, and 17 T2) were enrolled. A local recurrence was observed in 23 patients. Five-year disease-free survival was significantly impaired in patients with positive margins (p = .009) and in patients with deep involvement of the vocal muscle (p = .004).

Conclusion

The present study shows that invaded margin is a factor of poor local control even though laser vaporization was systematically applied after resection. In case of deep vocal fold involvement, TLM should be extended beyond the vocal muscle to improve local control. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Comparison of the incidence of osteoradionecrosis with conventional radiotherapy and intensity-modulated radiotherapy

‎Τρίτη, ‎31 ‎Μαΐου ‎2016, ‏‎8:55:27 πμ | Thibault De Maesschalck, Nicolas Dulguerov, Francesca Caparrotti, Paolo Scolozzi, Cristina Picardi, Nicolas Mach, Nikolaos Koutsouvelis, Pavel Dulguerov

Abstract

Background

Modern techniques of radiotherapy are supposed to decrease the incidence of osteoradionecrosis of the mandible (ORNM). The purpose of this study was to compare the incidence of ORNM after intensity-modulated radiotherapy (IMRT) in comparison to conventional 3D conformal radiotherapy techniques (conventional RT).

Methods

We conducted a retrospective study of consecutive unselected patients treated in a single institution between 2002 and 2012. To minimize confounding effects, only patients with oropharyngeal carcinoma without surgery of the primary site were included.

Results

The cohorts included 145 patients in the conventional RT group and 89 patients in the IMRT group. Total incidence rate of ORNM was similar for both groups with rates of 11% versus 10% (n = 16 for conventional RT and n = 9 for IMRT; p = 1.0). Subanalysis revealed more ORNM in T4 classified lesions with IMRT (p = .007). Analysis of different risk factors showed no statistically significant difference between ORNM and no-ORNM patients.

Conclusion

We found no reduction in ORNM with IMRT. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

New perspectives on the conservative management of osteoradionecrosis of the mandible: A literature review

‎Δευτέρα, ‎30 ‎Μαΐου ‎2016, ‏‎4:30:29 μμ | Diogo Alpuim Costa, Tiago Porfírio Costa, Eduardo Carlinhos Netto, Natércia Joaquim, Isabel Ventura, Ana Cristina Pratas, Patrícia Winckler, Inês Pires Silva, Ana Catarina Pinho, Isabel Goulão Sargento, Francisco Gamito Guerreiro, António Rita Moreira

Abstract

Over the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Infrazygomatico-coronoid fixation in a segmental mandibular reconstruction with a free vascularized flap: A simple and correct repositioning method without interfering with reconstructive and microsurgical procedures

‎Παρασκευή, ‎27 ‎Μαΐου ‎2016, ‏‎5:32:40 μμ | Hitoshi Yoshimura, Seigo Ohba, Masato Yasuta, Kunihiro Nakai, Shigeharu Fujieda, Kazuo Sano

Abstract

Background

In a segmental mandibular reconstruction with a free vascularized flap, reproducing the optimal relationship between the condyle and glenoid fossa, and maintaining correct occlusion are important. We examined the practicality of a repositioning technique that combined bone plate fixation of the infrazygomatic crest and the coronoid process (infrazygomatico-coronoid fixation [IZCF]) with maxillo-mandibular fixation (MMF).

Methods

Eight patients were treated with this method. To investigate masticatory function, the status of the dental and temporomandibular joints were examined, and a food scale questionnaire was administered.

Results

IZCF and MMF resulted in correct repositioning of the segmented mandibles and enabled accurate reconstructions. Most patients recovered to be able to ingest the same preoperative food in scale with stable occlusion.

Conclusion

This method is a simple and correct repositioning method without interfering with reconstructive and microsurgical procedures. We propose this technique as a reliable method for obtaining a functional outcome in mandibular reconstruction. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Prospective study of the pattern of lymphatic metastasis in relation to the submandibular gland in patients with carcinoma of the oral cavity

‎Παρασκευή, ‎27 ‎Μαΐου ‎2016, ‏‎5:32:35 μμ | Akshat Malik, Poonam Joshi, Aseem Mishra, Apurva Garg, Manish Mair, Swagnik Chakrabarti, Sudhir Nair, Deepa Nair, Pankaj Chaturvedi

Abstract

Background

The submandibular gland is responsible for 70% to 90% of unstimulated saliva production. Its excision causes a decrease in basal salivary flow resulting in increased symptoms of subjective xerostomia and decreased quality of life. In this study, we have tried to assess the pattern of nodal metastasis in relation to the submandibular gland. With this study, we have tried to find out whether submandibular gland preservation is a viable option in patients with carcinoma of the oral cavity.

Methods

This was a prospective study conducted in a tertiary care cancer center. The fibrofatty tissue surrounding the submandibular gland was divided into 6 parts depending upon its location with the submandibular gland. All these 6 parts along with the submandibular gland were separately sent for histopathological analysis. Metastasis pattern in level Ib region was noted.

Result

The study included 137 patients with carcinoma of the oral cavity who underwent neck dissections. Eighty-five patients had clinic-radiologically N0 neck, 52 patients had cN+ (clinically node positive) neck. Level Ib was involved in 8.2% of the cases with cN0 (clinically node negative neck). In patients with cN+ neck, level Ib metastasis was seen in 40% of the cases. Metastasis in N0 necks in the area deep to the submandibular gland was seen in only 1 case (9% of all pathologically node-positive patients) with cN0 neck. This was the only case in which submandibular gland mobilization would have been required to take out the metastatic node. Even in cases with N+ neck, deep metastasis was seen in 4 cases only (14.8%). None of them had a primary tumor in the tongue. Therefore, there is a possibility of preserving the submandibular gland in cases of carcinoma of the tongue.

Conclusion

Involvement of level Ib in early tongue cancers is not very common and direct metastases to the submandibular glands are rare. Even when metastasis is present in level Ib, it can be excised without affecting the submandibular gland. In early tongue lesions, submandibular gland mobilization for dissection at level Ib is not required as no metastases deep to the submandibular glands were seen in these patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Phase II trial of everolimus in patients with previously treated recurrent or metastatic head and neck squamous cell carcinoma

‎Παρασκευή, ‎27 ‎Μαΐου ‎2016, ‏‎5:15:22 μμ | Jessica L. Geiger, Julie E. Bauman, Michael K. Gibson, William E. Gooding, Prakash Varadarajan, Athanasios Kotsakis, Daniel Martin, Jorge Silvio Gutkind, Matthew L. Hedberg, Jennifer R. Grandis, Athanassios Argiris

Abstract

Background

Patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) demonstrate aberrant activation of the phosphotidylinositol-3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway. We examined the efficacy of everolimus, an mTOR inhibitor, in patients with recurrent or metastatic HNSCC.

Methods

This single-arm phase II study enrolled biomarker-unselected patients with recurrent or metastatic HNSCC who failed at least 1 prior therapy. Everolimus was administered until progressive disease or unacceptable toxicity. Primary endpoint was clinical benefit rate (CBR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), and evaluation of tissue and serum biomarkers related to the PIK3CA pathway.

Results

Seven of 9 patients treated in the first stage were evaluable. No objective responses were seen; CBR was 28%. Three patients discontinued everolimus because of toxicity. Median PFS and OS were 1.5 and 4.5 months, respectively. No activating PI3K mutations were identified in available tumor tissue.

Conclusion

Everolimus was not active as monotherapy in unselected patients with recurrent/metastatic HNSCC. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Nomogram prediction for survival of patients with oral cavity squamous cell carcinoma

‎Πέμπτη, ‎26 ‎Μαΐου ‎2016, ‏‎7:00:29 μμ | Saurabh Bobdey, Ganesh Balasubramaniam, Prabhashankar Mishra

Abstract

Background

Nomograms are visual predictive tools that are widely used for estimating cancer prognosis. The purpose of this study was to develop a prognostic tool that will accurately predict overall survival (OS) in individual patients with oral cancer.

Methods

Medical records of 609 patients with cancer of the oral cavity were retrospectively analyzed. The stepdown method was used to select the statistically most influential predictors for inclusion in the final nomogram for predicting OS.

Results

The most influential predictors of mortality probability were age, comorbidities, clinical lymph node status, stage of disease, tumor thickness, differentiation, and perineural invasion. Nomogram was developed for prediction of 5-year OS.

Conclusion

Nomogram has been widely used in a number of cancers, but its application in oral cancer prognostication has not been explored. In this study, we have developed a nomogram that can accurately estimate 5-year OS in patients with oral cavity cancer. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Risk factors of thrombosis in a single method of microsurgical head and neck reconstruction: A multi-institutional study of 773 reconstructions with a free jejunal graft after total pharyngolaryngoesophagectomy for hypopharyngeal cancer

‎Πέμπτη, ‎26 ‎Μαΐου ‎2016, ‏‎7:00:26 μμ | Narushi Sugiyama, Soshi Takao, Etsuji Suzuki, Yoshihiro Kimata

ABSTRACT

Background

The risk factors for thrombus formation in anastomotic vessels in free-flap head and neck reconstruction have been previously reported. However, the evidence is inconsistent.

Methods

In total, 773 patients who underwent free jejunal graft reconstruction after pharyngolaryngoesophagectomy for hypopharyngeal cancer were enrolled at 12 institutions in Japan from 1995 to 2006. Both the resection area and the applied reconstruction method were constrained to overcome the limitations of previous studies. After the exclusion of recurrent cases, odds ratios (ORs) and 95% confidence intervals (CIs) for thrombosis were calculated in a multivariate logistic regression analysis.

Results

Postoperative anastomotic thrombosis developed in 23 patients (3.0%). In the multivariate analysis, the OR for thrombosis per 100-mL increase in blood loss was 1.24 (95% CI = 1.02–1.51), even after controlling for other risk factors.

Conclusion

Our results show that the blood loss volume is an independent risk factor for thrombosis in free tissue grafts. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Social perception of morbidity in facial nerve paralysis

‎Πέμπτη, ‎26 ‎Μαΐου ‎2016, ‏‎9:35:30 πμ | Matthew Ka Ki Li, Navin Niles, Sinclair Gore, Ardalan Ebrahimi, John McGuinness, Jonathan Robert Clark

ABSTRACT

Background

There are many patient-based and clinician-based scales measuring the severity of facial nerve paralysis and the impact on quality of life, however, the social perception of facial palsy has received little attention. The purpose of this pilot study was to measure the consequences of facial paralysis on selected domains of social perception and compare the social impact of paralysis of the different components.

Method

Four patients with typical facial palsies (global, marginal mandibular, zygomatic/buccal, and frontal) and 1 control were photographed. These images were each shown to 100 participants who subsequently rated variables of normality, perceived distress, trustworthiness, intelligence, interaction, symmetry, and disability. Statistical analysis was performed to compare the results among each palsy.

Results

Paralyzed faces were considered less normal compared to the control on a scale of 0 to 10 (mean, 8.6; 95% confidence interval [CI] = 8.30–8.86) with global paralysis (mean, 3.4; 95% CI = 3.08–3.80) rated as the most disfiguring, followed by the zygomatic/buccal (mean, 6.0; 95% CI = 5.68–6.37), marginal (mean, 6.5; 95% CI = 6.08–6.86), and then temporal palsies (mean, 6.9; 95% CI = 6.57–7.21). Similar trends were seen when analyzing these palsies for perceived distress, intelligence, and trustworthiness, using a random effects regression model.

Conclusion

Our sample suggests that society views paralyzed faces as less normal, less trustworthy, and more distressed. Different components of facial paralysis are worse than others and surgical correction may need to be prioritized in an evidence-based manner with social morbidity in mind. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Utility of up-front transoral robotic surgery in tailoring adjuvant therapy

‎Πέμπτη, ‎26 ‎Μαΐου ‎2016, ‏‎9:35:27 πμ | Neil Gildener–Leapman, Jeehong Kim, Shira Abberbock, Garret W. Choby, Rajarsi Mandal, Umamaheswar Duvvuri, Robert L. Ferris, Seungwon Kim

Abstract

Background

The purpose of this study was to describe how the up-front transoral robotic surgery (TORS) approach could be used to individually tailor adjuvant therapy based on surgical pathology.

Methods

Between January 2009 and December 2013, 76 patients received TORS for oropharyngeal squamous cell carcinoma (OPSCC). Clinical predictors of adjuvant therapy were analyzed and comparisons were made between recommended treatment guidelines for up-front surgery versus definitive nonsurgical approaches.

Results

Advanced N classification, human papillomavirus (HPV)-positive tumor, extracapsular spread (ECS; 26 of 76), perineural invasion (PNI; 14 of 76), and positive margins (7 of 76) were significant predictors of adjuvant chemoradiotherapy (CRT) (p < .05). Up-front TORS deintensified adjuvant therapy; 76% of stage I/II and 46% of stage III/IV patients avoided CRT. Conversely, pathologic staging resulted in 33% of patients who would have received radiotherapy (RT) alone based on clinical staging, to be intensified to receive adjuvant CRT.

Conclusion

The TORS approach deintensifies adjuvant therapy and provides valuable pathologic information to intensify treatment in select patients. TORS may be less effective in deintensification of adjuvant therapy in patients with clinically advanced N classification disease. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Intestinal-type sinonasal adenocarcinomas: The road to molecular diagnosis and personalized treatment

‎Τετάρτη, ‎25 ‎Μαΐου ‎2016, ‏‎4:40:35 μμ | Ann Hoeben, Linda van de Winkel, Frank Hoebers, Kenneth Kross, Chantal Driessen, Pieter Slootweg, Vivianne C. G. Tjan–Heijnen, Carla van Herpen

Abstract

Background

Sinonasal intestinal-type adenocarcinomas (ITACs) are epithelial tumors of the nasal cavity and the paranasal sinuses, often related to professional exposure to organic dust, mainly wood or leather. It is a rare cancer. If resectable, surgery is the treatment of choice. Postoperative radiotherapy is often indicated to increase local control. Systemic treatment (chemotherapy, targeted agents, or immunotherapy) of irresectable ITACs and/or metastasized disease is less standardized.

Methods

Articles on ITAC histopathology, molecular profile, and current treatment options of this specific tumor were identified and reviewed, using the electronic databases Pubmed, Medline, Cochrane, and Web of Science.

Results

This article reviews what is currently known on the histopathology, tumorigenesis, molecular characteristics, and standardized treatment options of ITAC.

Conclusion

More translational research is needed to identify druggable targets that may lead to a personalized treatment plan in order to improve long-term outcome in patients with locally advanced and/or metastasized ITAC. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Radiation dose distribution in the teeth, maxilla, and mandible of patients with oropharyngeal and nasopharyngeal tumors who were treated with intensity-modulated radiotherapy

‎Τετάρτη, ‎25 ‎Μαΐου ‎2016, ‏‎4:40:33 μμ | Cláudia Joffily Parahyba, Fábio Ynoe Moraes, Pedro Augusto Minorim Ramos, Cecília Maria Kalil Haddad, João Luis Fernandes da Silva, Eduardo Rodrigues Fregnani

Abstract

Background

The purpose of this study was to evaluate the distribution of the intensity-modulated radiotherapy (IMRT) dose delivered to the teeth, maxilla, and mandible.

Methods

The mean dose (Dmean) and maximum dose (Dmax) of radiation for the maxilla, mandible, and teeth of 63 patients with oropharyngeal (n = 44) or nasopharyngeal (n = 19) tumors were retrospectively evaluated.

Results

The posterior regions of the mandible received the highest doses, and the teeth received lower doses than the bones (maximum dose, p < .001; average dose, p < .001). The Dmax (p < .001) and Dmean (p < .001) depended on primary tumor location. The superior bones and teeth of patients with nasopharyngeal tumors received more radiation than those of patients with oropharyngeal tumors.

Conclusion

A dose distribution map was generated based on the estimated doses received, which could allow prediction of the areas most affected by radiation and facilitate further correlations with dental complications after radiotherapy. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Comparison between Focus Harmonic scalpel and other hemostatic techniques in open thyroidectomy: A systematic review and meta-analysis

‎Τετάρτη, ‎25 ‎Μαΐου ‎2016, ‏‎4:40:25 μμ | Matteo Angelo Cannizzaro, Laura Borzì, Salvatore Lo Bianco, Valeriya Okatyeva, Andrea Cavallaro, Antonino Buffone

Abstract

Background

The purpose of this review was to compare the efficacy and surgical outcomes of total thyroidectomy between the Focus Harmonic scalpel (Ethicon, Cincinnati, OH) and other hemostatic procedures.

Methods

An extensive search was conducted using the PubMed and Cochrane databases from January 2008 to October 2014. Operating time, blood loss, pain, complications, and hospital stay were evaluated.

Results

When compared with conventional techniques or LigaSure Precise Vessel Sealing System (Medtronic, Minneapolis, MN), the use of the Focus Harmonic scalpel reduced operative time by 22,428 minutes and blood loss by 13,914 mL. Length of hospital stay was significantly shorter in the Focus Harmonic scalpel group with a mean reduction of 0.410 days.

Conclusion

According to our meta-analysis, when comparing the Focus Harmonic scalpel versus conventional techniques, it seems evident that the use of this device in thyroid surgery is associated with a mean reduction in operating time, blood loss, and hospital stay, without any increase in pain and complications. There was no appreciable difference between the Focus Harmonic scalpel and the LigaSure Precise Vessel Sealing System. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Metastases to nasal cavity and paranasal sinuses

‎Τρίτη, ‎24 ‎Μαΐου ‎2016, ‏‎5:35:44 μμ | Fernando López, Kenneth O. Devaney, Ehab Y. Hanna, Alessandra Rinaldo, Alfio Ferlito

Abstract

The sinonasal cavities are rare locations for metastases. Metastases to these locations are usually solitary and produce similar symptoms to those of a primary sinonasal tumor. Nasal obstruction and epistaxis are the most frequent symptoms. The maxillary sinus is most frequently involved. The most common primary tumor sites to spread to this region originate in the kidney, breast, thyroid, and prostate, although any malignancy could potentially lead to a metastasis to the paranasal sinuses. The patient’s prognosis is usually poor because of the fact that the sinonasal metastasis is usually associated with widespread disseminated disease. In the majority of patients, palliative therapy is the only possible treatment option. Nevertheless, whenever possible, surgical excision either alone or combined with radiotherapy may be useful for palliation of symptoms and, rarely, to achieve prolonged survival. This review considers the most interesting cases reported in the literature that presents metastases to the sinonasal cavities. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Oligometastases in AJCC stage IVc nasopharyngeal carcinoma: A subset with better overall survival

‎Τρίτη, ‎24 ‎Μαΐου ‎2016, ‏‎5:30:45 μμ | Yun-hong Tian, Wen-hui Zou, Wei-wei Xiao, Lei Zeng, Xia Yuan, Li Bai, Taixiang Lu, Yunming Tian, Fei Han

Abstract

Background

The purpose of this study was to analyze the patterns of metastasis and therapeutic approaches in American Joint Committee on Cancer (AJCC) stage IVc nasopharyngeal carcinoma (NPC).

Methods

A retrospective analysis of 263 patients with stage IVc NPC revealed the incidence of bone, liver, and lung metastases was 67.7%, 32.3%, and 16.0%, respectively. All patients received chemotherapy; 160 patients received radiotherapy (RT) to the primary tumor.

Results

The factors associated with poor overall survival (OS) were Karnofsky Performance Scale (KPS) ≤70, liver metastasis, multiple-organ metastasis, ≥6 lesions, no RT to the primary tumor, and <4 chemotherapy cycles. Two subgroups of M1 disease were divided into: M1a (oligometastases) = single-organ metastases or 1 to 5 lesions; and M1b = multiple-organ metastases or ≥6 lesions. The 5-year OS rates for M1a and M1b were 38.7% versus 7.0%, respectively.

Conclusion

Patients with oligometastases have significantly better OS than patients with widespread metastases. Long-term disease-free survival can be achieved in selected patients with oligometastases after systemic chemotherapy and definitive RT. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Impact of parathyroidectomy for primary hyperparathyroidism on quality of life: A case-control study using Short Form Health Survey 36

‎Παρασκευή, ‎20 ‎Μαΐου ‎2016, ‏‎1:45:26 μμ | Roderick Dulfer, Wanda Geilvoet, Annelien Morks, Esther M.M. van Lieshout, Casper P.C Smit, Els J.M. Nieveen van Dijkum, Klaas in’t Hof, Frits van Dam, Casper H.J. van Eijck, Peter W. de Graaf, Tessa M. van Ginhoven

Abstract

Background

Physical and mental complaints are common in patients with primary hyperparathyroidism (PHPT) and negatively impact quality of life (QOL). Subjective symptoms in current guidelines are not considered an indication for surgery. The purpose of this study was to assess the effect of parathyroidectomy on QOL in patients with PHPT.

Methods

This multicenter case-control study investigated preoperative and postoperative QOL scores in patients operated for PHPT, measured with the Short Form Health Survey-36 (SF-36) questionnaire. Results were compared with patients undergoing a hemithyroidectomy, the control group.

Results

Fifty-two patients and 49 controls were included. Patients with PHPT had significantly lower QOL scores preoperatively and improved significantly after successful surgical treatment. Postoperatively, no differences were observed between the 2 groups.

Conclusion

QOL was significantly lower in patients with untreated PHPT. Surgical treatment was associated with a significant increase in QOL. Decreased QOL should also be considered as an indicator for surgical treatment in patients with PHPT. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Letter to the Editor regarding squamoid pattern of anaplastic thyroid carcinoma, a poorly recognized entity

‎Παρασκευή, ‎20 ‎Μαΐου ‎2016, ‏‎7:01:19 πμ | Maria E. Cabanillas, Michelle D. Williams

Reply to Letter to the Editor regarding anaplastic thyroid carcinoma

‎Παρασκευή, ‎20 ‎Μαΐου ‎2016, ‏‎7:01:12 πμ | Neil A.J. Ryan, Darko Lazic

Shoulder morbidity after pectoralis major flap reconstruction

‎Παρασκευή, ‎13 ‎Μαΐου ‎2016, ‏‎10:50:47 πμ | Joel W. J. Refos, Birgit I. Witte, Cees J. T. de Goede, Remco de Bree

Abstract

Background

Donor site morbidity of pectoralis major pedicled flap (PMPF) is scarcely studied.

Methods

A cross-sectional study on patients who underwent reconstructive surgery with a PMPF at least 6 months before was performed. Patients with a similar type neck dissection on both sides and PMPF on one side (n = 9) were assigned to group 1; patients with neck dissection and PMPF (n = 26) were assigned to group 2; and neck dissection only (n = 47) were assigned to group 3. All 3 groups filled out a shoulder disability questionnaire and underwent shoulder function tests. Pain of the shoulder was rated on a visual analog scale (VAS). Patients were also asked if they had experienced stiffness of the shoulder during the previous week. Range of motion (ROM) of the shoulder was examined by one single examiner using an inclinometer, in accord with a standardized protocol. Radical neck dissection (RND), modified radical neck dissection (MRND), and selective neck dissection (SND) sides were separately analyzed.

Results

In group 2, shoulder morbidity was experienced more often (p = .065) than in group 3, particularly at the sides where an SND was performed (p = .010). Significant differences in prevalence of shoulder stiffness between PMPF and neck dissection sides and neck dissection only sides were found in the RND (p = .001) and MRND (p = .004) groups, but not in the SND group. A lower ROM of abduction (p = .026) was found in group 2 as compared to group 3.

Conclusion

Patients frequently have additional shoulder morbidity after PMPF harvest, particularly after SND. PMPF harvest adds to impairment of abduction. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Issue Information – Contents

‎Τετάρτη, ‎11 ‎Μαΐου ‎2016, ‏‎1:12:25 μμ

Head & Neck Special online-only issue, April 2016 Volume 38/Number S1

‎Τετάρτη, ‎11 ‎Μαΐου ‎2016, ‏‎1:12:21 μμ

Predictors of survival in parotid adenocarcinoma not otherwise specified: a National Cancer Database study of 3155 patients

‎Τετάρτη, ‎11 ‎Μαΐου ‎2016, ‏‎7:55:31 πμ | Kevin Y. Zhan, Andrew T. Huang, Sobia F. Khaja, Diana Bell, Terry A. Day

Abstract

Background

Parotid adenocarcinoma not otherwise specified (PANOS) is a common parotid cancer, but studies specifically on this subject are limited.

Methods

We conducted a retrospective review of the National Cancer Database.

Results

Ten percent of all parotid cancers were PANOS (n = 3155). Median age was 67 years. Most patients were men (62.8%) with high-grade histology (67.2%). Regional metastasis was common (35.9%), whereas occult nodal metastasis (20.2% overall) was less frequent in non-high-grade lesions (8.5% vs 31.6%; p < .001). Distant metastasis was rare (7.9%). Five-year overall survival (OS) was 47%. In multivariate analysis, age, regional metastasis, distant metastasis, high-grade, and T classification were predictors of lower survival. Patients with stage III to IV disease receiving surgery and radiotherapy had a better OS than those receiving surgery alone (51% vs 41%; p < .001).

Conclusion

PANOS is an aggressive disease with frequent regional metastasis and low survival. Numerous variables are associated with worse survival. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Resection and microvascular reconstruction of bisphosphonate-related osteonecrosis of the jaw: The role of microvascular reconstruction

‎Δευτέρα, ‎9 ‎Μαΐου ‎2016, ‏‎6:45:33 μμ | Tiago Neto, Ricardo Horta, Rui Balhau, Lígia Coelho, Pedro Silva, Inês Correia-Sá, Álvaro Silva

Abstract

Background

Current treatment guidelines caution against osseous reconstruction using free flap tissue to treat bisphosphonate-related osteonecrosis of the jaw (BRONJ). The primary rationale for this stance is the theoretical risk of nonunion and recurrence of disease within the reconstruction. Emerging evidence suggests that these theoretical risks may be overestimated. We performed a literature review of this procedure for the treatment of advanced BRONJ. We also present a new case report of resection and microvascular reconstruction in a 58-year-old man with stage III BRONJ.

Methods

A MEDLINE search was performed to gather all reports of maxillary and mandibular reconstruction using free tissue flap transfer for BRONJ. Inclusion criteria were confirmed stage II or III BRONJ, free tissue transfer and reconstruction, and reported complications. Articles were excluded if they contained only local flap reconstruction, wound closure without reconstruction, or osteoradionecrosis. Outcomes from our case report were added to the analysis.

Results

We identified 10 articles that met criteria. Adding our case, we identified 40 cases of free flap reconstruction. The rate of nonunion was 5% (2 of 40). Fistulas formed in 4 cases (10%). BRONJ recurred in 2 cases (5%).

Conclusion

Complication rates after free flap microvascular reconstruction in BRONJ seem acceptable. Nonunion is relatively rare and should not be the sole reason to recommend against free flap reconstruction. A randomized clinical trial would help clarify the role of this procedure in refractory BRONJ; however, we believe that segmental resection and microvascular reconstruction is a viable option in select cases of BRONJ. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Implementation of a comprehensive competency-based transoral robotic surgery training curriculum with ex vivo dissection models

‎Παρασκευή, ‎6 ‎Μαΐου ‎2016, ‏‎4:15:40 μμ | Ryan H. Sobel, Ray Blanco, Patrick K. Ha, Joseph A. Califano, Rajesh Kumar, Jeremy D. Richmon

ABSTRACT

Background

Despite its increasingly widespread adoption of transoral robotic surgery (TORS), there is still no uniform training curriculum. The purpose of this study was to describe the results of our novel TORS curriculum training program in which we introduce ex vivo dissection models for radical tonsillectomy and base of tongue (BOT) resections.

Methods

Prospective blinded data collection and objective assessment of a novel training curriculum. Trainee performance was evaluated on objective structured assessments of technical skills (OSATS) metrics, measured resection time, and margin analysis. Additionally, 4 expert TORS surgeons completed the ex vivo dissections.

Results

Trainees achieved OSATS scores similar to those of experts in both the BOT resection and radical tonsillectomy models. Peripheral and deep surgical margin measurements in the BOT model were significantly improved after training and were comparable to experts.

Conclusion

This graduated curriculum provides a realistic training experience to develop competency with oropharyngeal resections before transition to the operating room. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Reevaluation of postoperative radiation dose in the management of human papillomavirus–positive oropharyngeal cancer

‎Παρασκευή, ‎6 ‎Μαΐου ‎2016, ‏‎4:15:27 μμ | Re-I Chin, Christopher R. Spencer, Todd DeWees, Michael Y. Hwang, Pranav Patel, Parul Sinha, Hiram A. Gay, Bruce H. Haughey, Brian Nussenbaum, Douglas R. Adkins, James S. Lewis, Wade L. Thorstad

Abstract

Background

The purpose of this study was to compare outcomes of patients with p16-positive oropharyngeal squamous cell carcinoma (SCC) treated with postoperative intensity-modulated radiotherapy (IMRT) before and after an institutional dose reduction policy effective on February 2009.

Methods

Between 1998 and 2013, 175 consecutive patients with p16-positive oropharyngeal SCC with extracapsular extension (ECE) and/or close or positive margins were treated postoperatively to 66 Gy (n = 109) or 60 Gy (n = 66) in 2 Gy/fx.

Results

Between the 66 and 60 Gy groups, there was no difference in tumor classification (pT4 vs pT1–T3; p = .181) and nodal classification (pN2c–N3 vs pN0–N2b; p = .704), and American Joint Committee on Cancer (AJCC) group stage (IV vs I–III; p = .473). Median follow-up was 5.9 years overall (66 Gy: 7.4 years; 60 Gy: 4.0 years). There was no difference in locoregional recurrence-free survival (2-year: 98.1% vs 98.5%; p = .421).

Conclusion

This study suggests that treating p16-positive oropharyngeal SCC with ECE and/or close or positive margins with postoperative IMRT to 60 Gy may not compromise locoregional recurrence-free survival compared to 66 Gy. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Survival outcomes after endoscopic resection for sinonasal squamous cell carcinoma arising on inverted papilloma

‎Παρασκευή, ‎6 ‎Μαΐου ‎2016, ‏‎4:15:24 μμ | Apostolos Karligkiotis, Davide Lepera, Luca Volpi, Mario Turri–Zanoni, Paolo Battaglia, Davide Lombardi, Remo Accorona, Maurizio Bignami, Piero Nicolai, Paolo Castelnuovo

ABSTRACT

Background

Sinonasal inverted papillomas (IPs) can be associated synchronously or metachronously to invasive squamous cell carcinoma (SCC) in 5% to 10% of cases. The purposes of the present study were to analyze the outcomes of patients with sinonasal SCC arising from inverted papilloma (IP-SCC) treated through an endoscopic approach and review the pertinent literature.

Methods

The medical records of all patients treated for IP-SCC between 1997 and 2014 at 2 referral centers following a uniform policy were retrospectively analyzed.

Results

Thirty-four patients fulfilled the inclusion criteria. The 5-year overall survival (OS), disease-specific survival (DFS), and recurrence-free survival (RFS) rates were 66.8 ± 0.99%, 71.2 ± 0.96%, and 73.1 ± 0.82%, respectively. Multivariate analysis revealed that the advanced pT classification (pT3 or greater), the high-grade of tumoral differentiation, the cranioendoscopic approach, and the recurrence of disease impacted negatively on survival rates.

Conclusion

The endoscopic approach provides encouraging oncologic outcomes for sinonasal IP-SCC, comparable to those observed with traditional external approaches while minimizing morbidity for patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Endoscopy versus imaging: Analysis of surveillance methods in sinonasal malignancy

‎Τρίτη, ‎3 ‎Μαΐου ‎2016, ‏‎4:16:27 μμ | Sammy Khalili, Douglas M. Worrall, Steve Brooks, Shane M. Morris, Douglas Farquhar, Jason G. Newman, Kim O. Learned, Peter H. Ahn, John Craig, David W. Kennedy, Bert W. O’Malley, James N. Palmer, Nithin D. Adappa

Abstract

Background

The purpose of this study was to assess the utility of imaging and endoscopy in posttreatment surveillance of sinonasal malignancies.

Methods

We conducted a retrospective analysis of primary sinonasal malignancies diagnosed between 2000 and 2014. Posttreatment surveillance included nasal endoscopy and imaging (MRI, CT, and positron emission tomography [PET]/CT). Positive predictive value (PPV), negative predictive value (NPV), specificity, and sensitivity were calculated for each modality and compared.

Results

One hundred nine sinonasal malignancies were identified with 30 recurrences. Endoscopy showed a sensitivity and specificity of 24% and 89%, respectively, whereas imaging was 76% and 90%, respectively. Identifying suspicious symptoms significantly improved the PPV of both endoscopy and imaging. MRI demonstrates the highest PPV when compared with other imaging modalities.

Conclusion

Both modalities are necessary in posttreatment surveillance. MRI shows the highest PPV, whereas endoscopy trends toward a higher specificity. PET/CT scans have a high false-positive rate and should be reserved for tumors with a high propensity for distant metastases. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Nasoseptal flap for reconstruction after robotic radical tonsillectomy

‎Τρίτη, ‎3 ‎Μαΐου ‎2016, ‏‎4:16:06 μμ | Carlos D. Pinheiro–Neto, Lisa T. Galati

Abstract

Background

The nasoseptal flap has revolutionized reconstruction of ventral skull base defects. The past decade is also noticeable by the evolution of transoral robotic surgery (TORS). Reconstruction of the oropharyngeal defect is challenging. Good reconstructive options with less cicatricial retraction are desirable and still lacking in the literature.

Methods

Cadaver dissection and illustrative case are used to show the feasibility of harvesting a nasoseptal flap to reconstruct oropharyngeal defect after radical tonsillectomy. Surgical resection included part of the soft palate and tongue base.

Results

The flap was sufficient to cover two-thirds of the tonsillar defect during the cadaver dissection. In our illustrative case, the flap filled the palatal defect and also was sufficient to cover the superior half of the tonsillar defect.

Conclusion

The nasoseptal flap has shown to be feasible and reliable for reconstruction of the oropharyngeal defect after TORS. When soft palate resection is warranted, this flap provides excellent coverage. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Prognostic significance of metabolic tumor volume in patients with piriform sinus carcinoma treated by radiotherapy with or without concurrent chemotherapy

‎Τρίτη, ‎3 ‎Μαΐου ‎2016, ‏‎4:15:46 μμ | Kenichiro Yabuki, Daisuke Sano, Osamu Shiono, Yasuhiro Arai, Hideaki Takahashi, Yoshihiro Chiba, Teruhiko Tanabe, Goshi Nishimura, Masahiro Takahashi, Takahide Taguchi, Tomohiro Kaneta, Masaharu Hata, Nobuhiko Oridate

Abstract

Background

The purpose of this study was to elucidate the prognostic significance of the pretreatment metabolic tumor volume (MTV) in patients with piriform sinus carcinoma treated by radiation-based therapy.

Methods

This retrospective study included 100 patients with piriform sinus carcinomas who had received treatment by radiation-based therapy. The MTV values were obtained from pretreatment positron emission tomography (PET). The association between clinical factors, including the MTV, and survival was analyzed.

Results

Kaplan–Meier estimates revealed the 5-year disease-free survival (DFS) rates were significantly poorer for patients with a high MTV compared to those with a low MTV. In the multivariate analysis, MTV (p < .001), nodal metastasis (p = .011), and applied chemotherapy regimen (p = .004) were found to be independent prognostic factors for DFS.

Conclusion

The locoregional MTV is a prognostic factor for DFS in patients with piriform sinus carcinoma treated by radiation-based therapy. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

ACR Appropriateness criteria® for nasopharyngeal carcinoma

‎Σάββατο, ‎30 ‎Απριλίου ‎2016, ‏‎5:07:54 μμ | Nabil F. Saba, Joseph K. Salama, Jonathan J. Beitler, Paul M. Busse, Jay S. Cooper, Christopher U. Jones, Shlomo Koyfman, Harry Quon, John A. Ridge, Farzan Siddiqui, Francis Worden, Min Yao, Sue S. Yom,

Abstract

Background

Nasopharyngeal carcinoma (NPC) presents mostly with locally advanced disease and is treated with multimodal therapy; however, consensus is lacking for different clinical scenarios.

Methods

The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Results

The ACR Expert Panel on Radiation Oncology – Head and Neck Cancer developed consensus recommendations for guiding management of nasopharyngeal carcinoma.

Conclusion

Multidisciplinary evaluation is essential to guiding the optimal use of surgery, radiation, and systemic therapy in this disease. © 2015 Wiley Periodicals, Inc. Head Neck 38: 979–986, 2016

One-stage reconstruction of tracheal defects with the medial femoral condyle corticoperiosteal-cutaneous free flap

‎Σάββατο, ‎30 ‎Απριλίου ‎2016, ‏‎5:07:15 μμ | Milomir Ninkovic, Heinz Buerger, Ehrl Denis, Ulf Dornseifer

Abstract

Background

The demanding anatomic and mechanical requirements make the reconstruction of long tracheal defects challenging. Multiple attempts at replacing tracheal segments are described, including the use of autologous, allogeneic, and synthetic tissues. However, the multilayer structure of the trachea and its function as a conduit for air had generally resulted in the use of nonvascularized tissue and/or multistage procedures.

Methods

The authors report on a 1-stage autologous reconstruction using local skin flaps for inner lining and a free medial femoral condyle corticoperiosteal-cutaneous (FCCPC) flap for the remaining layers. The skin island directly located over the FCCPC flap serves as an external coverage of the tracheal reconstruction.

Results

Within the follow-up, the reconstructed trachea has retained its shape, diameter, and airway function. No notable stenosis or instability was observed.

Conclusion

This concept combines ideal biological and mechanical tissue properties, offering the potential to meet the reconstructive requirements for extended tracheal defects. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Pretreatment computed tomographic gross tumor volume as predictor of persistence of tracheostomy and percutaneous endoscopic gastrostomy tube in patients undergoing larynx preservation

‎Σάββατο, ‎30 ‎Απριλίου ‎2016, ‏‎5:03:48 μμ | Newton J. Hurst, Lucio M. Pereira, Michael M. Dominello, Gregory Dyson, Pamela Laszewski, Natasha Robinette, Ho-Sheng Lin, George Yoo, Ammar Sukari, Harold Kim

ABSTRACT

Background

Although larynx preservation affords patients improvements in laryngectomy-free survival, little has been reported regarding the functional outcomes after larynx preservation. The purpose of this study was to report the predictive value of pretreatment CT-gross tumor volume (GTV) for persistence of tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube in larynx preservation patients.

Methods

Each patient had a CT scan before initiation of therapy and the GTV was contoured.

Results

Using recursive partitioning analysis (RPA), threshold GTVs of 27.16 cc and 12 cc were identified for association of time with tracheostomy and PEG tube, respectively. Median (95% confidence interval [CI]) times above and below these thresholds were 1.84 (1.06–not reached [NR]) and 0.75 (0.63–1.26) years, respectively (p = .03) for time with tracheostomy and 1.75 (1.34–NR) and 0.84 (0.46–NR) years, respectively (p = 0.10) for time with PEG tube.

Conclusion

This study demonstrates that pretreatment CT-GTV is predictive of an approximately 2.5-fold and approximately 2-fold, respectively, increase in time with tracheostomy and PEG tube. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Management of orbital invasion in sinonasal malignancies

‎Σάββατο, ‎30 ‎Απριλίου ‎2016, ‏‎5:03:44 μμ | Quentin Lisan, Frédéric Kolb, Stéphane Temam, Yungan Tao, François Janot, Antoine Moya-Plana

Abstract

Background

Indications for preservation of orbital contents in case of malignant sinonasal tumors invading the orbit remain controversial.

Methods

A retrospective consecutive review was conducted of patients in a tertiary care center over a 15-year period.

Results

Ninety-three patients were diagnosed with a malignant tumor invading the orbit. Eighty-three were treated with curative intent of which 58 underwent surgery. Mean follow-up was 45 months. Orbital preservation was feasible in 66% of cases, whereas orbital clearance was performed in cases of locally advanced disease (invasion of extraocular muscles, ocular globe, or orbital apex). Local control rate was 70% for patients treated with orbital clearance and 74% for those with orbital preservation, with no statistical difference. Five-year survival and 5-year relapse-free survival were similar in both groups.

Conclusion

Using our strategy, the eye can be spared in more patients than what is currently proposed, without oncologic or survival disadvantages. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

HERG1 potassium channel expression in potentially malignant disorders of the oral mucosa and prognostic relevance in oral squamous cell carcinoma

‎Σάββατο, ‎30 ‎Απριλίου ‎2016, ‏‎5:03:43 μμ | Álvaro Fernández–Valle, Juan Pablo Rodrigo, Tania Rodríguez–Santamarta, M. Ángeles Villaronga, Saúl Álvarez–Teijeiro, Juana M. García–Pedrero, Laura Suárez–Fernández, Paloma Lequerica–Fernández, Juan Carlos de Vicente

ABSTRACT

Background

HERG1 potassium channel plays a critical role in the cell proliferation.

Methods

HERG1 protein expression was analyzed by immunohistochemistry (IHC) in 62 patients with oral leukoplakias and 100 patients with oral squamous cell carcinomas (OSCC). HERG1 mRNA levels were assessed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in 22 patients with primary head and neck squamous cell carcinoma (HNSCC).

Results

Statistically significant associations were found between HERG1 expression and tobacco consumption, disease stage, tumor differentiation, tumor recurrence, and reduced survival. There was no association between HERG1 expression and the risk of progression from oral leukoplakia to OSCC. In addition, a high proportion of tumors (80%) showed increased HERG1 mRNA levels compared to normal mucosa from nononcologic patients.

Conclusion

Aberrant HERG1 expression increases as oral tumorigenesis progresses from oral hyperplasia to OSCC. Increased HERG1 mRNA levels were also frequently detected in OSCC and other HNSCC subsites. HERG1 expression emerges as a clinically relevant feature during tumor progression and a potential poor prognostic biomarker for OSCC. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Right-sided aortic arch and aberrant left subclavian artery with or without a left nonrecurrent inferior laryngeal nerve

‎Σάββατο, ‎30 ‎Απριλίου ‎2016, ‏‎5:03:40 μμ | Hiroo Masuoka, Akira Miyauchi, Takuya Higashiyama, Tomonori Yabuta, Minoru Kihara, Akihiro Miya

ABSTRACT

Background

In thyroid surgery, preserving the recurrent laryngeal nerve (RLN) is crucial for preventing postoperative phonatory dysfunction. Right nonrecurrent laryngeal nerves (NRLNs) are not particularly rare, and they are vulnerable to injury during surgery. This anomaly is associated with a right aberrant subclavian artery. Thus, a right-sided aortic arch with an aberrant left subclavian artery (LSA) suggests a possible left NRLN.

Methods

We report the cases of 4 patients with right-sided aortic arch and aberrant LSA. Preoperative imaging studies revealed those anomalies, but no signs of situs inversus. During the surgeries, only 1 of the 4 cases had a left NRLN. We retrospectively evaluated the patients’ imaging studies.

Results

An aortic diverticulum was found at the point at which the aberrant LSA originated in the 3 patients with left-RLNs, but not in the patient with the left-NRLN.

Conclusion

In right-sided aortic arch + aberrant LSA cases, the absence of an aortic diverticulum suggests a left NRLN. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck, 2016

Functional outcomes of sensate versus insensate free flap reconstruction in oral and oropharyngeal reconstruction: A systematic review

‎Σάββατο, ‎30 ‎Απριλίου ‎2016, ‏‎5:03:33 μμ | Arya W. Namin, Mark A. Varvares

ABSTRACT

The purposes of this article were to review the literature regarding subjective outcomes, objective functional outcomes, and objective sensation return after sensate and/or insensate free flap reconstruction of the oral cavity and oropharynx. Sensate radial forearm and anterolateral thigh free flaps tend to have better static 2-point discrimination and pressure threshold sensitivity than insensate flaps. There is insufficient evidence to draw conclusions on whether sensate flaps improve functional speech and swallowing outcomes measured by videofluoroscopic swallowing studies and percentage of word intelligibility by a listener blinded to the study. These data highlight the complexity and number of variables affecting functional outcomes in patients who have undergone reconstructive surgery after oral and oropharyngeal cancer ablative operations. A prospective randomized multicenter study that properly and rigidly stratifies patients by defect, flap and recipient nerve choice, adjuvant therapies, and uses widely agreed upon pretreatment and posttreatment evaluation tools could help to answer this important question. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Complications after surgery for benign parotid gland neoplasms: A prospective cohort study

‎Σάββατο, ‎30 ‎Απριλίου ‎2016, ‏‎5:03:29 μμ | Johanna Ruohoalho, Antti A. Mäkitie, Katri Aro, Timo Atula, Aaro Haapaniemi, Harri Keski–Säntti, Annika Takala, Leif J. Bäck

Abstract

Background

Prospective studies on procedure-specific incidences of complications after benign parotid surgery are lacking. Predictive factors for postoperative facial dysfunction remain controversial.

Methods

We conducted a prospective study on 132 patients undergoing parotid surgery for benign parotid neoplasms. We analyzed complication rates and assessed risk factors of postoperative transient facial palsy.

Results

Facial palsy rate was 40.2% on the first postoperative day, 28.3% at 2 weeks, 3.9% at 6 months, and 1.6% at 12 months. Immediate postoperative palsy rates in subgroups of partial superficial parotidectomy, superficial parotidectomy, extended parotidectomy, and ECD were 41.5%, 43.8%, 53.8%, and 6.3%, respectively. Age, duration of surgery, and use of ultrasound knife were identified as risk factors for transient facial palsy.

Conclusion

Depending on the operation type, up to half of the patients experience facial palsy after benign parotid surgery. Higher age and longer duration of operation increase the risk. The role of operative instrumentation requires further studies. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Pedicled adipofascial infraclavicular flap: Elevation technique and its use for maintaining neck contour and vessel coverage after radical and modified radical neck dissection

‎Παρασκευή, ‎29 ‎Απριλίου ‎2016, ‏‎10:17:35 πμ | John Yoo, Tsu-Hui (Hubert) Low, Samantha Tam, Allison Partridge, S. Danielle MacNeil, Anthony C. Nichols, Kevin Fung

ABSTRACT

Background

The pedicled adipofascial infraclavicular flap (ICF) is based on the anterior perforator of the supraclavicular artery and supplies the fasciocutaneous tissue of the upper chest. This flap may be used to address neck contour defects and vessel coverage after radical and modified radical neck dissections (MRNDs).

Methods

We described the pedicled adipofascial ICF elevation technique and its use immediately after neck dissections in order to maintain soft tissue volume and vessel coverage. A video of the operation is provided.

Results

Our results demonstrated satisfactory neck contours with adequate volume replacement, great vessel coverage, and little donor-site morbidity.

Conclusion

The pedicled adipofascial ICF is a technically straightforward operation with broad possible applications in head and neck surgery. It may be useful to provide vascularized soft-tissue coverage and maintain neck contour after neck dissections. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Modified technique of functional vertical hemilaryngectomy for cancer invading 1 hemicricoid

‎Παρασκευή, ‎22 ‎Απριλίου ‎2016, ‏‎9:05:49 πμ | Anne-Claude Guinchard, Philippe Monnier, Yves Jaquet, Yan Monnier, Christos Ikonomidis

Abstract

Background

Partial laryngectomy techniques are challenging, especially in young patients where function has to be preserved without compromising the oncologic outcome. We present a modified laryngectomy technique indicated for tumors invading one hemicricoid.

Methods

Vertical hemilaryngectomy with reconstruction of neo-glottis by hemi trachea and placement of an endolaryngeal silicon prosthesis for a 21-y old female patient presenting with a synovial sarcoma located on the left arytenoid area.

Results

The prosthesis was removed at 6 w with tracheotomy closure at 8w post-op. Patient underwent adjuvant radiotherapy. Functional outcome showed good swallowing without aspiration. Voice was hoarse. At 5 years post-op the patient is free of recurrence presenting only mild dyspnea upon effort.

Conclusion

Vertical hemilaryngectomy including a hemicricoid is feasible with single stage reconstruction by a hemi-trachea of 4 to 5 rings intussuscepted into the thyroid cartilage. The functional outcome is good considering oncologic safety and avoidance of a permanent tracheostomy. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Multimodal nonlinear microscopy of head and neck carcinoma — toward surgery assisting frozen section analysis

‎Πέμπτη, ‎21 ‎Απριλίου ‎2016, ‏‎1:52:31 μμ | Sandro Heuke, Olga Chernavskaia, Thomas Bocklitz, Fisseha Bekele Legesse, Tobias Meyer, Denis Akimov, Olaf Dirsch, Günther Ernst, Ferdinand von Eggeling, Iver Petersen, Orlando Guntinas–Lichius, Michael Schmitt, Jürgen Popp

Abstract

Background

Treatment of early cancer stages is deeply connected to a good prognosis, a moderate reduction of the quality of life, and comparably low treatment costs.

Methods

Head and neck squamous cell carcinomas were investigated using the multimodal combination of coherent anti-Stokes Raman scattering (CARS), two-photon excited fluorescence (TPEF), and second-harmonic generation (SHG) microscopy.

Results

An increased median TPEF to CARS contrast was found comparing cancerous and healthy squamous epithelium with a p value of 1.8·10−10. A following comprehensive image analysis was able to predict the diagnosis of imaged tissue sections with an overall accuracy of 90% for a 4-class model.

Conclusion

Nonlinear multimodal imaging is verified objectively as a valuable diagnostic tool that complements conventional staining protocols and can serve as filter in future clinical routine reducing the pathologist’s workload. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Risk factors for surgical site infection after supraclavicular flap reconstruction in patients undergoing major head and neck surgery

‎Πέμπτη, ‎21 ‎Απριλίου ‎2016, ‏‎1:52:06 μμ | Neerav Goyal, Kevin S. Emerick, Daniel G. Deschler, Derrick T. Lin, Bharat B. Yarlagadda, Debbie L. Rich, Marlene L. Durand

Abstract

Background

Surgical site infections can adversely affect flaps in head and neck reconstruction. The purpose of this study was to evaluate the risk factors of surgical site infections in supraclavicular artery island flap reconstructions.

Methods

Records of patients undergoing head and neck surgery from 2011 to 2014 with supraclavicular artery island flap reconstruction at a single specialty hospital were reviewed; surgical site infections ≤30 days postoperatively were noted.

Results

Of 64 patients, 86% underwent resection for malignancy, 55% previously received radiation. Sixty-three percent of surgeries were clean-contaminated. Seven patients (11%) developed recipient site surgical site infections, all in patients who underwent clean-contaminated surgery for malignancy. There was no complete flap loss. No significant differences in demographics or perioperative factors were noted. Oral cavity and laryngeal reconstructions (p = .014) and clean-contaminated surgery (p = .04) were factors associated with increased surgical site infection risk on univariate but not multivariate analysis. Patients with surgical site infections had longer hospitalizations (p = .003).

Conclusion

The supraclavicular artery island flap can be used for head and neck reconstruction with a low rate of surgical site infection. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Feasibility of a novel classification for parotid gland cytology: A retrospective review of 512 cytology reports taken from 4 United Kingdom general hospitals

‎Πέμπτη, ‎21 ‎Απριλίου ‎2016, ‏‎1:51:39 μμ | Mandeep S. Bajwa, Samantha J. Rose, Priya Mairembam, Robert Nash, David Hotchen, Daryl Godden, Peyman Alam, Louise Daborn, Anne V. Spedding, Peter A. Brennan

Abstract

Background

A novel classification for parotid cytology has been previously proposed. The purpose of this study was to assess the feasibility and clinical relevance of this classification.

Method

Between 2010 and 2013, cytology reports from 4 United Kingdom general hospitals were retrospectively classified and compared to histological and clinical outcomes.

Results

Based on the cytology reports of 512 patients, we revised our previous “P” system to a “Sal” (salivary) classification to encompass all cytologic outcomes. The percentage of patients with a final diagnosis of malignancy according to each category heading were: Sal 1 (inadequate) 7.9%; Sal 2I (nonneoplastic) 10%; Sal 2N (benign neoplastic) 1.4%; Sal 3 (atypical) 20.4%; Sal 4 (suspicious) 52.6%; Sal 5P (primary salivary gland malignancy) 71.4%; Sal 5NOS (malignancy not otherwise specified) 100%; and Sal 5M (metastasis) 91.7%.

Conclusion

By stratifying the probability of encountering a malignant neoplasm, the classification could guide clinical management decisions. A future prospective study is warranted. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Method for dealing with severe aspiration using a new concept of intralaryngeal prosthesis: A case report

‎Πέμπτη, ‎21 ‎Απριλίου ‎2016, ‏‎1:51:18 μμ | Thibaut Raguin, Jean Carvalho, Sophie Riehm, Catherine Takeda, Agnès Dupret–Bories

Abstract

Background

Deglutition disorders are frequent in patients treated for cancer of the oropharynx, and are responsible for severe aspiration and, in some cases, may require the use of enteral nutrition by gastrostomy or tracheotomy.

Methods

We present the case of a patient with a medical history of infiltrating laryngeal carcinoma treated by partial laryngectomy and radiochemotherapy, presenting severe aspiration causing significant weight loss. The patient received a new intralaryngeal prosthesis to prevent aspiration with the objective of regaining safe oral nutrition and closure of the tracheotomy.

Results

Deglutition tests after postimplantation demonstrated significantly improved airway protection and recovery deglutition, allowing the patient to return home with resumption of varied solid and a liquid diet.

Conclusion

For a patient presenting severe aspiration, the intralaryngeal prosthesis allowed a resumption of oral feeding without exclusion of the larynx or airway protection by tracheotomy. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Adjuvant radiotherapy versus concurrent chemoradiotherapy for the management of high-risk salivary gland carcinomas

‎Πέμπτη, ‎21 ‎Απριλίου ‎2016, ‏‎1:50:58 μμ | Matthew J. Mifsud, Tawee Tanvetyanon, Judith C. Mccaffrey, Kristen J. Otto, Tapan A. Padhya, Julie Kish, Andy M. Trotti, Louis B. Harrison, Jimmy J. Caudell

Abstract

Background

Given the aggressive behavior of advanced salivary malignancies, the purpose of the current study was to explore the utility of adjuvant chemoradiotherapy (CRT) in this population.

Methods

A retrospective study of salivary carcinomas treated from 1998 to 2013 with postoperative CRT (37 patients) or radiotherapy (RT; 103 patients) was completed.

Results

The decision to utilize adjuvant CRT versus RT was influenced by tumor grade and histology, cervical lymph node status, surgical margins, and perineural invasion. In both treatment cohorts, high locoregional control rates were obtained (79% for CRT vs 91% for RT; p = .031). Multivariate Cox regression analysis did not identify a difference in 3-year progression-free survival (PFS) with the use of CRT versus RT (hazard ratio [HR] = 0.783; 95% confidence interval [CI] = 0.396–1.549; p = .482).

Conclusion

Until prospective evidence is available, such as from Radiation Therapy Oncology Group 1008, the standard use of CRT for advanced salivary malignancies cannot be recommended. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Comparative analysis of micro-RNAs in human papillomavirus–positive versus –negative oropharyngeal cancers

‎Πέμπτη, ‎21 ‎Απριλίου ‎2016, ‏‎1:50:43 μμ | Haitham Mirghani, Nicolas Ugolin, Catherine Ory, Maud Goislard, Marine Lefèvre, Sylvain Baulande, Paul Hofman, Jean Lacau St Guily, Sylvie Chevillard, Roger Lacave

Abstract

Background

Oncogenic mechanisms of human papillomavirus (HPV)-positive oropharyngeal cancer are still poorly characterized. Analysis of their microRNA expression profile might provide valuable information.

Methods

The microRNA expression profiles were analyzed by micro-arrays in 26 oropharyngeal cancers. A microRNA signature specific to HPV-status was identified by analyzing a learning/training set consisting of 16 oropharyngeal cancers. The robustness of this signature was further confirmed by blind case-by-case classification of a validation set composed of 10 independent tumors. Putative targeted molecular pathways were proposed using DIANA miRPath online software (http://ift.tt/1T16MOr).

Results

We have identified 25 miRNA signatures, which discriminates HPV16-positive oropharyngeal cancer from their HPV-negative counterparts. These 25 microRNAs play a potential role in Wnt and PI3K-pathways, cell-adhesion/cell-polarity, and the cytoskeleton regulation.

Conclusion

Our study contributes to a better understanding of pathogenic mechanisms involved in the development of HPV-positive oropharyngeal cancer and in the identification of potential therapeutic molecular targets. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Intraoral technique for locking reconstruction plate fixation using an implant handpiece with adapted drills

‎Δευτέρα, ‎18 ‎Απριλίου ‎2016, ‏‎9:48:32 πμ | Orion Luiz Haas, Neimar Scolari, Lucas da Silva Meirelles, Otávio Emmel Becker, Marcelo Fernandes Santos Melo, Vinícius Nery Viegas, Rogério Belle de Oliveira

Abstract

Background

Locking reconstruction plates are used in the treatment of jaw trauma and diseases if there is a need for surgical resection and to prevent pathologic fracture after tumor excision. Fixation is typically performed using an extraoral approach.

Methods

This article describes a technique for the intraoral fixation of locking reconstruction plates that uses prototyping to model the plate before the procedure as well as an implant handpiece with adapted drills for bone drilling and the insertion of screws into relatively inaccessible areas.

Conclusion

Intraoral fixation not only prevents nerve damage and facial scarring but also minimizes the plate’s risk of extraoral exposure and reduces surgical morbidity. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Decreased mitochondrial copy numbers in oral squamous cell carcinoma

‎Παρασκευή, ‎15 ‎Απριλίου ‎2016, ‏‎9:04:12 πμ | Daisuke Takeda, Takumi Hasegawa, Takeshi Ueha, Akiko Sakakibara, Teruya Kawamoto, Tsutomu Minamikawa, Yoshitada Sakai, Takahide Komori

Abstract

Background

Mitochondrial dysfunction and altered respiration have long been suspected to affect the development and progression of cancer. Although quantitative changes in mitochondrial DNA (mtDNA) have been reported in head and neck squamous cell carcinoma (SCC), differences in mtDNA copy numbers between normal and cancerous tissues from same patients have not been assessed.

Methods

We compared mtDNA copy numbers and expressions of peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) and mitochondrial transcription factor A (TFAM) between normal mucous membrane and cancerous tissues resected from 35 patients with oral SCC, using TaqMan quantitative real-time polymerase chain reaction (PCR) and immunohistochemical staining.

Results

We found mtDNA copy numbers and expressions of PGC-1α and TFAM were decreased in cancerous tissues compared with normal tissues from the same patients.

Conclusion

The PGC-1α–TFAM mitochondrial pathway may be associated with malignant potential in human oral SCC, and could be an attractive therapeutic target. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Neurologic late effects associated with radiologic evidence of vertebral osteoradionecrosis after salvage laryngectomy: A syndrome associated with survivors of laryngeal and hypopharyngeal cancer

‎Παρασκευή, ‎15 ‎Απριλίου ‎2016, ‏‎9:03:46 πμ | Andrew J. Rosko, Matthew E. Spector, Garrett R. Griffin, Jeffrey M. Vainshtein, Jae Lee, Carol R. Bradford, Mark E. P. Prince, Jeffrey S. Moyer, Francis P. Worden, Avraham Eisbruch, Douglas B. Chepeha

Abstract

Background

Delayed nonspecific posterior neck pain after pharyngeal instrumentation can be associated with a syndrome of rapidly progressive neurologic embarrassment. We present this cohort to help define the syndrome and aid in early detection.

Methods

We conducted a retrospective case series of 6 patients presenting from 2003 to 2012 with a history of laryngeal or hypopharyngeal squamous cell carcinoma (SCC) who underwent radiotherapy (RT) or chemoradiotherapy (CRT) followed by salvage laryngectomy.

Results

Posterior neck and upper back pain developed a mean of 27.5 days after instrumentation of the pharynx (reconstruction after laryngectomy or pharyngeal dilation). Myelopathy developed an average of 21.5 days after the onset of posterior neck pain. Five patients required urgent decompression. Three patients developed quadriplegia. The disease-specific mortality was 50%.

Conclusion

There is a syndrome of late neurological effects after RT, salvage surgery, and pharyngeal instrumentation that is associated with high morbidity and mortality. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

Clinical characteristics and outcomes of oropharyngeal carcinoma related to high-risk non–human papillomavirus16 viral subtypes

‎Παρασκευή, ‎15 ‎Απριλίου ‎2016, ‏‎9:03:27 πμ | Indu Varier, Brieze R. Keeley, Rosemarie Krupar, Alexis Patsias, Joanna Dong, Nikita Gupta, Arjun K. Parasher, Eric M. Genden, Brett A. Miles, Marita Teng, Richard L. Bakst, Vishal Gupta, Krzysztof J. Misiukiewicz, Elizabeth Y. Chiao, Michael E. Scheurer, Simon Laban, David Zhang, Fei Ye, Miao Cui, Elizabeth G. Demicco, Marshall R. Posner, Andrew G. Sikora

Abstract

Background

The majority of human papillomavirus (HPV)-related oropharyngeal carcinomas (OPCs) are associated with HPV genotype 16; however, OPC can be associated with other high-risk non-HPV16 genotypes.

Methods

This was a retrospective analysis of patients with high-risk non-HPV16 OPC treated at a single tertiary institution. Sociodemographic and clinical information was obtained by chart review. HPV genotype was determined by polymerase chain reaction (PCR). Baseline data and outcomes were compared between HPV16 and high-risk non-HPV16 groups.

Results

High-risk non-HPV16 genotypes accounted for 9% of HPV-related OPC. Of the 27 total high-risk non-HPV16 OPCs, HPV35 was most prevalent (48%). High-risk non-HPV16 OPC presented at a slightly higher age (p = .021) and higher clinical T classification (p = .008) compared to HPV16 OPC, but there was no significant survival difference.

Conclusion

Clinical characteristics of high-risk non-HPV16 OPC were largely consistent with those of HPV16 OPC. Additional multi-institutional studies will be required to demonstrate conclusively that the favorable prognosis of patients with HPV16 applies to all high-risk HPV types. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Oncologic outcomes of surgically treated early-stage oropharyngeal squamous cell carcinoma

‎Παρασκευή, ‎15 ‎Απριλίου ‎2016, ‏‎9:02:57 πμ | Jason I. Kass, Laureano Giraldez, William Gooding, Garret Choby, Seungwon Kim, Brett Miles, Marita Teng, Andrew G. Sikora, Jonas T. Johnson, Eugene N. Myers, Umamaheswar Duvvuri, Eric M. Genden, Robert L. Ferris

Abstract

Background

The purpose of this study was to characterize oncologic outcomes in early (T1–T2, N0) and intermediate (T1–T2, N1) oropharyngeal squamous cell carcinoma (SCC) after surgery.

Methods

Patients with oropharyngeal SCC treated with surgery were identified from 2 academic institutions.

Results

Of 188 patients, 143 met the inclusion criteria. Eighty-six (60%) had T1 to T2 N0 and 57 (40%) had T1 to T2 N1 disease. Sixty-five patients (45%) underwent a robotic-assisted resection, whereas the remaining had transoral (n = 60; 42%), mandible-splitting (n = 11; 8%), or transhyoid approaches (n = 7; 5%). Human papillomavirus (HPV) status was known for 97 patients (68%), and 54 (55%) were HPV positive. Three-year recurrence-free survival (RFS) was 82% (95% confidence interval [CI] = 0.75–0.89). Since 2008, HPV infection was protective of recurrence (log-rank p = .0334). A single node did not increase the risk of recurrence (p = .467) or chance of a second primary (p = .175).

Conclusion

Complete surgical resection is effective therapy for early and intermediate oropharyngeal SCC. HPV-negative patients were at increased risk for locoregional recurrence or second primary disease. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Salivary duct carcinoma of the sinonasal cavity: A case report and review of the literature

‎Παρασκευή, ‎15 ‎Απριλίου ‎2016, ‏‎9:02:29 πμ | Sarina Müller, Konstantinos Mantsopoulos, Heinrich Iro, Abbas Agaimy

ABSTRACT

Minimally invasive carcinosarcoma ex pleomorphic adenoma: A case report and literature review with cytohistological correlation

‎Παρασκευή, ‎15 ‎Απριλίου ‎2016, ‏‎9:02:11 πμ | Yingting Mok, Min En Nga, Chwee Ming Lim, Fredrik Petersson

Abstract

Background

Carcinosarcoma of the salivary glands is a rare neoplasm, and the minimally invasive form constitutes a subgroup with a more favorable prognosis. The cytomorphologic features of this neoplasm can be appreciated on fine-needle aspiration biopsy.

Methods and Results

We present a patient with a minimally invasive carcinosarcoma ex non-recurrent pleomorphic adenoma (Ca ex PA) who underwent initial fine-needle aspiration biopsy followed by surgical resection. The tumor was composed predominantly of a light microscopic pleomorphic high-grade sarcoma exhibiting partial myoepithelial immunohistochemical features, with a minor component of in situ and invasive salivary duct carcinoma (10%). A limited area with features of a hyalinized pleomorphic adenoma was identified.

Conclusion

This is the third case report of the cytological features of Ca ex PA of the salivary gland, with histologic correlation. It further illustrates the oncogenic relationship between epithelial and myoepithelial elements in the early stages of carcinosarcomatous transformation. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Population-based validation of the recursive partitioning analysis–based staging system for oropharyngeal cancer

‎Παρασκευή, ‎15 ‎Απριλίου ‎2016, ‏‎9:01:50 πμ | Florence K. Keane, Yu-Hui Chen, Roy B. Tishler, Jonathan D. Schoenfeld, Robert I. Haddad, Laura A. Goguen, Paul Catalano, Bridget A. Neville, Danielle N. Margalit

Abstract

Background

The American Joint Committee on Cancer (AJCC) staging system does not adequately distinguish prognostic groups in the era of human papillomavirus (HPV)-related oropharyngeal cancer. The purpose of this study was to validate a recursive partitioning analysis (RPA)-based stage grouping on a population-wide level.

Methods

We identified 8427 patients in Surveillance, Epidemiology, and End Results (SEER) with nonmetastatic oropharyngeal cancer with unknown HPV-status diagnosed from 2004 to 2008. We estimated the overall survival (OS) and head and neck cancer-specific mortality by RPA stage and AJCC stage and compared the predictive power of the systems.

Results

RPA stage was significantly associated with OS and head and neck cancer-specific mortality (p < .0001) with 5-year OS of 70% for RPA-I, 55.6% for RPA-II, and 44.3% for RPA-III. AJCC stage failed to divide patients into distinct subgroups. RPA stage had significantly improved predictive ability versus AJCC stage for OS (c-statistic: 0.60 = RPA vs 0.54 = AJCC) and head and neck cancer-specific mortality (c-statistic: 0.62 = RPA vs 0.55 = AJCC).

Conclusion

The RPA-based stage grouping divided patients into prognostically distinct cohorts and provided superior prediction of OS and head and neck cancer-specific mortality compared to AJCC staging. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Transthyrohyoid access to the larynx for endoscopic resection of early-stage glottic cancer

‎Παρασκευή, ‎15 ‎Απριλίου ‎2016, ‏‎9:01:38 πμ | Yan Monnier, Patrick Schoettker, Benoit Morisod, Christos Ikonomidis, Christian Simon

Abstract

Background

The effectiveness of transoral microsurgery for early-stage glottic cancer relies on the possibility to obtain adequate exposure of the lesion. The purpose of this study was to design a new surgical technique allowing efficient endoscopic removal of these tumors in patients with unsatisfactory transoral exposure.

Methods

A minimal invasive access to the glottis, made through the thyrohyoid membrane and the preepiglottic space, was used for endoscopic resection of an early-stage glottic tumor in a patient with a medical history of previous radiotherapy and unsatisfactory endoscopic exposure of the lesion.

Results

This approach provided excellent exposure of the glottis and allowed endoscopic resection with adequate surgical margins. The surgical procedure and the postoperative period were uneventful. Functional outcomes were back to baseline after 1 month.

Conclusion

This technique represents an attractive solution for patients presenting with early-stage glottic tumors that cannot be exposed transorally and have contraindications to alternative therapeutic procedures. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Pools of programmed death-ligand within the oral cavity tumor microenvironment: Variable alteration by targeted therapies

‎Σάββατο, ‎9 ‎Απριλίου ‎2016, ‏‎3:17:42 μμ | Sujay Shah, Andria Caruso, Harrison Cash, Carter Van Waes, Clint T. Allen

Abstract

Background

Enhanced understanding of programmed death-ligand (PD-L) expression in oral cancer is important for establishing rational combinations of emerging immune checkpoint and molecular targeted therapies.

Methods

We assessed PD-L and interferon (IFN) expression in immunogenic murine oral cancer-1 (MOC1) and poorly immunogenic MOC2 cell models after treatment with mammalian target of rapamycin (mTOR) and MEK1/2 small molecule inhibitors in vitro and in vivo.

Results

PD-L1 but not PD-L2 is expressed on MOC1 and 2 cells and is type I and II IFN-dependent. PD-L1 is differentially expressed on cancer and endothelial cells and infiltrating myeloid-derived suppressor cells, macrophages, and regulatory T cells (Tregs) in highly and poorly immunogenic tumors. PD-L1 expression is variably altered after treatment with inhibitors in vivo, with an imperfect relationship to alterations in IFN levels in the tumor microenvironment.

Conclusion

PD-L1 expressed on cancer and infiltrating immune cells is variably altered by targeted therapies and may, in part, reflect changes in tumor IFN. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

Association of the upregulated expression of focal adhesion kinase with poor prognosis and tumor dissemination in hypopharyngeal cancer

‎Σάββατο, ‎9 ‎Απριλίου ‎2016, ‏‎3:16:59 μμ | Go Omura, Mizuo Ando, Yuki Saito, Kenya Kobayashi, Masafumi Yoshida, Yasuhiro Ebihara, Kaori Kanaya, Chisato Fujimoto, Takashi Sakamoto, Kenji Kondo, Takahiro Asakage, Tatsuya Yamasoba

Abstract

Background

Focal adhesion kinase (FAK) plays an important role in tumor metastasis. The purpose of this study was to evaluate the significance of FAK expression in surgically treated patients with hypopharyngeal cancer.

Methods

We retrospectively reviewed the clinical charts of patients treated at our institution between 2004 and 2012 and identified 87 patients with hypopharyngeal cancer. FAK expression status was retrospectively evaluated using immunohistochemistry.

Results

FAK-positive patients displayed significantly worse disease-specific survival than FAK-negative patients (p = .001). Multivariate analyses revealed that FAK positivity and extracapsular spread (ECS) were independent, significant adverse prognostic factors. Furthermore, FAK positivity significantly correlated with the number of metastatic lymph nodes (p = .048), and FAK-positive patients displayed a higher incidence of distant metastases (p = .009).

Conclusion

The current study demonstrated that upregulated FAK expression correlates with poor prognosis and tumor dissemination in surgically treated patients with hypopharyngeal cancer. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Successful intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve, a multidisciplinary approach: The Massachusetts Eye and Ear Infirmary monitoring collaborative protocol with experience in over 3000 cases

‎Σάββατο, ‎9 ‎Απριλίου ‎2016, ‏‎3:16:35 μμ | Alvaro A. Macias, Sunil Eappen, Ilya Malikin, Jeremy Goldfarb, Sharon Kujawa, Paul M. Konowitz, Dipti Kamani, Gregory W. Randolph

Abstract

Background

Although intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up-to-date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anesthetic parameters. To our knowledge, this is the first interdisciplinary collaborative protocol for monitored neck surgery based on the published evidence and clinical experience.

Methods

The Departments of Otolaryngology Head and Neck Surgery, Anesthesiology, and Audiology collaboratively developed a protocol for IONM of the recurrent laryngeal nerve (RLN) based on published evidence and our experience with 3000 patients over a 16-year period.

Results

No complications related to monitoring or endotracheal tube placement were noted when the IONM protocol was implemented at Massachusetts Eye and Ear Infirmary (MEEI). The IONM protocol has proven to be vital in standardizing care and in avoiding intraoperative errors.

Conclusion

An IONM system entails an anesthesiologist who understands the challenges posed by this technique; muscle relaxation must be minimized/eliminated to optimize IONM. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Brachytherapy after salvage surgery in cases with large isolated cervical recurrence of squamous cell carcinoma in the previously irradiated neck

‎Σάββατο, ‎9 ‎Απριλίου ‎2016, ‏‎3:16:16 μμ | Jessica Miroir, Julian Biau, Nicolas Saroul, Jean-François Moreira, Marc Russier, Michel Lapeyre

Abstract

Background

Perioperative brachytherapy after salvage surgery is a therapeutic option in patients with cervical relapse of a primary, controlled, previously irradiated head and neck squamous cell carcinoma. The purpose of this study was to analyze the outcome of this treatment.

Methods

Between 2008 and 2013, 8 patients underwent cervical brachytherapy after neck dissection. The mean node size was 5.5 cm. Recurrence occurred in an irradiated field (median dose, 50 Gy). Brachytherapy was performed with 192iridium and dosimetry in accord with the rules of the Paris system. The dose was 60 to 62.7 Gy on the reference isodose.

Results

The mean follow-up was 17 months. The median overall survival (OS) was 12 months. The OS was 19% at 2 years and 0% at 5 years. A grade 5 postoperative adverse event occurred in 1 patient. At 6 months, all patients had a grade 3 neck soft tissue fibrosis. One patient had a lethal hemorrhage at 56 months.

Conclusion

Brachytherapy is toxic in this population with poor OS. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Cricothyroidotomy – The emergency surgical airway

‎Τρίτη, ‎29 ‎Μαρτίου ‎2016, ‏‎6:55:03 μμ | Jacob Melchiors, Tobias Todsen, Lars Konge, Birgitte Charabi, Christian von Buchwald

Inflammatory myofibroblastic tumor of carotid artery resulting in recurrent syncope: A case report

‎Τρίτη, ‎29 ‎Μαρτίου ‎2016, ‏‎6:52:47 μμ | Liu Yang, Wen Li, Hongying Zhang

Abstract

Background

Inflammatory myofibroblastic tumor rarely occurs in the carotid artery, whereas syncope is infrequently associated with neck mass.

Methods and Results

We reby present a case in which a 56-year-old man with inflammatory myofibroblastic tumor at the left carotid bifurcation and is accompanied by recurrent syncope and falls. He underwent surgery, after which corticosteroids and antibiotics were administered for a short term. No recurrence was observed during the 2-year follow-up.

Conclusion

To our knowledge, this is the first case of inflammatory myofibroblastic tumor in which recurrent syncope is the only clinical manifestation. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2461–E2463, 2016

Esthesioneuroblastoma with bilateral metastases to the parotid glands

‎Τρίτη, ‎29 ‎Μαρτίου ‎2016, ‏‎6:52:26 μμ | Adnan S. Hussaini, John J. Dombrowski, E. Stephen Bolesta, Ronald J. Walker, Mark A. Varvares

Abstract

Background

Esthesioneuroblastoma (ENB) is a rare, poorly characterized, intranasal cancer arising from olfactory neuroepithelium.

Methods

This case report reviews the underlying pathophysiology, clinical presentation, and diagnosis of primary ENB and parotid metastases.

Results

We present the case of a 43-year-old man who was referred to our practice with radiographically and biopsy confirmed ENB. After neoadjuvant chemotherapy, radiation, and open surgical resection, he returned to the clinic 30 months postoperatively with a right parotid mass, which was found to be a recurrence of his primary cancer. A parotidectomy was performed; however, he returned 10 months later with a new left parotid mass. Subsequent imaging and biopsy confirmed recurrence of ENB and a second parotidectomy was performed.

Conclusion

This case illustrates that delayed metastases in the setting of ENB are not limited to the cervical lymph nodes and, in rare instances, may involve the parotid glands. Surveillance should include the parotid lymph node basin with a high clinical index of suspicion in the setting of parotid lymphadenopathy after primary surgical therapy. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2457–E2460, 2016

Free sural artery perforator flap: An occasional gift in oral cavity reconstruction

‎Τρίτη, ‎29 ‎Μαρτίου ‎2016, ‏‎6:52:03 μμ | Natalie L. Pease, Andrew Davies, William A. Townley

Abstract

Background

The medial sural artery perforator (MSAP) flap is becoming a popular strategy for reconstructing intraoral defects. We present a case in which no MSAPs were present, however, a perforator-based calf flap was successfully raised on the sural artery and used for tongue reconstruction. A corresponding anatomic study was undertaken to establish if this finding was reproducible.

Methods

A 58-year-old woman underwent left hemiglossectomy for a squamous cell carcinoma of the tongue. Subsequently, 6 fresh frozen cadaveric limbs were dissected examining the blood supply of the posterior calf skin.

Results

The sural artery perforator (SAP) flap successfully reconstructed the defect. Our cadaveric study similarly demonstrated a septocutaneous SAP supplying the posterior calf skin in 1 of 6 limbs.

Conclusion

SAPs allow a favorable flap dissection, as opposed to the musculocutaneous course of MSAPs. Our findings provide further evidence of the versatility of the calf donor site. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2454–E2456, 2016

Effectiveness of honey on radiation-induced oral mucositis, time to mucositis, weight loss, and treatment interruptions among patients with head and neck malignancies: A meta-analysis and systematic review of literature

‎Τρίτη, ‎29 ‎Μαρτίου ‎2016, ‏‎6:51:20 μμ | Jayson L. Co, Michael Benedict A. Mejia, Jocelyn C. Que, Janine Margarita R. Dizon

Abstract

Background

Mucositis is a disabling effect of radiotherapy in head and neck cancers. There is no current standard on management of radiation-induced mucositis. Honey has been shown to reduce radiation-induced mucositis.

Methods

A systematic review and meta-analysis were undertaken to assess the ability of honey in reducing the severity of oral mucositis, time to mucositis, weight loss, and treatment interruptions.

Results

Eight studies were included and showed that honey was significantly better in lowering the risk for treatment interruptions, weight loss, and delaying time to mucositis, but not severity of mucositis.

Conclusion

There is current evidence that honey is beneficial for patients with head and neck cancers by decreasing treatment interruptions, weight loss, and delaying the onset of oral mucositis, but not in decreasing peak mucositis score. In light of the results, honey is a reasonable treatment for radiation-induced mucositis, but more randomized clinical trials (RCTs) should be done. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1119–1128, 2016

AHNS Series: Do you know your guidelines?Principles of radiation therapy for head and neck cancer: A review of the National Comprehensive Cancer Network guidelines

‎Παρασκευή, ‎25 ‎Μαρτίου ‎2016, ‏‎4:30:43 μμ | Zhen Gooi, Carole Fakhry, David Goldenberg, Jeremy Richmon, Ana P. Kiess,

ABSTRACT

This article is a continuation of the “Do You Know Your Guidelines” series, an initiative of the American Head and Neck Society’s Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network guidelines for radiotherapy in the treatment for head and neck cancers are reviewed here in a systematic fashion according to site and stage. These guidelines outline indications for primary and adjuvant treatment, as well as general principles of radiotherapy. © 2016 Wiley Periodicals, Inc. Head Neck 38: 987–992, 2016

Overview of surgery for oral cavity cancer in Ontario

‎Τρίτη, ‎22 ‎Μαρτίου ‎2016, ‏‎4:51:02 μμ | Antoine Eskander, Jonathan Irish, Patrick Gullane, Ralph Gilbert, John R. Almeida, Jeremy Freeman, Meredith Giuliani, David R. Urbach, David P. Goldstein

Abstract

Background

The pupose of this study was to describe variations in incidence and resection rates of patients with oral cavity squamous cell carcinoma (SCC) in Ontario.

Methods

All oral cavity SCCs in Ontario between 2003 and 2010 were identified from the Ontario Cancer Registry. Incidence and resection rates along with variations in care were compared by sociodemographic factors and Ontario health regions.

Results

The 8-year incidence rates for oral cavity SCC was 21.3 per 100,000 with variations by sex, age group, neighborhood income, and community size. Seventy-four percent of patients underwent an oral cavity cancer resection, of which 91% were at a regional head and neck cancer center. Variations in resection rates existed by region of residence and treatment.

Conclusion

Oral cavity cancer incidence rates vary by sex, age, neighborhood income, community size, and health region. Resection rates vary by age and health region. Oral cavity cancer care is highly regionalized in Ontario. © 2015 Wiley Periodicals, Inc. Head Neck 38: 1113–1118, 2016

Base of tongue squamous cell carcinoma with infiltrative bone marrow carcinomatosis after definitive chemoradiation: A case report

‎Τρίτη, ‎15 ‎Μαρτίου ‎2016, ‏‎3:41:15 μμ | Kaitlin Christopherson, David N. Reisman, Kristianna Fredenburg, Reordan DeJesus, William M. Mendenhall

Abstract

Background

Oropharyngeal squamous cell carcinoma (SCC) is known for its propensity for aggressive local progression and regional lymphatic spread. Distant metastases are relatively uncommon and the likelihood of hematogenous dissemination is primarily related to the extent and location of cervical lymph node metastases. Common sites of distant metastasis include the liver and lung.

Methods

We report an unusual case of base of tongue SCC with infiltrative bone marrow carcinomatosis presenting months after definitive chemoradiation despite locoregional control.

Results

Our patient exhibited an unusual pattern of distant dissemination after definitive chemoradiation had resulted in locoregional control.

Conclusion

Patients who present with bone marrow failure after definitive treatment with apparent disease control should be monitored for bone marrow infiltration by the tumor and, if such infiltration is present, should be evaluated for palliative chemotherapy. Unfortunately, the prognosis for such patients is poor. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2449–E2453, 2016

Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement

‎Παρασκευή, ‎11 ‎Μαρτίου ‎2016, ‏‎10:51:02 πμ | Catherine F. Sinclair, Jeffrey M. Bumpous, Bryan R. Haugen, Andres Chala, Daniel Meltzer, Barbra S. Miller, Neil S. Tolley, Jennifer J. Shin, Gayle Woodson, Gregory W. Randolph
This American Head and Neck Society (AHNS) consensus statement discusses the techniques of laryngeal examination for patients undergoing thyroidectomy and parathyroidectomy. It is intended to help guide all clinicians who diagnose or manage adult patients with thyroid disease for whom surgery is indicated, contemplated, or has been performed. This consensus statement concludes that flexible transnasal laryngoscopy is the optimal laryngeal examination technique, with other techniques including laryngeal ultrasound and stroboscopy being useful in selected scenarios. © 2016 Wiley Periodicals, Inc. Head Neck 38: 811–819, 2016

Tracheal exposure: Anticipatory management of the difficult airway

‎Παρασκευή, ‎11 ‎Μαρτίου ‎2016, ‏‎10:50:27 πμ | Christopher J. Britt, Marc R. Rohrbach, Timothy M. McCulloch

Abstract

Background

When a patient cannot be intubated or ventilated, cricothyrotomy is indicated. Risks associated with emergent cricothyrotomy are significant, and this procedure typically requires revision. Additional options for establishing an emergent airway are limited. Thus, elective tracheotomy to ensure a safe airway after procedures involving the upper aerodigestive tract is common. Although safe and effective overall, this procedure is not without additional risks, added resources, complex cares, and extended hospitalizations.

Methods

We present a case in which exposure of the anterior trachea was performed without tracheotomy in a patient with a high-risk airway undergoing an open partial laryngectomy.

Results

The patient did not develop respiratory distress postoperatively and was able to avoid a tracheostomy and its associated cares.

Conclusion

Pretracheotomy with tracheal exposure simplifies emergent surgical access to the airway. We believe tracheal exposure in the appropriately selected patient is a safe and cost-effective alternative to elective tracheotomy. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2446–E2448, 2016

Salvage transoral laser microsurgery for recurrent glottic carcinoma after primary laser-assisted treatment: Analysis of prognostic factors

‎Παρασκευή, ‎11 ‎Μαρτίου ‎2016, ‏‎10:50:20 πμ | Marco Lucioni, Andy Bertolin, Marco Lionello, Luciano Giacomelli, Giuseppe Rizzotto, Gino Marioni

Abstract

Background

Treatment for local glottic cancer recurrences after primary transoral laser microsurgery (TLM) has not been standardized.

Methods

In 33 consecutive cases of salvage TLM after laser surgery for early glottic carcinoma failed, we retrospectively considered the potential clinicopathological prognostic factors in univariate statistical setting.

Results

Patient age <65 years and pathological involvement of the deep margins were associated with a higher second recurrence rate and shorter disease-free survival.

Conclusion

The age of the patient and the pathological status of surgical margins after salvage TLM could be useful for planning a closer endoscopic/radiological follow-up in selected patients at high risk of recurrence. Other appropriately designed studies are needed to see if an open surgical approach should be considered for younger patients (<65 years old) with recurrent glottic carcinoma after primary TLM. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1043–1049, 2016

Comparative multidimensional assessment of laryngeal function and quality of life after radiotherapy and laser surgery for early glottic cancer

‎Παρασκευή, ‎11 ‎Μαρτίου ‎2016, ‏‎10:50:11 πμ | Takeyuki Kono, Koichiro Saito, Haruna Yabe, Kosuke Uno, Kaoru Ogawa

Abstract

Background

This study was designed to comparatively assess laryngeal function and quality of life (QOL) of patients after laser surgery (LS) or radiotherapy (RT) for early glottic cancer.

Salient body image concerns of patients with cancer undergoing head and neck reconstruction

‎Παρασκευή, ‎11 ‎Μαρτίου ‎2016, ‏‎10:49:14 πμ | Irene Teo, Kassandra M. Fronczyk, Michele Guindani, Marina Vannucci, Sara S. Ulfers, Matthew M. Hanasono, Michelle Cororve Fingeret

Abstract

Background

Patients with cancer undergoing head and neck reconstruction can experience significant distress from alterations in appearance and bodily functioning. We sought to delineate salient dimensions of body image concerns in this patient population preparing for reconstructive surgery.

Methods

Participants completed self-report questionnaires evaluating numerous aspects of body image. We used Bayesian factor analysis modeling methods to identify latent factors emerging from the data.

Results

We identified 2 latent factors: appearance distress and functional difficulties. The highest level of preoperative body image concerns were related to distress about appearance changes and its perceived social consequences. Appearance distress items displayed greater variability compared with functional difficulties.

Conclusion

Appearance and functional changes to body image are important areas of concern for patients with head and neck cancer as they prepare for reconstructive surgery. Knowledge regarding specific body image issues can be used to guide psychosocial assessments and intervention to enhance patient care. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1035–1042, 2016

Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers

‎Παρασκευή, ‎11 ‎Μαρτίου ‎2016, ‏‎10:48:49 πμ | Giorgio Peretti, Cesare Piazza, Sara Penco, Gregorio Santori, Francesca Del Bon, Sabrina Garofolo, Alberto Paderno, Luca Guastini, Piero Nicolai

Abstract

Background

T3 laryngeal cancer encompasses heterogeneous lesions whose treatment is still debated. The purpose of this study was to evaluate transoral laser microsurgery (TLM) in management of selected T3 glottic and supraglottic cancers.

Methods

Fifty-six patients with selected T3 glottic and supraglottic squamous cell carcinomas (SCCs) treated by TLM ± selective neck dissection ± adjuvant therapy were evaluated in terms of overall survival (OS), disease-free survival (DFS), and organ preservation rates.

Results

For the entire cohort, 5-year OS and DFS were 63.3% and 72.4%, whereas they were 65.2% and 72.9% for glottic and 59.3% and 76.3% for supraglottic SCC, respectively. No patient required permanent tracheostomy and 1 patient was gastrostomy tube-dependent at last follow-up.

Conclusion

TLM ± selective neck dissection ± adjuvant (chemo)radiotherapy for selected T3 glottic and supraglottic SCC represents an effective alternative treatment to open partial laryngectomies and nonsurgical organ preservation protocols, particularly in elderly and frail patients. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1107–1112, 2016

Consultation via telemedicine and access to operative care for patients with head and neck cancer in a Veterans Health Administration population

‎Δευτέρα, ‎22 ‎Φεβρουαρίου ‎2016, ‏‎6:55:52 πμ | Daniel M. Beswick, Anita Vashi, Yohan Song, Rosemary Pham, F. Chris Holsinger, James D. Rayl, Beth Walker, John Chardos, Annie Yuan, Ella Benadam–Lenrow, Dolores Davis, C. Kwang Sung, Vasu Divi, Davud B. Sirjani

Abstract

Background

The purpose of this study was to evaluate a telemedicine model that utilizes an audiovisual teleconference as a preoperative visit.

Methods

Veterans Health Administration (VHA) patients with head and neck cancer at 2 remote locations were provided access to the Palo Alto Veterans Affairs (PAVA) Health Care System otolaryngology department via the telemedicine protocol: tissue diagnosis and imaging at the patient site; data review at PAVA; and a preoperative teleconference connecting the patient to PAVA. Operative care occurred at PAVA. Follow-up care was provided remotely via teleconference.

Results

Fifteen patients were evaluated. Eleven underwent surgery, 4 with high-grade neoplasms (carcinoma). Average time from referral to operation was 28 days (range, 17–36 days) and 72 (range, 31–108 days), respectively, for high-grade and low-grade groups. The average patient was spared 28 hours traveling time and $900/patient was saved on travel-related costs.

Conclusion

A telemedicine model enables timely access to surgical care and permits considerable savings among select VHA patients with head and neck cancer. © 2016 Wiley Periodicals, Inc. Head Neck 38: 925–929, 2016

Correlating thyroid cytology and histopathology: Implications for molecular testing

‎Δευτέρα, ‎22 ‎Φεβρουαρίου ‎2016, ‏‎6:55:31 πμ | Michael J. Reed, Steven M. Sperry, Michael P. Gailey, Chris S. Jensen, Robert A. Robinson, Gerry F. Funk, Nitin A. Pagedar

ABSTRACT

Background

A gene expression classifier (GEC) has been advocated in management of some indeterminate nodules without surgery. We assessed the potential negative predictive value (NPV) of the GEC at our academic center.

Methods

Retrospectively, all cytologically indeterminate fine-needle aspirates (FNAs) diagnosed by University of Iowa cytopathologists over a 3-year period were identified. Histopathologic findings were recorded. Using published sensitivity and specificity, NPVs were calculated.

Results

Of 178 nodules (17, 135, and 26 in classes III, IV, and V, respectively), 71 (40%) were malignant. Prevalence of malignancy was 41%, 29%, and 96% for classes III, IV, and V, respectively. Using sensitivities and specificities for the GEC, NPVs were 91% for the cohort: 88%, 92%, and 26% for classes III, IV, and V, respectively.

Conclusion

Molecular testing should be associated with an NPV no lower than that from clinical criteria alone. With the prevalences reported, GEC use may result in more missed cancer diagnoses. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1104–1106, 2016

Hemiglossectomy tongue reconstruction: Modeling of elevation, protrusion, and functional outcome using receiver operator characteristic curve

‎Δευτέρα, ‎22 ‎Φεβρουαρίου ‎2016, ‏‎6:54:22 πμ | Douglas B. Chepeha, Matthew E. Spector, Steven B. Chinn, Keith A. Casper, Eric J. P. Chanowski, Jeffrey S. Moyer, Robert Morrison, Emily Carvill, Teresa H. Lyden

Abstract

Background

The purpose of this study was to model >12 month speech and the oral phase of swallowing outcomes with the reconstructive metrics of tongue elevation and protrusion in patients reconstructed with the rectangle tongue template for a hemiglossectomy defect.

Methods

We conducted a study using 40 surviving patients (23 men, 17 women) treated between 2000 and 2012. Statistically significant correlations of elevation and protrusion with functional outcomes were modeled with receiver operator characteristic (ROC) curves to understand the performance and reliability of the rectangle tongue reconstruction.

Results

Tongue elevation (1.8–1.9 cm) reliably produces best outcomes in nutritional mode, range of liquids, and ≥4/6 for range of solids. Greater tongue elevation (2.1–2.2 cm) reliably produces best outcomes for eating and speaking in public and understandability of speech. Tongue protrusion (0.8–1.0 cm) reliably produces best scores across all assessed outcomes except ≥4/6 for range of solids and ≥4/5 understandability of speech.

Conclusion

ROC curves are useful for assessing reliability and relating reconstructive objectives to functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1066–1073, 2016

Prevalence and nature of survivorship needs in patients with head and neck cancer

‎Παρασκευή, ‎19 ‎Φεβρουαρίου ‎2016, ‏‎3:22:10 μμ | Meredith Giuliani, Maurene McQuestion, Jennifer Jones, Janet Papadakos, Lisa W. Le, Nour Alkazaz, Terry Cheng, John Waldron, Pamela Catton, Jolie Ringash

ABSTRACT

Background

The purpose of this study was to determine the number, type, and predictors of patients with head and neck cancer unmet survivorship needs.

Methods

This study accrued patients with head and neck cancer at any time point in their survivorship course, and they completed a survey, including demographic information and the Cancer Survivors’ Unmet Needs Measure (CaSUN).

Results

The median age of the 158 participants was 64 years. Ninety-six patients (61%) reported at least one unmet need on the CaSUN and 6 patients had a very high number of needs between 31 and 35. The mean number of unmet needs was 5.8 ± 8.9. Comprehensive Cancer Care was the most common domain of unmet need (n = 69; 45%). Younger age, earlier survivorship phase, and worse quality of life were associated with increased survivorship unmet needs on multivariable analysis.

Conclusion

A high proportion of patients with head and neck cancer have unmet needs. These data can guide the development of head and neck survivorship programs. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1097–1103, 2016

Exponentially growing osteosarcoma of mandible with acromegaly

‎Τρίτη, ‎16 ‎Φεβρουαρίου ‎2016, ‏‎8:10:50 πμ | Nayeon Choi, Seokhwi Kim, Jungkyu Cho, Byung Kil Kim, Young Sang Cho, Jeon Yeob Jang, Chung-Hwan Baek

ABSTRACT

Background

Osteosarcoma of the head and neck is aggressive malignancy that might be affected by growth hormone. The purpose of this study was to demonstrate an unusual case of osteosarcoma with acromegaly.

Methods and Results

This case is about a 39-year-old woman with an osteosarcoma of the mandible, who had a history of exponential tumor growth in spite of chemotherapy at another hospital. She transferred to Samsung Medical Center and underwent a wide resection of tumor and free flap reconstruction. During postoperative care, a brain MRI and hormonal test revealed a growth hormone-secreting pituitary adenoma, and then a transsphenoidal approach pituitary tumor removal was performed. Immunohistochemistry of the osteosarcoma indicated positive for insulin-like growth factor (IGF)−2 and somatostatin receptor.

Conclusion

This study proved the IGF-2 and somatostatin receptor from the osteosarcoma of the patient with acromegaly, and this could explain that the growth hormone secreting from the pituitary adenoma might be a risk factor of therapeutic intractability and growth acceleration of osteosarcoma. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2432–E2436, 2016

Tumor infiltrating lymphocytes and survival in patients with head and neck squamous cell carcinoma

‎Τρίτη, ‎16 ‎Φεβρουαρίου ‎2016, ‏‎8:08:00 πμ | Nghia Nguyen, Emily Bellile, Daffyd Thomas, Jonathan McHugh, Laura Rozek, Shama Virani, Lisa Peterson, Thomas E. Carey, Heather Walline, Jeffery Moyer, Matthew Spector, Daniel Perim, Mark Prince, Scott McLean, Carol R. Bradford, Jeremy M. G. Taylor, Gregory T. Wolf,

Abstract

Background

Because immune responses within the tumor microenvironment are important predictors of tumor biology, correlations of types of tumor infiltrating lymphocytes (TILs) with clinical outcomes were determined in 278 patients with head and neck squamous cell carcinoma (HNSCC).

Methods

Infiltrating levels of CD4 (helper T cells), CD8 (cytotoxic/suppressor T cells), FoxP3 (regulatory T cells), CD68 (myeloid-derived suppressor cells,) and CD1a (Langerhans) cells were measured in tissue microarrays (TMAs). Cox models tested associations with patient outcomes after adjusting for all known prognostic factors. Median follow-up was 36.6 months.

Results

Higher CD4 and CD8 TIL levels were associated with improved overall survival (OS; hazard ratio [HR] = 0.77; 95% confidence interval [CI]  = 0.65–0.93; p = .005 and HR = 0.77; 95% CI = 0.64–0.94; p = .008, respectively), and relapse-free survival (RFS; p = .03 and .05, respectively). After controlling for prognostic factors, higher CD4 levels predicted improved OS and disease-specific survival (DSS; p = .003 and p = .004, respectively).

Conclusion

The findings suggest that TILs are a significant independent prognostic factor for HNSCC that differ by treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1074–1084, 2016

Expression and clinical significance of MAGE and NY-ESO-1 cancer-testis antigens in adenoid cystic carcinoma of the head and neck

‎Σάββατο, ‎13 ‎Φεβρουαρίου ‎2016, ‏‎12:38:52 μμ | Johannes A. Veit, Daniela Heine, Julia Thierauf, Jochen Lennerz, Subasch Shetty, Patrick J. Schuler, Theresa Whiteside, Dirk Beutner, Moritz Meyer, Inga Grünewald, Gerd Ritter, Sacha Gnjatic, Andrew G. Sikora, Thomas K. Hoffmann, Simon Laban

Abstract

Background

Adenoid cystic carcinoma (ACC) of the head and neck is a rare but highly malignant tumor. Cancer-testis antigens (CTAs) represent an immunogenic family of cancer-specific proteins and thus represent an attractive target for immunotherapy.

Methods

Eighty-four cases of ACC were identified, the CTAs pan-Melanoma antigen (pan-MAGE; M3H67) and New York esophageal squamous cell carcinoma (NY-ESO-1; E978) were detected immunohistochemically (IHC) and correlated with clinical data.

Results

Expression of NY-ESO-1 was found in 48 of 84 patients (57.1%) and of pan-MAGE in 28 of 84 patients (31.2%). Median overall survival (OS) in NY-ESO-1 positive versus negative patients was 130.8 and 282.0 months (p = .223), respectively. OS in pan-MAGE positive versus negative patients was 105.3 and 190.5 months, respectively (p = .096). Patients expressing both NY-ESO-1 and pan-MAGE simultaneously had significantly reduced OS with a median of 90.5 months compared with 282.0 months in negative patients (p = .047).

Conclusion

A significant fraction of patients with ACC show expression of the CTAs NY-ESO-1 and/or pan-MAGE with promising immunotherapeutic implications. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1008–1016, 2016

Impact of neck failure on survival in older patients with differentiated thyroid cancer

‎Σάββατο, ‎13 ‎Φεβρουαρίου ‎2016, ‏‎12:38:29 μμ | David M. Marcus, Renjian Jiang, Kevin C. Ward, Kristin A. Higgins, Nabil F. Saba, J. Trad Wadsworth, Jonathan J. Beitler

Abstract

Background

Regional recurrence of differentiated thyroid cancer (DTC) is often salvaged with neck dissection without survival penalty. It is unknown whether recurrence may be associated with inferior survival in older patients.

Methods

Surveillance, Epidemiology, and End Results (SEER) and Medicare data were linked to identify patients age ≥65 with nonmetastatic DTC. Patients undergoing neck dissection >6 months after their initial diagnosis were considered to have regional recurrent disease. We compared overall survival (OS) and cause-specific survival (CSS) for patients with recurrent disease versus a matched cohort of patients with non-recurrent DTC.

Results

Of 6235 patients, 143 had treatment-defined recurrent disease. Patients with recurrent disease had inferior OS (p < .01) and CSS (p < .01). Multivariate analysis demonstrated that recurrent disease was independently associated with inferior 10-year OS (hazard ratio [HR] = 1.75; p < .01) and CSS (HR = 3.05; p < .01).

Conclusion

Regional recurrence of DTC may negatively impact OS and CSS in patients ≥65 years old. © 2016 Wiley Periodicals, Inc. Head Neck 38: 919–924, 2016

Outcomes of endoscopic cricopharyngeal myotomy with CO2 laser surgery: A retrospective study of 47 patients

‎Σάββατο, ‎13 ‎Φεβρουαρίου ‎2016, ‏‎12:37:45 μμ | Arta Hoesseini, Jimmie Honings, Rabia Taus–Mohamedradja, Frank J. A. van den Hoogen, Henri A. M. Marres, Guido B. van den Broek, Hanneke Kalf, Robert P. Takes

ABSTRACT

Background

Endoscopic cricopharyngeal myotomy (ECPM) using CO2 laser surgery presents a less invasive treatment technique when compared to transcervical cricopharyngeal myotomy.

Methods

Forty-seven patients who underwent ECPM from 2002 until 2013 were included in this study. Patient characteristics, and preoperative and postoperative outcome and complications were scored by retrospective chart review and by using the Deglutition Handicap Index (DHI).

Results

Overall, 40 of 47 patients (85%) experienced relief of symptoms postoperatively. Ten patients (25%) developed recurrent symptoms of dysphagia requiring re-laser surgery. All 40 patients were satisfied at the postoperative visit after an average of 1.3 interventions. DHI scores were better in patients with idiopathic dysfunction and neurologic disease, compared to dysfunction because of prior treatment of head and neck cancer. One patient developed mediastinitis that was successfully treated with antibiotics. There was no mortality.

Conclusion

ECPM is an effective treatment for cricopharyngeal dysfunction with a low rate of surgical morbidity and complications. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1022–1027, 2016

Transoral laser microsurgery for locally advanced (T3–T4a) supraglottic squamous cell carcinoma: Sixteen years of experience

‎Σάββατο, ‎13 ‎Φεβρουαρίου ‎2016, ‏‎12:37:24 μμ | Isabel Vilaseca, José Luis Blanch, Joan Berenguer, Juan José Grau, Eugenia Verger, África Muxí, Manuel Bernal–Sprekelsen

Abstract

Background

Controversy exists regarding treatment of advanced laryngeal cancer. The purpose of this study was to evaluate the oncologic and functional outcomes of T3 to T4a supraglottic squamous carcinomas treated with transoral laser microsurgery (TLM).

Methods

We conducted a retrospective analysis from an SPSS database. Primary outcomes were: locoregional control, overall survival (OS), disease-specific survival (DSS), laryngectomy-free survival, and function-preservation rates. Secondary objectives were: rate of tracheostomies and gastrostomies according to age. Risk factors for local control and larynx preservation were also evaluated.

Results

One hundred fifty-four consecutive patients were chosen for this study. Median follow-up was 40.7 + /- 32.8 months. Five and 10-year OS, DSS, and laryngectomy-free survival were 55.6% and 47%, 67.6% and 58.6%, and 75.2% and 59.5%, respectively. Paraglottic involvement was an independent factor for larynx preservation. Six patients (3.9%) needed a definitive tracheostomy, a gastrostomy, or both. The gastrostomy rate was higher in the group of patients above 65 years of age (p = .03). Five-year laryngectomy-free survival with preserved function was 74.5%.

Conclusion

TLM constitutes a true alternative for organ preservation in locally advanced supraglottic carcinomas with good oncologic and functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1050–1057, 2016

Survival and overall treatment time after postoperative radio(chemo)therapy in patients with head and neck cancer

‎Σάββατο, ‎13 ‎Φεβρουαρίου ‎2016, ‏‎12:37:05 μμ | Silke Tribius, Johanna Donner, Henning Pazdyka, Adrian Münscher, Alexander Gröbe, Cordula Petersen, Andreas Krüll, Pierre Tennstedt

Abstract

Background

Generally, overall treatment time for patients with locally advanced head and neck cancer should be as short as reasonably possible. This analysis was undertaken to determine at what overall treatment time additional survival/locoregional control benefits could be achieved compared to a 100-day cutoff.

Methods

Clinical impact of overall treatment time was assessed in 272 patients by multivariable Cox regression and Kaplan–Meier analyses using the historical 100-day cutoff and the optimal overall treatment time, determined using recursive partitioning analysis. Survival endpoints were determined for the 100-day and optimal overall treatment times validated using bootstrap resampling.

Results

Recursive partitioning determined the optimal overall treatment time as 87 days. In the 87-day multivariable analysis, adverse factors for overall survival (OS) and disease-free survival (DFS) were overall treatment time ≥87 days and extracapsular spread, and overall treatment time and R1 status, respectively.

Conclusion

Overall treatment time is important for survival in patients with head and neck cancer. Completing treatment within as short a timeframe as possible may be associated with longer OS and DFS. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1058–1065, 2016

Prophylactic neck dissection for low-risk differentiated thyroid cancers: Risk-benefit analysis

‎Σάββατο, ‎13 ‎Φεβρουαρίου ‎2016, ‏‎12:35:58 μμ | Xavier Dubernard, Sandrine Dabakuyo, Samiratou Ouedraogo, Koceila Amroun, David Kere, Talal Nasser, Sophie Deguelte, Jean-Marie Pochart, Jean-Claude Merol, Marc Makeieff, André Chays, Claire Schvartz

Abstract

Background

The benefit of neck dissection is the subject of debate in differentiated thyroid cancer (DTC). We analyze the risk-benefit of neck dissection for low-risk DTC without detectable lymph nodes.

Methods

We conducted a retrospective study from 1983 to 2003; which included 295 patients without detectable lymph nodes who were treated by thyroidectomy with (C+) or without (C-) neck dissection. All patients had iodine131 therapy. We compared the frequency of remission, disease progression, and permanent complications between groups.

Results

Two hundred twelve patients comprised the C+ group, and 83 patients the C- group. Respectively for C+ versus C-, remission rates were 92% versus 89.2% (p = .40), and progressive disease observed was 3.3% versus 7.2% (p = .10). Permanent hypoparathyroidism occurred in 15.1% in C+ versus 3.6% in C- (p = .006).

Conclusion

The risk-benefit analysis of neck dissection in patients with low-risk DTC shows no benefit in terms of complete remission or occurrence of progression. However, risk of complications seems to be higher in patients with neck dissection. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1091–1096, 2016

Modified endoscopic transnasal-transmaxillary-transpterygoid approach to parapharyngeal space tumor resection

‎Δευτέρα, ‎8 ‎Φεβρουαρίου ‎2016, ‏‎4:00:36 μμ | Koichiro Wasano, Sayuri Yamamoto, Shuta Tomisato, Taiji Kawasaki, Kaoru Ogawa

ABSTRACT

Background

Conventional approaches for removing parapharyngeal space tumors require a cervical skin incision and resection of soft tissues between the skin and parapharyngeal space. The surgical visual field for this conventional approach is limited.

Methods

To decrease invasiveness during removal of benign parapharyngeal space tumors and to enhance the visual field, we devised a new approach called the modified endoscopic transnasal-transmaxillary-transpterygoid approach (MENMAP). The “surgical corridor” to the parapharyngeal space consists of the maxillary sinus, submucous tunnel under the lateral nasal wall, and the space created by removing the pterygoid process.

Results

We successfully performed en bloc removal of a parapharyngeal space tumor using the MENMAP approach. The only surgical complication was hypoesthesia of the right hard palate and maxillary gingiva, which gradually improved.

Conclusion

The MENMAP approach is a viable alternative for removing parapharyngeal space tumors, as it is safe, feasible, and less invasive. © 2016 Wiley Periodicals, Inc. Head Neck 38: 933–938, 2016

BRAF V600E detection in cytological thyroid samples: A key component of the decision tree for surgical treatment of papillary thyroid carcinoma

‎Δευτέρα, ‎8 ‎Φεβρουαρίου ‎2016, ‏‎3:59:33 μμ | Jean-François Collet, Roger Lacave, Sylvain Hugonin, Virginie Poulot, Marc Tassart, Anne Fajac

Abstract

Background

Whether preoperative knowledge of the BRAF mutation status would help to determine the extent of surgery for thyroid nodules is still under investigation.

Methods

We developed a method to state the V600E mutation before surgery on fine-needle aspiration (FNA) stained smears checked to contain tumor cells. We evaluated the interest of the preoperative assessment of the mutation for surgical strategy of nodules, diagnosed as malignant, suspicious for malignancy or follicular neoplasms.

Results

The mutation was found in 81% (79 of 97) malignant, 59% (20 of 34) suspicious nodules, and in none of follicular neoplasms (n = 29). Overall, the mutation was detected in 82% of papillary carcinomas. The sensitivity, specificity, and positive and negative predictive values for the diagnosis of malignancy were 75%, 100%, 100%, and 46%, respectively.

Conclusion

The preoperative knowledge of the V600E mutation status is fundamental to plan total thyroidectomy with certainty and should be part of the decision tree for the management of thyroid nodules. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1017–1021, 2016

Intensity-modulated radiotherapy or volumetric-modulated arc therapy in patients with head and neck cancer: Focus on salivary glands dosimetry

‎Δευτέρα, ‎8 ‎Φεβρουαρίου ‎2016, ‏‎3:58:53 μμ | Alexis Vallard, Jean-Baptiste Guy, Sylvie Mengue Ndong, Nicolas Vial, Romain Rivoirard, Pierre Auberdiac, Benoîte Méry, Julien Langrand–Escure, Sophie Espenel, Coralie Moncharmont, Majed Ben Mrad, Peng Diao, Dominique Goyet, Nicolas Magné

Abstract

Background

Despite radiotherapy (RT) technical improvements, high salivary dysfunction rates are still reported in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of the present study was to report salivary glands dosimetry with volumetric-modulated arc therapy (VMAT) and intensity-modulated RT (IMRT).

Methods

Dosimetry of consecutive patients receiving IMRT or VMAT for proven HNSCC between 2007 and 2013 were retrospectively reviewed.

Results

Data of 609 patients were studied. Mean dose, mean maximum dose, and mean percentage of salivary gland volume receiving at least 26 Gy (V26) of the contralateral parotid were 24.50 Gy (range, 0–70.4 Gy), 39.08 Gy (range, 0.38–76.45 Gy), and 40.92% (range, 0% to 100%), respectively. Mean and maximum dose on contralateral submandibular gland were 48.18 Gy (range, 0.19–70.73 Gy), and 61.25 Gy (range, 0–75.8 Gy), respectively.

Conclusion

Target volume coverage still has to be prioritized over organs at risk (OAR) sparing with new RT techniques. Submandibular glands are not sufficiently taken into account in guidelines. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1028–1034, 2016

Multiportal combined transnasal transoral transpharyngeal endoscopic approach for selected skull base cancers

‎Δευτέρα, ‎8 ‎Φεβρουαρίου ‎2016, ‏‎3:58:32 μμ | Mario Turri–Zanoni, Paolo Battaglia, Iacopo Dallan, Davide Locatelli, Paolo Castelnuovo

Background

Minimally invasive endoscopic endonasal approaches to the ventral skull base have evolved considerably over the past several years. However, where there is a lateral extension of tumors as far as the parapharyngeal spaces with inferior extension below the level of the soft palate, limitations remain for an exclusive transnasal approach.

Methods

A combined endoscopic-assisted transnasal-transoral-transpharyngeal multiportal approach was performed to resect selected skull base malignancies that could not be adequately managed using a single approach.

Results

Three cases of skull base cancer (squamous cell carcinoma, polymorphous low-grade adenocarcinoma, and high-grade osteosarcoma) were suitable for such an approach. In all cases, a radical resection was obtained without major complications and with minimal morbidity for the patient.

Conclusion

The transnasal, transoral, and transpharyngeal surgical windows are complementary approaches that, when combined, provide excellent exposure for selected skull base malignancies that have extended too laterally and inferiorly to allow an exclusively transnasal approach. © 2016 Wiley Periodicals, Head Neck 38: E2440–E2445, 2016

Dysgenetic polycystic disease of the minor and submandibular salivary glands

‎Δευτέρα, ‎8 ‎Φεβρουαρίου ‎2016, ‏‎3:57:41 μμ | Eleftherios Koudounarakis, Stefan Willems, Baris Karakullukcu

Abstract

Background

Dysgenetic polycystic salivary gland disease is a rare pathology. No case of minor salivary gland involvement has been reported in the literature.

Methods

A female patient presented with bilateral tumors of the parotid glands, bilateral submandibular gland enlargement, and multiple cystic lesions of the oral mucosa. MRI of the neck was performed along with fine-needle aspiration (FNA) of the parotid tumors and excisional biopsy of an oral lesion.

Results

Imaging and FNA findings of the parotid glands were suggestive of bilateral Warthin tumors. Excisional biopsy of the oral lesion revealed a minor salivary gland with histopathological features of dysgenetic polycystic salivary gland disease. Submandibular gland enlargement was also attributed to this rare entity based on the imaging characteristics.

Conclusion

This is the first report of dysgenetic polycystic salivary gland disease of the minor salivary glands, combined with involvement of the submandibular glands and bilateral Warthin tumors of the parotid gland. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2437–E2439, 2016

Treatment and survival of patients with insular thyroid carcinoma: 508 cases from the National Cancer Data Base

‎Πέμπτη, ‎4 ‎Φεβρουαρίου ‎2016, ‏‎9:07:45 πμ | Todd A. Pezzi, Vlad C. Sandulache, Christopher M. Pezzi, Ashley E. Turkeltaub, Lei Feng, Maria E. Cabanillas, Michelle D. Williams, Stephen Y. Lai

Abstract

Background

Insular thyroid carcinoma (ITC) is a rare but aggressive thyroid malignancy.

Methods

Patients with ITC (n = 508) reported to the National Cancer Data Base from 1998 to 2012 were evaluated for patient, tumor, and treatment characteristics and outcomes.

Results

Compared to papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), patients with ITC cancer were older, more often were men, had larger tumors, were more likely to present with distant metastasis, were less likely to have an R0 resection, more likely to receive external beam radiation and chemotherapy, and had significantly worse survival. Multivariate Cox regression identified age >65 years (hazard ratio [HR] = 1.53), presence of at least 1 comorbidity (HR = 1.80), positive lymph nodes (HR = 1.67), the presence of metastasis (HR = 2.73), positive margins (HR = 2.48), and radioactive iodine therapy (HR = 0.63) as significant and independent predictors of survival in ITC.

Conclusion

Treatment recommendations should incorporate the use of radioactive iodine after complete surgical resection and clearance of involved nodal basins. © 2016 Wiley Periodicals, Inc. Head Neck 38: 906–912, 2016

Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports

‎Τρίτη, ‎29 ‎Δεκεμβρίου ‎2015, ‏‎4:16:47 μμ | Chen-Chi Wang, Shih-An Liu, Shang-Heng Wu, Wen-Jiun Lin, Rong-San Jiang, Lily Wang

Abstract

Background

Transoral robotic surgery (TORS) for early glottic cancer has been reported, but the issue of anterior commissure involvement has seldom been addressed. Therefore, the purpose of this study was to preliminarily report the treatment results of TORS in this disease entity.

Methods

Eight patients with T1 and T2 glottic carcinoma with anterior commissure involvement were selected to receive TORS. The clinical parameters, including rates of adjuvant radiotherapy (RT), survivals, as well as organ and function preservation, were retrospectively analyzed.

Results

TORS was successfully performed in all patients without temporary tracheostomy. There were no major complications and no patient received adjuvant RT to the larynx after surgery. With a mean follow-up of 40 months, all patients survived with their larynx preserved and no local recurrence, tracheostomy, or tube feeding dependence.

Conclusion

TORS is a feasible approach for selected patients with early T classification glottic carcinoma with anterior commissure involvement. The preliminary oncologic and functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck 38: 913–918, 2016

Management of the cervico-petrous internal carotid artery in class C tympanojugular paragangliomas

‎Σάββατο, ‎28 ‎Νοεμβρίου ‎2015, ‏‎11:38:54 πμ | Andrea Bacciu, Sampath Chandra Prasad, Natalie Sist, Giulia Rossi, Paolo Piazza, Mario Sanna

Abstract

Background

Management of the cervical and petrous internal carotid artery (ICA) is frequently required in Fisch class C tympanojugular paragangliomas (TJPs). The purpose of this study was to discuss the perioperative intervention of the ICA in patients who underwent surgical resection of a TJP.

Methods

A retrospective study of 237 patients surgically treated for Fisch class C TJPs was done to identify cases that required ICA management.

Results

Management of the ICA was required in 176 patients (74.2%). Forty-two patients required just an ICA decompression, 88 underwent a subperiosteal dissection, 19 underwent subadventitial dissection without intraluminal stenting, 17 underwent subadventitial dissection with intraluminal stenting, and 12 underwent arterial resection after permanent balloon occlusion. There were no complications associated with the endovascular procedures. Gross total tumor resection was achieved in 91.5% of the cases.

Conclusion

Preoperative endovascular intervention, in selected cases, facilitates gross total tumor removal and significantly reduces the risk of an intraoperative ICA injury. © 2015 Wiley Periodicals, Inc. Head Neck 38: 899–905, 2016

Quality assessment in head and neck oncologic surgery in a Brazilian cancer center compared with MD Anderson Cancer Center benchmarks

‎Σάββατο, ‎28 ‎Νοεμβρίου ‎2015, ‏‎11:36:08 πμ | Renan Bezerra Lira, André Ywata de Carvalho, Genival Barbosa de Carvalho, Carol M. Lewis, Randal S. Weber, Luiz Paulo Kowalski

Abstract

Background

Quality assessment is a major tool for evaluation of health care delivery. In head and neck surgery, the University of Texas MD Anderson Cancer Center (MD Anderson) has defined quality standards by publishing benchmarks.

Methods

We conducted an analysis of 360 head and neck surgeries performed at the AC Camargo Cancer Center (AC Camargo). The procedures were stratified into low-acuity procedures (LAPs) or high-acuity procedures (HAPs) and outcome indicators where compared to MD Anderson benchmarks.

Results

In the 360 cases, there were 332 LAPs (92.2%) and 28 HAPs (7.8%). Patients with any comorbid condition had a higher incidence of negative outcome indicators (p = .005). In the LAPs, we achieved the MD Anderson benchmarks in all outcome indicators. In HAPs, the rate of surgical site infection and length of hospital stay were higher than what is established by the benchmarks.

Conclusion

Quality assessment of head and neck surgery is possible and should be disseminated, improving effectiveness in health care delivery. © 2015 Wiley Periodicals, Inc. Head Neck 38: 1002–1007, 2016

Transoral robotic surgery for early T classification hypopharyngeal cancer

‎Τετάρτη, ‎11 ‎Νοεμβρίου ‎2015, ‏‎4:31:24 μμ | Chen-Chi Wang, Shih-An Liu, Shang-Heng Wu, Ching-Ping Wang, Kai-Li Liang, Rong-San Jiang, Jin-Ching Lin

Abstract

Background

For hypopharyngeal cancer, transoral robotic surgery (TORS) has been reported as a new organ preserving treatment but outcomes are rarely reported.

Methods

From 2010 to 2013, 10 patients with early T classification pyriform sinus cancer were selected to receive TORS and conventional neck dissection. The clinical parameters, including rates of adjuvant radiotherapy, survivals, as well as organ and function preservation, were retrospectively analyzed.

Results

TORS was successful in all 10 patients, and 5 patients received adjuvant radiotherapy. After mean follow-up of 26 months, 1 patient died of distant metastasis and 1 patient died of other malignancy. There was no local recurrence and larynxes were all preserved. Eight surviving patients who were followed up continuously could receive oral intake and had a serviceable voice without tracheostomy or feeding tubes.

Conclusion

TORS is a feasible transoral approach for selected patients with early T classification hypopharyngeal cancer. The reported oncologic/functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck 38: 857–862, 2016

Clinical and pathological parameters prognostic for increased risk of recurrence after postoperative radiotherapy for temporal bone carcinoma

‎Τρίτη, ‎8 ‎Σεπτεμβρίου ‎2015, ‏‎6:17:30 μμ | Gino Marioni, Elisabetta Zanoletti, Luciano Giacomelli, Leonardo Braggio, Alessandro Martini, Antonio Mazzoni

Abstract

Background

Most authors agree that radical surgery for advanced, aggressive temporal bone squamous cell carcinoma (SCC) should be followed by postoperative radiotherapy (PORT). The purpose of this study was to identify clinical and/or conventional pathological parameters capable of pinpointing patients with temporal bone SCC at higher risk of recurrence after PORT.

Methods

The investigation concerned 27 consecutive patients undergoing PORT for primary temporal bone SCC.

Results

Univariate statistics revealed a difference in the distributions for pT classification (p = .0004), pathological grade (p = .006), and dura mater involvement (p = .015) when patients were grouped by presence versus absence of recurrence after PORT. A panel of 3 parameters comprising pT classification (pT4), pathological grade (G2 or G3), and dura mater involvement demonstrated an outstanding discriminatory power (area under the curve [AUC] receiver operating characteristic [ROC] = 0.912) in predicting temporal bone SCC recurrence after PORT.

Conclusion

The panel considered had an outstanding discriminatory power in pinpointing patients at higher risk of recurrence who could benefit from stricter follow-up protocols and postoperative chemoradiotherapy (CRT) for temporal bone SCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: 894–898, 2016

Strategies and long-term outcomes in the surgical management of tympanojugular paragangliomas

‎Δευτέρα, ‎7 ‎Σεπτεμβρίου ‎2015, ‏‎9:27:25 πμ | Sampath Chandra Prasad, Hassen Ait Mimoune, Mohsen Khardaly, Paolo Piazza, Alessandra Russo, Mario Sanna

Abstract

Background

The purpose of this study was to share our review of surgical strategies and long-term outcomes in the management of tympanojugular paragangliomas.

Methods

This was a retrospective study with a literature review. The records of 184 patients with 185 tympanojugular paragangliomas were analyzed for tumor class, surgical procedure, preoperative vascular management, and perioperative sequelae.

Results

Of class C1, C2, C3, and C4 tumors, we found 46 (24.9%), 95 (51.3%), 41 (22.2%), and 3 (1.6%), respectively. One hundred four (56.2%) tumors had intracranial extensions and 8 (4.3%) involved the vertebral artery. A single-stage procedure was adopted in 158 (85.4%) tumors. The infratemporal fossa type A approach was used in all cases. In 17 patients (9.7%), an intra-arterial stenting of the internal carotid artery was performed. Gross-total tumor removal was achieved in 166 cases (89.7%) and 4 (2.4%) among them developed a recurrence.

Conclusion

A thorough understanding of skull base techniques and a logical decision-making process in the management of tympanojugular paragangliomas can achieve a high rate of success in terms of recurrences and complications. © 2015 Wiley Periodicals, Inc. Head Neck 38: 871–885, 2016

Adjuvant chemoradiotherapy versus with radiotherapy alone for locally advanced salivary gland carcinoma among older patients

‎Παρασκευή, ‎4 ‎Σεπτεμβρίου ‎2015, ‏‎4:49:43 μμ | Tawee Tanvetyanon, Kate Fisher, Jimmy Caudell, Kristen Otto, Tapan Padhya, Andy Trotti

Abstract

Background

The majority of patients with locally advanced salivary gland carcinoma will die of the disease even after curative surgery. Few studies on adjuvant therapy have been conducted. In this study, we compared adjuvant chemoradiotherapy (CRT) with adjuvant radiotherapy among the older patient population.

Methods

Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1992–2009) was analyzed. Eligible cases were those receiving curative surgery followed by adjuvant therapy. Outcomes were overall survival and toxicity.

Results

Analyses included 741 patients: 641 patients (86.5%) received adjuvant radiotherapy and 100 (13.5%) received adjuvant CRT. The median overall survival was 41.0 months with adjuvant radiotherapy and 24 months with CRT. Both multivariable and propensity score-adjusted analyses indicated that adjuvant CRT was associated with an increased mortality (hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.07–1.79 and HR: 1.49; 95% CI: 1.14–1.94, respectively). Toxicity rates were significantly higher in the CRT group.

Conclusion

Treatment with adjuvant CRT was associated with an increased mortality and toxicity when compared to adjuvant radiotherapy alone. © 2015 Wiley Periodicals, Inc. Head Neck 38: 863–870, 2016

Impact of selective neck dissection on chronic dysphagia after chemo-intensity-modulated radiotherapy for oropharyngeal carcinoma

‎Παρασκευή, ‎4 ‎Σεπτεμβρίου ‎2015, ‏‎4:49:21 μμ | Katherine A. Hutcheson, Amal R. Abualsamh, Alejandro Sosa, Randal S. Weber, Beth M. Beadle, Erich M. Sturgis, Jan S. Lewin

Abstract

Background

Conflicting results are reported regarding the impact of neck dissection on radiation-associated dysphagia. The purpose of this study was to reexamine this question specific to oropharyngeal intensity-modulated radiotherapy (IMRT).

Methods

Three hundred forty-nine patients with oropharyngeal cancer treated with bilateral IMRT with systemic therapy (induction and/or concurrent) were reviewed. Chronic dysphagia was defined by aspiration, stricture, pneumonia, and/or gastrostomy dependence ≥12 months post-IMRT.

Results

Selective neck dissection was performed after IMRT in 75 patients (21%). Overall, 41 patients (12%) developed chronic dysphagia. Neck dissection did not increase the rate of chronic dysphagia (9% neck dissection; 12% no neck dissection; p = .464) or gastrostomy duration (p = .482). On multivariate analysis, age (odds ratio [OR] per 5-year = 1.25; 95% confidence interval [CI] = 1.04–1.51), baseline abnormal diet (OR = 2.78; 95% CI = 1.31–5.88), and IMRT dose (OR per 5-Gy = 5.11; 95% CI = 1.77–14.81) significantly predicted dysphagia.

Conclusion

In the setting of selective neck dissection for residual adenopathy after IMRT, neck dissection did not impact dysphagia. © 2015 Wiley Periodicals, Inc. Head Neck 38: 886–893, 2016

Oral squamous cell carcinoma of the tongue: Prospective and objective speech evaluation of patients undergoing surgical therapy

‎Πέμπτη, ‎6 ‎Αυγούστου ‎2015, ‏‎6:38:54 μμ | Max Riemann, Christian Knipfer, Maximilian Rohde, Werner Adler, Maria Schuster, Elmar Noeth, Nico Oetter, Nima Shams, Friedrich-Wilhelm Neukam, Florian Stelzle

Abstract

Background

Prospective speech intelligibility assessments lack objectivity in patients undergoing surgery for oral squamous cell carcinoma (OSCC) of the tongue.

Methods

Speech intelligibility was measured based on word recognition by means of an automatic and objective speech recognition system preoperatively, and 14 to 20 days, and 3 months, 6 months, and 12 months postoperatively. The study comprised 25 patients with OSCC of the tongue and a healthy control group (n = 40).

Results

Patients yielded significant speech impairments compared to the healthy control group both before surgery and after 12 months (p ≤ .002). The speech intelligibility of the patients decreased significantly 14 to 20 days after surgery (p < .001) but realigned to preoperative values after 12 months (p = .159). Preservation of the tip of the tongue resulted in significantly higher word recognition after 12 months (p = .007; Δword recognition = 16.29).

Conclusion

Having OSSC of the tongue results in a significant impairment of speech intelligibility. The preservation of the tip of the tongue seems to be a central factor concerning the recovery of speech. © 2015 Wiley Periodicals, Inc. Head Neck 38: 993–1001, 2016

Clinical outcomes in elderly patients with human papillomavirus–positive squamous cell carcinoma of the oropharynx treated with definitive chemoradiation therapy

‎Πέμπτη, ‎30 ‎Ιουλίου ‎2015, ‏‎10:30:00 πμ | Sheela Hanasoge, Kelly R. Magliocca, Jeffrey M. Switchenko, Nabil F. Saba, J. Trad Wadsworth, Mark W. El-Deiry, Dong M. Shin, Fadlo Khuri, Jonathan J. Beitler, Kristin A. Higgins

Abstract

Background

The benefit of combined chemoradiation in elderly patients with human papillomavirus (HPV)-positive locally advanced oropharyngeal squamous cell carcinoma (SCC) must be balanced with the potential for higher toxicity rates. We performed a retrospective review of our institutional experience.

Methods

Patients 70 years or older with p16-positive oropharyngeal SCC treated with definitive chemoradiation from 2005 to 2013 were evaluated. Overall survival (OS), disease-free survival (DFS), and locoregional failure–free survival were calculated.

Results

Twenty-one eligible patients had a follow-up of 22.4 months. Estimated 5-year OS, DFS, and locoregional failure–free survival were 76.0%, 40%, and 95%, respectively. There was 1 death from acute toxicity, and 50% had unplanned hospitalizations. Sixty percent had late toxicity, and 6-month feeding tube dependence was 25%.

Conclusion

Elderly patients with HPV-positive locally advanced SCC of the oropharynx treated with definitive chemoradiation had good OS but high rates of acute and long-term toxicity. © 2015 Wiley Periodicals, Inc. Head Neck 38: 846–851, 2015

Clinical characteristics and treatment outcomes of primary and recurrent malignancy involving the salivary glands in children

‎Τετάρτη, ‎15 ‎Ιουλίου ‎2015, ‏‎10:30:34 πμ | Sajid S. Qureshi, Monica Bhagat, Nitin Singhal, Nitin Tathe, Seema Kembhavi, Siddharth Laskar, Mukta Ramadwar, Prabha Yadav

Abstract

Background

Malignant salivary gland neoplasms are rare in children. The purpose of this study was to present our experience in the treatment of primary and recurrent salivary gland neoplasm and contribute to the fractional available data.

Methods

All patients <18 years, treated between June 2005 and April 2014 were included in this study.

Results

The parotid gland was the most common site for both primary (n = 18) and recurrent (n = 6) tumors and mucoepidermoid carcinoma, low or intermediate grade, main histological type. Surgical excision was performed in all patients, of which 13 patients received radiotherapy. Lymph node metastasis was present in 3 patients with primary tumor, which were assessed accurately on frozen section examination. Local recurrence occurred in 1 patient with primary tumor and all patients are alive.

Conclusion

Surgery is the prime modality of treatment for malignant salivary gland neoplasm and is associated with excellent outcomes. The role of lymph node sampling and frozen section examination needs further evaluation in identifying lymph node metastasis. © 2015 Wiley Periodicals, Inc. Head Neck 38: 852–856, 2016

Clar as Mud? Origins of the head mirror: A historical note

‎Τρίτη, ‎14 ‎Ιουλίου ‎2015, ‏‎5:24:06 μμ | Ollivier Laccourreye, Alfred Werner, Iain McGill, F. Christopher Holsinger

ABSTRACT

In Europe, the name “Clar” immediately evokes to any otorhinolaryngologist the classic head mirror that remains a symbol of our profession. Yet, the origin of Clar has never been investigated. In this clinical and historical review, based on an Internet and PubMed database search together with perusal of Fischer’s Biographical Lexikon, the authors seek to elucidate this medical enigma. The data presented suggest that Clar was not a physician but rather a term picked by the company that designed the mirror by the end of the 19th century to underscore the bright and sharp view provided by this then innovative medical device. © 2015 Wiley Periodicals, Inc. Head Neck 38: 930–932, 2016

Improved surgical margin definition by narrow band imaging for resection of oral squamous cell carcinoma: A prospective gene expression profiling study

‎Σάββατο, ‎27 ‎Ιουνίου ‎2015, ‏‎6:56:26 πμ | Camile S. Farah, Andrew J. Dalley, Phan Nguyen, Martin Batstone, Farzaneh Kordbacheh, Joanna Perry–Keene, David Fielding

ABSTRACT

Background

Incomplete primary tumor excision contributes to localized postsurgical recurrence of oral squamous cell carcinoma (OSCC). The purpose of this study was to provide molecular evidence that surgical margin definition using narrow band imaging (NBI) resulted in more complete OSCC excision than conventional white light (WL) panendoscopy.

Methods

Molecular divergence among tumor, WL, and NBI-defined surgical margins was compared in 18 patients through microarray analysis (GeneChip U133-plus-2.0).

Results

The numbers of differentially expressed genes (NBI = 4387; WL = 3266; vs tumor) signified that NBI placed margins into less involved tissue than WL examination. Principal component analysis segregated tumor, WL, and NBI tissues appropriately based solely on mRNA profiles, and unsupervised hierarchical clustering identified 4 patients (22%) who benefited directly from NBI surgical margin definition. Gene ontology enrichment indicated increasing cell phenotypic diversity: tumor<WL<NBI.

Conclusion

Resection to NBI-defined margins will leave less dysplastic and malignant residual tissue and thereby increase ablative surgery success rates. © 2015 Wiley Periodicals, Inc. Head Neck 38: 832–839, 2016

Revisiting the argument for 1- versus 2-vein outflow in head and neck free tissue transfers: A review of 317 microvascular reconstructions

‎Τρίτη, ‎16 ‎Ιουνίου ‎2015, ‏‎4:49:44 μμ | Dustin A. Silverman, Wojciech H. Przylecki, Jill M. Arganbright, Yelizaveta Shnayder, Kiran Kakarala, Niaman Nazir, Terance T. Tsue, Douglas A. Girod, Brian T. Andrews

Abstract

Background

The purpose of this study was to determine the benefit of 1-vein versus 2-vein outflow in microvascular free tissue transfers.

Methods

A retrospective review reflects the experience of 6 surgeons. Analysis included all patients who underwent reconstruction at a single institution between January 2004 and December 2012.

Results

Three hundred nine patients underwent a total of 317 microvascular free flap reconstructions for head and neck defects. Two hundred thirteen of 317 flaps (67.2%) used 1 venous anastomosis and 104 (32.8%) used 2 venous anastomoses. Venous congestion necessitated urgent take back in 37 of 57 patients (64.9%) requiring exploration for perioperative complications. Thirty of 37 flaps (81.1%) with venous congestion had 1 vein anastomosis, whereas 7 (18.9%) had dual vein outflow (p = .03). Overall flap success was 303 of 317 (95.6%), despite an 18.0% (57 of 317) perioperative take back rate.

Conclusion

Coapting 2 veins was shown to minimize venous congestion. © 2015 Wiley Periodicals, Inc. Head Neck 38: 820–823, 2016

Carbon nanoparticle–guided central lymph node dissection in clinically node-negative patients with papillary thyroid carcinoma

‎Τρίτη, ‎16 ‎Ιουνίου ‎2015, ‏‎6:58:23 πμ | Youzhi Zhu, Xiangjin Chen, Huihao Zhang, Ling Chen, Shujun Zhou, Kunlin Wu, Zongcai Wang, Lingjun Kong, Hezhu Zhuang

ABSTRACT

Background

Distinguishing the involved lymph nodes from other tissues during surgery is critical for lymph node dissection. The purpose of this study was to assess the feasibility by using carbon nanoparticles as guidance for lymph node dissection in patients with papillary thyroid carcinoma (PTC).

Methods

Eighty-one patients were injected with carbon nanoparticles (carbon nanoparticle group), whereas the other 81 patients were not (control group). Routine pathological examination was performed.

Results

The lymph node dissection and metastatic lymph node dissection rates of the carbon nanoparticle group were significantly higher than that of the control group. In the carbon nanoparticle group, the number of mistakenly dissected parathyroid gland, the case number of postoperative hypocalcemia, the case number of postoperative hypoparathyroidism, and the recovery time from hypocalcemia were 4, 6, 8, and 2.33 ± 0.58 weeks, respectively, significantly less than 14, 17, 20, 3, and 3.8 ± 0.92 weeks in the control group (p < .05).

Conclusion

Carbon nanoparticles can be applied to more accurately guide the dissection of lymph nodes during thyroidectomy in patients with PTC. © 2015 Wiley Periodicals, Inc. Head Neck 38: 840–845, 2016

Outcomes after surgery and postoperative radiotherapy for perineural spread of head and neck cutaneous squamous cell carcinoma

‎Τετάρτη, ‎6 ‎Μαΐου ‎2015, ‏‎6:01:13 μμ | Timothy A. Warren, Benedict Panizza, Sandro V. Porceddu, Mitesh Gandhi, Parag Patel, Martin Wood, Christina M. Nagle, Michael Redmond

Abstract

Background

Queensland, Australia, has the highest rates of cutaneous squamous cell carcinoma (SCC). Perineural invasion (PNI) is associated with reduced local control and survival.

Methods

A retrospective review of a prospective database of patients with clinical PNI from cutaneous SCC of the head and neck (SCCHN) treated with surgery and postoperative radiotherapy (PORT) between 2000 and 2011 and a minimum of 24 months follow-up. Patients were excluded if immunosuppressed, had non-SCC histology, or were treated palliatively.

Results

Fifty patients (mean age, 60 years) with median follow-up of 50 months were included in this study. A total of 54.8% of known primary tumors had incidental PNI. Ten percent had nodal disease at presentation. MRI neurogram was positive in 95.8%. Recurrence-free survival (RFS) at 5-years was 62%. Five-year disease-specific survival (DSS) and overall survival (OS) were 75% and 64%, respectively. There were no perioperative deaths.

Conclusion

This report demonstrates that long-term survival is achievable in patients with clinical PNI from cutaneous SCCHN after surgery and PORT. © 2015 Wiley Periodicals, Inc. Head Neck 38: 824–831, 2016

Erratum

‎Σάββατο, ‎16 ‎Αυγούστου ‎2014, ‏‎9:12:14 πμ | Eitan Prisman, Stephan K. Haerle, Jonathan C. Irish, Michael Daly, Brett Miles, Harley H.L. Chan

Retracted: 18FDG-PET/CT computer-assisted biopsies for suspected persistent or recurrent malignant skull base disease

‎Δευτέρα, ‎12 ‎Μαΐου ‎2014, ‏‎8:00:00 πμ | Patrick Dubach, Thiago Oliveira-Santos, Stefan Weber, Nicolas Gerber, Andreas Dietz, Marco Caversaccio

Abstract

18FDG-PET/CT computer-assisted biopsies for suspected persistent or recurrent malignant skull base disease. Patrick Dubach, Thiago Oliveira-Santos, Stefan Weber, Nicolas Gerber, Andreas Dietz and Marco Caversaccio. Head & Neck. DOI: 10.1002/hed.23756
The above article, published online on 12 May 2014 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor in Chief, Ehab Y. Hanna, MD, and Wiley Periodicals, Inc. The retraction has been agreed due to potentially incomplete nuclear medicine protocol resulting in errors in the results.
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