bluuebunny/crossref_metadata_2025 huggingface dataset:
Using a Modified Frailty Index to Predict Mortality Risk after Tracheostomy
Authors: Johnson Matthew S. , Bailey Travis , Schmid Kendra , Johanning Jason
Published: August 2013

Objectives:

Evaluate the utility of a modified frailty index to predict post‐operative mortality in patients undergoing tracheostomy.

Methods:

A retrospective chart review was conducted including all patients who underwent tracheostomy between 2007 and 2012. A modified frailty index consisting of 11 items based on the Revised Minimum Data Set Mortality Rating Index was retrospectively applied using the patients’ status immediately prior to tracheostomy. The resultant 6‐month predicted mortality was compared to the Veterans Health Administration Surgical Quality Improvement Program's (VASQIP) 30‐day predicted mortality as well as actual mortality.

Results:

A total of 100 patients underwent tracheostomy during the study period. No patients were excluded. Sixty‐nine patients died within the study period. The 1, 6, and 12‐month mortality rates after tracheostomy were 25%, 43%, and 59% respectively. The predicted 30‐day mortality risk was 9.1% for non‐survivors compared to 5.2% for survivors (p = 0.05). The predicted 6‐month mortality risk was 40.5% for non‐survivors compared to 25.4% for survivors (p = 0.0003). The VASQIP calculator and modified frailty index both differentiated mortality risks between patients who survived less than 6 months versus greater than 6 months (p = 0.004 and 0.001, respectively). However, neither the VASQIP or modified frailty index differentiated mortality risks for head and neck cancer patients who survived less than 6 months versus greater than 6 months (p = 0.46 and 0.13, respectively).

Conclusions:

The modified frailty index identifies non‐cancer patients at high risk of post‐operative mortality after tracheostomy but does not identify high‐risk patients with head and neck cancer.
Accuracy of Intraoperative Determination of Central Lymph Node Metastasis by Surgeon in Papillary Thyroid Carcinoma
Authors: Tae Kyung , Ji Yong‐Bae , Song Chang‐Myeon , Lee Dong‐Won
Published: August 2013

Objectives:

Prophylactic central neck dissection (CND) in papillary thyroid carcinoma (PTC) remains controversial because of its potential morbidity and unclear benefit. If we can judge central lymph node metastasis preoperatively or intraoperatively, we can avoid unnecessary CND. However, ultrasound (US)/computed tomography (CT) or sentinel node biopsy is not enough to determine central lymph node metastasis accurately. The aim of this study was to evaluate the accuracy of intraoperative determination of central lymph node metastasis by surgeon during thyroidectomy.

Methods:

From October 2011 to September 2012, 122 consecutive patients with clinically node negative PTC on US and CT were enrolled. Any suspicious metastatic lymph node on palpation or inspection was sent for frozen biopsy, and then bilateral CND with total thyroidectomy was completed in all patients. The criteria of suspicious lymph node included dark cystic or hard palpable lymph node, or larger than about 7 mm in diameter. We compared the intraoperative surgeon's judgment with final pathologic results.

Results:

Suspicious metastatic lymph nodes were found in 37 (30.3%) patients, and 15 of them had metastasis in permanent biopsy. Of 85 patients with no suspicious lymph node, 27 patients had metastasis in permanent biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative determination of lymph node metastasis was 35.7%, 72.5%, 40.5%, and 68.2%, respectively. In 22 of false positive patients, 14 (63.6%) had Hashimoto's thyroiditis.

Conclusions:

Intraoperative determination of central lymph node metastasis by surgeon is limited to guide CND in clinically node negative PTC because of its low sensitivity.
Reducing Readmission Rates at a Large Academic Otolaryngology Practice
Authors: Rajasekaran Karthik , Revenaugh Peter C. , Benninger Michael S. , Sindwani Raj
Published: August 2013

Objectives:

Hospital readmissions are an important focus of national quality and cost containment efforts. With increased emphasis on readmissions in the current healthcare climate, it is critical to evaluate factors contributing to readmission rates and strategies aimed at reducing these rates. The objectives of this study are to analyze the reasons for hospital readmission within 30 days of discharge and discuss methods implemented to reduce readmissions.

Methods:

A retrospective chart analysis was performed from 2010 to 2012 at a tertiary‐care medical center. A quality plan was developed and implemented during this time to reduce readmissions. All patients who were admitted to an otolaryngology inpatient service and readmitted within 30 days of discharge were identified.

Results:

There were 763, 820, and 804 admissions during the years 2010, 2011, and 2012, respectively. The number of readmissions during this time were 51 (6.7%), 54 (6.6%), and 28 (3.5%), respectively. Common diagnoses for readmissions included dehydration, syncope, venous thromboembolism, postoperative bleeding, and cellulitis. There were no statistically significant differences in demographics and subsequent length of stay for those patients requiring readmission. The reduction in number of readmissions in 2012 compared to 2011 and 2010 was statistically significant.

Conclusions:

Readmission within 30 days in a large otolaryngology practice can be multifactorial. In order to reduce rates of readmission it is essential to understand post‐operative complications, diagnoses, and comorbidities contributing to readmission. Implementation of a quality plan comprising comprehensive discharge planning efforts and close post‐discharge follow‐up can lead to a reduction in readmissions.
BMP‐2 Expression Correlates with Local Failure in Surgically Treated Head and Neck Squamous Cell Carcinoma
Authors: Sand Jordan P. , Zakharkin Stanislav , Kokorina Natalia , Lewis James S. , Nussenbaum Brian
Published: August 2013

Objectives:

Preclinical data show that exogenous administration of recombinant human bone morphogenetic protein‐2 (rhBMP‐2) to human oral carcinoma cell lines increases pathogenicity using a nude mouse model. The objectives of this study are to 1) describe the characteristics of baseline protein expression of BMP‐2 in head and neck squamous cell carcinomas (HNSCCs), and 2) determine if BMP‐2 expression level correlates with worse oncologic outcomes.

Methods:

Tissue samples from 149 patients with oral, oropharyngeal, and laryngeal/hypopharyngeal squamous cell carcinomas treated at an academic medical center between 1999 and 2010 were assembled into a tissue microarray. Immunohistochemistry for BMP‐2 was performed, and staining was quantified using a standardized scoring system. Specimens were categorized by high or low expression level. Statistical analyses using log‐rank, Wilcoxon, and Fisher's exact test were performed for associations between clinical and pathologic features and patient survival.

Results:

BMP‐2 expression at any level was present in 146 of 149 (97.9%) tissue samples. Tumors with high BMP‐2 expression had higher rates of local failure compared with low‐expressing tumors (17.3% vs 6.3% P = 0.04). However, there was no significant association for BMP‐2 expression level and tumor location, T stage, N stage, regional failure, distant failure, or overall survival.

Conclusions:

HNSCCs with high levels of BMP‐2 protein expression are associated with higher rates of local recurrence. These data may have important implications for using rhBMP‐2 in tissue engineering reconstructive approaches in the setting of cancer‐related defects. Further, the consistent expression of BMP‐2 suggests this pathway may be a novel therapeutic target.
CD147 and the EGFR Signaling Cascade in Head and Neck Cancer
Authors: Frederick John W. , Sweeny Larissa , Hartman Yolanda , Rosenthal Eben L.
Published: August 2013

Objectives:

Establish the relationship between two membrane bound proteins, CD147 and epidermal growth factor receptor (EGFR), through cutaneous squamous cell carcinoma (cSCC) cell lines.

Methods:

A pre‐clinical investigation using three cSCC cell lines (Colo‐16, SRB‐1, and SRB‐12) that were treated in vitro with a range of chimeric anti‐CD147 mAb (0, 50, 100, 200 µg/mL) or transfected with a small interfering RNA against CD147 (SiCD147). Cell proliferation, migration, and protein expression was then assessed. PCR analysis and immunofluorescent staining were also obtained. In vivo, Colo‐16 xenografts were treated with anti‐CD147 mAb (200µg i.p. triweekly), and tumors were then harvested for histologic analysis.

Results:

In response to anti‐CD147 treatments there was a significant decrease in cell proliferation (P <.05) and migration in vitro (P <. 001). These findings were confirmed with a Colo‐16 SiCD147 cell line. Western blot analysis showed a decrease in not only CD147 expression but also the EGFR signaling cascade, specifically EGFR, BAD, and AKT. EGFR mRNA expression was decreased on PCR analysis in response to anti‐CD147. In vivo response to anti‐CD147 showed decreased tumor growth and, on histologic analysis, decreased CD147 and EGFR expression.

Conclusions:

Blocking CD147 inhibits cell growth in vitro and in vivo and results in downregulation of EGFR expression and signaling cascades. CD147 could be exploited as a therapeutic target in cSCC by modulation of the EGFR signaling pathway.
Cervical Metastasis of Unknown Primary: Use of Discovering Occult Primary Lesions
Authors: Davis Kara , Byrd James K. , Mehta Vikas , Kim Seungwon , Ferris Robert L. , Johnson Jonas T. , Duvvuri Umamaheswar
Published: August 2013

Objectives:

Cancer of an unknown primary squamous cell carcinoma (CUP) metastatic to cervical lymph nodes is a challenging problem for the treating physician. The use of discovering the primary lesion in these patients with regards to oncologic outcomes remains unclear. Our aim is to determine if identification of the primary is associated with improved oncologic outcomes.

Methods:

Records of 136 patients initially diagnosed as CUP were retrospectively reviewed (1980‐2010). Patients were divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan‐Meier analysis. A nested subset of 34 patients in which the primary was discovered were matched to 34 patients remaining undiscovered according to nodal stage and age. Matched‐pair analysis was compared using the stratified Cox regression model.

Results:

Discovery of the occult primary was associated with improvement in overall survival (10.19 vs 8.83 years, P < 0.001) when stratified across N1‐N2c disease. Matched‐pairs analyses demonstrated that discovery of the primary was associated with better overall survival (hazard ratio [HR] = 0.222; 95% confidence interval [CI] 0.06 to 0.81; P = 0.023). Discovery of the primary trended towards association with lower recurrence (HR = 0.33; 95% CI 0.09 to 1.19; P = 0.091).

Conclusions:

Discovery of the primary lesion is associated with improved overall survival in patients initially presenting as CUP, both in matched‐pair and cohort comparison analyses. Within this subset, improved locoregional control with discovery of the primary was suggested by a trend towards decreased recurrence. Further studies may clarify treatment discrepancies and molecular differences.
Changing Trends of Speech Outcomes after Total Laryngectomy in the 21st Century
Authors: Moon Seo Y. , Raffa Francesca , Ojo Rosemary B. , Landera Mario A. , Weed Donald T. , Sargi Zoukaa B. , Lundy Donna
Published: August 2013

Objectives:

Management of laryngeal cancer has changed significantly in the past decade. Total laryngectomy (TL) has been mainly reserved for patients with recurrence or failure after chemo‐radiation or patients requiring major ablative and reconstructive surgeries. Tracheoesophageal puncture (TEP) continues to be the gold standard for speech rehabilitation, yet it is unknown what the overall speech outcomes are for individuals undergoing TL in the 21st century. Our study will describe the speech rehabilitation outcomes of patients after TL in the 21st century.

Methods:

This is a retrospective analysis of 391 patients who underwent TL from June 2000 to February 2012 with a minimum of one year follow‐up. Demographic variables and medical/surgical factors related to laryngectomy will be reviewed. Patient speech rehabilitation outcomes will be assessed and categorized into the following groups: 1) use of esophageal speech; 2) use of electrolarynx; 3) use of TEP; 4) failure to achieve functional speech; and 5) non‐compliant. To be in groups 1, 2, or 3, patients must use speech as the dominant mode of communication.

Results:

Patients who underwent TL in the 21st century may have overall decreased success rate in speech rehabilitation; there may be decreased success rate in the use of esophageal speech and TEP.

Conclusions:

The current gold standard for speech rehabilitation should be readdressed, as it may not adequately meet the need of the current patient populations. More up‐to‐date techniques and technologies are needed to improve the communication and speech rehabilitation of current laryngectomy patients.
Chemoprevention with 2 Weeks of COX‐2 Inhibitors Predict Malignant Transformation of Oral Potentially Malignant Disorders
Authors: Hao Sheng‐Po
Published: August 2013

Objectives:

Use 2 weeks of chemoprevention with Celecoxib® (80mg /day) to screen malignant transformation of oral potentially malignant disorders (PMD).

Methods:

In a chemopreventive trial with 12 weeks of Celecoxib®, 133 testers out of 374 had persistent or growing tumors after 2 weeks of Celecoxib® and underwent excisional biopsy to define the tumor.

Results:

Pathology diagnosis of these 133 testers found squamous cell carcinoma in 46; verrucous carcinoma in 2; dysplasia in 21, including severe (2), moderate (5), and mild (14); verrucous hyperplasia in 60; and epithelial hyperplasia with ulcer in 4. Thus, chemoprevention screening identified 48 cancers and 2 severe dysplasias [(48+2)/133 = 37.6%] who needed definite surgical resection.

Conclusions:

Chemoprevention with 2 weeks of Celecoxib® can be a screening procedure to pick up oral PMD cases with possible malignant transformation that need definite surgical resection, and the incidence could be as high as 37.6%.
A Comparison of Cellular Damage Using Electrocautery and CO2 Laser in Transoral Robotic Glossectomy
Authors: Cavenaugh Rachel , Schniederjan Ryan W. , Brown Robert , Karni Ron J.
Published: August 2013

Objectives:

1) Compare the zone of cellular damage using monopolar electrocautery and CO2 laser during transoral robotic glossectomy. 2) Examine the effect of tissue tension during glossectomy on the extent of cellular damage. 3) Highlight the choice of energy source during transoral robotic glossectomy with margin assessment.

Methods:

Setting: Memorial Hermann Robotics Institute, November 2012.. A live anesthetized porcine model placed supine with the ventral tongue exposed. Multiple robotic glossectomies were performed using monopolar cautery (15 watts delivered via a robotic arm) and CO2 laser (8 watts delivered via FlexGuide Fiber Introducer carried by a Robotic needle driver). The study was then repeated with 4 lbs of weighted tension on each side of the tongue to simulate the concept of tension‐countertension. Glossectomy specimens were harvested and evaluated in a blinded manner by a pathologist for the zone of cellular damage.

Results:

Unpaired t‐test with unequal variance was conducted to compare the zone of cellular damage (mm) from the electrocautery and the CO2 laser glossectomy. There was a significant difference in the damage zone for EC and CO2; two‐tailed P less than 0.0001; t(27) = 7.08; Standard Error of Difference = 0.062.

Conclusions:

The zone of cellular damage from the edge of the incision is significantly greater with electrocautery than CO2 laser in this robotic porcine glossectomy model. The difference is further amplified when tension‐countertension is applied to the tissues. These data suggest that robotic CO2 laser glossectomy may preserve more normal tissue (margins) around a specimen than electrocautery.
Section for Residents and Fellows Leaders: Where Are They Now?
Authors: Wilson Meghan N. , Roby Brianne B. , Deckard Nathan A. , Carter John M. , Yoo Estelle S. , Kelley Kanwar , Raol Nikhila M.
Published: August 2013

Objectives:

1) Look at the experiences of prior governing council (GC) members of the American Academy of Otolaryngology (AAO) Section for Residents and Fellows (SRF), and 2) assess the impact of early Academy involvement.

Methods:

Survey of all prior members of the AAO SRF GC.

Results:

The AAO‐SRF has elected 52 GC members since its 2003 inception. Ten members are currently in training, and no data were obtained for 3. The remaining 38 prior GC members were analyzed. Each member served an average of 1.5 years (terms ranged 1 ‐ 3 years). The mean time since completion of training to present is 4.1 years (range 0 ‐ 10 years). A subspecialty fellowship was pursued in 86%, with 92% matching into their fellowship field of choice. Fifty‐seven percent practice in an academic setting, with 3 members advancing to a subspecialty division director within their department. All prior GC members are current AAO members. Over half (59%) have served on an AAO committee, and most are frequent attendees of the annual meeting. When asked, “What did being on the SRF GC do for you?”, the most common responses included understanding the importance of the AAO and involvement in it, networking, and leadership experience.

Conclusions:

All prior SRF GC members felt involvement in the SRF GC was a beneficial experience, enabling them to gain leadership skills and a deeper understanding of the inner‐workings of our specialty. Most prior SRF GC members have pursued fellowship training and remain involved in the Academy.
Delayed Sinonasal Complications of Radiotherapy for Nasopharyngeal Carcinoma
Authors: Yakirevitch Arkadi , Lipschitz Noga , Alon Eran E. , Yudovich Keren , Wolf Michael , Bedrin Lev
Published: August 2013

Objectives:

There are only sporadic reports of delayed sinonasal complications associated with nasopharyngeal carcinoma (NPC) treated with radiotherapy. These include choanal stenosis, osteoradionecrosis, chronic sinusitis, and intranasal synechiae. The aim of this study was to identify the time of onset and incidence of complications associated with the treatment of NPC and to compare them to the extent of the primary tumor and radiation dose.

Methods:

A retrospective chart review was performed on all patients who presented to our institution between 1988 through 2009 and who were diagnosed and treated for NPC. The inclusion criteria required at least a 3‐year follow‐up. Excluded were patients with disease recurrence. Furthermore, patients were contacted prospectively and were asked to complete a SNOT‐16 questionnaire.

Results:

Sixty‐four patients were included in our review. There were 43 males and 21 females. The average age at onset was 42. The T staging for T1, T2, T3, and T4 were 22, 11, 18, and 11 respectively. There were no T staging data for one patient. Two patients suffered from synechiae, which required synechiolysis. Five patients developed osteoradionecrosis and underwent debridement. Ten patients developed choanal stenosis, and it was repaired in 2. Ten patients suffered from sinusitis. Four of those required functional endoscopic sinus surgery.

Conclusions:

The incidence of delayed sinonasal complications of NPC radiotherapy is not negligible, and they should be kept in mind both for the informed consent of the patients and their active detection and treatment.
Development of a Diagnostic Panel of Methylated MicroRNA Markers for Head and Neck Cancer
Authors: Green Katherine K. , Lu Shi‐Long , Song John I.
Published: August 2013

Objectives:

Early detection of head and neck squamous cell carcinoma (HNSCC) improves long‐term survival. More than half of patients with HNSCC present with locoregional or metastatic disease at the time of diagnosis. MicroRNAs are promising markers for early detection, as they are stable, tissue‐specific, and known to be involved in processes critical for tumor development and progression. Methylated miRNA sequences have already been studied in early detection of lung and gastrointestinal (GI) cancers.

Methods:

Genomic DNA was extracted from 30 SCC samples, 24 samples of grossly normal adjacent mucosa from those tumor patients, and 8 samples from normal controls (no cancer). The gDNA was treated with bisulfate to identify methylation patterns, and quantitative polymerase chain reaction was run for 6 miRNA markers (9‐1, 9‐3, 124‐1, 124‐2, 124‐3, 137) to determine the level of expression in each sample.

Results:

Overall expression of each marker was significantly higher in the tumor group when compared to the controls (P < 0.001) and the adjacent mucosa (P < 0.001). Using the expression levels within the controls as a baseline, a positive cut‐off value was determined for each marker to create 100% specificity. The sensitivity of each individual marker ranged from 60‐76%, but when used in combination as a diagnostic panel, the sensitivity increased to 90%.

Conclusions:

We have successfully created a diagnostic panel of methylated microRNA markers that demonstrated 90% sensitivity and 100% specificity in the detection of HNSCC. This panel is currently being tested on saliva, blood, and tissue samples of tumor‐positive and tumor‐negative (control) patients as part of a larger early detection clinical study.
Does IMRT Decrease Radiation Related Toxicity Compared to 3D‐CRT in Patients with Laryngeal Cancer?
Authors: Lohia Shivangi , Knackstedt Rebecca , Sharma Anand K. , Day Terry A.
Published: August 2013

Objectives:

Radiation is an integral part of the treatment of head and neck cancer. However, side effects and toxicities are high and lead to dysphagia and dysphagia related morbidity in a significant proportion of patients. There has been interest in intensity modulated radiation therapy (IMRT) to decrease these side effects while preserving locoregional control and survival.

Methods:

We performed a retrospective review of patients who underwent definitive radiation for laryngeal squamous cell carcinoma (SCCa) at MUSC. Primary endpoints included: gastrostomy (PEG) tube dependence 1 year after radiation start, time to PEG tube removal, weight loss during treatment, Radiation Therapy Oncology Group (RTOG) toxicity profiles, disease‐free survival, and overall survival.

Results:

Of 315 patients identified in the database, 74 had primaries of the larynx and underwent definitive radiation therapy. Twenty‐four and 50 patients were treated with conventional radiation (3D‐CRT) and IMRT respectively. Data analysis revealed that PEG tube dependence after treatment initiation, time to PEG tube removal, weight loss during treatment, and skin and larynx RTOG toxicity scores did not markedly differ between IMRT and 3D‐CRT. There was a significantly lower rate of ≥3 mucous membrane toxicity in patients treated with IMRT versus 3D‐CRT (P = 0.0030). Lastly, there were no significant differences in disease free survival (P = 0.9318) or overall survival (P = 0.5586) between the 2 groups.

Conclusions:

The use of IMRT techniques does not compromise locoregional control or overall survival compared to 3D‐CRT. IMRT may also improve mucous membrane toxicity and other toxicity scores compared to 3D‐CRT.
Effect of Physician Perspective on Allocation of Medicare Resources for Patients with Advanced Cancer
Authors: Rocke Daniel J. , Beumer Halton W. , Taylor Donald H. , Schulz Kristine A. , Thomas Steven , Puscas Liana , Lee Walter T.
Published: August 2013

Objectives:

1) Assess how physician perspective affects Medicare resource allocation for advanced cancer patients. 2) Compare how physician allocations differ from advanced cancer patients and their caregivers.

Methods:

Otolaryngology–head and neck surgery (OHNS) physicians nationwide used a validated tool to create a Medicare plan for advanced cancer patients. Participants took the perspective of an advanced cancer patient and made resource allocations between 15 benefit categories (round 2, November/December 2012). Results were compared with data from a prior assessment made from a physician's perspective (round 1, February/March 2012) and with data from an ongoing study with cancer patients and caregivers.

Results:

Seven hundred and sixty‐seven physicians completed round 1, and 237 completed round 2. Results were compared with 146 cancer patients and 114 caregivers. Round 1 physician responses differed significantly from patients/caregivers in 13 categories (P < 0.05), while round 2 differed significantly in 11. When comparing physician data, round 2 allocations differed significantly from round 1 in 7 categories. When these 7 categories were compared with patient/caregiver data, round 2 allocations in the Emotional Care, Drug Coverage, and Nursing Facility categories were not significantly different from patient/caregiver allocations. In 4 categories, Cosmetic Care, Dental, Home Care, and Primary Care, round 1 allocations were more similar to patient/caregiver allocations, although all but Home Care were still significantly different.

Conclusions:

OHNS physician perspectives on end‐of‐life care differ significantly from cancer patient/caregiver perspectives even when physicians take a patient's perspective when allocating resources. These findings demonstrate the challenges inherent in end‐of‐life discussions between physicians and patients.
Epithelial‐Mesenchymal Transition in HPV‐Positive and ‐Negative Oropharyngeal Squamous Cell Carcinoma
Authors: Hatakeyama Hiromitsu , Mizumachi Takatsugu , Kano Satoshi , Homma Akihiro , Fukuda Satoshi
Published: August 2013

Objectives:

High‐risk human papilloma virus (HPV) infection is associated with carcinogenesis in oropharyngeal squamous carcinoma (OSCC), and patients with HPV (+) tumors have significantly favorable prognosis. However, the reason for this good clinical outcome has not been revealed. Epithelial‐mesenchymal transition (EMT) causes aggressiveness of cancer cells. We investigated the expression of the EMT markers and analyzed their correlation with HPV status and prognosis to detect the reason HPV (+) OSCCs respond to treatment.

Methods:

Eighty patients with OSCC were examined in this study. All high‐risk HPV infection were determined with the multiplex PCR kit from each formalin‐fixed paraffin‐embedded pre‐treatment sample. We performed immunohistochemical staining for E‐cadherin and vimentin and evaluated the results. Expressions of the markers were graded, and the correlation with TNM stages and prognosis was correlated.

Results:

Twenty‐three of the 80 OSCC tissues were shown to be HPV(+). The 5‐year survival rate for patients with HPV (+) tumors (79.1%) was higher than for those with HPV (‐) tumors (50.7%). Low e‐cadherin expression rate was 56.5% in HPV (+) and 19.2 % in HPV (‐). (P = 0.019) E‐cadherin expression was not correlated with survival rate in either HPV (+) or (‐). Vimentin expression was correlated with N‐stage in HPV (‐).

Conclusions:

HPV(+) OSCC originally lost their epithelial cell phenotype compared with HPV(‐). The EMT enhances aggressive behavior in HPV (‐) OSCC but not in HPV (+).
Fine‐Needle Aspiration Cytology of Thyroid Gland: A Cytology/Histology Correlation Study in Northern Ireland
Authors: Gurunathan Ramesh K. , McCadden Luke , McBride Greg , McGahey David , Nadig Shrinath
Published: August 2013

Objectives:

Fine needle aspiration cytology (FNAC) is a well‐established preoperative investigation of thyroid nodules. British‐Thyroid‐Association (BTA) guidance recommends thyroid cytology reporting with “Thy” classification (Thy1 (non‐diagnostic), Thy2 (benign), Thy3 (indeterminate), Thy4 (suspicious), Thy5 (malignant)). Our aim was to correlate the thyroid FNAC results with final histo‐pathological diagnosis in patients undergoing thyroidectomy.

Methods:

Retrospective case‐note analysis of 190 consecutive patients who underwent thyroid operations from 2009 to 2012. Most had ultrasound‐guided‐FNA (USgFNA) by an experienced radiologist. Patient demographics, FNAC results, ultrasound reports, and final histo‐pathological diagnoses were analyzed.

Results:

Mean age was 50 (range 14‐87). Male: Female was 1:5 (36:154). Sixty‐one percent (115/190) had hemi‐thyroidectomy. Thirty‐nine percent (75/190) had total/completion thyroidectomy. Twenty‐four percent (45/190) had diagnosis of thyroid cancer. Preoperative FNAC showed Thy1‐9% (17), Thy2‐16% (30), Thy3‐55% (105), Thy4‐8% (15), and Thy5‐3% (5). No FNAC was carried out in 9% (18) (4 had surgery for refractory Graves, and 14 had surgery for massive retro‐sternal‐goiter). Postoperative histopathology results correlated correctly in 80% of Thy4 and Thy5 (4/5 with Thy5 and 12/14 with Thy4 had thyroid malignancy (9‐PTC, 5‐follicular, 2‐anaplastic)). In the Thy3 category, 21% had thyroid cancer (11‐PTC, 7‐Follicular, 3‐undifferentiated), 35% had multi‐nodular goiter, and 25% had adenoma. Twenty‐nine percent (5/17) of Thy1 and 3% (1/20) who had surgery for suspicious clinical/ultrasound features also had cancer.

Conclusions:

USgFNA offers a very sensitive and accurate method in detecting malignancy (>80% both in Thy5 and Thy4 and >29% in Thy3 lesions). Our study demonstrated >29% of patients with non‐diagnostic FNAC (Thy1) with suspicious clinical or radiological features had thyroid malignancy, and we recommend diagnostic hemi‐thyroidectomy in this subgroup.
Impact of Radiation on Lymph Node Counts and Incidence of Extracapsular‐Spread in Neck Dissection Specimens
Authors: Lippert Dylan C. , Dang Phat , Cannon Donald , Harari Paul , McCulloch Timothy M. , Hartig Gregory K.
Published: August 2013

Objectives:

1) Analyze the impact of preoperative radiotherapy on total lymph node yield in neck dissection specimens. 2) Analyze the impact of preoperative radiotherapy on the presence of extracapsular‐spread in neck dissection specimens.

Methods:

Historical cohort study. Setting: Academic medical center. Patients: 525 subjects who underwent neck dissection for a diagnosis of squamous cell carcinoma from 1990 to 2010 were analyzed. Subjects were divided into 2 groups; those who underwent neck dissection alone or had neck dissection before radiation (surgery first group), versus subjects who received radiation therapy before neck dissection (radiation first group). Outcome Measures: The total number of lymph nodes harvested as well as the incidence of extracapsular‐spread was examined between these two groups.

Results:

A total of 366 patients in the surgery first group and 159 in the radiation first group were analyzed. The mean number of lymph nodes harvested in the surgery first group was 29.4, compared to 20.9 lymph nodes in the radiation first group (P < 0.001). Of 461 patients with available extracapsular‐spread data, 106 (23.0%) had extracapsular‐spread identified in their pathology report. Preoperative radiation significantly decreased the incidence of extracapsular‐spread (OR=0.296, P < 0.001). The incidence of extracapsular‐spread was 26.9% (84/312) in the surgery first group, and 14.8% (22/149) in the radiation first group.

Conclusions:

We identified a significantly decreased number of lymph nodes harvested and a decreased frequency of extracapsular‐spread in the neck dissection specimens from patients who had undergone prior neck irradiation as compared to those without prior neck irradiation.
Is There a Role of Adjuvant Therapy for the Treatment of Salivary Duct Carcinoma?
Authors: Nakashima Torahiko , Yasumatsu Ryuji , Toh Satoshi , Komune Shizuo
Published: August 2013

Objectives:

Salivary duct carcinoma (SDC) is a highly malignant tumor arising from the ductal epithelium of the salivary gland. The treatment of SDC is surgical excision along with lymph node dissection, followed by post‐operative radiation and/or systemic chemotherapy. Despite the multidisciplinary approach, prognosis is poor and the role of adjuvant therapy is controversial. The objective of this study was to retrospectively analyze the role of postoperative radiotherapy/chemotherapy for the treatment of SDC.

Methods:

26 patients (16 parotid gland, 8 submandibular gland, 2 minor salivary gland) with SDC were treated. The clinical stage was stage I:1 case, stage II:2cases, stage III:7 cases, stage IV:16 cases. All patients underwent surgery with neck dissection. 19 patients received post‐operative radiotherapy and 13 patients received post‐operative chemotherapy (CDDP/DOC: 3 cases, CDDP/ADM/CPA: 8 cases, S‐1:1 case).

Results:

The overall 3‐year and 5‐year survival rate was 54% and 48.1% respectively. Among the 14 fatal cases, there were 5 cases with local recurrence and 9 cases with distant metastasis. The overall 3‐year survival of the patients with or without post‐operative radiotherapy was 64% and 33% respectively (P = 0.29). The overall 3‐year survival of the patients with or without post‐operative chemotherapy was 53% and 56% respectively (P = 0.78).

Conclusions:

In our retrospective analysis, there was no benefit of post‐operative adjuvant therapy for SDC patients. Despite of the multidisciplinary approach, most patients recur locally or with distant metastasis. Developing novel treatment modalities (including molecular targeting) is necessary to improve the prognosis of this disease and will be discussed.
Modified Cervicofacial Rotation Flap with Tissue Expansion for Cosmetic Resection of a Large Hemifacial Congenital Nevus
Authors: Miguel George S. , Standring Robert T. , Darian Vigen , Schweitzer Vanessa G.
Published: August 2013

Objectives:

A 23‐year‐old Armenian female was evaluated in Armenia by the senior author and sponsoring church members for a deforming 8.5 × 6 cm heavily pigmented congenital nevus involving the right hemiface (cheek, eyelids, nose). The lesion affected function of the right lower eyelid. The patient wore her hair long with bangs as a camouflaging mask to wrap around her face.

Methods:

She was shortly thereafter brought to the United States for cosmetic reconstructive surgery for this lesion. She underwent a 2‐stage procedure: tissue expander placement with full thickness skin graft of the right lower eyelid defect, with subsequent removal of the expander two months later and modified cervicofacial angle rotation flap with full thickness skin graft to the nasal bridge, creating a superb cosmetic closure.

Conclusions:

Intra‐operative photographs detail the 2‐staged angle rotation flap reconstruction.
Mucositis as a Complication of Radiation Therapy in Nasopharyngeal Carcinoma: A Systematic Review
Authors: D'Aguillo Christine , Husain Qasim , Patel Chirag , Baredes Soly , Eloy Jean A.
Published: August 2013

Objectives:

1) Review the current literature on mucositis in patients with nasopharyngeal carcinoma (NPC) treated with radiation therapy. 2) Describe the rate of mucositis, grade, mucositis sequelae, dose‐limiting mucositis toxicity, and overall survival during radiation therapy for NPC.

Methods:

A systematic review of studies published regarding the treatment of NPC from 1990 to 2012 was conducted. A PubMed search for articles using the search terms “mucositis,” “radiation therapy,” and “nasopharyngeal carcinoma,” along with a review of the articles’ bibliographies was performed. Criteria for inclusion were clinical trials that reported radiation therapy as a treatment modality, and mucositis as a complication. Demographics, treatment type, treatment order, mucositis grade, percentage of mucositis sufferers, mucositis sequelae, dose‐limiting mucositis toxicity, and overall survival rates were recorded.

Results:

A total of 50 journal articles were included representing 4621 patients. Radiation therapy only was used in 1942 patients, and some combination of radiation therapy and chemotherapy was seen in 2679 patients. Grade 1 or higher mucositis was reported in 3441 patients, and 1588 patients reported Grade 3 or higher mucositis. On average, 76.8% of patients treated for NPC developed some level of mucositis. Dose‐limiting mucositis toxicity was reported in 95 patients. Alternate feeding methods due to mucositis (nasogastric tube placement or percutaneous endoscopic gastrostomy) were needed in 99 patients.

Conclusions:

This study is the first to examine mucositis as a complication of radiation therapy specifically for NPC. Mucositis is a serious complication in treatment of NPC, affecting the majority of patients and limiting their treatment.
Modulation of Radiogenic Effects in a Co‐culture Model of Adipose‐Derived Stem Cells and Fibroblasts
Authors: Haubner Frank , Pohl Fabian , Prantl Lukas , Gassner Holger G.
Published: August 2013

Objectives:

Determine modulatory effects of adipose‐derived stem cells on irradiated fibroblasts. The inflammatory response clinically observed after radiation has been described to correlate with elevated expression of cytokines in fibroblasts. Therapeutic compensation for this compromise could be an important approach in the treatment of irradiated wounds. Clinical reports describe the potential of adipose‐derived stem cells to enhance wound healing, but the underlying cellular mechanisms remain largely unclear.

Methods:

Normal human fibroblasts (NHF) and human adipose‐derived stem cells (ASC) were cultured in a co‐culture setting and irradiated with sequential doses of 2 to 12 Gy. Cell count was determined 48 h after radiation using a semi‐automated cell counting system. Levels of interleukin‐6 (IL‐6) and vascular endothelial growth factor (VEGF) were determined in the supernatants using enzyme‐linked immunosorbent assay (ELISA). Irradiated NHF and ASC as well as non‐irradiated co‐cultures, NHF, or ASC respectively were used as controls.

Results:

Cell count was significantly reduced in irradiated co‐cultures of NHF and ASC compared to non‐irradiated controls. Levels of IL‐6 and VEGF in the supernatants of the co‐cultures were significantly less affected by external radiation when compared to NHF mono‐culture.

Conclusions:

The increased expression of cytokines by NHF after external radiation is mitigated in the co‐culture setting with ASC. These in vitro changes seem to support the clinical observation that ASC may have a stabilizing effect on irradiated wounds.
Outcomes of Transoral Robotic Surgery: Initial Experience
Authors: Toscano Ullyanov B. , Dias Fernando L. , Lima Roberto A. , Soares Jose R. N.
Published: August 2013

Objectives:

Transoral robotic surgery (TORS) has gained importance in the resection of head and neck tumors. The use of robotics in this field has provided surgeons with the ability to access anatomic locations that were previously only managed via open techniques. This has resulted in decreased overall morbidity, excellent functional results and the promise of equivalent oncologic outcomes. TORS provides access to the oropharynx, hypopharynx, larynx, oral cavity and parapharyngeal space vial the oral aperture. We aimed to assess the initial experience for TORS, as observed in the BNCI TORS group.

Methods:

Forty‐four consecutive patients who were scheduled for TORS between March 2012 and January 2013 were included in this single institutional prospective cohort study. The operative times, conversion rates, morbidity, feeding tube rates, and tracheotomy were evaluated.

Results:

Most patients (55.5%) had squamous cell carcinoma of the tonsils, and 44.5% had SCC of the tongue base. Tumor resection with free margins was achieved in all cases. No patient needed conversion to an open approach. There were 6.8% postoperative hemorrhages and tracheotomy was performed in 9 patients. 43.2% of patients needed a feeding tube after TORS. The median setup and procedure times were 21 ± 18 and 61 ± 45 minutes, respectively. All patients underwent a neck dissection one week after TORS. The extent of neck dissection depended on neck nodes status. The average hospital stay was 4.5 days.

Conclusions:

Based on our initial experience, TORS appears to be safe and feasible, with minimal complications and favorable clinical and functional outcomes.
Paranasal Sinuses Tumors: Experience of Lisbon Oncology Institute between 2000 and 2011
Authors: Costa Eurico H. R. , Oliveira Filipa , Pereira Sonia , Cavilhas Pedro , Hebe Ana , Estibeiro Hugo , Magalhães Miguel
Published: August 2013

Objectives:

1) Analyze treatment outcomes, including 3 years overall and disease‐free survival rates of patients with paranasal sinus tumors. 2) Report epidemiologic data, primary tumor location, histologic diagnosis, clinical staging, and treatment modalities.

Methods:

Retrospective study of 165 patients with paranasal sinus tumors treated in I.P.O.F.G. Lisboa between 2000 and 2011. For survival analysis only, patients treated before 2010 were included, guaranteeing a minimal 3 year follow‐up period. Survival was analyzed by Kaplan‐Meier method with SPSS10.0 software.

Results:

Of 165 patients with paranasal sinus tumors, 109 presented with malignant tumors while 56 revealed benign pathology. The most frequent malignant tumor was squamous cell carcinoma (49 patients) followed by adenocarcinoma (12 patients). Maxillary sinus was the most frequent primary location (61%) except for adenocarcinomas, which tended to arise in the ethmoid sinuses. Mean age was 62, with a small predominance of male gender (68%). Of the 73 epithelial tumors, 62% presented at A.J.C.C. stage IV. Surgery was the primary treatment in 87% of cases, with adjuvant radiotherapy in 88%. Overall survival at 3 years was 37%, with 30% disease‐free survival. SCC revealed a poorer survival rate (22% and 17%, respectively). In the majority of cases, recurrence was caused by local failure.

Conclusions:

Our results confirm poor prognosis of malignant paranasal sinus tumors, explained by their aggressive biologic behavior, challenging surgical resection due to complex anatomic relations and mostly due to advanced stage presentation. Complete surgical removal with postoperative radiotherapy remains the standard treatment modality.
Photothermal Ablation of Head and Neck Squamous Cell Carcinoma by Nanoparticle Loaded Macrophages
Authors: Hong Seok‐Jin , Kwon Soon‐Young , Hirschberg Henry
Published: August 2013

Objectives:

Investigate the effect of photothermal treatment with gold nanoshells (NS) using macrophage‐mediated delivery system in head and neck squamous cancer (HNSC) cell line.

Methods:

The human HNSC cell line (FaDU) and Rat Ma (NR8383) was used for both monolayers and spheroids experiments. Ma were loaded with gold nanoshells. In spheroid models, the cytotoxicity of FaDU cell spheroid with NS loaded Ma was compared to FaDU cell spheroid with empty Ma (without NS). Monolayers and spheroids were exposed to increasing levels of 810nm laser light. The effect of laser ablation treatment was evaluated using MTS assay and spheroid growth kinetics. Live/dead assay was examined by two photon microscopy.

Results:

The cell viability (MTS assay) of PTT‐treated FaDU/NS loaded MS monolayers decreased in a laser dose‐dependent and NS loaded MS cell count. In live/dead assay, PTT‐treated hybrid FaDU spheroid with NS loaded Ma show significant cell death after exposure to NIR laser light. In kinetics of spheroid growth, PTT‐treated hybrid FaDU spheroids containing NS loaded Ma displayed significant decrease in their growth pattern compared to that observed for spheroids containing empty Ma (without NS).

Conclusions:

NIR laser irradiation of HNSC monolayers or spheroids incorporating NS loaded Ma resulted in significant growth inhibition in a irradiance dependent manner. With further development, photothermal treatment with gold nanoparticle loaded macrophages have the potential to improve the quality of life of head and neck cancer patients, providing minimally invasive modality for cancer treatment.
Prognostic Significance of Hyoid Bone Invasion in Advanced Base of Tongue Carcinoma Treated by Chemoradiation
Authors: Heaton Chase , Liu Chia‐Shang , Al‐Shwaiheen Fatemah , Ryan William R.
Published: August 2013

Objectives:

Examine the prognostic influence of hyoid bone invasion in advanced base of tongue squamous cell carcinoma (BOTSCC) treated with chemoradiation.

Methods:

We retrospectively reviewed pre‐treatment imaging (computed tomography/magnetic resonance imaging) for the presence or absence of hyoid bone invasion in patients with advanced (T3 or T4a) BOTSCC treated with chemoradiation from January 2001 to January 2011 at our tertiary academic medical center. We compared patients with hyoid bone invasion to those without based on the following metrics: 1‐year, 2‐year and 5‐year disease‐free survival (DFS), disease‐specific survival, and overall survival.

Results:

13 out of 40 patients had hyoid invasion present on pretreatment imaging. Average follow up was 43 months (range: 19‐96 months). Patients with hyoid bone invasion were found to have lower percentages in all survival metrics measured compared to patients without, respectively, with statistical significance achieved in the following: 1‐year DFS: 53.9% vs. 84.6% (P = 0.04), 2‐year DFS: 36.4% vs. 80.0% (P = 0.01) and 5‐year DFS: 22.2% vs. 62.5% (P = 0.05). Patients with hyoid bone invasion were also found to have lower percentages in DFS compared to patients without hyoid bone invasion the following subgroups: T4a BOTSCC, N stage 2 only, and positive smoking history. A multivariate analysis did not find hyoid bone invasion as a statistically significant independent variable.

Conclusions:

Hyoid bone invasion by BOTSCC may indicate a poorer prognosis despite treatment. Hyoid bone invasion may be a possible indication for the intensification of radiation therapy or the addition of chemotherapy, may encourage the consideration of primary surgery, and/or may increase the degree of post‐treatment surveillance monitoring and imaging.
Prospective Randomized Control Trial Using Best‐Selling Smoking Cessation Book
Authors: Oh Anita , Luginbuhl Adam , Curry Joseph , Cognetti David M.
Published: August 2013

Objectives:

Test the efficacy of international best‐selling author Allen Carr's The Easy Way to Stop Smoking in an outpatient office‐based practice.

Methods:

Prospective randomized controlled study involving 58 active smokers who presented to an academic otolaryngology clinic. Study participants were recruited during regular office visits and randomized to receive a free copy of the book or to act as a control group receiving only the name of the book and author. Both cohorts received physician directed cessation counseling. Follow‐up phone calls were conducted at 2 weeks and 6 months to assess smoking status, whether the control group participants bought the book, and how many pages of the book were read.

Results:

At 2‐weeks, 4 patients in the book intervention group and 4 patients in non‐book group stated they were no longer smoking. (17.4% vs. 19.0%). Fifteen of the 31 patients that received the book reported having read some portion of it whereas 3 patients in the control group purchased the book based on recommendation during counseling.

Conclusions:

Smoking cessation rates were not significantly different between the participants who received the book versus those who did not, and were similarly low in both groups. The majority of participants in both groups reported a readiness to quit smoking; however, 97% did not read the book to completion. Although the low rate of readership precludes the ability to assess efficacy, this study indicates smokers’ willingness to read the book is a significant hurdle for its success.