The impact of feeding tube choice on severe late dysphagia after definitive chemoradiation for HPV-negative head and neck cancer
Matthew C Ward, Priyanka Bhateja, Tobenna Nwizu, Joann Kmiecik, Chandana A Reddy, Joseph Scharpf, Eric D. Lamarre, Brian B Burkey, John F Greskovich, David J Adelstein, Shlomo A Koyfman, 2015-08-19 10:16:43 AM
Abstract
BACKGROUND: Severe late dysphagia (SLD) is common after chemoradiation (CRT) for cancers of the larynx and oropharynx. Options for reduction of SLD are limited for HPV-negative patients. Here the role of feeding tube (FT) choice in SLD is investigated.
METHODS: Patients disease-free after CRT for HPV-negative cancers of the laryngopharynx who received a FT on-treatment were identified. The incidence of SLD after reactive nasogastric (R-NG), proactive or reactive percutaneous gastrostomy (P-PEG and R-PEG) was assessed using log-rank and Cox analyses.
RESULTS: 78 patients received a FT on-treatment and remained disease-free. Median follow-up was 64 months. The 5-year incidence of SLD was 30.8% in the R-NG cohort (n=36), 56.4% in the R-PEG (n=17, p=0.193) and 60.9% in the P-PEG (n=25, p=0.016) cohorts. On multivariate analysis, PEG feeding was independently associated with an increased rate of SLD.
CONCLUSIONS: R-NG use during chemoradiation is associated with less SLD and is preferred over PEG. This article is protected by copyright. All rights reserved.
Surgical approaches to jugular foramen schwannomas: an anatomic study
Noritaka Komune, Ken Matsushima, Toshio Matsushima, Shizuo Komune, Albert L. Rhoton, 2015-08-19 10:16:43 AM
Abstract
Background. The variety of surgical approaches to jugular schwannomas makes selection of an approach difficult. This study defined the anatomic elements of these approaches.
Methods. Ten adult cadaveric heads were examined.
Results. There are lateral, posterior, and anterior routes that access various parts of the jugular foramen. Removal of the jugular process of the occipital bone provides access to the posterior aspect of the foramen, the infralabyrinthine mastoidectomy provides access to the lateral edge and dome of the jugular bulb, and the preauricular approaches provide access to the anterior margin of the bulb and foramen. Additions to these approaches may include cervical and vertebral artery exposure, facial nerve transposition, foramen magnum exposure, and external canal and condylar resection.
Conclusions. An understanding of the anatomy of the jugular foramen is crucial in achieving total tumor removal while minimizing risk. This article is protected by copyright. All rights reserved.
Intestinal type adenocarcinoma of the ethmoid: Outcomes of a treatment regimen based on endoscopic surgery with or without radiotherapy
Piero Nicolai, Alberto Schreiber, Andrea Bolzoni Villaret, Davide Lombardi, Laura Morassi, Elena Raffetti, Francesco Donato, Paolo Battaglia, Mario Turri-Zanoni, Maurizio Bignami, Paolo Castelnuovo, 2015-08-19 10:16:43 AM
ABSTRACT
Background
The objective of this study was to assess survival, prognostic factors, and complications in a cohort of patients with intestinal-type adenocarcinoma (ITAC) treated with transnasal endoscopic surgery (ES) ± radiotherapy [RT].
Methods
Patients with ITAC who underwent ES ± RT at two tertiary centers were retrospectively reviewed. Overall (OS) and event-free (EFS) survivals were calculated, and statistically significant variables were entered in a multivariate Cox regression model. Complications were also analyzed.
Results
One-hundred-sixty-nine patients were included. Major complications occurred in 9.5% of patients. Adjuvant RT was delivered in 58.6% of patients. Five-year OS and EFS were 68.9% and 63.6%, respectively. Advanced pT classification, high grade, and positive surgical margins were independently predictive of poor survival.
Conclusions
ES ± RT is a valid treatment option in most cases of ITAC. When compared with series based on external surgery, our results support a definitive paradigm shift in the management of ITAC. This article is protected by copyright. All rights reserved.
Healthcare-associated infections in patients with head and neck cancer treated with chemotherapy and/or radiotherapy
A. Mirabile, C. Vismara, F. Crippa, P. Bossi, L. Locati, C. Bergamini, R. Granata, C. Resteghini, E. Conte, D. Morelli, P. Scarpellini, L. Licitra, 2015-08-19 10:16:43 AM
Abstract
Background:
The incidence of Healthcare-associated infections (HAIs) in head and neck (HNC) patients receiving chemotherapy (CT) and/or radiotherapy (RT) is unknown. This retrospective study investigates the most common pathogens and their antibiotic sensitivity/resistance patterns in HNC patients.
Methods:
Infection rates in HNC patients were analysed over two periods (January 2005-December 2009 and January 2010-November 2012).
Results:
In the first period, 140 HAIs were observed among 2288 admissions, mostly due to Gram-negative pathogens affecting the respiratory tract. In the second period, 212 HAIs were observed. An increase in antibiotic resistance was reported.
HAI were more frequent with: male gender, age <65 years, important comorbidities, smoking, proton pump inhibitors prophylaxis and/or central venous catheter, locally advanced disease, CT/RT, especially after the third week of treatment.
Conclusions:
HAIs increased over time, with corresponding increases in Gram-negative pathogens and resistant strains. Prevention and treatment protocols should be implemented in institutions treating HNC patients. This article is protected by copyright. All rights reserved.
Secondary tracheoesophageal puncture using transnasal esophagoscopy in gastric pull-up reconstruction following total laryngopharyngoesophagectomy
Daniel Noel, Daniel S. Fink, Melda Kunduk, Mell A. Schexnaildre, Michael DiLeo, Andrew J. McWhorter, 2015-08-19 10:16:43 AM
Abstract
Background: There is debate about the optimal voice restoration method and technique for patients who have undergone total laryngopharyngectomy, esophagectomy and gastric pull-up. We report a series of patients who underwent awake, secondary tracheo-esophageal puncture after this procedure.
Methods: A retrospective chart review was performed at a tertiary referral center. All subjects who underwent TEP placement under trans-nasal esophagoscopy (TNE) guidance between 2003 and 2013 were included.
Results: All patients underwent uncomplicated TEP in the clinic. At the time of last follow up, all patients had functional TEP speech that they were using preferentially over an available electrolarynx.
Conclusion: In-office placement of secondary TEP using TNE is an efficient means of providing a conduit for voice prostheses in patients who have undergone laryngopharyngectomy with gastric-pull up reconstruction. This procedure can be performed with minimal complications and with expectation of voice outcomes comparable to that seen with standard laryngectomy. This article is protected by copyright. All rights reserved.
International head and neck cancer epidemiology consortium: Update No. 20
Jose P. Zevallos, 2015-08-19 10:16:43 AM
Base of tongue squamous cell carcinoma with infiltrative bone marrow carcinomatosis after definitive chemoradiation: A case report
Kaitlin Christopherson, David N. Reisman, Kristianna Fredenburg, Reordan DeJesus, William M. Mendenhall, 2015-08-19 10:16:43 AM
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 local-regional control.
Results: Our patient exhibited an unusual pattern of distant dissemination after definitive chemoradiation had resulted in local-regional 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. This article is protected by copyright. All rights reserved.
Staging of early lymph node metastases with the sentinel lymph node technique and predictive factors in T1/T2 oral cavity cancer: A retrospective single-center study of 253 consecutive patients
Nicklas Juel Pedersen, David Hebbelstrup Jensen, Nora Hedbäck, Martin Frendø, Katalin Kiss, Giedrius Lelkaitis, Jann Mortensen, Anders Christensen, Lena Specht, Christian von Buchwald, 2015-08-19 10:16:43 AM
Abstract
Background: The purpose of this study was to examine the diagnostic accuracy of detecting lymph node metastases and to identify predictive and prognostic clinicopathological factors in patients with oral squamous cell carcinoma (OSCC) undergoing sentinel lymph node biopsy (SNB). Methods: All patients diagnosed with cT1-T2N0 OSCC who underwent a diagnostic SNB between 2007 and 2013 were included. Results: We identified 253 patients, of whom 27% had a positive sentinel node. The false negative rate, sensitivity and negative predictive value were 5%, 88% and 95%, respectively. Patients with micro- as well as macrometastases had a separately, significantly shorter disease-specific survival than pN0 patients. In a logistic regression model the maximum tumor thickness, perineural invasion and differentiation grade were independent predictive factors for the presence of metastases. Conclusion: These data support the use of the SNB technique as an accurate and safe staging tool in OSCC patients with a cN0 neck. This article is protected by copyright. All rights reserved.
The minimum absolute lymphocyte count during radiotherapy as a new prognostic factor for nasopharyngeal cancer
Oyeon Cho, Young-Taek Oh, Mison Chun, O Kyu Noh, Jae-sung Hoe, Hwanik Kim, 2015-08-19 10:16:43 AM
ABSTRACT
Background, The purpose of this study was to investigate whether the minimum absolute lymphocyte count during radiotherapy (min ALC) could predict clinical outcome in nasopharyngeal cancer (NPC) patients.
Methods, We analyzed 70 NPC patients including 63 patients treated with chemo-radiotherapy and used multivariate analysis to determine whether min ALC affected clinical outcome.
Results, Patients were grouped by min ALC, with a cut-off of 245 cells/μL. Five-year disease specific survival (DSS) and progression-free survival (PFS) for patients with min ALC ≥ 245 versus min ALC < 245 were 88.1% versus 60.8% (p=0.004) and 71.2% versus 35.2% (p=0.004). All 10 patients with min ALC < 120 experienced disease progression. Four of 6 patients (67%) with ALC < 120 who died experienced disease progression within 6 months.
Conclusion, Min ALC may predict poor 5-year DSS, and should be evaluated by prospective studies. This article is protected by copyright. All rights reserved.
Neutrophil-to-lymphocyte ratio and overall survival in all sites of head and neck squamous cell carcinoma
Saleh Rachidi, Kristin Wallace, John M. Wrangle, Terry A. Day, Anthony J. Alberg, Zihai Li, 2015-08-19 10:16:43 AM
Abstract
Background
Current prognostic criteria are insufficient in predicting outcomes in head and neck cancers, necessitating new, readily available biomarkers
Methods
Pretreatment neutrophil and lymphocyte counts and their ratio (NLR) were retrospectively investigated for correlation with overall survival while controlling for demographic and clinical confounders.
Results
Patients in the highest tertile of neutrophil counts and those in the lowest tertile of lymphocytes experienced shorter survival than the rest of the population. Patients in the highest tertile of the NLR were at a higher risk compared to those in the lowest tertile after multivariate analysis (HR=2.39, p=0.0001). Additionally, NLR was lower in patients with Human Papilloma Virus (HPV) positive tumors compared to HPV negative ones and predicted survival in both tumor types.
Conclusions
Neutrophil and lymphocyte counts are strong biomarkers with opposing prognostic significance and the NLR is a robust predictor of overall survival in oral, pharyngeal and laryngeal squamous cell carcinomas. This article is protected by copyright. All rights reserved.
Tumour depth of invasion of pT1 squamous cell carcinoma of the oral tongue and risk of pathologically detected neck metastases
Muammar Abu-Serriah, Ketan A. Shah, Ramanan Rajamanohara, Adekunmi Fasanmade, Jennifer Graystone, Stephen Gerry, Stephen Bond, 2015-08-19 10:16:43 AM
Abstract
Background: Tumour depth of invasion (TDI) is considered a predictor of pathologically detected neck metastases (PDNM) for squamous cell carcinoma (SCC), but different investigators have arrived at different cut-off of TDI. However, the relationship between TDI of pT1 SCC of the oral tongue and PDNM remains unknown.Methods: Data was collected for patients with pT1SCC of the oral tongue. TDI, neurovascular invasion, pattern of invasion and presence of PDNM were recorded. The relationship between data was studied using logistic regression and ROC methods. Results: With all other factors held constant, data showed that the odds ratio for each millimetre increase in TDI and risk of PDNM was 1.09 (95% CI: 0.95 – 1.25, p = 0.234), which was insignificant. Conclusion: TDI is not accurate and cannot be used as predictor of PDNM in patients with pT1 SCC of the tongue. Further, true TDI can only be assessed on resection specimens. This article is protected by copyright. All rights reserved.
Overview of Surgery for Oral Cavity Cancer in Ontario
Antoine Eskander, Jonathan Irish, Patrick Gullane, Ralph Gilbert, John R. de Almeida, Jeremy Freeman, Meredith Giuliani, David R. Urbach, David P. Goldstein, 2015-08-19 10:16:43 AM
ABSTRACT
Background: The objective of this study was to describe variations in incidence and resection rates of patients with oral cavity cancer in Ontario.
Methods: All squamous cell cancers of the oral cavity in Ontario between 2003 -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 OCSCC was 21.3 per 100,000 with variations by sex, age group, neighborhood income and community size. 74% 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.
Conclusions: 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. This article is protected by copyright. All rights reserved.
Complications following CO2 laser surgery for early glottic cancer: an institutional experience
Migie Lee, Malcolm A. Buchanan, Faruque Riffat, Carsten E. Palme, 2015-08-19 10:16:43 AM
Abstract
Background: Trans-oral laser microsurgery (TLM) of the glottis is increasingly utilized in the current management of early glottic cancer, its advantages being administrative ease, potential to be repeated, ability to keep radiotherapy and open laryngeal surgery available as salvage options, and low complication rates.Methods: A retrospective chart review of prospectively-gathered data on all patients over a 10-year period who had undergone TLM for Tis or early (T1-2) glottic squamous cell carcinomas was analyzed, to examine the complications experienced. Results: Of 132 patients undergoing TLM, complications were: edema requiring tracheostomy (1), surgical emphysema (1), pharyngeal bruising (1), endotracheal tube cuff perforation (1), anterior glottic web (14), vocal cord granuloma (14), laryngocele (1) and none of airway fire or intra- or post-operative hemorrhage. Conclusions: Our results suggest that for early glottic cancers, and in skilled hands, with appropriate anesthetic and theater staff support, TLM is a safe and repeatable procedure. This article is protected by copyright. All rights reserved.
The therapeutic role of ultrasound-guided intranodal lymphangiography in refractory cervical chylous leakage following neck dissection-Report of a case and review of literature
Chia-Yu Chen, Yu-Hung Chen, En-Li Shiau, Hui-Lung Liang, Hao-Sheng Chang, Hung-Chih Chen, 2015-08-19 10:16:43 AM
ABSTRACT
Background: Chylous leakage is a well-recognized but rare complication of head-and-neck surgery, affecting 1∼2.5% of head-and-neck dissections. It is a potentially life-threatening condition characterized by electrolyte imbalance, immunosuppression, delayed wound healing, risk of infection and generalized sepsis. Management can be problematic and prolonged.
Methods: We present a case of refractory cervical chylous leakage following neck dissection treated with ultrasound-guided intranodal lymphangiography.
Results: Ultrasound-guided intranodal lymphangiography alone resulted in rapid and complete resolution of chylous leakage with minimal morbidity.
Conclusions: Based on our clinical experience and following a thorough literature review, we propose that ultrasound-guided intranodal lymphangiography with contrast agent could be considered a viable therapeutic option for persistent chylous leakages in selected patients. This article is protected by copyright. All rights reserved.
Predictive factors for difficult robotic thyroidectomy using bilateral axillo-breast approach
Hee Yong Kwak, Hoon Yub Kim, Hye Yoon Lee, Seung Pil Jung, Sang Uk Woo, Gil Soo Son, Jae Bok Lee, Jeoung Won Bae, 2015-08-19 10:16:43 AM
ABSTRACT
Background This article is protected by copyright. All rights reserved.
Guideline recommended follow-up and surveillance of head and neck cancer survivors
Benjamin R. Roman, David Goldenberg, Babak Givi, , 2015-08-19 10:16:43 AM
Abstract
In this first paper of the "Do You Know Your Guidelines" series, we review National Comprehensive Cancer Network (NCCN) recommendations and underlying evidence for the follow-up and surveillance of head and neck cancer survivors. The goals of follow-up and surveillance care are to 1) Maximize long-term oncologic outcomes of therapy with appropriate evaluation for recurrence; 2) Maximize functional and quality of life outcomes, while 3) Minimizing unnecessary and harmful low-value care. Finding the right balance of testing and surveillance is a challenge for providers and patients. Herein we review all NCCN recommendations for head and neck cancer survivors. We pay particular attention to an area of controversy: the use of ongoing surveillance imaging, in particular PET/CT scans. This article is protected by copyright. All rights reserved.
Do you know your guidelines? An initiative of the American Head and Neck Society's Education Committee
Matthew C. Miller, David Goldenberg, , 2015-08-19 10:16:43 AM
Abstract
The following paper is an introduction to a new series to be published periodically in Head and Neck. This series is an initiative of the American Head and Neck Society's Education Committee and will review clinical practice guidelines for head and neck oncology. The primary goal is to increase awareness of current best practices pertaining to head and neck surgery and oncology. Through this process, we will also review the evidence in support of guideline recommendations and will present recent literature and/or innovations germane to each topic. This article is protected by copyright. All rights reserved.
EGFR inhibitors in recurrent metastatic cancer of the head and neck
Krzysztof Misiukiewicz, Rajan P Dang, Michael Parides, Nadia Camille, Helen Uczkowski, Nicholas Sarlis, Marshall Posner, 2015-08-19 10:16:43 AM
Abstract
Targeted therapy has become an important new class of therapeutic agents used in squamous cell carcinoma of the head and neck (SCCHN). Among them epidermal growth factor receptor (EGFR) inhibitors have been studied the most. Today, two classes of EGFR inhibitors are routinely used in the clinic: anti-EGFR monoclonal antibodies and small-molecule inhibitors of the EGFR tyrosine kinase activity. These agents have been used clinically in the recurrent metastatic (R/M) settings but only cetuximab has reached a regulatory approval. Current research is focused on innovative compound design, predictive biomarker discovery, and combination strategies in order to overcome resistance. Efforts should also be focused on endpoints other than overall survival, which is the current gold standard, such as surrogate endpoints. This article summarizes the clinical evidence of the anticancer activity of EGFR inhibitors in patients with R/M SCCHN, and analyzes the current, controversial clinical issues with respect to their interpretation. This article is protected by copyright. All rights reserved.
PENTOCLO: A novel treatment for osteoradionecrosis of the temporal bone
Jordan T Glicksman, Sammy Khalili, Kevin Fung, Lorne S Parnes, Sumit K Agrawal, 2015-08-19 10:16:43 AM
Abstract
Background:
Osteoradionecrosis (ORN) of the temporal bone is a complication of radiation therapy that is extremely challenging to manage.
Methods:
We report the case of a patient treated at our institution and present a review of literature.
Results:
A 52 year old woman presented with ORN of the temporal bone 20 years following radiation therapy for an ipsilateral parotid tumor. She failed conservative management including serial debridements, oral and topical antibiotics/antifungals, and aural lavage. As an alternative to hyperbaric oxygen and/or temporal bone resection, treatment with PENTOCLO was pursued and her condition improved dramatically.
Conclusions:
This is the first document use of PENTOCLO to treat ORN of the temporal bone. PENTOCLO may represent an effective non-surgical management option for ORN of the temporal bone. This article is protected by copyright. All rights reserved.
Predictors and costs of readmissions at an academic head and neck surgery service
Peter T Dziegielewski, Brian Boyce, Amy Manning, Amit Agrawal, Matthew Old, Enver Ozer, Theodoros N. Teknos, 2015-08-19 10:16:43 AM
Abstract
Background: Healthcare metrics, such as readmission rates, are being scrutinized to improve quality and decrease cost of care. This study aimed to determine the (1)rate, (2)predictors of and (3)costs of 30-day unplanned readmissions(30dUR) in head and neck surgery patients.
Methods: All patients undergoing head and neck surgery at the Ohio State University from July 1, 2011–June 30, 2012 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to identify risk factors for 30dUR.
Results: 607 patients underwent 660 operations. 48(7.3%) cases had a 30dUR. Significant independent risk factors for readmissions included: coronary artery disease[OR=2.80; CI=1.3-5.9]], chronic renal failure[OR=3.56; CI=1.5-8.5]], not attending pre-operative clinic[OR=2.74; CI=1.2-6.3], length of stay>5 days[OR=3.19; CI=1.6-6.5]], and presence of a gastrostomy tube[OR=2.75; CI=1.3-5.8].The total cost of 30dURs was $1.68 million.
Conclusion: 30dUR in head and neck surgery patients can be low, but costly. Identifying patients at risk for 30dUR will help develop preventative strategies. This article is protected by copyright. All rights reserved.
Tumor deposits in head and neck carcinomas
Sulen Sarioglu, Resident Nilhan Akbulut, Selen Iplikci, Barbaros Aydin, Ersoy Dogan, Mehtat Unlu, Hulya Ellidokuz, Emel Ada, Fadime Akman, Ahmet Omer Ikiz, 2015-08-19 10:16:43 AM
Abstract
Background: Tumor deposits, nodules in the peritumoral adipose tissue with no architectural residue of lymph node, have previously been described in colorectal adenocarcinomas. To date, however, there has been no examination of tumor deposits in head and neck squamous cell carcinoma (HNSCC)
Methods: Neck dissection specimens of 140 patients with HNSCC were re-evaluated for tumor deposits.
Results: Tumor deposits were detected in 24 cases (17%). Cases with tumor deposits had more lymphatic invasion (p=0.007), higher pathological N classification (p=0.00), and more frequently showed distant metastasis (p=0.003). Disease-free and overall survival were significantly shorter for tumor deposit positive cases (p=0.016, p=0.005). Only tumor deposits were significant for over-all survival. Tumor deposits increased the risk of recurrent disease 2,294 times. Tumor deposits and pericapsular invasion were identified as independent prognostic markers; tumor deposits increased the risk of death from disease 3.4 times, while pericapsular invasion was associated with a 2.2-fold increase in the risk of death.
Conclusions: These results highlight the existence of tumor deposits in neck dissection specimens of HNSCC and their association with poor prognosis. This article is protected by copyright. All rights reserved.
Hospital re-admission and 30-day mortality following surgery for oral cavity cancer: Analysis of 21,681 cases
Alexander L. Luryi, Michelle M. Chen, Saral Mehra, Sanziana A. Roman, Julie A. Sosa, Benjamin L. Judson, 2015-08-19 10:16:43 AM
Abstract
Background: Oral cavity squamous cell cancer (OCSCC) is treated primarily with surgery. Rates of 30-day hospital readmission and mortality after surgery for OCSCC are unknown.
Methods: Retrospective analysis of postoperative 30-day unplanned readmission and mortality in patients with OCSCC in the National Cancer Data Base.
Results: Among 21,681 cases, the 30-day unplanned readmission rate was 3.2%, and the 30-day mortality rate was 1.0%. Male gender (OR 1.23, p=0.02), stage T3 (OR 1.55, p=0.007) or T4 (OR 1.52, p=0.002), and neck dissection (OR 1.37, p=0.04) were independently associated with readmission. Age 76-85 years (OR 4.80,p<0.001), age > 85 years (OR 10.24, p<0.001), comorbidity index ≥1 (OR 2.31, p<0.001), and stage T3 (OR 3.02, p<0.001) or T4 (OR 3.24, p<0.001) were associated with 30-day mortality.
Conclusions: Interventions aimed at decreasing hospital readmissions should target high-risk patients identified here. Factors associated with 30-day mortality reflect risk factors for overall mortality. This article is protected by copyright. All rights reserved.
Retracted: 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, Marco Caversaccio, 2015-08-19 10:16:43 AM
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.
Oncologic safety of facial artery myomucosal flaps in oral cavity reconstruction
Silvano Ferrari, Andrea Ferri, Bernardo Bianchi, Andrea Varazzani, Francesco Giovacchini, Enrico Sesenna, 2015-08-19 10:16:43 AM
Abstract
Background
Buccinator myomucosal flaps are routinely used for oral cavity reconstruction and are indicated mainly in patients classified as having stage N0 cancer. This purpose of this study was to investigate whether preservation of the vascular pedicle of the flap (facial artery and vein) during stadiative neck dissection alters the oncologic safety in these patients.
Methods
Fifty patients underwent resection of T1 to 3, N0 squamous cell carcinoma of the tongue or floor of the mouth, stadiative neck dissection, and reconstruction with a facial artery musculomucosal (FAMM) flap were retrospectively analyzed concerning rate of occult neck metastasis and recurrences.
Results
Occult metastasis was detected in 10 patients. Mean follow-up was 41 months. The overall survival rate was 88%, and the disease-specific survival rate was 92%.
Conclusion
Neck dissection with preservation of the facial artery and vein does not alter the rate of regional recurrences, confirming the oncologic safety of myomucosal flaps in oral cavity reconstruction. © 2015 Wiley Periodicals, Inc.Head Neck, 2015
Metastatic synovial sarcoma of the scalp: Case report
Dylan C. Lippert, Christopher J. Britt, Zachary E. Pflum, Patrick S. Rush, Gregory K. Hartig, 2015-08-19 10:16:43 AM
Abstract
Background
Synovial sarcoma is a malignant tumor of soft tissue that is rarely found in the head and neck. Even less common are metastasis within the head and neck.
Methods
We describe a case of a delayed metastatic synovial sarcoma to the scalp. A man who had been diagnosed and treated 16 years previously for monophasic synovial sarcoma of the groin, presented with a new scalp lesion confirmed to be metastatic monophasic synovial sarcoma. Wide local excision and sentinel lymph node biopsy (SLNB) were performed and adjuvant radiation therapy was deferred.
Results
A positron emission tomography (PET)/CT was obtained 3 months after surgery and showed no evidence of local recurrence or metastatic disease.
Conclusion
This case report describes a rare case of synovial sarcoma metastasizing to the scalp. The genetic, histopathologic, and clinical features of synovial sarcoma are reviewed with a focus on their manifestation and management within the head and neck. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Establishment of a bioluminescence model for microenvironmentally induced oral carcinogenesis with implications for screening bioengineered scaffolds
Salwa Suliman, Himalaya Parajuli, Yang Sun, Anne Christine Johannessen, Anna Finne–Wistrand, Emmet McCormack, Kamal Mustafa, Daniela Elena Costea, 2015-08-19 10:16:43 AM
Abstract
Background
Microenvironmental cues play a major role in head and neck cancer. Biodegradable scaffolds used for bone regeneration might also act as stimulative cues for head and neck cancer. The purpose of this study was to establish an experimental model for precise and noninvasive evaluation of tumorigenic potential of microenvironmental cues in head and neck cancer.
Methods
Bioluminescence was chosen to image tumor formation. Early neoplastic oral keratinocyte (DOK) cells were luciferase-transduced (DOKLuc), then tested in nonobese diabetic severe combined immunodeficient IL2rγnull mice either orthotopically (tongue) or subcutaneously for their potential as "screening sensors" for diverse microenvironmental cues.
Results
Tumors formed after inoculation of DOKLuc were monitored easier by bioluminescence, and bioluminescence was more sensitive in detecting differences between various microenvironmental cues when compared to manual measurements. Development of tumors from DOKLuc grown on scaffolds was also successfully monitored noninvasively by bioluminescence.
Conclusion
The model presented here is a noninvasive and sensitive model for monitoring the impact of various microenvironmental cues on head and neck cancer in vivo. © 2015 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck, 2015
68Ga-DOTA-peptide: A novel molecular biomarker for nasopharyngeal carcinoma
Lih Kin Khor, Hoi Yin Loi, Arvind Kumar Sinha, Kian Ti Tong, Boon Cher Goh, Kwok Seng Loh, Suat-Jin Lu, 2015-08-19 10:16:43 AM
Abstract
Background
Increased somatostatin receptor (SSTR) expression in patients with undifferentiated nasopharyngeal carcinoma (NPC) has been demonstrated with receptor autoradiography, 111In-Octreotide scintigraphy, and 68Ga-DOTA-TOC positron emission tomography (PET)/CT imaging. We sought to compare and correlate the uptake of fluorodeoxyglucose (FDG) and DOTA-NOC in undifferentiated NPC to ascertain the possible role of 68Ga-DOTA-NOC PET/CT as a new imaging biomarker and to assess whether targeted peptide receptor radionuclide therapy is a feasible treatment option.
Methods
After obtaining approval from our institutional review board, 4 patients with biopsy proven nonkeratinizing undifferentiated NPC who had just undergone routine staging/restaging 18F-FDG PET/CT imaging were prospectively and consecutively recruited for 68Ga-DOTA-NOC PET/CT imaging. Of these 4 patients, 3 were newly diagnosed with untreated NPC, whereas 1 patient was diagnosed with a case of recurrent NPC with previous treatment. These patients subsequently underwent 68Ga-DOTA-NOC PET/CT within 10 days from the 18F-FDG PET/CT to ensure lesion comparability. Tracer uptake in tumor lesions were assessed visually and semiquantitatively by measuring maximum standardized uptake values (SUVmax).
Results
There were 12 FDG-avid lesions of which 7 showed avid uptake of DOTA-NOC greater than liver uptake, whereas 5 showed low uptake of DOTA-NOC less than liver uptake. Subset analysis of the FDG-avid lesions at the primary and recurrent sites showed that all the FDG-avid primary tumors in the nasopharynx showed avid uptake of DOTA-NOC. On the contrary, the case of recurrent NPC showed avid FDG uptake but low DOTA-NOC uptake. Subset analysis of the suspicious FDG-avid cervical lymph nodes showed that 50% of them demonstrated avid DOTA-NOC uptake greater than liver uptake, whereas the remaining demonstrated low-grade DOTA-NOC uptake less than liver uptake. The 2 subcentimeter cervical lymph nodes that showed low-grade uptake of FDG lower than mediastinal blood pool activity were deemed to be reactive/inflammatory and showed low-grade uptake of DOTA-NOC.
Conclusion
This study highlights the potential of 68Ga-DOTA-peptide PET/CT as a new molecular biomarker for newly diagnosed undifferentiated NPC, and less so for recurrent NPC and metastatic nodes. This potentially opens up new diagnostic and therapeutic options in the management of undifferentiated NPC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Evaluation of individual sensitivity of head and neck squamous cell carcinoma to cetuximab by short-term culture of tumor slices
Marine Peria, Jérôme Donnadieu, Caroline Racz, Jean-Fortuné Ikoli, Antoine Galmiche, Bruno Chauffert, Cyril Page, 2015-08-19 10:16:43 AM
ABSTRACT
Background
Cetuximab is a targeted therapy with demonstrated efficacy in the management of head and neck squamous cell carcinoma (HNSCC). However, no laboratory assay is available to predict its efficacy in an individual patient.
Methods
Short-term cultures of tumor slices were performed on 9 tumor samples obtained after surgical resection in patients. Cancer cell proliferation was evaluated by immunohistochemistry and the impact of cetuximab on cell proliferation was examined.
Results
Tumor architecture and the heterogeneous composition of HNSCC were preserved for at least 48 hours during short-term culture of tumor slices. HNSCC cells demonstrated a heterogeneous individual response to cetuximab.
Conclusion
Short-term culture of tumor slices is a strategy to estimate the clinical activity of cetuximab in individual patients with HNSCC. Further studies are required to correlate the results obtained with the clinical response of individual patients to cetuximab. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Improving guideline sensitivity and specificity for the identification of proactive gastrostomy placement in patients with head and neck cancer
Teresa E. Brown, Jane Crombie, Ann-Louise Spurgin, Lee Tripcony, Jacqui Keller, Brett G. M. Hughes, Graeme Dickie, Lizbeth Moira Kenny, Robert A. Hodge, 2015-08-19 10:16:43 AM
Abstract
Background
Swallowing and nutrition guidelines for patients with head and neck cancer are available for identification of proactive gastrostomy placement in patients with high nutritional risk. The purpose of this study was to investigate improvements to the validity of these guidelines.
Methods
A multivariate analysis was fitted to the original dataset (n = 501) to examine the variables that may predict gastrostomy placement (eg, tumor site, treatment, sex, and age). Using these factors, the high risk category was modified and retrospectively validated in the same cohort to provide new measures of sensitivity and specificity.
Results
The following were positive predictors of gastrostomy placement: T3 (p = .01), T4 (p < .001), and chemoradiotherapy (p < .001). Laryngeal (p = .02) and skin cancer (p < .001) were negative predictors. Modification of the high risk definition improved sensitivity to 58% and maintained specificity at 92%.
Conclusion
Minor modifications to the high risk definition in the guidelines have improved the guideline sensitivity for future use. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Getting personal: Head and neck cancer management in the era of genomic medicine
Andrew C. Birkeland, Wendy R. Uhlmann, J. Chad Brenner, Andrew G. Shuman, 2015-08-19 10:16:43 AM
Abstract
Background
Genetic testing is rapidly becoming an important tool in the management of patients with head and neck cancer. As we enter the era of genomics and personalized medicine, providers should be aware of testing options, counseling resources, and the benefits, limitations, and future of personalized therapy.
Methods
This article offers a primer to assist clinicians treating patients in anticipating and managing the inherent practical and ethical challenges of cancer care in the genomic era.
Results
Clinical applications of genomics for head and neck cancer are emerging. We discuss the indications for genetic testing, types of testing available, implications for care, privacy/disclosure concerns, and ethical considerations. Hereditary genetic syndromes associated with head and neck neoplasms are reviewed, and online genetics resources are provided.
Conclusion
This article summarizes and contextualizes the evolving diagnostic and therapeutic options that impact the care of patients with head and neck cancer in the genomic era. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Metastatic lymph node status in the central compartment of papillary thyroid carcinoma: A prognostic factor of locoregional recurrence
Young Min Park, Soo-Geun Wang, Jin-Choon Lee, Dong Hoon Shin, In-Ju Kim, Seok-Man Son, Mijin Mun, Byung-Joo Lee, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to present our focus on the lymph node status in the central compartment and evaluate the relevant factors and disease recurrence.
Methods
Between January 2004 and December 2009, 1040 patients were diagnosed with papillary thyroid carcinoma (PTC) and underwent surgery.
Results
The number of metastatic lymph nodes was a significant predictor for recurrence conferring a hazard ratio of 1.36 (confidence interval = 1.103–1.680; p = .004). The receiver operating characteristic (ROC) curve was calculated to determine the cutoff number of lymph nodes that predicted recurrence with the highest sensitivity and specificity (area under the ROC curve, 0.794; SE, 0.077; p = .001). The sensitivity/specificity of >3 metastatic lymph nodes for predicting recurrence was 63.6%/77.0%, respectively.
Conclusion
The number of metastatic lymph nodes in the central compartment was a statistical significant predictive factor associated with disease recurrence. Further study is required to confirm the relationship between the number of lymph nodes and disease recurrence. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Grade of dysplasia and malignant transformation in adults with premalignant laryngeal lesions
Annelienke M. van Hulst, Wouter Kroon, Evi S. van der Linden, Lily Nagtzaam, Sarah R. Ottenhof, Inge Wegner, Amy C. Gunning, Wilko Grolman, Weibel Braunius, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this systematic review was to determine the significance of the grade of dysplasia in the development of invasive carcinoma.
Methods
A systematic search was performed to identify all relevant evidence. Titles and abstracts were screened using predefined criteria. Remaining articles were critically appraised. Absolute risks and 95% confidence intervals (CIs) were calculated.
Results
Seven articles were included. Four studies demonstrated an increased risk for the development of laryngeal carcinoma from mild, moderate, and severe dysplasia. Three studies showed an increased risk between the categories of mild and moderate dysplasia.
Conclusion
The risk of malignant transformation seems to increase with the grade of dysplasia, although percentages between studies are highly dissimilar. The wide variety and overlapping 95% CIs make it difficult to formulate a strong recommendation. However, moderate dysplasia is more prone for malignant transformation than previously thought, which might influence follow-up and treatment decisions in the future. © 2015 Wiley Periodicals, Head Neck, 2015
Obesity and perioperative complications in head and neck free tissue reconstruction
Gabriel de la Garza, Oleg Militsakh, Aru Panwar, Tabitha L. Galloway, Jeffrey B. Jorgensen, Levi G. Ledgerwood, Katelyn Kaiser, Collin Kitzerow, Yelizaveta Shnayder, Colin A. Neumann, Samir S. Khariwala, W. Chad Spanos, Nitin A. Pagedar, 2015-08-19 10:16:43 AM
Abstract
Background
Free tissue transfer is a mainstay in reconstruction of complex head and neck defects. The purpose of this study was to determine if perioperative complications were more common in patients with body mass index (BMI) >30 kg/m2 undergoing free flap reconstruction.
Methods
A multi-institutional retrospective cohort was created. Medical complications, surgical complications, and procedural variables were recorded. Logistic regression was used to investigate univariate and multivariate associations between outcomes and predictors.
Results
Of 582 cases, 128 patients (22%) had BMI >30. Surgical complications occurred in 153 cases (26.3%), with an adjusted odds ratio (OR) for association of surgical complications with BMI >30 of 0.92 (p = .71). Medical complications occurred in 178 cases (30.6%), with an adjusted OR of 0.78 (p = .26). Age and advanced comorbidity status (Adult Comorbidity Evaluation-27 [ACE-27] 2 or 3) were associated with medical complications (p < .0001).
Conclusion
BMI >30 does not predict medical or surgical complications in patients undergoing head and neck free flap surgery. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
BRAF V600E mutation: Differential impact on central lymph node metastasis by tumor size in papillary thyroid carcinoma
Seo Ki Kim, Jun Ho Lee, Jung-Woo Woo, Inhye Park, Jun-Ho Choe, Jung-Han Kim, Jee Soo Kim, 2015-08-19 10:16:43 AM
Abstract
Background
The necessity of prophylactic central neck dissection is one of debating issues in the treatment of papillary thyroid carcinoma (PTC). In a previous study, the predictive value of BRAF mutation for lymph node metastasis was only significant in 0.5 to 1.0 cm PTC. Thus, we assess the predictive value of BRAF mutation for central lymph node metastasis according to tumor size.
Methods
Medical records of 3107 patients with PTC who underwent thyroidectomy with central neck dissection were retrospectively reviewed.
Results
BRAF mutation was a predictor for central lymph node metastasis in 2.0 to 4.0 cm PTC (odds ratio [OR] = 3.494;p = .002). Although BRAF mutation was associated with central lymph node metastasis in 0.5 to 1.0 cm PTC in univariate analysis (OR = 1.334; p = .047), this significance was not observed in multivariate analysis (OR = 1.232; p = .163). BRAF mutation was not associated with central lymph node metastasis in other tumor sizes.
Conclusion
Prophylactic central neck dissection could be considered in 2.0 to 4.0 cm PTC with positive BRAF mutation. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Institution-specific risk of papillary thyroid carcinoma in atypia/follicular lesion of undetermined significance
Jonathan M. Bernstein, Manish Shah, Christina MacMillan, Jeremy L. Freeman, 2015-08-19 10:16:43 AM
Abstract
Background
The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) is used in surgical decision-making according to malignancy risk in each category. Malignancy risk in atypia/follicular lesion of undetermined significance (AUS/FLUS) is estimated in BSRTC to be 5% to 15%, but institutional data have varied widely.
Methods
We conducted A post-BSRTC 4-year retrospective analysis of index thyroid nodule cytology and histopathology in an academic head and neck endocrine surgery setting.
Results
Of 2939 thyroid cytology reports from 1944 patients, the most advanced BSRTC category was AUS/FLUS in 233 patients (12.0%) of which 187 went to thyroidectomy. In AUS/FLUS, the upper and lower boundary estimates of the malignancy rate were 46% and 37%, accordingly. The malignancy rate did not vary significantly by cytopathologist or cytopathologic features.
Conclusion
Malignancy rates in AUS/FLUS vary by institution from 6% to 46%. Given the subjective nature of thyroid cytopathology and interpretation of the BSRTC categories, guidelines should encourage the use of institution-specific data on malignancy risk in treatment decisions. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Reirradiation for second primary or recurrent cancers of the head and neck: Dosimetric and outcome analysis
Shivank Garg, Jeremy M. Kilburn, John T. Lucas, David Randolph, James J. Urbanic, William H. Hinson, William T. Kearns, Mercedes Porosnicu, Kathryn Greven, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to examine outcomes, toxicity, and dosimetric characteristics of patients treated with reirradiation for head and neck cancers.
Methods
Fifty patients underwent ≥2 courses of radiation therapy (RT) postoperatively or definitively with or without chemotherapy. Composite dose volume histograms (DVHs) for selected anatomic structures were correlated with grade ≥3 late toxicity.
Results
Median initial and retreatment radiation dose was 64 and 60 Gy, respectively. Median overall survival (OS), progression-free survival (PFS), and 1-year PFS rates were 18 months, 11 months, and 45%, respectively, with 13 months median follow-up. Thirty-four percent of patients experienced grade ≥3 late toxicity with 1 death from carotid blowout. The DVH corresponding to the carotid blowout fell above the third quartile compared with other patients.
Conclusion
Our analysis is the first to systematically evaluate the dose to the carotid artery using composite dosimetry in head and neck reirradiation patients, and demonstrates a promising technique for evaluating the dose to other normal tissue structures. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Use of negative pressure wound therapy with instillation in the management of cervical necrotizing fasciitis
Jonathan K. Frankel, Rod P. Rezaee, Donald J. Harvey, Evan R. McBeath, Chad A. Zender, Pierre Lavertu, 2015-08-19 10:16:43 AM
ABSTRACT
Background
Cervical necrotizing fasciitis is an aggressive infection that can be rapidly fatal if aggressive therapies are not initiated early. Negative pressure wound therapy has been established as an effective tool in promoting wound healing, but its use in the acutely infected wound has been avoided because it limits frequent irrigations and standard dressing changes.
Methods
We discuss a novel application of negative pressure wound therapy with instillation in an immunocompromised patient with extensive cervical necrotizing fasciitis.
Results
The negative pressure wound therapy with instillation provided pain relief by minimizing the frequency of dressing changes, increased the speed of healing, helped to control infection, and facilitated the development of a healthy wound bed sufficient for reconstruction with a split thickness skin graft.
Conclusion
The role of negative pressure wound therapy with instillation continues to expand and can be used in the management of both acute and chronic wounds in the head and neck. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Oral squamous cell carcinoma of the tongue: Prospective and objective speech evaluation of patients undergoing surgical therapy
Max Riemann, Christian Knipfer, Maximilian Rohde, Werner Adler, Maria Schuster, Elmar Noeth, Nico Oetter, Nima Shams, Friedrich-Wilhelm Neukam, Florian Stelzle, 2015-08-19 10:16:43 AM
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, 2015
Identifying outcome predictors of transoral laser cordectomy for early glottic cancer
Caroline Hoffmann, Stéphane Hans, Babak Sadoughi, Daniel Brasnu, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to determine the predictors of outcomes in patients with early glottic cancer treated by transoral laser cordectomy.
Methods
This was an inception cohort study of 201 patients with early glottic cancer who were treated by transoral laser cordectomy. Five-year Kaplan–Meier analyses were realized.
Results
Patients with anterior commissure involvement (n = 75) had a significantly lower disease-free survival (DFS) rate (54.6% vs 79.8%; p = .0004), ultimate local control with laser alone rate (71.0% vs 95.7%; p < .0001), laryngeal preservation rate (91.6% vs 100%; p = .0003), and disease-specific survival (DSS) rate (90.8% vs 99.0%; p = .03). There was no significant difference in overall-survival (OS) rates (76.9% vs 88.5%; p = .29). Surgical margin status was not found to be a significant predictor of outcomes in this series.
Conclusion
Although anterior commissure involvement has a significant impact on outcomes, laser cordectomy remains a valuable option considering its high organ preservation and survival rates. In cases of local recurrence, all standard further treatment options remain available. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Head and neck free flap surgical site infections in the era of the Surgical Care Improvement Project
Bharat B. Yarlagadda, Daniel G. Deschler, Debbie L. Rich, Derrick T. Lin, Kevin S. Emerick, James W. Rocco, Marlene L. Durand, 2015-08-19 10:16:43 AM
Abstract
Background
Compliance with Surgical Care Improvement Project (SCIP) parameters regarding antibiotic prophylaxis may affect surgical site infection rates. The purpose of this study was for us to report SCIP compliance, surgical site infection rates, and risk factors in a large series of head and neck free flap surgeries.
Methods
A retrospective review of 480 free flap cases was performed. Surgical site infections occurring within 30 days postoperatively were noted.
Results
Surgical site infection occurred in 13.3% of cases. Prophylaxis was given in 99.8% of cases; ampicillin-sulbactam (83%) and clindamycin (9%) were most common. Prophylaxis was "on-time" in 92.3% of cases. There were no significant associations between surgical site infection and tumor stage, American Society of Anesthesiologists (ASA) classification, tumor subsite, or flap type. Prior radiation was a risk factor for surgical site infection in patients treated for malignancy.
Conclusion
A surgical site infection rate of 13.3% was noted. In this cohort, with a compliance rate with prophylactic antibiotic measures, prior radiation was found to be a risk factor only in patients with cancer. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
A prospective study of positron emission tomography for evaluation of neck node response 6 weeks after radiotherapy in patients with head and neck squamous cell carcinoma
Johanna Sjövall, Peter Wahlberg, Helen Almquist, Elisabeth Kjellén, Eva Brun, 2015-08-19 10:16:43 AM
ABSTRACT
Background
The purpose of this study was to evaluate if a positron emission tomography (PET) scan, 6 weeks after radiotherapy (RT), adequately selects patients in whom a neck node dissection can be omitted. Primary endpoints were isolated neck recurrences and overall survival (OS).
Methods
One hundred five patients, mainly with oropharyngeal human papillomavirus (HPV)-positive tumors, with a positive PET scan before treatment, were evaluated regarding the neck response 6 weeks post-RT. The PET results determined the management of the neck: observation versus neck dissection.
Results
Median follow-up was 25 months. Positive predictive value (PPV) and negative predictive value (NPV) were 56% and 94%, respectively. Four isolated neck recurrences occurred. The 2-year OS rate was 86.3%.
Conclusion
PET scans performed 6 weeks after RT have a high NPV and can obviate neck dissections but the PPV is insufficient. A later scheduled scan is recommended. © 2015 Wiley Periodicals © 2015 Wiley Periodicals, Inc.Head Neck, 2015
Head and neck second primary cancer rates in the human papillomavirus era: A population-based analysis
Dayssy Alexandra Diaz, Isildinha M. Reis, Donald T. Weed, Nagy Elsayyad, Michael Samuels, Matthew C. Abramowitz, 2015-08-19 10:16:43 AM
Abstract
Background
Patients with head and neck cancer are at high risk for second primary malignancies. Human papillomavirus (HPV)-driven tumors are generally high-grade oropharyngeal cancers. We analyzed the incidence of second primary malignancy of the head and neck in patients with primary squamous cell carcinoma (SCC) of the head and neck and temporal trends in the HPV era.
Methods
The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with SCC of the head and neck (range, 1973–2008). Cumulative incidence rates of second primary malignancy of the head and neck were compared based on competing risk analysis.
Results
A total of 104,639 cases were included in this study, of which 4616 patients had second primary malignancy of the head and neck. Oropharyngeal cancer incidence increased over time. Estimated incidence rate/10,000 person-years (105.5, 80.6, and 50.2 for 1973–1989, 1990–1999, and 2000–2008, respectively) and cumulative incidence rates (10-year rates of 6.68%, 5.72%, and 4.59% for 1973–1989, 1990–1999, and 2000–2008, respectively) of second primary malignancies of the head and neck for patients with oropharyngeal cancer decreased over time (p < .001). The second primary malignancy of the head and neck incidence rate was significantly lower in patients with high-grade oropharyngeal cancer from 2000 to 2008 (30.3 vs 65.5 and 54.6 from 1973–1989 and 1990–1999, respectively; p < .001).
Conclusion
The incidence of second primary malignancy of the head and neck in patients with head and neck cancer has decreased over time. This is driven by lower rates in patients with high-grade oropharyngeal cancer, is temporally related with increases in HPV-associated oropharyngeal cancer, and suggests that incidence rates of second primary malignancy of the head and neck may be lower for HPV-associated cancer. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Clinical outcomes in elderly patients with human papillomavirus–positive squamous cell carcinoma of the oropharynx treated with definitive chemoradiation therapy
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, 2015-08-19 10:16:43 AM
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, 2015
Oral lichen planus patients exhibit consistent chromosomal numerical aberrations: A follow-up analysis
Ran Yahalom, Noam Yarom, Tali Shani, Ninet Amariglio, Ilana Kaplan, Luba Trakhtenbrot, Abraham Hirshberg, 2015-08-19 10:16:43 AM
Abstract
Background
Oral lichen planus (OLP) carries an increased risk for malignant transformation with aneuploid cells (ACs) being found in brush samples of a quarter of patients with OLP.
Methods
Patients with OLP were followed and repeated brush samples were simultaneously analyzed for morphology and fluorescent in situ hybridization (FISH) using centromeric probes for chromosomes 2 and 8.
Results. Three patients with a high proportion of ACs developed oral cancer. Fifteen patients had ≥1% ACs (13 in affected sites and 2 in nonaffected sites), whereas only 2 of the 15 patients with <1% ACs in the first sample had ≥1% ACs in the second sample. A strong positive correlation between the results of the initial and repeated samples was found.
Conclusion
High proportion of ACs in brush samples from patients with OLP may imply an impending malignant transformation. As FISH analysis is consistent over time, it can be used to identify a subgroup of patients who would require close follow-up. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Prognostic value of continued smoking on survival and recurrence rates in patients with head and neck cancer: A systematic review
Lieke C.R. van Imhoff, Gabriëlle G.J. Kranenburg, Sven Macco, Nicoline L. Nijman, Elisabeth J. van Overbeeke, Inge Wegner, Wilko Grolman, Ajit J. Pothen, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this systematic review was to determine the prognostic value of continued smoking after diagnosis on survival and recurrence rates in head and neck cancer.
Methods
A systematic search was performed and predefined inclusion and exclusion criteria were used to screen and select the articles. The remaining articles were critically appraised.
Results
Six articles were used for data extraction. The survival rate of patients who continued to smoke was 21% to 35% lower compared with patients who quit smoking. The recurrence rate for continued smoking was 23% and 30% higher. In 1 study, there was no difference between continuation and cessation of smoking, and 1 study showed a higher recurrence rate for patients who continued to smoke, which was not statistically significant.
Conclusion
There is consistent evidence that survival rates are lower and recurrence rates are higher for patients who continue to smoke after being diagnosed with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Thyroidectomy without lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases and negative intraoperative frozen section
Seok-Mo Kim, Hyeung Kyoo Kim, Kuk-Jin Kim, Ho Jin Chang, Bup-Woo Kim, Yong Sang Lee, Hang-Seok Chang, Cheong Soo Park, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to investigate the outcomes of patients with papillary thyroid cancer (PTC) with lateral neck metastasis according to their permanent pathology report but negative frozen section findings who did not undergo lateral neck dissection.
Methods
Between September 2009 and December 2011, 575 patients at Gangnam Severance Hospital (Seoul, Korea) underwent frozen section analysis for a suspicious lateral neck lymph node. In 16 patients, the intraoperative findings were negative, but lateral neck metastasis was diagnosed on the basis of permanent pathology findings. The outcomes of these patients who underwent thyroidectomy but not lateral neck dissection were retrospectively investigated.
Results
One patient underwent a subsequent lateral neck dissection. After a mean (SD) follow-up period of 42.1 (8.5) months, none of the patients had distant metastasis.
Conclusion
Total thyroidectomy with subsequent lateral neck dissection is not necessary in patients with PTC who are diagnosed with lateral neck metastasis according to their permanent pathology report but have negative intraoperative frozen section findings. © 2014 Wiley Periodicals, Inc. Head Neck, 2015
Genetic polymorphisms in UDP-glucuronosyltransferase 1A6 and 1A7 and the risk for benign Warthin's tumors of the parotid gland
Martin Lacko, Adri C. Voogd, Rens C.E. van de Goor, Hennie M.J. Roelofs, Rene H.M. te Morsche, Nicole D. Bouvy, Wilbert H.M. Peters, Johannes J. Manni, 2015-08-19 10:16:43 AM
Abstract
Background
Warthin's tumors of the parotid gland are associated with smoking, whereas pleomorphic adenomas are not. Genetic polymorphisms in biotransformation enzymes, involved in detoxification of toxins and carcinogens in cigarette smoke, might modify the corresponding enzyme activity and influence detoxifying capacity. We hypothesize that these genetic polymorphisms may influence the individual risk for Warthin's tumor, but not for pleomorphic adenomas.
Methods
Blood from 146 patients with benign parotid gland tumors and 437 controls were investigated for polymorphisms in several biotransformation enzymes. Based on these polymorphisms, patients and controls were divided according to predicted enzyme activity (low, intermediate, and high).
Results
Prevalence of predicted intermediate and high activity UGT1A7 and UGT1A6 genotypes was significantly higher in the patients with Warthin's tumors, but not in patients with pleomorphic adenomas, compared with healthy controls.
Conclusion
Predicted intermediate and high activity UGT1A7 and UGT1A6 genotypes are associated with an increased risk for Warthin's tumor. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Evaluation of clinical presentation and referral indications for ultrasound-guided fine-needle aspiration biopsy of the thyroid as possible predictors of thyroid cancer
Sara Abu-Ghanem, Oded Cohen, Anna Lazutkin, Yasmin Abu-Ghanem, Dan M. Fliss, Moshe Yehuda, 2015-08-19 10:16:43 AM
Abstract
Background
Whether initial clinical presentation and thyroid ultrasonography referral indications can significantly predict malignant/suspicious for malignancy (Bethesda System for Reporting Thyroid Cytopathology [Bethesda] V/VI) thyroid ultrasound-guided fine-needle aspiration (FNA) cytology results is unknown.
Methods
Between January 2010 and May 2014, we performed 705 thyroid ultrasound-guided FNA biopsies, according to the American Thyroid Association (ATA) guidelines. Univariate analysis was used to identify significant predictors for Bethesda V/VI thyroid ultrasound-guided FNA cytology, including age, sex, imaging modality, thyroid dysfunction, neck pain, breathing difficulties, dysphagia, odynophagia, fatigue, lateral cervical mass, parotid mass, and hyperparathyroidism.
Results
Sixty percent of patients were referred to thyroid ultrasound-guided FNA because of thyroid incidentalomas and 40% because of palpable thyroid nodules found on physical examination. Only positron emission tomography (PET)-CT emerged as being a significant predictor for Bethesda V/VI thyroid ultrasound-guided FNA cytology (odds ratio [OR] = 5.64; 95% confidence interval [CI] = 1.16–27.33; p = .03).
Conclusion
Patient symptomatology and initial clinical thyroid ultrasound-guided FNA referral indications cannot predict the nature of thyroid nodules. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Establishment of a novel human papillomavirus–negative and radiosensitive head and neck squamous cell carcinoma cell line
Kyung-Min Kim, Eun-Ji Park, Jiyoung Yeo, Young-Hoon Joo, Kwang-Jae Cho, Min-Sik Kim, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to develop a CMCSCC−1 cell line for head and neck cancer research into new therapies for head and neck squamous cell carcinoma (HNSCC).
Methods
The CMCSCC-1 cell line was isolated from a primary oral tongue tumor specimen of a female patient. Tumor cells were evaluated for biomarkers expression by Western blots, reverse transcriptase-polymerase chain reaction (RT-PCR), fluorescence activated cell sorter, and immunostaining. Cell proliferation in response to radiation was measured by the WST-8 assay.
Results
The characterization analyses revealed a typical epithelial morphology; a doubling time of approximately 24 hours, high tumorigenicity in immunodeficient mice, and upregulated biomarkers. CMCSCC-1 cells were negative for human papillomavirus (HPV) infection, but more sensitive to radiation compared with those FaDu cell lines.
Conclusion
CMCSCC-1, a novel oral tongue SCC cell line, was established. It will help in the elucidation of the molecular pathogenesis of HPV-negative radiosensitive tumors. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Challenging the need for random directed biopsies of the nasopharynx, pyriform sinus, and contralateral tonsil in the workup of unknown primary squamous cell carcinoma of the head and neck
Emily D. Tanzler, Robert J. Amdur, Christopher G. Morris, John W. Werning, William M. Mendenhall, 2015-08-19 10:16:43 AM
Abstract
Background
Many guidelines recommend random directed biopsies of the nasopharynx, contralateral tonsil, and hypopharynx to evaluate an unknown primary squamous cell carcinoma of the head and neck. There are no published data documenting the need for these recommendations. The purpose of our study was to report the rate of positive blind biopsies in this setting.
Methods
We recorded the rate of positive random directed biopsies performed as part of the workup for 156 patients treated with radiotherapy between 1985 and 2014 for an unknown primary squamous cell carcinoma presenting with the main location of adenopathy in nodal stations 2, 3, 4, or 5.
Results
Rate of positive result by subsite: nasopharynx and pyriform sinus = 0%; tonsillectomy: ipsilateral = 39%, bilateral = 6%; and base of tongue = 18%.
Conclusion
With modern imaging, random directed biopsies of the nasopharynx and hypopharynx are unnecessary in the workup of unknown primary squamous cell carcinoma of the head and neck. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Rapid detection and destruction of squamous cell carcinoma of the head and neck by nano-quadrapeutics
Ekaterina Y. Lukianova–Hleb, Dmitri O. Lapotko, 2015-08-19 10:16:43 AM
ABSTRACT
Survival and quality of life remain poor for patients with head and neck squamous cell carcinoma (HNSCC) that cannot be fully resected safely, and form therapy-resistant residual and recurrent tumors. We report novel cell-level technology, quadrapeutics. Quadrapeutics converts surgery, drug, and radiation therapies into on-demand microtreatment that unites the diagnosis and treatment in 1 rapid procedure by using 4 standard components: (1) targeted gold colloids; (2) liposomal drugs; (3) a laser pulse; and (4) radiation, all at safe doses. The therapeutic strength of quadrapeutics increases with cancer aggressiveness. In animal models of a primary and microscopic residual HNSCC, quadrapeutics increased the efficacy of standard chemoradiation therapy by more than 17-fold by using only 3% to 6% of clinical doses of drug and radiation, did not cause side effects, and detected residual microtumors in vivo intraoperatively. Quadrapeutics can be applied to detect and eradicate HNSCC and similar microtumors in a safe and rapid theranostic procedure. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
On the horizon: Optical imaging for cutaneous squamous cell carcinoma
Esther de Boer, Lindsay S. Moore, Jason M. Warram, Conway C. Huang, Margaret S. Brandwein–Gensler, Gooitzen M. van Dam, Eben L. Rosenthal, Cecelia E. Schmalbach, 2015-08-19 10:16:43 AM
Abstract
Background
Surgical resection with negative margins remains the standard of care for high-risk cutaneous squamous cell carcinoma (SCC). However, surgical management is often limited by poor intraoperative tumor visualization and inability to detect occult nodal metastasis. The inability to intraoperatively detect microscopic disease can lead to additional surgery, tumor recurrence, and decreased survival.
Methods
A comprehensive literature review was conducted to identify studies incorporating optical imaging technology in the management of cutaneous SCC (January 1, 2000–December 1, 2014).
Results
Several innovative optical imaging techniques, Raman spectroscopy, confocal microscopy, and fluorescence imaging, have been developed for intraoperative surgical guidance. Fifty-seven studies review the ability of these techniques to improve cutaneous SCC localization at the gross and microscopic level.
Conclusion
Significant advances have been achieved with real-time optical imaging strategies for intraoperative cutaneous SCC margin assessment and tumor detection. Optical imaging holds promise in improving the percentage of negative surgical margins and in the early detection of micrometastatic disease. © 2015 Wiley Periodicals, Inc.Head Neck, 2015
Past and future impact of next-generation sequencing in head and neck cancer
Neeraj Sethi, Kenneth MacLennan, Henry M. Wood, Pamela Rabbitts, 2015-08-19 10:16:43 AM
Abstract
Progress in sequencing technology is intrinsically linked to progress in understanding cancer genomics. The purpose of this review was to discuss the development from Sanger sequencing to next-generation sequencing (NGS) technology. We highlight the technical considerations for understanding reports using NGS. We discuss the findings of studies in head and neck cancer using NGS as well as The Cancer Genome Atlas. Finally we discuss future routes for research utilizing this methodology and the potential impact of this. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Early oral cancer diagnosis: The Aarhus statement perspective. A systematic review and meta-analysis
Juan Seoane, Pablo Alvarez–Novoa, Iria Gomez, Bahi Takkouche, Pedro Diz, Saman Warnakulasiruya, Juan M. Seoane–Romero, Pablo Varela–Centelles, 2015-08-19 10:16:43 AM
ABSTRACT
Background
Mortality is linked to diagnostic intervals in certain cancers. As symptom perception is conditioned by tumor site, a specific study on oral cancer is needed.
Methods
This study's inclusion criteria were original data, symptomatic primary oral squamous cell carcinoma, and exposure of interest, diagnostic interval, or diagnostic delay. The outcome of interest was survival and disease stage. A meta-analysis was undertaken to investigate the relationship between intervals to diagnosis, TNM classification, and survival in oral cancer.
Results
Regarding referral delay, the results present no heterogeneity and showed a risk increase in mortality of 2.48 (range = 1.39–4.42). The larger the diagnostic delay, the more advanced the stage at diagnosis. High quality studies reveal a higher risk increase than low quality studies (odds ratio [OR] = 2.44; 95% confidence interval [CI] = 1.36–4.36 vs OR = 1.53; 95% CI = 1.26–1.86).
Conclusion
A longer time interval from first symptom to referral for diagnosis is a risk factor for advanced stage and mortality of oral cancer. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Recommendations for implant-retained nasal prostheses after ablative tumor surgery: Minimal surgical aftercare, high implant survival, and satisfied patients
Anke Korfage, Gerry M. Raghoebar, Willem D. Noorda, Boudewijn E. Plaat, Arjan Vissink, Anita Visser, 2015-08-19 10:16:43 AM
Abstract
Background
Nasal defects resulting from tumor resection are preferably rehabilitated with implant-retained nasal prostheses. Aftercare, clinical outcome of the implants, and patients' satisfaction with implant-retained nasal prostheses were assessed.
Methods
Twenty-eight consecutive patients needing total rhinectomy because of tumor resection between 1998 and 2013 were treated according to a standardized protocol with 2 implants in the nasal floor. Surgical and prosthetic aftercare was scored using patient records. Finally in 2014, skin reaction, peri-implant bone loss, and patients' satisfaction were assessed in all 13 still living patients.
Results
In total, 56 implants were inserted (median follow-up, 35.1 months; interquartile range [IQR], 8.9–63.3). Implant survival was 96.4%. Implant survival was independent of radiotherapy. Peri-implant skin was healthy and patients' satisfaction high. Longevity of the prostheses was limited.
Conclusion
Rehabilitation of nasal defects resulting from total rhinectomy with implant-retained nasal prostheses, according to our protocol, resulted in high patient satisfaction and favorable treatment outcome. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Sialoblastoma of the parotid gland in a 13-year-old girl with multiple recurrences and long-term follow-up
Panagiotis Saravakos, Joerg Hartwein, Afshin Fayyazi, 2015-08-19 10:16:43 AM
Abstract
Background
Sialoblastoma is an extremely rare congenital salivary gland tumor of epithelial origin. It is usually localized in the parotid or submandibular gland and presents primarily at birth or in early childhood.
Methods
We report a case of a 13-year-old girl with a sialoblastoma of the parotid gland presenting as an asymptomatic painless mass.
Results
The patient showed multiple recurrences and, based on the histopathological finding of facial nerve infiltration, was treated surgically with total parotidectomy and facial nerve reconstruction.
Conclusion
Because of the rare occurrence of sialoblastoma, there is no evidence-based treatment of choice. The treatment should be individualized, taking into consideration the patient's age, the high locoregional recurrence rate, the local aggressive characteristics, and the potential metastatic activity of this rare tumor. A close follow-up of the patient is strongly recommended. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Clinical significance of melanoma-associated antigen A1–6 expression in sputum of patients with squamous cell carcinoma of the larynx and hypopharynx
Kang Dae Lee, Hyoung Shin Lee, Sung Won Kim, Taejung Park, Jong Chul Hong, Hee Kyung Chang, Sang Bong Jung, Chang-Ho Jeon, Jong Wook Park, 2015-08-19 10:16:43 AM
Abstract
Background
Several studies have reported the expression of the melanoma-associated antigen (MAGE) gene in head and neck squamous cell carcinoma (HNSCC). In this study, we evaluated the correlations between MAGE expression in sputum and the clinical features and oncologic outcomes of SCC of the larynx and hypopharynx.
Methods
We performed a retrospective review of 119 patients treated for SCC of the larynx and hypopharynx and analysis of their induced sputum by nested reverse transcription-polymerase chain reaction (RT-PCR) to detect the MAGE-A1–6 gene. The associations between MAGE expression and clinical characteristics were analyzed.
Results
Expression of MAGE-A1–6 in sputum was identified in 57 of 119 patients (47.9%), and was independently correlated to double primary cancer (p = .024; odds ratio [OR] = 4.135). Expression of MAGE-A1–6 in sputum was correlated to poor survival.
Conclusion
Expression of MAGE-A1–6 in sputum predicts poor oncologic outcome in patients with SCC of the larynx and hypopharynx. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Intraoral sebaceous carcinoma metastatic to the lung and subcutis: Case report and discussion of the literature
Meghan E. Rowe, Azita S. Khorsandi, Grant R. Urken, Bruce M. Wenig, 2015-08-19 10:16:43 AM
Abstract
Background
Intraoral sebaceous carcinoma is a rare form of sebaceous carcinoma with only 9 published cases in the world literature to date. We present a 10th case of intraoral sebaceous carcinoma located in the anterior maxillary gingiva with metastases to the lung and subcutis and discuss 3 possible etiologies for this unique presentation.
Methods
We analyze the clinical presentation, pathology, histology, and genetic testing for a single case study and review relevant literature.
Results
The histologic findings of the lung tumor and surgical excisions of the tumors in the gingiva and subcutis suggest the gingiva is the primary site. There is no evidence for the genetic abnormalities consistent with Muir–Torre syndrome.
Conclusion
The histologic findings suggest the oral cavity is the most likely site of tumor origin. This is the first case of intraoral sebaceous carcinoma reported to arise in the gingiva as well as to spread to cutaneous sites. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Nodular fasciitis of the tongue
Antonio Celentano, Massimo Mascolo, Gaetano De Rosa, Michele Davide Mignogna, 2015-08-19 10:16:43 AM
Abstract
Background
Nodular fasciitis is a non-neoplastic proliferation within the subcutaneous tissue and the deep fascia of the fibroblasts, probably of a reactive nature characterized by apparent infiltration of the connective tissues by a mitotically active spindle cell lesion. Nodular fasciitis in the head/neck region is rarely found and only 2 previous cases affecting the tongue have been reported.
Methods and Results
The purpose of this study was for us to report a very rare case of a 67-year-old man with a history of a 3-month subepithelial asymptomatic nodule of the tongue tip with an ulcerated surface. An excisional biopsy of the mass was performed with 0.5-mm surgical margins.
Conclusion
The clinical and histological features of nodular fasciitis may mimic a head and neck malignancy, but it is often misdiagnosed as a malignant mesenchymal neoplasm. Even if it is a rare entity, nodular fasciitis should be considered in cases of rapidly growing masses of the head and neck region. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Immunohistochemical predictors in squamous cell carcinoma of the tongue and floor of the mouth
Michał Gontarz, Grażyna Wyszyńska–Pawelec, Jan Zapała, Jacek Czopek, Agata Lazar, Romana Tomaszewska, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to evaluate the clinical usefulness of the immunoexpression of Ki-67, matrix metalloproteinase (MMP)-2, MMP-9, vascular endothelial growth factor (VEGF)-C, and VEGF-D in predicting follow-up treatment in patients with squamous cell carcinoma (SCC) of the tongue and floor of the mouth (FOM).
Methods
Marker expression was evaluated in surgical specimens taken from 60 patients who underwent surgery because of primary SCC without prior therapy.
Results
Strong MMP-2 expression was positively correlated with a higher risk of nodal recurrence (p = .047). Strong VEGF-C expression was found in patients with distant metastases (p = .008). Cox's regression model showed high Ki-67, MMP-2, and VEGF-C expression, which were independent predictors of disease-specific survival (p = .001,p = .002, and p < .001, respectively).
Conclusion
It seems that targeting MMP-2 and VEGF-C may improve local control, thereby reducing the risk of distant metastasis in patients with SCC of the tongue and FOM. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Pediatric odontogenic fibromyxoma of the mandible: Case report and review of the literature
Grace C. Haser, Henry K. Su, Juan C. Hernandez–Prera, Azita S. Khorsandi, Beverly Y. Wang, Mark L. Urken, 2015-08-19 10:16:43 AM
Abstract
Background
Odontogenic fibromyxoma is an uncommon benign tumor arising from the maxillofacial bones. Fibromyxomas are rare in children under 10 years of age. Although this tumor is reported most frequently in the mandible for the general population, it has rarely been reported in the mandible in children <10 years of age.
Methods
We reviewed the 39 reported cases of odontogenic fibromyxoma in children under the age of 10. We add 1 case to the literature.
Results
This case represents the seventh case of odontogenic fibromyxoma of the mandible in a child under the age of 10 years reported in the English literature.
Conclusion
A case of pediatric odontogenic fibromyxoma in the mandible is described. Although rare in the pediatric population, odontogenic fibromyxomas should be included as a differential diagnostic consideration when evaluating tumors of the maxillofacial skeleton. Accurate pathologic diagnosis is critical to ensure proper management. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Recurrent sebaceous carcinoma of the eyelid: Outcome after postoperative reirradiation
Puja Sahai, Nootan Kumar Shukla, Saurabh Arora, Bidhu Kalyan Mohanti, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was for us to describe a case of recurrent sebaceous carcinoma treated with postoperative reirradiation.
Methods
A 38-year-old man was diagnosed with sebaceous carcinoma of the right lower eyelid. The patient developed local recurrence 4 times, with the first one at 30 months after the excision. The first local recurrence was treated with excision and postoperative radiotherapy with 60 Gy/30 fractions/6 weeks. He manifested preauricular nodal metastasis with the third local recurrence, which was confirmed with 18F-fluorodeoxyglucose positron emission tomography-CT (18F-FDG PET-CT). He received 2 courses of adjuvant reirradiation to the right orbit with 45 Gy/25 fractions/5 weeks and 30 Gy/15 fractions/3 weeks, respectively.
Results
The patient was successfully treated with no evidence of locoregional recurrence at 2 years after the cancer-directed therapy. The patient's follow-up from the date of diagnosis has been 9 years.
Conclusion
Adjuvant reirradiation with modest doses may be considered with a view to provide disease control and long-term survival. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Transoral robotic retropharyngeal node dissection
Babak Givi, Scott H. Troob, Will Stott, Teresa Cordeiro, Peter E. Andersen, Neil D. Gross, 2015-08-19 10:16:43 AM
Abstract
Background
Surgical access to metastases in the retropharyngeal lymph nodes (RPLNs) could be difficult. Transoral robotic surgery (TORS) can be utilized to access RPLNs. The purpose of this study was to describe a TORS approach to RPLN dissection.
Methods
A case series of patients undergoing RPLN dissection by TORS was conducted and compared to matched controls (1:2).
Results
Twelve patients underwent robotic RPLN dissection. Median age was 63 years (range, 43–73 years). Pathology was oropharyngeal squamous cell carcinoma (SCC) in 9 patients and papillary thyroid cancer (PTC) in 3 patients. The feeding tube dependence duration was 12 days (range, 1–46 days) on average. Complications occurred in 8 patients (66%); most commonly, aspiration pneumonitis in 6 patients. In comparison to the matched controls (24), there was no difference in length of stay or feeding tube dependence. Complications were higher in patients with oropharyngeal SCC.
Conclusion
TORS is feasible for accessing RPLNs. The procedure is well tolerated in patients with PTC; whereas patients with oropharyngeal SCC are at increased risk of complications. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Significance of mammalian target of rapamycin in patients with locally advanced stage IV head and neck squamous cell carcinoma receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil
Shau-Hsuan Li, Wei-Che Lin, Tai-Lin Huang, Chang-Han Chen, Tai-Jan Chiu, Fu-Min Fang, Wan-Ting Huang, Cheng-Ming Hsu, Sheng-Dean Luo, Chi-Chih Lai, Yan-Ye Su, Hui-Ching Chuang, Chih-Yen Chien, 2015-08-19 10:16:43 AM
Abstract
Background
This study evaluated the significance of mammalian target of rapamycin (mTOR) activation on the prognosis of patients with locally advanced head and neck squamous cell carcinoma (HNSCC) receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF).
Methods
Immunohistochemistry (IHC) for phosphorylated-mTOR and phosphorylated-p70 ribosomal S6 protein kinase (p70S6K) examined in 107 patients with locally advanced HNSCC receiving TPF was correlated with treatment outcome. The effect of mTOR inhibition on HNSCC cell lines was investigated in vitro and in vivo.
Results
Phosphorylated-mTOR expression was independently significantly associated with response to TPF, progression-free survival (PFS), and overall survival (OS). In cell lines and xenograft models, mTOR inhibitor, everolimus, enhanced the effect of docetaxel.
Conclusion
In patients with locally advanced HNSCC treated with TPF, phosphorylated-mTOR expression was independently associated with prognosis. In vitro and in vivo, concomitant inhibition of mTOR enhanced the effect of docetaxel. Our findings suggest the potential of mTOR as a therapeutic target for locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction
Edward I. Chang, Hong Zhang, Jun Liu, Peirong Yu, Roman J. Skoracki, Matthew M. Hanasono, 2015-08-19 10:16:43 AM
ABSTRACT
Background
Risk factors and techniques for free flap salvage in head and neck reconstruction are poorly described.
Methods
We conducted a retrospective review of all head and neck free flaps performed from 2000 to 2010.
Results
Overall, 151 of 2296 flaps (6.6%) underwent salvage for microvascular complications. Age, comorbidities, surgeon experience (p = .88), vein grafts, and supercharging (p = .45) did not affect flap salvage. Muscle-only flaps (p = .002) were associated with significantly worse outcomes. Coupled venous anastomoses were superior to handsewn anastomoses (p = .03). Arteriovenous thrombosis had worse outcomes than a venous or arterial thrombosis alone (p < .0001). Anticoagulation, thrombolytics, and thrombectomy did not improve survival. Multiple takebacks (p = .003) and late takebacks (>3 days) had significantly worse outcomes (p = .003). Flap salvage was 60.3% successful with 60 total flap losses (2.6%).
Conclusion
Although flap salvage should be attempted, multiple attempts are not recommended, especially for muscle-only flaps. Combined arteriovenous and late thrombosis has a dismal prognosis regardless of different salvage techniques. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Optimal timing of first posttreatment FDG PET/CT in head and neck squamous cell carcinoma
Alan S. Leung, Tanya J. Rath, Marion A. Hughes, Seungwon Kim, Barton F. Branstetter, 2015-08-19 10:16:43 AM
Abstract
Background
The optimal timing for the initial posttreatment fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan after definitive treatment of head and neck squamous cell carcinoma (HNSCC) is unclear.
Methods
We conducted a retrospective review of 247 patients with definitively treated nonmetastatic HNSCC. First posttreatment PET/CT scans were grouped into: <7 weeks, 7 to 10 weeks, 11 to 14 weeks, and ≥15 weeks. Scans were categorized as positive or negative and accuracy of scans was calculated for each group using biopsy, subsequent imaging, or clinical follow-up for 1 year after treatment as a reference standard.
Results
Sixty-seven of the 247 patients (27.1%) had treatment failure. Scans performed at <7 weeks were less accurate than all other time intervals (p < .05). Scans performed at all other intervals were similar in accuracy.
Conclusion
First posttreatment PET/CT can be obtained as early as 2 months after therapy. Scans performed earlier than 2 months have lower accuracy. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Comparison of quality of life between open and endoscopic thyroidectomy for papillary thyroid cancer
Myung Chul Lee, Hoon Park, Byeong-Cheol Lee, Guk-Haeng Lee, Ik Joon Choi, 2015-08-19 10:16:43 AM
Abstract
Background
Recently, various endoscopic thyroidectomy techniques have been introduced for cosmetic purposes. However, few reports have compared the quality of life (QOL) between post–endoscopic thyroidectomy and post–conventional open thyroidectomy. In this study, we investigated whether endoscopic thyroidectomy was comparable to conventional open thyroidectomy with respect to QOL.
Methods
Between January 2010 and September 2011, 75 patients underwent endoscopic thyroid lobectomy and 233 patients underwent conventional open thyroid lobectomy. The QOL was assessed preoperatively and at 1, 3, and 6 months postoperatively by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-question (EORTC-QLQ-C30) instruments.
Results
Both groups showed similar changes over time in most of the QOL scales. However, patients who underwent endoscopic thyroidectomy showed significantly greater improvement in emotional function at 1 month (p = .039) and physical function at 3 months (p = .032). However, the pain increased more in the patients who underwent endoscopic thyroidectomy at 1 month (p = .042).
Conclusion
Current findings suggest that endoscopic thyroidectomy may offer more rapid recovery of emotional and physical function than open thyroidectomy. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
High prevalence of discordant human papillomavirus and p16 oropharyngeal squamous cell carcinomas in an African American cohort
Jeffrey C. Liu, Shobha Parajuli, Elizabeth Blackman, Denise Gibbs, Ashley Ellis, Anna Hull, J. Robert Beck, Veda Giri, Patrick Iherjirka, Jasvir S. Khurana, Camille R. Ragin, 2015-08-19 10:16:43 AM
ABSTRACT
Background
Most studies on human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (SCC) have been performed on white Americans. Our study examined the incidence of HPV in an African American oropharyngeal SCC cohort and its survival.
Methods
African American patients with oropharyngeal SCC in a combined tumor registry were identified. HPV16 testing was performed by polymerase chain reaction (PCR) from DNA extracted from tumor blocks. The p16 staining was performed using standard immunohistochemistry.
Results
Forty-four patients were identified for analysis. Seventy-three percent of the tumors were HPV-positive. Only 39% of the patients who were HPV-positive were also p16-positive. Survival between all 3 tumor types, patients who tested HPV-positive/p16, HPV-positive/p16-positive, and HPV-negative/p16-negative was significantly different (p = .03). HPV/p16 status was significant on univariate and multivariate analysis.
Conclusion
HPV oropharyngeal SCC is strongly present in this African American cohort. Two thirds of the patients who were HPV-positive were p16-negative. Greater study is needed to explain the high p16 negativity among this HPV-positive oropharyngeal SCC African American cohort. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Disease control and toxicity outcomes for T4 carcinoma of the nasopharynx treated with intensity-modulated radiotherapy
Vinita Takiar, Dominic Ma, Adam S. Garden, Jing Li, David I. Rosenthal, Beth M. Beadle, Steven J. Frank, Clifton D. Fuller, Gary B. Gunn, William H. Morrison, Kate Hutcheson, Adel K. El-Naggar, Kathryn A. Gold, Michael E. Kupferman, Jack Phan, 2015-08-19 10:16:43 AM
ABSTRACT
Background
Treatment of T4 nasopharyngeal carcinoma (NPC) is challenging because of the proximity of the tumor to the central nervous system. The purpose of this study was to present our evaluation of disease control and toxicity outcomes for patients with T4 NPC treated with intensity-modulated radiation therapy (IMRT) and chemotherapy.
Methods
The medical records of 66 patients with T4 NPC treated from 2002 to 2012 with IMRT were reviewed. Endpoints included tumor control and toxicity outcomes (Common Terminology Criteria for Adverse Events [CTCAE v4.0]).
Results
Median follow-up was 38 months. Five-year rates of locoregional control, distant metastasis-free survival, progression-free survival (PFS), and overall survival (OS) were 80%, 62%, 57%, and 69%, respectively. Nodal involvement was associated with worse PFS (p = .015). Gross target volume (GTV) volume >100 cm and planning target volume (PTV) volume >400 cm were associated with worse OS (p = .038 and p = .004, respectively). Four patients had significant cognitive impairment, and 9 had MRI evidence of brain necrosis.
Conclusion
For patients with T4 NPC treated with IMRT and chemotherapy, survival and locoregional disease control rates have improved; however, late treatment toxicity remains a concern. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Neuroendocrine neoplasms of the sinonasal region
Diana Bell, Ehab Y. Hanna, Randal S. Weber, Franco DeMonte, Asterios Triantafyllou, James S. Lewis, Antonio Cardesa, Pieter J. Slootweg, Göran Stenman, Douglas R. Gnepp, Kenneth O. Devaney, Juan P. Rodrigo, Alessandra Rinaldo, Bruce M. Wenig, William H. Westra, Justin A. Bishop, Henrik Hellquist, Jennifer L. Hunt, Kimihide Kusafuka, Bayardo Perez–Ordoñez, Michelle D. Williams, Robert P. Takes, Alfio Ferlito, 2015-08-19 10:16:43 AM
Abstract
Neuroendocrine neoplasms of the sinonasal region, which are relatively uncommon but clinically very important, are reviewed here in the light of current knowledge. Using a definition for neuroendocrine based on phenotypic, histologic, immunohistochemical, and electron microscopic features rather than histogenetic criteria, sinonasal neuroendocrine carcinomas are examined with a particular emphasis on the small-cell and large-cell subtypes. This is followed by revisiting olfactory neuroblastoma because it is also a tumor that shows a neuroendocrine phenotype. Kadish clinical and Hyams histologic grading systems as prognosticators of olfactory neuroblastoma are also considered in detail. Finally, controversies regarding sinonasal undifferentiated carcinoma as a neuroendocrine tumor are discussed and a possible relationship with high-grade olfactory neuroblastoma is explored. Genetic events and current management of these tumors are also outlined. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Head and Neck Module, updated version: Preliminary psychometric data from Serbian laryngectomized patients
Sanja Krejovic Trivic, Aleksandar Trivic, Susanne Singer, Jovica Milovanovic, Predrag Stankovic, Anton Mikic, Milan Vukasinovic, Vladimir Djordjevic, Ana Jotic, Miljan Folic, Dejan Stevanovic, 2015-08-19 10:16:43 AM
ABSTRACT
Background
We provided preliminary psychometric data for the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire–Head and Neck Module, updated version (QLQ-H&N43) from a group of Serbian laryngectomized patients.
Methods
The study included 170 subjects. The QLQ-H&N43 is a 43-item questionnaire, with 12 multi-item scales and 7 single-item symptom scales. All subjects also completed the Quality of Life Questionnaire-Core 30-questions (QLQ-C30).
Results
Good internal consistency (Cronbach's α of above 0.7) was found for 5 of the 7 scales. All QLQ-H&N43 scales correlated negatively as predicted with all QLQ-C30 functioning scales. The correlations with the QLQ-C30 symptoms supported discriminant validity, with only one exception: the head and neck social eating scale overlapped with the QLQ-C30 pain scale. For 14 of 19 QLQ-H&N43 scale scores, significant known-group differences were observed between those who differ in type of laryngectomy, adjuvant therapy, or 5-year survival.
Conclusion
Preliminary evidence suggests that a great majority of the QLQ-H&N43 scales have acceptable internal consistency and promising construct validity, but more research studies are needed with other cancer groups to extend these findings. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Down-regulation of malic enzyme 1 and 2: Sensitizing head and neck squamous cell carcinoma cells to therapy-induced senescence
Sang Hyeok Woo, Liang P. Yang, Hui-Ching Chuang, Alison Fitzgerald, Ho-Young Lee, Curtis Pickering, Jeffrey N. Myers, Heath D. Skinner, 2015-08-19 10:16:43 AM
ABSTRACT
Background
The purpose of this study was to present the results of our investigation of malic enzyme (ME) expression and the induction of senescence in head and neck squamous cell carcinoma (HNSCC).
Methods
P53, ME1, ME2, and aspects of cellular metabolism, such as reactive oxygen species (ROS) were investigated in HNSCC cell lines.
Results
Both metformin and ionizing radiation inhibited the expression of ME2, but not ME1, in HNSCC. Knockdown of ME1 or ME2 potentiated therapy-induced senescence in HNSCC cells regardless of p53 status, and led to increased p21 and generation of ROS. Therapy-induced senescence in ME-depleted cells was blocked by the antioxidant N-acetyl cysteine. Finally, high expression of ME2 was associated with poorer overall survival (OS) in patients with HNSCC.
Conclusion
Depletion of ME enhances therapy-induced senescence and seems driven largely by ROS. ME2 expression in HNSCC may be associated with poor outcome, providing a possible link between therapy-induced senescence and patient outcome, and indicating a potential therapeutic benefit of targeting ME2. © 2015 Wiley Periodicals, Inc.Head Neck, 2015
Short-term donor site morbidity: A comparison of the anterolateral thigh and radial forearm fasciocutaneous free flaps
P. Daniel Knott, Rahul Seth, Heather H. Waters, Peter C. Revenaugh, Daniel Alam, Joseph Scharpf, Noah E. Meltzer, Michael A. Fritz, 2015-08-19 10:16:43 AM
ABSTRACT
Background
Donor site morbidity is an important consideration in the overall decision-making algorithm for fasciocutaneous free flap reconstruction of the head and neck.
Methods
A retrospective case series was conducted of donor site complications occurring within 30 days of surgery among 226 consecutive anterolateral thigh (ALT) or radial forearm free flap (RFFF) microvascular free tissue transfers performed by multiple reconstructive surgeons between 2005 and 2010.
Results
A greater number of donor site complications occurred among patients undergoing RFFF versus ALT free flaps (40; 35.4%; vs 14; 12.4%; p < .001). Wound dehiscence occurred significantly more frequently among patients undergoing RFFF versus ALT free flap reconstruction (34; 30%; vs 6; 5%; p < .001). Tendon exposure occurred in 16 of the 113 RFFFs (14.1%). Seromas occurred more commonly in the ALT group (6; 5%; vs 2; 1.7%; p = .280).
Conclusion
Although short-term donor site morbidity was low in both groups, the ALT was associated with a significantly lower incidence of wound dehiscence with or without tendon exposure. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Prevalence and risk factors of sialocele formation after partial superficial parotidectomy: A multi-institutional analysis of 357 consecutive patients
Young Chan Lee, Gi Cheol Park, Jung-Woo Lee, Young Gyu Eun, Seung Woo Kim, 2015-08-19 10:16:43 AM
ABSTRACT
Background
The purpose of this study was to identify the prevalence of sialoceles and the risk factors associated with their formation after parotidectomy.
Methods
We performed a retrospective analysis of the data from consecutive patients who underwent partial superficial parotidectomy of parotid tumors. Demographic data, preoperative imaging results, operative variables, including tumor type, incision type, tumor size, and method of parenchymal disruption were assessed.
Results
Twenty-three of 357 patients (6.4%) undergoing partial superficial parotidectomy developed sialoceles during the postoperative period. Sialoceles occurred more often in patients who had tumors in the anterior portion of the parotid gland. Multivariate analysis showed that an anterior tumor location was a significant risk factor for sialocele formation.
Conclusion
The incidence of sialocele development was 6.4% in patients undergoing partial superficial parotidectomy. An anterior tumor location may increase the risk of sialocele formation. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Efficacy and safety of a cisplatin and paclitaxel induction regimen followed by chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma
Luciano de Souza Viana, Felipe Coelho de Aguiar Silva, Alexandre Andrade dos Anjos Jacome, Danielle Calheiros Campelo Maia, Marcos Duarte de Mattos, Alexandre Arthur Jacinto, Augusto Elias Mamere, Domingos Boldrini Junior, Renato de Castro Capuzzo, Carlos Roberto Santos, Andre Lopes Carvalho, 2015-08-19 10:16:43 AM
ABSTRACT
Background
The purpose of this phase II trial was to evaluate the tolerability, safety, and efficacy of a non–5-fluorouracil (5-FU)-based induction chemotherapy followed by chemoradiotherapy (CRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC).
Methods
Sixty patients with stage III to IV HNSCC were treated with induction paclitaxel and cisplatin (TP; paclitaxel 175 mg/m2 and cisplatin 80 mg/m2, 3 cycles) followed by CRT (cisplatin 100 mg/m2; D1, 22, and 43 of radiotherapy).
Results
Fifty-six patients (93.3%) completed 3 cycles of induction TP (no treatment-related deaths), 52 (86.7%) completed definitive CRT per protocol (adverse event [AE] grade ≥2 in 53.3%). The overall response rate after induction TP was 82.5% for patients with resectable disease and 55.5% for unresectable disease (p = .023), and complete response (CR) rate after CRT was 70.0% for patients with resectable disease and 30.0% for unresectable disease (p = .005).
Conclusion
Induction TP followed by cisplatin based-CRT was well-tolerated, safe, and had high overall response rate in selected patients with locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Concomitant chemoradiotherapy for advanced squamous cell carcinoma of the temporal bone
Hirotaka Shinomiya, Shingo Hasegawa, Daisuke Yamashita, Yasuo Ejima, Yoshida Kenji, Naoki Otsuki, Naomi Kiyota, Shunsuke Sakakibara, Tadashi Nomura, Kazunobu Hashikawa, Eiji Kohmura, Ryohei Sasaki, Ken-ichi Nibu, 2015-08-19 10:16:43 AM
ABSTRACT
Background
The purpose of this study was to analyze outcomes for the treatment of locally advanced temporal bone cancer by means of concomitant chemoradiotherapy (CCRT) with a combination of cisplatin (CDDP), 5-fluorouracil (5-FU), and docetaxel (TPF).
Methods
Between 2006 and 2011, 34 patients with squamous cell carcinoma of the temporal bone were treated at Kobe University Hospital. Medical records were retrospectively reviewed to obtain information concerning patient characteristics, extent of disease, treatment, adverse events, and oncologic results.
Results
Ten patients were treated with CCRT using TPF regimen. The 5-year overall survival rate and disease-free survival rate were both 60%. Of special interest is that even for patients with unresectable T4 disease, the 5-year overall survival rate was 56%.
Conclusion
The results of our study indicate that CCRT with TPF for locally advanced temporal bone cancer is an effective and promising regimen. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Impact of positional changes in neural monitoring endotracheal tube on amplitude and latency of electromyographic response in monitored thyroid surgery: Results from the Porcine Experiment
Hoon Yub Kim, Ralph P. Tufano, Gregory Randolph, Marcin Barczyński, Che-Wei Wu, Feng-Yu Chiang, Xiaoli Liu, Hiroo Masuoka, Akira Miyauchi, Soo Young Park, Hee Yong Kwak, Hye Yoon Lee, Gianlorenzo Dionigi, , 2015-08-19 10:16:43 AM
ABSTRACT
Background
The purpose of this study was to evaluate electromyography (EMG) amplitude and latency changes during tube dislocation in monitored thyroid surgery, which may be observed without recurrent laryngeal nerve injury.
Methods
Duroc–Landrace piglets were intubated with the TriVantage EMG tube. We measured EMG changes during both upward and downward tube dislocation (10–20 mm) and rotation (45–90°) with continuous neuromonitoring.
Results
The EMG amplitude varied significantly with induced endotracheal tube rotation and depth changes. However, the EMG latency was relatively unaffected by such tube dislocation, just a transient artifactual latency change was observed in the situation of extreme amplitude variation.
Conclusion
Amplitude changes without latency changes may be due to changes in tube position alone during surgery, but could still reflect a neurophysiologic event; amplitude changes during neuropraxic injury merit additional investigation. Thus, the combined event (concordant amplitude decrease and latency increase) serves as an appropriate adverse EMG event correlating with impending neural injury. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Reconstruction of an inferior orbital rim and cheek defect with a pedicled osteomyocutaneous submental flap
Mohammad A. Al Felasi, Eric Bissada, Tareck Ayad, 2015-08-19 10:16:43 AM
ABSTRACT
Background
The purpose of this study was to present the feasibility of reconstructing an inferior orbital rim and cheek defect with a pedicled osteomyocutaneous submental flap.
Method
A 77-year-old women with a right nasosinusal adenoid cystic carcinoma invading soft tissues and skin of the cheek, the inferior rim of the orbit, the hard palate, and the middle turbinate is presented. A right radical maxillectomy with preservation of the eye was performed. A pedicled osteomyocutaneous submental island flap was used to reconstruct the defect. An inferior marginal mandibular section was incorporated with the flap and used to reconstruct the inferior orbital rim.
Results
Satisfactory cosmetic and functional results were reached by reconstructing the inferior rim of the orbit and the cheek skin using this flap.
Conclusion
This is the first case report of an osteomyocutaneous submental flap for reconstruction of an inferior orbital rim defect. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Merkel cell carcinoma: Overall survival after open biopsy versus wide local excision
Georg Haymerle, Alexandra Fochtmann, Rainer Kunstfeld, Johannes Pammer, Boban M. Erovic, 2015-08-19 10:16:43 AM
ABSTRACT
Background
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor of the skin with a dismal prognosis.
Methods
We conducted a retrospective medical chart review of patients with MCC who were initially diagnosed with an open biopsy (n = 30) or wide local excision (n = 24).
Results
Stages I, II, and III disease was found in 38%, 20%, and 16%, respectively. The 2-year and 5-year overall and disease-specific survival rates were 64.8% and 38.8% versus 45.2% and 26.4%, respectively. Cox regression multivariate model, including tissue sampling technique, re-resection, therapy modalities, pathological staging, and T and N classifications, showed that patients diagnosed initially with an open biopsy have significant worse overall (p = .014) and disease-free (p = .005) survival rates compared with patients who had a wide local excision.
Conclusion
This study showed an improved overall survival in patients with MCC after wide local excision compared to open biopsy of the primary site at first diagnosis. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Potential relationship between Hashimoto's thyroiditis and BRAFV600E mutation status in papillary thyroid cancer
Rui-chao Zeng, Lang-ping Jin, En-dong Chen, Si-yang Dong, Ye-feng Cai, Guan-li Huang, Quan Li, Chun Jin, Xiao-hua Zhang, Ou-chen Wang, 2015-08-19 10:16:43 AM
ABSTRACT
Background
The purpose of this study was to evaluate the potential relationship between Hashimoto's thyroiditis and BRAFV600E mutation status in patients with papillary thyroid carcinoma (PTC).
Methods
A total of 619 patients with PTC who underwent total thyroidectomy with lymph node dissection were enrolled in this study. Univariable and multivariate analyses were used.
Results
Hashimoto's thyroiditis was present in 35.9% (222 of 619) of PTCs. Multivariate logistic regressions showed that BRAFV600E mutation, sex, extrathyroidal extension, and lymph node metastasis were independent factors for Hashimoto's thyroiditis. Female sex, more frequent extrathyroidal extension, and a higher incidence of lymph node metastasis were significantly associated with PTCs accompanied by BRAFV600E mutation without Hashimoto's thyroiditis compared with PTCs accompanied by BRAFV600E mutation with Hashimoto's thyroiditis.
Conclusion
Hashimoto's thyroiditis was negatively associated with BRAFV600E mutation, extrathyroidal extension, and lymph node metastasis. In addition, Hashimoto's thyroiditis was related to less lymph node metastasis and extrathyroidal extension in PTCs with BRAFV600E mutation. Therefore, Hashimoto's thyroiditis is a potentially protective factor in PTC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Long-term late toxicities and quality of life for survivors of nasopharyngeal carcinoma treated with intensity-modulated radiotherapy versus non–intensity-modulated radiotherapy
Tai-Lin Huang, Chih-Yen Chien, Wen-Ling Tsai, Kuan-Cho Liao, Shang-Yu Chou, Hsin-Ching Lin, Sheng Dean Luo, Tsair-Fwu Lee, Chien-Hung Lee, Fu-Min Fang, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to investigate late toxicities and quality of life (QOL) of patients with nasopharyngeal carcinoma (NPC) with long-term survival after treatment by intensity-modulated radiotherapy (IMRT) versus non-IMRT.
Methods
An observational, cross-sectional study of QOL and late toxicities was conducted in 242 patients with NPC with survival of >5 years after treatment with IMRT (n = 100) or non-IMRT (n = 142) by using physician-assessed toxicities (Common Terminology Criteria for Adverse Events [CTCAE] version 4) and the patient-reported European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC QLQ-C30) and the Head and Neck 35-questions (EORTC QLQ-C30-H&N35) module.
Results
The IMRT group had both statistically (p < .05) and clinically (difference of predicted mean scores ≥10 points) better outcome in global QOL, cognitive functioning, social functioning, fatigue, and 11 scales of the head and neck module. Late toxicities, including neuropathy, hearing loss, dysphagia, xerostomia, and neck fibrosis were significantly less severe in the IMRT group. Multivariate analysis revealed that the radiotherapy (RT) technique was statistically significantly associated with late toxicities and QOL outcome after adjusting for other clinical and demographic variables.
Conclusion
The use of the IMRT technique was associated with the improvement of physician-assessed late toxicities and patient-reported QOL in NPC survivors. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Plasminogen activator inhibitor-1 as regulator of tumor-initiating cell properties in head and neck cancers
Yueh-Chun Lee, Cheng-Chia Yu, Chih Lan, Che-Hsin Lee, Hsueh-Te Lee, Yu-Liang Kuo, Po-Hui Wang, Wen-Wei Chang, 2015-08-19 10:16:43 AM
Abstract
Background
The existence of tumor-initiating cells (TICs) has been described in head and neck cancers. Plasminogen activator inhibitor-1 (PAI-1) has been demonstrated to act as a prognostic factor in head and neck cancers.
Methods
Tiplaxtinin (PAI-039), a specific inhibitor of PAI-1, and PAI-1-specific siRNA were used to examine the role of PAI-1 in the self-renewal property of head and neck cancer-TICs by tumorsphere formation. Western blot, real-time polymerase chain reaction, and luciferase-based reporter assay were used to study the effect of PAI-039 in the sex-determining region Y-box 2 (Sox2) expression.
Results
PAI-039 suppressed the self-renewal capability of head and neck cancer-TICs derived from head and neck cancer cell lines through the inhibition of Sox2 expression. PAI-039 decreased the activity of the core promoter and the enhancer of the Sox2 gene in head and neck cancer-TICs. Knockdown of PAI-1 expression also inhibited self-renewal and radioresistance properties of head and neck cancer-TICs.
Conclusion
The inhibition of PAI-1 by PAI-039 or siRNA could suppress head and neck cancer-TICs within head and neck cancer cell lines through the downregulation of Sox2. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Convallaria keiskei as a novel therapeutic alternative for salivary gland cancer treatment by targeting myeloid cell leukemia-1
Haeng-Eun Lee, Jeong-Seok Nam, Ji-Ae Shin, In-Sun Hong, In-Hyoung Yang, Myung-Jo You, Sung-Dae Cho, 2015-08-19 10:16:43 AM
ABSTRACT
Background
Various chemotherapeutic agents have been used largely for the treatment of salivary gland cancer. However, results are disappointing, and these agents can cause some serious side effects. Therefore, recent studies have focused on the possible roles of natural products to overcome these limitations.
Methods
Salivary gland cancer cells treated with or without Convallaria keiskei (MECK) for 24 hours. Apoptotic changes were evaluated by live/dead assay, immunoblotting, and expression levels of caspase-3 and B-cell lymphoma-2 family member.
Results
MECK significantly inhibited salivary gland cancer growth. At the molecular level, MECK dramatically reduced myeloid cell leukemia-1 (Mcl-1) in a translation-dependent manner and thereby induced apoptosis through Bax/Bid. Furthermore, we found that Mcl-1 could be a potential therapeutic target of MECK-induced apoptosis and its stability is regulated by extracellular signal-regulated kinases 1/2 (ERK1/2) signaling
Conclusion
MECK can be used as a safe and efficient therapeutic alternative for the treatment of salivary gland cancer. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
Prophylactic pectoralis major muscle flap in prevention of pharyngocutaneous fistula in total laryngectomy after radiotherapy
Annie-Kim Gendreau–Lefèvre, Nathalie Audet, Scott Maltais, François Thuot, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to assess the utility of the pectoralis major muscle flap (PMMF) in the prevention of pharyngocutaneous fistula for total laryngectomy after radiotherapy (RT)
Methods
We conducted a retrospective review of 166 patients who underwent a total laryngectomy after RT between 1998 and 2012 at the CHU de Québec.
Results
One hundred fifteen patients underwent a total laryngectomy with primary pharyngeal closure alone and 51 patients received an onlay PMMF. The incidence of pharyngocutaneous fistula in the PMMF group was 14% compared to 36% when only primary closure was done (p = .004). However, the PMMF did not influence the treatment needed for the healing of this complication (p = 1.00). The development of pharyngocutaneous fistula increased the length of stay from 19 to 50 days (p < .0001) and delayed the initiation of oral diet from 15 to 25 days (p = .03).
Conclusion
Nonirradiated tissue coverage should be routine in total laryngectomy after RT. PMMF is a good adjunct to prevent pharyngocutaneous fistula. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1233–1238, 2015
Loss of heterozygosity in mammary serine protease inhibitor (maspin) and p53 at chromosome 17 and 18 in oral cavity squamous cell carcinoma
Kyu Young Choi, Hyung-Joon Choi, Eun-Jae Chung, Dong Jin Lee, Jin Hwan Kim, Young-Soo Rho, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to evaluate the loss of heterozygosity (LOH) in chromosomes 17p13 (p53 gene) and in 18q21 (mammary serine protease inhibitor [maspin] gene), and the expression of both genes in tissues, in patients with oral cavity squamous cell carcinoma (SCC).
Methods
Thirty patients with oral cavity SCC have been evaluated for the presence of LOH in chromosomes 17p13 and 18q21, and the expression of p53 and maspin in tissues. Clinicopathological features and survival in these patients were also analyzed.
Results
LOH in 17p13 was more frequently identified in patients with lymph node metastasis and/or high TNM classification. LOH in 18q21 was more frequently identified in high primary T classification patients. Increased expression rate of p53 and/or decreased maspin expression rate were significantly higher in oral cavity SCC than normal tissues.
Conclusion
LOH on chromosome 17, 18, the expression of p53, and maspin are related to the carcinogenesis of oral cavity SCC. Relationships with clinicopathological factors in oral cavity SCC were also revealed. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1239–1245, 2015
Oropharyngeal squamous cell carcinoma in the veteran population: Association with traditional carcinogen exposure and poor clinical outcomes
Vlad C. Sandulache, John Hamblin, Syeling Lai, Todd Pezzi, Heath D. Skinner, Numan A. Khan, Shayan M. Dioun, Christine Hartman, Jennifer Kramer, Elizabeth Chiao, Xiaodong Zhou, Jose P. Zevallos, 2015-08-19 10:16:43 AM
Abstract
Background
A significant fraction of oropharyngeal squamous cell carcinoma (SCC) cases is associated with traditional carcinogens; in these patients, treatment response and clinical outcomes remain poor.
Methods
We evaluated patient, tumor, and treatment characteristics for 200 veterans with oropharyngeal SCC treated at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) between 2000 and 2012.
Results
Most patients (77%) were white and heavy smokers. Twenty-seven patients required tracheostomy and 63 required gastrostomy placement during treatment. Overall survival (OS) at 5 years was 40%. Survival was impacted by T classification, treatment intensity, completion of treatment, and p16 tumor status. Almost 30% of patients were unable to complete a treatment regimen consistent with National Comprehensive Cancer Network (NCCN) guidelines.
Conclusion
Oropharyngeal SCC in veterans is associated with traditional carcinogens and poor clinical outcomes. Despite heavy smoking exposure, p16 tumor status significantly impacts survival. Careful consideration must be given to improving treatment paradigms for this cohort given their limited tolerance for treatment escalation. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1246–1253, 2015
Determination of biometric measures to evaluate patient suitability for transoral robotic surgery
Asit Arora, Jalpa Kotecha, Amish Acharya, George Garas, Ara Darzi, D. Ceri Davies, Neil Tolley, 2015-08-19 10:16:43 AM
Abstract
Background
Transoral robotic surgery (TORS) represents a novel treatment for oropharyngeal cancer and obstructive sleep apnea. Appropriate patient selection is crucial. The purpose of this study was to investigate whether anatomic biometric measures are useful to determine the feasibility of performing TORS.
Methods
Three surgeons independently evaluated feasibility in 51 soft-fix cadavers. Transoral visualization was performed with 2 retractors commonly used in TORS. Seven anthropometric parameters and the degree of mouth opening were recorded.
Results
Mandibular body height, hyoid-mental length, and neck circumference demonstrated significant differences between "suboptimal" and "adequate" visualization of base of tongue and epiglottis (p < .05). Limited mouth opening was associated with suboptimal visualization. Neck circumference had the strongest influence on predicting TORS feasibility.
Conclusion
Mandibular body height, hyoid-mental length, and neck circumference in conjunction with the degree of mouth opening may determine patient suitability for TORS. Clinical evaluation is essential to validate their collective usefulness. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1254–1260, 2015
Targeting angiogenesis as a therapeutic means to reinforce osteocyte survival and prevent nonunions in the aftermath of radiotherapy
Alexis Donneys, Noah S. Nelson, Erin E. Page, Sagar S. Deshpande, Peter A. Felice, Catherine N. Tchanque–Fossuo, Joshua P. Spiegel, Steven R. Buchman, 2015-08-19 10:16:43 AM
Abstract
Background
Radiotherapy (XRT) exerts detrimental collateral effects on bone tissue through mechanisms of vascular damage and impediments to osteocytes, ultimately predisposing patients to the debilitating problems of late pathologic fractures and nonunions. We posit that angiogenic therapy will reverse these pathologic effects in a rat model of radiated fracture healing.
Methods
Three groups of rats underwent mandibular osteotomy. Radiated groups received a fractionated 35-Gy dose before surgery. The deferoxamine (DFO) group received local injections postoperatively. A 40-day healing period was allowed before histology. Analysis of variance (ANOVA; p < .05) was used for group comparisons.
Results
Radiated fractures revealed a significantly decreased osteocyte count and corresponding increase in empty lacunae when compared to nonradiated fractures (p = .001). With the addition of DFO, these differences were not appreciated. Further, a 42% increase in bony unions was observed after DFO therapy.
Conclusion
Targeting angiogenesis is a useful means for promoting osteocyte survival and preventing bone pathology after XRT. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1261–1267, 2015
Effect of metformin on the incidence of head and neck cancer in diabetics
Yung-Chang Yen, Charlene Lin, Shih-Wei Lin, Yung-Song Lin, Shih-Feng Weng, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to examine the effect of metformin on head and neck cancer in patients with diabetes.
Methods
We compared 66,600 patients, all with diabetes and all newly diagnosed with head and neck cancer in 2002. Half were being treated with metformin for diabetes (Met+) and half were not (Met−: controls). All were matched for comorbidities (obesity, coronary artery disease, hyperlipidemia, and hypertension), sex, and age. The risk of head and neck cancer at the end of 2011 was determined.
Results
The incidence of head and neck cancer was 34% lower in the Met+ cohort than in the Met− cohort (adjusted hazard ratio [HR] = 0.66; 95% confidence interval [CI] = 0.55–0.79). The risks for oropharyngeal cancer (adjusted HR = 0.66; 95% CI = 0.17–0.74) and nasopharyngeal carcinoma (NPC; adjusted HR = 0.50; 95% CI = 0.31–0.80) were significantly lower in the Met+ cohort than in the Met− cohort.
Conclusion
Metformin is associated with a lower risk of developing head and neck cancer in patients with diabetes. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1268–1273, 2015
Prognostic value of 18F-fludeoxyglucose uptake in 287 patients with head and neck squamous cell carcinoma
Jacob H. Rasmussen, Ivan R. Vogelius, Barbara M. Fischer, Jeppe Friborg, Marianne C. Aznar, Gitte F. Persson, Katrin Håkansson, Claus A. Kristensen, Søren M. Bentzen, Lena Specht, 2015-08-19 10:16:43 AM
Abstract
Background
The prognostic value of 18F-Fludeoxyglucose (FDG) uptake could be due to its association with already known clinical risk factors.
Methods
Correlation between FDG uptake metrics and other known risk factors from 287 patients were analyzed. Time to any failure was analyzed using Cox proportional hazards model stratified by tumor subsite. The resulting multivariate prognostic model was used to generate a table of 2-year freedom from failure estimates with confidence intervals (CIs).
Results
Increasing values of standardized uptake value maximum (SUVmax) correlated with other known risk factors. The reduced Cox model included SUVmax (hazard ratio [HR] = 1.34), cisplatin (HR = 0.37), smoking status (HR = 1.49), and gross target volume (GTV; HR = 1.74) as significant prognostic factors. Including SUVmax in the model changed the 2-year failure estimate by more than 10% for a quarter of the patients (23%).
Conclusion
FDG uptake retains statistical significance in a multivariate analysis and has clinically relevant prognostic impact. We developed a prognostic model for risk stratification of patients in a clinical setting. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1274–1281, 2015
Posttraumatic stress disorder symptoms in newly diagnosed patients with head and neck cancer and their partners
Donna M. Posluszny, Angela Liegey Dougall, Jonas T. Johnson, Athanassios Argiris, Robert L. Ferris, Andrew Baum, Dana H. Bovbjerg, Mary Amanda Dew, 2015-08-19 10:16:43 AM
Abstract
Background
Head and neck cancer is a life-threatening illness requiring aversive treatments. Despite clear potential for posttraumatic stress disorder (PTSD) symptoms in both patients and their partners, research is scant.
Methods
Newly diagnosed patients and partners (number of dyads = 42) completed questionnaires to assess symptoms of PTSD, anxiety, and depression, as well as demographic, medical, and attitudinal variables.
Results
Partners had higher average levels of PTSD symptoms than patients (p = .023). More partners (28.6%) met criteria for estimated PTSD caseness than did patients (11.9%). There were no significant differences in levels of other anxiety or depression symptoms. Perceived threat of disease appeared to be a stronger correlate of PTSD symptom levels than medical variables in patients and partners.
Conclusion
A diagnosis of head and neck cancer elicits significant levels of PTSD symptoms in patients, and even higher levels among partners. Identified correlates of distress, including perceived threat of disease, are potential intervention targets. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1282–1289, 2015
Utility of algorithm-based chemoradioselection in the treatment for advanced hypopharyngeal carcinoma
Muneyuki Masuda, Mioko Matsuo, Takeichiro Aso, Hideyuki Kiyohara, Fumihide Rikimaru, Naonobu Kunitake, Yuichiro Higaki, 2015-08-19 10:16:43 AM
Abstract
Background
Current organ-preserving dose-intensified modalities have apparently reached the limit of human tolerance. To optimize the therapeutic ratio, we evaluated the utility of a chemoradioselection strategy for the treatment of advanced hypopharyngeal carcinoma.
Methods
Fifty-five patients with advanced hypopharyngeal carcinoma were enrolled in our algorithm-based protocol. After 40 Gy of concurrent chemoradiation therapy (CCRT), patients who were chemoradioselected (chemoradioselected group, complete response [CR] at the primary site) received further 30 Gy of CCRT up to 70 Gy, whereas the remaining nonchemoradioselected (nonchemoradioselected group) patients underwent radical surgery.
Results
Based on this algorithm, 27 patients were chemoradioselected and 28 nonchemoradioselected. The 5-year cumulative disease-specific and overall survival (OS) rates were 76% and 65%, respectively. The chemoradioselected group demonstrated favorable laryngoesophageal dysfunction-free survival (77% at 3 years).
Conclusion
Although preliminary, our results indicate that algorithm-based chemoradioselection may provide a novel platform for improving the treatment of advanced hypopharyngeal carcinoma by providing the complete advantages of CCRT and radical surgical resection. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1290–1296, 2015
Outcome and toxicity profile after brachytherapy for squamous cell carcinoma of the nasal vestibule
Djoeri Lipman, Lia C. Verhoef, Robert P. Takes, Johannes H. Kaanders, Geert O. Janssens, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to evaluate outcome and toxicity profile after primary brachytherapy for squamous cell carcinoma of the nasal vestibule.
Methods
A retrospective study was conducted for patients with Wang classification T1 to 2 cN0 squamous cell carcinoma of the nasal vestibule who received primary treatment with brachytherapy between 1992 and 2010. Tumor control, acute skin, mucosal, and late cartilage toxicity were scored.
Results
Of 60 patients (T1, 50; T2, 10), 38 were treated with an interstitial implant and 22 by a mold technique. The 3-year local, regional, and locoregional control rates were 91%, 93%, and 84%, respectively. Tumor diameter <1.5 cm resulted in a better local (p = .02) and regional (p = .05) control. The cumulative incidence of moist skin desquamation and confluent mucositis was 64% and 82%, respectively. The actuarial incidence of chondritis and/or chondronecrosis was 19%.
Conclusion
Primary brachytherapy for Wang T1 to 2 squamous cell carcinoma of the nasal vestibule offers excellent tumor control rates with acceptable toxicity and preservation of anatomy. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1297–1303, 2015
Transoral robotic surgery versus conventional surgery in treatment for squamous cell carcinoma of the upper aerodigestive tract
Karim Hammoudi, Eric Pinlong, Soo Kim, David Bakhos, Sylvain Morinière, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of our work was to compare a group of patients undergoing transoral robotic surgery (TORS group) for squamous cell carcinoma of the upper aerodigestive tract and a matched group of patients undergoing conventional surgery (conventional surgery group) for the same indication.
Methods
In this retrospective single-center study, 26 patients were included in each group.
Results
There were significantly fewer tracheotomies in the TORS group (p < .001). The mean durations of feeding by nasogastric tube and hospitalization were shorter for the TORS group (p = .001). There was no significant difference in disease-free survival at 3 years (p = .76). Mean treatment cost was $7124 lower for the TORS group (p = .03).
Conclusion
This comparative study shows that robotic technology can be used to treat selected squamous cell carcinomas of the upper aerodigestive tract, reducing morbidity and treatment costs while providing equivalent cancer control at 3 years. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1304–1309, 2015
Identification of human papillomavirus status specific biomarker in head and neck cancer
Ki-Yeol Kim, Xianglan Zhang, In-Ho Cha, 2015-08-19 10:16:43 AM
Abstract
Background
In an attempt to improve the prognosis of patients with head and neck cancer, it could be necessary to identify biomarkers in homogeneous subgroups of patients with head and neck cancer.
Methods
We explored the necessity of human papillomavirus (HPV) status-specific biomarkers in patients with head and neck cancer and identified an HPV status-specific gene set. The identified gene set was validated with the external microarray datasets. For this purpose, we used 4 microarray datasets obtained from a public database. One dataset was used for identifying the HPV status specific gene set, and the other datasets were used for validation.
Results
The identified gene set for distinguishing head and neck cancer from head and neck normal, did not accurately discriminate the HPV specific patients with head and neck cancer from the head and neck normal group. Also, it was demonstrated that some HPV-positive (HPV+) head and neck cancer-specific genes may not be significant in HPV-negative (HPV–) head and neck cancer patients. The identified HPV specific gene sets showed good performance in validation datasets. The HPV+ head and neck cancer-specific gene set included various metabolism-related pathways, and the HPV– head and neck cancer-specific gene set included several pathways; fibroblast, collagen degradation, actin-binding, and actin cytoskeleton.
Conclusion
The identification of HPV status-specific significant gene set was necessary. It is expected that HPV status-specific biomarkers can be helpful in deciding therapeutic methods for patients with head and neck cancer, after biological validation and large prospective trials. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1310–1318, 2015
Lymph node density as an independent predictor of cancer-specific mortality in patients with lymph node–positive laryngeal squamous cell carcinoma after laryngectomy
In Sun Ryu, Jong-Lyel Roh, Kyung-Ja Cho, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim, 2015-08-19 10:16:43 AM
Abstract
Background
We examined the prognostic value of lymph node density in predicting cancer-specific mortality (CSM) for patients with lymph nodes positive (pN+) laryngeal squamous cell carcinoma (SCC) after laryngectomy.
Methods
The records of 156 patients with laryngeal SCC who initially underwent curative resection of the primary tumor combined with neck dissection were reviewed.
Results
The 5-year cumulative incidence of CSM was 20.4%. N classification and extralaryngeal spread (ELS) were independent variables for CSM in all patients. Univariate analyses in 71 pN+ patients showed that ELS, number of positive lymph nodes >4, and lymph node density >0.044 were significantly associated with increased CSM, whereas pN classification was not (p = .218). On multivariate analysis, lymph node density ≥0.044 remained an independent predictor of CSM (p = .001).
Conclusion
Among the pN+ patients with laryngeal SCC, no pN classification but lymph node density was noted to have an independent impact on CSM. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1319–1325, 2015
Inhibition of myeloid cell leukemia-1: Association with sorafenib-induced apoptosis in human mucoepidermoid carcinoma cells and tumor xenograft
Hyun-Ju Yu, Ji-Ae Shin, Ji-Youn Jung, Jeong-Seok Nam, In-Sun Hong, Nam-Pyo Cho, Sung-Dae Cho, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of our study was to investigate the anticancer effect of sorafenib on mucoepidermoid carcinoma (MEC) and find its new molecular mechanism.
Methods
The apoptotic effects of sorafenib were performed using MTS assay, diamidino-phenylindole (DAPI) staining, Western blotting, reverse transcription-polymerase chain reaction (RT-PCR), siRNA, and xenograft.
Results
Sorafenib had apoptotic effects on MC-3 and YD15 cells and decreased myeloid cell leukemia-1 (Mcl-1) through proteasome-dependent protein degradation and the inhibition of protein synthesis. Sorafenib significantly affected truncated bid (t-Bid) and siMcl-1 resulting in the upregulation of t-Bid to induce apoptosis. Signal transducer and activator of transcription 3 (STAT3) phosphorylation was also blocked by sorafenib and a potent STAT3 inhibitor, cryptotanshinone clearly induced poly ADP-ribose polymerase (PARP) cleavage by inhibiting Mcl-1 and increasing t-Bid. Finally, administration of sorafenib significantly suppressed tumor growth and induced apoptosis in tumor xenograft model in association with downregulation of Mcl-1 without any side effects.
Conclusion
Taken together, these findings suggest that sorafenib can be a good anticancer drug candidate for the treatment of MEC. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1326–1335, 2015
Prognostic significance of extranodal extension of regional lymph node metastasis in papillary thyroid cancer
Ming-Hsun Wu, Wen T. Shen, Jessica Gosnell, Quan-Yang Duh, 2015-08-19 10:16:43 AM
Abstract
Background
The presence and location of regional lymph node metastasis affect the prognosis of patients with thyroid cancer. Lymph node classification of the current TNM system may be inadequate because it insufficiently characterizes the nature and severity of lymph node metastasis that may influence prognosis.
Methods
We retrospectively studied 240 patients with papillary thyroid cancer and node metastases who had undergone total thyroidectomy, lymph node dissection, and postoperative 131I treatment at the University Cancer Center between 1994 and 2004. We reviewed the status of regional lymph node metastasis, including the location, number, largest size, and extranodal tumor extension and analyzed their effect on the prognosis of the patients.
Results
There were 172 women and 68 men, with a median age of 38 years and median tumor size of 1.9 cm. Thirty-five percent had only central compartment (N1a) nodal metastasis and 65% had involvement of both central and lateral compartments (N1b). There were a median of 4 nodes containing metastasis with a median largest diameter of 1.2 cm. Sixty patients (25%) had extranodal extension of cancer. Multivariate analysis showed that patient age (p = .0017; hazard ratio [HR], 2.156), >3 lymph node metastasis (p = .0316; HR, 1.806), and extranodal extension (p < .0001; HR, 4.027) were independent predictors of disease recurrence. Patient age (p = .0034; HR, 22.068), vascular invasion (p = .01; HR, 8.2), and extranodal extension (p = .022; HR, 12.597) were independent predictors of disease-specific survival (DSS). The DSS and recurrence-free survival curve between patients with and without extranodal extension differ significantly (p < .0001). For those older than 45 years, the 10-year recurrence was 11 of 43 patients for those without extranodal extension and 24 of 27 patients for those with extranodal extension (p < .001). Among patients with stage 4a/4b, those with extranodal extension had a significantly worse DSS and disease-free survival (DFS; p < .001) than those without extranodal extension. The prognosis of patients with stage 4a/4b cancer who had no extranodal extension was the same as patients with stage 3 cancer. The status of extranodal extension seems to be a stronger prognostic predictor than the location of metastatic lymph nodes (N1a/1b).
Conclusion
Presence of extranodal extension of metastatic nodes is a significant adverse independent prognostic factor for patients with lymph node metastasis from papillary cancer. This may need to be considered in future updates of the TNM system for thyroid cancer. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1336–1343, 2015
Alpha-B-crystallin expression in human laryngeal squamous cell carcinoma tissues
Mehmet Yilmaz, Omer Faruk Karatas, Betul Yuceturk, Huseyin Dag, Murat Yener, Mustafa Ozen, 2015-08-19 10:16:43 AM
Abstract
Background
Laryngeal squamous cell carcinoma (SCC), being an aggressive malignancy, is one of the most commonly diagnosed malignant types of head and neck SCC worldwide. The recent studies suggested that αB-crystallin might play an important role in tumorigenesis. The purpose of this study was to investigate the αB-crystallin expression level in metastatic and nonmetastatic laryngeal SCC tissues and to determine its prognostic significance.
Methods
Alpha-B-crystallin expression status in metastatic, nonmetastatic laryngeal SCC, and normal tissue samples was investigated by quantitative real-time polymerase chain reaction (qRT-PCR).
Results
We demonstrated that the expression of αB-crystallin was significantly upregulated in laryngeal SCC tumor tissue samples in comparison with the corresponding normal tissues (p < .001), although no significant association has been found between αB-crystallin expression and either the metastatic potential or the T classification of the specimens.
Conclusion
Although expression of αB-crystallin is not statistically correlated with neck metastases, we demonstrated that αB-crystallin is significantly overexpressed in laryngeal cancer. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1344–1348, 2015
Trajectory and risk factors for chemotherapy-induced nausea and vomiting in Asian patients with head and neck cancer
Alexandre Chan, Maung Shwe, Yanxiang Gan, Kevin Yap, Lita Chew, Wan–Teck Lim, 2015-08-19 10:16:43 AM
Abstract
Background
The purpose of this study was to analyze the trajectory of and risk factors for chemotherapy-induced nausea and vomiting in Asian patients with head and neck cancer.
Methods
Adult patients with head and neck cancer scheduled to receive cisplatin-based chemotherapy were recruited for the study. Clinical events were collated from standardized diaries.
Results
Two hundred thirty-five patients were included in the analyses. The majority (75.7%) was men, Chinese (81.7%), and manifested nasopharyngeal cancer (83.4%). The overall incidence of significant nausea and vomiting was 73.7% and 24.7%, respectively, with single-day cisplatin regimens of 48.9% and 28.9%, respectively, with the multiple-day cisplatin regimen. Patients using complementary alternative medicine were less likely than others to achieve a complete response to antiemetics.
Conclusion
Although postchemotherapy vomiting is relatively well controlled in Asian patients with head and neck cancer, postchemotherapy nausea remains problematic in this population. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1349–1357, 2015
Measuring quality of life in patients with head and neck cancer: Update of the EORTC QLQ-H&N Module, Phase III
Susanne Singer, Cláudia Araújo, Juan Ignacio Arraras, Ingo Baumann, Andreas Boehm, Bente Brokstad Herlofson, Joaquim Castro Silva, Wei-Chu Chie, Sheila Fisher, Orlando Guntinas–Lichius, Eva Hammerlid, María Elisa Irarrázaval, Marianne Jensen Hjermstad, Kenneth Jensen, Naomi Kiyota, Lisa Licitra, Ourania Nicolatou–Galitis, Monica Pinto, Marcos Santos, Claudia Schmalz, Allen C. Sherman, Iwona M. Tomaszewska, Irma Verdonck de Leeuw, Noam Yarom, Paola Zotti, Dirk Hofmeister, , 2015-08-19 10:16:43 AM
Abstract
Background
The objective of this study was to pilot test an updated version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N60).
Methods
Patients with head and neck cancer were asked to complete a list of 60 head and neck cancer-specific items comprising the updated EORTC head and neck module and the core questionnaire EORTC QLQ-C30. Debriefing interviews were conducted to identify any irrelevant items and confusing or upsetting wording.
Results
Interviews were performed with 330 patients from 17 countries, representing different head and neck cancer sites and treatments. Forty-one of the 60 items were retained according to the predefined EORTC criteria for module development, for another 2 items the wording was refined, and 17 items were removed.
Conclusion
The preliminary EORTC QLQ-H&N43 can now be used in academic research. Psychometrics will be tested in a larger field study. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1358–1367, 2015
Prognostic value of S100/CD31 and S100/podoplanin double immunostaining in mucosal malignant melanoma of the head and neck
Kai Wermker, Till Brauckmann, Martin Klein, Stefan Haßfeld, Hans-Joachim Schulze, Christian Hallermann, 2015-08-19 10:16:43 AM
Abstract
Background
In uncommon mucosal melanomas of the head and neck established prognostic factors are rare and controversially discussed. The purpose of this study was to evaluate outcome and value of S100/podoplanin and S100/CD31 double immunostaining in head and neck mucosal melanomas.
Methods
Retrospectively, patients with head and neck mucosal melanomas treated between 1973 and 2008 were analyzed. S100/podoplanin and S100/CD31 immunostaining were performed to detect lymph vessel invasion (LVI) and blood vessel invasion (BVI). Predictive parameters for disease-specific survival (DSS) were identified using univariate and multivariate statistics.
Results
Forty-two patients with head and neck mucosal melanoma were included. Three-year, 5-year, and 10-year DSS rates were 59%, 44%, and 20%, respectively. Age above 70 years, occurrence of distant metastasis, LVI, and BVI were significantly associated with shorter DSS time (p < .05), whereas localization at the conjunctiva showed better outcome.
Conclusion
S100/podoplanin and S100/CD31 double immunostaining detect reliable LVI and BVI in head and neck mucosal melanoma and both are associated significantly with worse prognosis. © 2014 Wiley Periodicals, Inc. Head Neck37: 1368–1374, 2015
Facial artery musculomucosal flap in head and neck reconstruction: A systematic review
Tareck Ayad, Liyue Xie, 2015-08-19 10:16:43 AM
Abstract
Background
The facial artery musculomucosal (FAMM) flap has emerged as a popular option in head and neck reconstruction in the last decade. The purpose of this study was to conduct a literature review of the FAMM flap.
Methods
We have conducted a search on PubMed using specific key words to identify all articles related to the FAMM flap. We reviewed the modifications of the FAMM flap, its indications, contraindications, complications, and outcomes.
Results
Thirty-eight articles published from 1992 to 2013 were included for review. A total of 441 FAMM flaps were reported in the literature and the most commonly reconstructed site was the floor of the mouth. Functional and aesthetic outcomes were judged to be excellent.
Conclusion
The FAMM flap is a versatile reconstructive option for small and medium size defects in the head and neck. Recent studies have explored new applications for this flap, such as in skull base reconstruction. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1375–1386, 2015
Locoregional and free flap reconstruction of the lateral skull base
Jeremy D. Richmon, Bharat B. Yarlagadda, Mark K. Wax, Urjeet Patel, Jason Diaz, Derrick T. Lin, 2015-08-19 10:16:43 AM
Abstract
Lateral temporal bone reconstruction after ablative surgery for malignancy, chronic infection, osteoradionecrosis, or trauma presents a challenge for the reconstructive surgeon. This complexity is due to the 3D nature of the region, potential dural exposure, and the possible need for external surface repair. Successful reconstruction therefore requires achieving separation of the dura, obliteration of volume defect, and external cutaneous repair. There is significant institutional bias on the best method of reconstruction of these defects. In this review, the advantages and disadvantages of reconstructive options will be discussed as well as the potential pitfalls and complications. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1387–1391, 2015
Primary cN0 lip squamous cell carcinoma and elective neck dissection: Systematic review and meta-analysis
Kishor Bhandari, Dian-can Wang, Shan-chang Li, Bing-hua Jiang, Yu-xing Guo, Ujjwal Koirala, Xiao-yan Du, 2015-08-19 10:16:43 AM
Abstract
Background
Management of clinically negative lymph nodes (cN0) in primary lip squamous cell carcinoma (SCC) has always been a controversial topic.
Methods
A systematic review of English–language electronic databases using Medline, Embase, Cochrane library, Google Scholar, SCI, and specific journals on the subject matter was done. Only the studies mentioning primary nonmetastatic lip SCC with cN0 neck treated by surgery only and having at least 2 years of follow-up data were selected. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews and meta-analysis was followed.
Results
The pooled estimate of occult metastasis in neck dissected specimen was 0.17 (95% confidence interval [CI], 0.10–0.28) and that of delayed nodal metastasis in patients without neck dissection was 0.08 (95% CI, 0.01–0.18).
Conclusion
The results do not prove sufficient to justify elective treatment of the neck in primary cN0 lip SCC and close observation would be a viable option in such cases. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1392–1400, 2015
Endoscopic management of esophageal discontinuity
Edward T. Chang, Douglas S. Ruhl, Patrick R. Kenny, Joseph C. Sniezek, 2015-08-19 10:16:43 AM
Abstract
Background
The management of esophageal discontinuity remains challenging and often involves complex reconstructive surgeries.
Methods and Results
We describe a unique and successful treatment of esophageal discontinuity using a modification of the natural orifice translumenal surgery (NOTES) approach in a patient presenting with long-standing esophageal discontinuity resulting from an iatrogenic esophageal injury.
Conclusion
This case provided an opportunity to affirm the efficacy of endoscopy for treating esophageal discontinuities to minimize the degree of morbidity and mortality normally associated with the surgical treatment of this type of injury. Our case reveals a novel and possibly more direct means of evaluating and treating esophageal injuries in which the degree of discontinuity and/or stenosis initially remains unknown. © 2015 Wiley Periodicals, Inc. Head Neck 37: E103–E105, 2015
Benign intranodal thyroid tissue mimicking nodal metastasis in a patient with papillary thyroid carcinoma: A case report
Yoo Jin Lee, Dong Wook Kim, Ha Kyoung Park, Tae Kwun Ha, Do Hun Kim, Soo Jin Jung, Sang Kyun Bae, 2015-08-19 10:16:43 AM
Abstract
Background
A case of benign intranodal thyroid tissue mimicking nodal metastasis on ultrasound and CT in a patient with papillary thyroid carcinoma has not been reported.
Methods
The clinical, imaging, and histopathological findings of the patient are presented. A 52-year-old woman who underwent ultrasound-guided fine-needle aspiration for 2 small, suspicious thyroid nodules in both lobes at a local clinic was referred to our hospital for surgical treatment. Ultrasound-guided fine-needle aspiration for a suspicious lymph node in the left upper neck was performed. According to the imaging and cytology results, total thyroidectomy and nodal dissection for both central and left lateral nodes were performed.
Results
In the histopathology, the lymph node was confirmed as a benign lymph node with intranodal thyroid tissue.
Conclusion
This case illustrates that benign intranodal thyroid tissue may mimic nodal metastasis on ultrasound or CT in a patient with papillary thyroid carcinoma. © 2015 Wiley Periodicals, Inc. Head Neck 37: E106–E108, 2015
Primary thyroid diffuse large B-cell lymphoma coexistent with papillary thyroid carcinoma: A case report
Shumin Xie, Wei Liu, Yuyan Xiang, Yinghuan Dai, Jihao Ren, 2015-08-19 10:16:43 AM
Abstract
Background
Primary thyroid lymphoma (PTL) is uncommon, accounting for 2% to 5% of all thyroid malignancies. Papillary thyroid carcinoma (PTC) is the most frequent thyroid cancer. The coexistence of PTL and PTC is very rare, and the preoperative diagnosis is rather difficult.
Methods
A 41-year-old male patient complaining of fast painless thyroid enlargement for 2 months and a cervical mass for half a month was presented. Imaging demonstrated an enlarged thyroid and a mass in the thyroid.
Results
Surgery was conducted, and the final diagnosis of coexistence of PTL and PTC was confirmed by histopathological and immunohistochemical examination. The patient was then treated with cyclophosphamide, hydroxy doxorubicin, oncovin, prednisone (CHOP) chemotherapy and radiotherapy. After 2 months of follow-up, no recurrence or metastasis was noted.
Conclusion
This rare case highlights the importance for physicians to keep PTL in mind for differential diagnosis in patients with sudden thyroid enlargement and who have clinical history of Hashimoto thyroiditis. © 2015 Wiley Periodicals, Inc. Head Neck 37: E109–E114, 2015
Anterolateral approach to the upper cervical spine: Case report and operative technique
Yohan Song, Suzanne Tharin, Vasu Divi, Laura M. Prolo, Davud B. Sirjani, 2015-08-19 10:16:43 AM
Abstract
Background
Transcervical approaches to the upper cervical spine are challenging because several upper anterior neurovascular structures need to be displaced to provide access. Although various techniques have been described, the anterolateral approach is one of the safest and most effective methods available to access the anterior C2–C3 disc space. Despite the approach's efficacy, however, it can cause postoperative complications because of, at least partly, the inter-surgeon differences in the methods by which the larynx and hypopharynx are displaced medially.
Methods and Results
We present a case report of a patient treated with a modified anterolateral approach to C2–C3. The approach provided excellent visualization while protecting vital structures. The patient recovered without any postoperative dysphagia or other surgical complications.
Conclusion
The anterolateral approach to C2–C3 described herein safely protects the contents of the submandibular triangle while providing a wide exposure for direct access to the C2–C3 disc space. © 2015 Wiley Periodicals, Inc. Head Neck 37: E115–E119, 2015
Τετάρτη 19 Αυγούστου 2015
Head Neck
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