bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes for Patients at Head and Neck Cancer Consultation
Authors: Pereira Sonia , Montalvão Pedro , Magalhães Miguel 
Published: February 2015

ObjectiveHead and neck cancer outpatient departments have to deal with challenging, impairing, and highly lethal diseases. As the search for better treatments continues, we aimed to analyze the clinical outcomes of our patients and to identify factors that may affect short‐term survival.MethodWe performed a retrospective cohort study concerning all patients referred to the head and neck consultation of a Portuguese cancer center (Lisbon’s Instituto Português Oncologia) during 2008. Clinical and demographic data were obtained from medical records of those patients, from their first appointment until December 2011.ResultsFour hundred forty‐four patients were referred to our consultation over the study period. Most of them were men (87%) and the mean age was 60.4 years (range, 14‐86 years). The most common cancers were laryngeal (37%) and oropharyngeal (23%), and the majority (58%) were advanced (stage IVa or higher). Sixty percent of our patients were treated with surgery and adjuvant radiotherapy. The average time elapsed between treatment and first appointment was 80 days (range, 2‐275 days). The overall 2‐year survival rate was 58% and the 2‐year disease‐specific survival rate was 64%. The overall recurrence rate was 25%, mostly at the primary site.ConclusionMost of our patients had advanced tumors at the time of referral. Despite the early beginning of treatment at our center, survival, locoregional control, and treatment options are compromised. Public health policies should be developed to improve public health education regarding head and neck cancer prevention and early referral.
Outcomes of Total Laryngectomy: How to Improve?
Authors: Pereira Sonia , Montalvão Pedro , Magalhães Miguel 
Published: February 2015

Objective1) To analyze postoperative clinical outcomes in patients after total laryngectomy (TL). 2) To identify factors that may affect long‐term survival. 3) To evaluate the computed tomography (CT) scan’s value in the study of laryngeal and hypopharyngeal cancer.MethodWe performed a retrospective cohort study of patients who underwent TL for cancer between January 1, 2000, and December 31, 2004, at Instituto Português de Oncologia, Lisbon. Baseline characteristics, pretreatment clinical variables, and follow‐up data were collected from medical records.ResultsThree hundred seventy‐eight patients underwent TL. Most of the cancers were in advanced stage (IVa or higher), and arising at the larynx (71%). CT scan correctly evaluated the T stage only in 35%. The patients were primarily treated with surgery and adjuvant radiotherapy in 86%. The overall 5‐year survival rate and the 5‐year disease‐specific survival rate were 31% and 38%, respectively. The overall locoregional control was 66% and the overall recurrence rate was 55% (39% distant metastasis). Factors identified as related to long‐term survival: Cancer site in the larynx, T3 stage, N0‐N1 stage, and no more than 2 comorbidities.ConclusionMost of our patients had advanced tumors, which compromised survival. Other clinical variables (tumor site, comorbidities) may affect survival and treatment options. Those are often decided based on tumor evaluation by CT scan, which showed limited value. Public health education, earlier referral, and attention in treatment selection should be held.
Pharyngeal Horizontal Closure in Total Laryngectomies
Authors: Clavenna Matthew , Obokhare Joy , Gill Matthew T. , Lian Timothy S. 
Published: February 2015

ObjectiveTo determine the viability of horizontal pharyngeal closure during total laryngectomies, as an alternative to vertical and T‐closure methods, by evaluating the rates of pharyngocutaneous fistulas (PCFs) and dysphagia postoperatively.MethodRetrospective analysis of postoperative complications associated with horizontal pharyngeal closure during total laryngectomies at a tertiary institution from 2007 to 2011. Chart reviews were performed on a total of 15 total laryngectomy patients with horizontal pharyngeal closure, evaluating for fistula formation and dysphagia compared to reported rates in the literature.ResultsTwenty percent (3/15) of patients developed postoperative PCFs, and 18% (2/11) with dysphagia. Patients that had not been tried on oral feeds due to wound complications or those with recurrent disease were excluded for evaluating dysphagia.ConclusionA literature search revealed no studies evaluating horizontal pharyngeal closure. Reported ranges of PCFs are 13% to 25%, with dysphagia 17% to 70%. This study shows PCFs and dysphagia rates within these ranges. Thus, horizontal pharyngeal closure appears to be a viable alternative to T and vertical closures.
Pharyngoceles: Photo‐Anatomic Study and Novel Management
Authors: Naunheim Margaret , Langerman Alexander 
Published: February 2015

ObjectivePharyngoceles are outpouchings of the lateral pharyngeal wall through the thyrohyoid membrane. They are often noted as incidental findings on pharyngoesophageal imaging studies and are rarely symptomatic. Open surgical repair has been the mainstay of treatment for symptomatic pharyngoceles, save 2 reports of stapling which lack detailed anatomical description.MethodA systematic review was conducted to identify papers presenting cases of pharyngoceles. Articles were examined specifically for anatomic discussions, figures delineating the anatomy, and management strategies. To this data, we add 2 cases of bilateral symptomatic pharyngoceles with full multimedia documentation, including one treated successfully with a novel endoscopic suture‐pharyngoplasty.ResultsThirty papers were identified which described 49 cases of pharyngoceles, for a total of 51 with our cases. The anatomic boundaries of the pharyngocele space are the hyoid bone, thyroid cartilage, and thyrohyoid ligament with close involvement of the superior laryngeal nerve. Both unilateral and bilateral pharyngoceles have been reported, presenting with a variety of symptoms including dysphagia, globus, and neck‐swelling. One reported case of bilateral pharyngoceles was asymptomatic. Of those patients symptomatic enough to require surgery, all endorsed resolution of symptoms postoperatively. Both of our patients had complete resolution of symptoms, as determined by interview and oropharyngeal motility study.ConclusionRelatively few true pharyngoceles have been reported in the literature. We offer the first detailed endoscopic anatomic description of pharyngoceles and a novel technique of endoscopic suture pharyngoplasty, as well as a formal evaluation of swallowing outcomes postoperatively. These lesions may be amenable to endoscopic repair with minimal morbidity.
Predicting Quality of Life in Hypopharynx and Larynx Cancer
Authors: Moubayed Sami P. , Sampalis John S. , Christopoulos Apostolos 
Published: February 2015

Objective1) To identify independent predictive factors of quality of life (QOL) and depression in advanced‐stage (III/IV) hypopharyngeal and laryngeal cancer. 2) To construct a clinical prediction rule of QOL and depression in this population using multivariate analyses.MethodA historical cohort study will be conducted on stage III and IV hypopharyngeal and laryngeal cancer patients at least 12 months after diagnosis. We require 77 patients according to sample size calculations. We will evaluate QOL and depression using 3 validated questionnaires: EORTC QLQ‐C30, EORTC QLQ‐HN35, and HADS. HPV status will be evaluated using PCR on tissue samples. The following factors will be evaluated: site, sub‐site, TNM classification, stage, comorbidities, age, sex, pretreatment depression, malnutrition, neutrophil count, hemoglobin, treatment type, locoregional, specific, and global survival. Bivariate analyses will identify long‐term predictors of QOL and depression (t test, ANOVA, Pearson correlation coefficient). Multivariate linear regression will identify the factors with independent significance and will be used to construct a clinical prediction rule.ResultsWe expect to identify several significant predictors of long‐term QOL in late‐stage hypopharyngeal and laryngeal cancer. This is the first study in the literature to evaluate the impact of HPV status on QOL in this population, and one of the first studies to evaluate QOL in head and neck cancer according to subsite. Results will be presented at the meeting.ConclusionThis study can potentially generate economies in costs related to QOL assessment as it can help with predicting QOL using significant predictive factors instead of lengthy self‐administered questionnaires.
Topiramate‐Induced Unilateral Ptosis
Authors: Zhao Kathy , Spiegel Jeffrey H. 
Published: February 2015

ObjectiveTo present the case of a rare ocular side effect induced by topiramate use.MethodThis is a case of a 43‐year‐old transgender man who presented with unilateral ptosis of the right eye. Ptosis was noted after 4 years of topiramate therapy, prescribed as prophylaxis against migraines.ResultsWhile some adverse vision and eye effects associated with the use of topiramate have been documented, eyelid ptosis has only been reported in 0.14% of patients using the drug. Thus, topiramate‐induced ptosis is a very unusual finding.ConclusionExperience with this case has demonstrated that immediate discontinuation of the drug can restore eyelid function within 1 week.
Reflux Surgery for Improved TEP Outcomes after Laryngectomy
Authors: Jensen Katrina M. , Ducic Yadranko N. , Thompson Allison L. , Garcia Fernando 
Published: February 2015

Objective1) Identify the potential benefits of adequate reflux intervention in the management of TEP complications in the laryngectomized population. 2) Understand the role of PPI utilization for TEP complications. 3) Identify surgical intervention for reflux as a hierarchical treatment option for TEP complications not responsive to PPI utilization.MethodA retrospective chart review of laryngectomy patients in an otolaryngology private practice identified 4 patients from November 2009 to November 2011 who underwent fundoplication for TEP complications not responsive to PPI utilization. Prosthetic device life (days) as well as the presence of periprosthetic leakage was compared in preoperative and postoperative groups.ResultsThe 4 patients who underwent fundoplication for reflux management were referred for surgical intervention after persistent TEP complications following greater than 6 months of PPI utilization. Evidence of reflux was determined using transnasal esophagoscopy, barium swallow, and/or 24‐hour pH monitor prior to surgery. Two of 4 were noted to have periprosthetic leakage prior to fundoplication which resolved following surgery. Both individual and group mean device life was noted to increase, with individual mean increases of 71.7%, 88.4%, 188.1%, and 41.3%, respectively. Group mean increase was noted at 85.9%, with significance demonstrated; P =. 03.ConclusionAlthough PPI treatment has been found to be an effective intervention for reducing TEP complications, some patients continue to demonstrate complications, despite months of PPI utilization. These findings suggest surgical intervention may be an effective means in this population of reducing associated complications and prolonged need for PPI utilization.
Screening Laryngeal Dysplasia Using Gynecological Principles
Authors: Douglas Justin W. , McChesney Jason , Williams Harold J. , Yu Jing J. 
Published: February 2015

Objective1) Devise a pilot study to develop a noninvasive laryngeal screening technique that could be used to detect lesions not readily visible to the unaided eye via a laryngoscope. 2) Extend the validity of the screening technique that is already accepted by the FDA for gynecological and oral cavity dysplasia.MethodPilot study examining fresh laryngectomy specimens using chemiluminescent staining techniques was undertaken from July to December 2010 at our institution. Specimens were painted with an acetic acid solution and examined under lumenoscopic lighting. Normal appearing and aceto‐white areas were biopsied. Results of HPV testing, cytology, and tissue analysis were compared.ResultsFour (N = 4) total laryngectomy specimens from patients aged 40 to 81 years old (mean, 57 years) where examined with chemiluminescent staining techniques to detect dysplasia not readily visible. Preoperative cancer stages of these larynges ranged from T2 to T4. There were 3 men and 1 woman, 75% were smokers, and 50% used alcohol. High‐risk HPV serotype 16 or 18 was found in 75% of specimens. Dilute acetic acid solution was successful in identifying dysplasia or invasive cancer not visble. HPV 16 stained more intensely than HPV 18. Cytobrush alone was not adequate to detect cells with HPV effect.ConclusionThere seems to be a role for a dilute acetic acid solution in the detection of laryngeal dysplasia. HPV‐16 subtypes seem to produce a more dramatic staining pattern. High‐risk subtypes found in 75% of laryngectomy specimens. Future research is needed to optimize the described technique.
Selective vs Superselective Neck Dissection in Larynx Cancer
Authors: Kim Won Shik , Byeon Hyung Kwon , Lee So‐Yoon , Hong HyunJun , Koh Yoon Woo , Choi Hong‐Shik , Choi Eun Chang 
Published: February 2015

ObjectiveSince regional metastasis has a tremendous impact on the prognosis of laryngeal cancer, neck management is important. We reported the study regarding the necessity of level IV dissection in cN0 laryngeal carcinoma previously. Based on the previous study, we compared selective neck dissection II‐III with SND II‐IV in laryngeal cancer.MethodThirty‐six patients with cN0 laryngeal cancer were randomly assigned to receive SND II‐III or SND II‐IV for the elective neck dissection. The estimated blood loss and the rate of postoperative chyle leakage or phrenic nerve palsy were analyzed according to the different extent of neck dissections. Oncologic results were measured.ResultsThe mean age of patients was 63.4 years. Nineteen patients (52.8%) received SND II‐III (group I) and 17 patients (47.2%) received SND II‐IV (group II). No cases of chyle leakage or phrenic nerve paralysis were reported in both groups. Ten out of 36 patients (27.8%) had recurred. In group I, recurrence rate was 21.1% (4/19) and it was 35.3% (6/17) in group II. The 5‐year recurrence‐free survivals were 64.7% and 59.2% in group I and group II, respectively. The 5‐year overall survivals for group I and group II were 93.3% and 86.9%, respectively.ConclusionAlthough more cases should be accumulated for a definitive demonstration, we suggest that SND II‐III is an appropriate modality in the neck management of cN0 laryngeal cancer in the aspects of perioperative morbidity and oncological safety compared with SND II‐IV.
Surgical Outcomes of Parotid Cancer: A 10‐Year Experience
Authors: Kim Won Shik , Lee Hyoung Shin , Park Young Min , Hong HyunJun , Koh Yoon Woo , Kim Se‐Heon , Choi Eun Chang 
Published: February 2015

ObjectiveThe aim of the study was to investigate the treatment outcomes of malignant parotid tumors. This investigation is to report our experience with the management of patients with malignant parotid tumors that were treated with combinations of surgery, radiation, and chemotherapy.MethodFrom January 1999 to December 2008, 126 patients with primary parotid cancer were treated. Data including age, sex, histologic findings, tumor stage, surgery type, complications, and prognosis were collected retrospectively from medical charts.ResultsTheir mean age was 55.4 years (range, 15‐96 years). Mean follow‐up was 29.7 months. Thirty three patients were stage I, 40 stage II, 30 stage III, 23 stage IVA. Fifteen patients had recurrences: 6 patients had local, 2 had locoregional, and 1 had regional failure, 6 had distant metastasis. The most common malignant tumor was mucoepidermoid carcinoma (38, 29.5%). Sixty‐one patients underwent superficial, 43 had total, and 22 had radical parotidecomy. Postoperative radiotherapy was done in 57 of 126 cases (45.2%) on the basis of the histologic findings, tumor dimensions, amount of surgery, and extent of cervical metastasis. The disease‐specific survival rate for malignant tumor was 97% for stage I, 81% for stage II, 56% for stage III, and 15% for stage IV. The most common complication was transient facial palsy (20, 14.7%).ConclusionOur experience allows us to confirm the results of the literature in the treatment of parotid cancers. In our study, the patients with high disease stage and tumor grade have a bad prognosis with the statistical significance.
Synovial Sarcoma of the Head and Neck
Authors: Li Wen 
Published: February 2015

ObjectiveTo investigate the relationship between pathological diagnosis and clinical outcome of synovial sarcoma (SS) of head and neck.MethodThirty‐nine cases of SS in head and neck region from 1966 to 2011 were retrospectively studied by reviewing the pathological slices of the operative specimen and followed‐up from 1 to 16 years with a mean time of 4 years postoperatively.ResultsAll patients were men aged from 8 to 66 years old with a mean age of 35 years and the disease demonstrated a predilection for lateral upper neck. Pathologically, 18 cases were biphasic, 17 cases were monophasic, and 3 cases were low‐differentiated SS. Four cases were proved by cytogenetic methods of either fluorescence in situ hybridization (FISH) or/and RT‐PCR. Six cases experienced repeated recurrence with the most up to 4 times operations after sole surgical approach. No lymphatic metastasis was observed during the 1‐ to 16‐year follow‐up. One patient developed scalp, arms, thoracic, and abdominal wall metastases during the postoperative 6‐year follow‐up, and one patient developed likely pulmonary metastatic foci but showed no growth and was not pathologically confirmed during the postoperative 2‐years’ follow‐up. Sixteen patients received adjuvant radiotherapy or chemotherapy. Nine patients died, but no death was directly associated with SS.ConclusionThe locoregional control of SS seemed related more closely to the anatomy of the tumor location rather than pathological patterns. SS of head and neck is a special entity that has good prognosis, cytogenetic methods are recommended to be employed to ascertain the diagnosis in order to choose reasonable treatment protocols.
Technical Considerations in Sinonasal Tumor Recurrences
Authors: Singh Ameet , Joshi Arjun S. , Sadeghi Nader 
Published: February 2015

Objective1) To study the rate of reoperations and recurrences of endoscopically treated benign and malignant sinonasal tumors. 2) To propose technical considerations in preventing reoperations and recurrences for endoscopically treated sinonasal tumors.MethodA retrospective review of all endoscopically treated benign and malignant sinonasal tumor pathologies from January 2002 to January 2012 was performed. Patient demographics, tumor characteristics, surgical approaches, and complications with a specific emphasis on reoperations and tumor recurrences were analyzed.ResultsSixty‐four operative procedures were performed in 50 patients. Pathologies included 39 benign (21 IP, 5 JNA, 3 fibro‐osseous lesions, 3 meningiomas, 2 lymphomas, 5 assorted lesions) and 11 malignant (2 esthesioneuroblastomas, 3 SCC, 2 olfactory carcinomas, 1 SNUC, 1 hemangiopericytoma, 1 NPC, and 1 ACC) tumors. Fourteen reoperations (21%) were performed secondary to tumor recurrence (9 cases) or residual tumor (5 cases). The majority of reoperations resulted from inadequate surgical exposure, incomplete adherence to oncological principles, excessive concern for functional preservation, and lack of a well‐defined reproducible technique. Tumor biology played a key role in a small fraction of cases.ConclusionAdvances in endoscopic techniques, equipment, and experience have increased the number of sinonasal tumors being treated endoscopically. Wide surgical access, adherence to oncologic principles, and well‐defined endoscopic techniques are paramount for successful treatment of these tumors. It is imperative that the endoscopic tumor surgeon balance oncologic principles with functional preservation.
The Role of PET/CT for Lung Lesions in Oral Cavity Cancer
Authors: Chang Yu‐chang , Hao Sheng‐Po 
Published: February 2015

ObjectiveDetermine the significant parameters of PET/CT in the prediction of the nature of lung lesions during the staging of newly diagnosed or recurrent oral cavity cancer.MethodWe retrospectively reviewed the charts of 183 patients from July 2010 to December 2011 with newly diagnosed or recurrent oral cavity cancer. Twelve cases with positive PET/CT lung lesions (SUVmax >4) subsequently underwent biopsy. The SUVmax, number of lesion, and side were studied.ResultsA total of 12 patients were collected as suspicious for lung metastases. One case with esophageal cancer was excluded. Five were lung metastases, 3 were second primary lung cancer, and the remaining 3 were chronic inflammation. Comparing with second primary and chronic inflammation, metastases had higher SUVmax but without significant difference (P value >.05). Metastases and chronic inflammation had higher incidence of multifocal lesions comparing with second primary (P value, metastases vs second primary:. 008, chronic inflammation vs second primary:. 09). There is no significant difference between the metastases and chronic inflammation (P value:. 38). For side and lesion, no significance was noted.ConclusionBased on our preliminary data, higher SUVmax value (mean: lung metastases: 6.65, second primary lung cancer: 3.96, chronic inflammation: 3.98) and multifocal lesions favor metastatic lung lesions compared with second primary or chronic inflammation.
The Value of the Exposure of Recurrent Laryngeal Nerve
Authors: Xiang Ming L. , Shen Chen L. , Wu Hao 
Published: February 2015

ObjectiveTo explore the value of dissecting the recurrent 1aryngeal nerve (RLN) in thyroid surgery to prevent RLN from injury.MethodRetrospective study from 2005 to 2011. Disease studied: thyroid tumors. Setting: Xin Hua hospital, Shanghai Jiao Tong University School of Medicine. The recurrent laryngeal nerve was exposed in thyroid surgery. Outcome measurements: Recurrent laryngeal nerve injury rate. Preliminary snalyses: Chi‐square analysis.ResultsThere were 12 cases of RLN injuries in the RLN anatomy group (the RLN injury rate was 2.2%) and 512 cases of RLN injuries in the non‐RLN anatomy group (10.7% injury rate). The difference of RLN injury between the 2 groups was statistically significant (P <. 01).ConclusionExposure of RLN in the thyroid surgery is an effective step to prevent the nerve from injury.
Total Laryngectomy with Radiotherapy in Stage T3‐T4
Authors: Sobczyk Grzegorz , Kizler‐Sobczyk Krystyna , Kawecki Andrzej , Krzeski Antoni , Wójtowicz Piotr 
Published: February 2015

ObjectiveEvaluation of the result of treatment with total laryngectomy and complementary radiotherapy in patients with cancer of the larynx in stage T3‐ T4 N0M0. Analysis of the impact of the primary cancer localization, feature G and T, unradical result of the surgery treatment.MethodThe study population included 136 patients with cancer of the larynx in stadium T3‐T4 N0M0 treated with curative intent by total laryngectomy with complementary radiotherapy. T3 was in 61 patients, T4 was in 75 patients.ResultsIn coregression analysis of multivariate failure did not show the statistically related to the recurrence and death P > 0.1. Two‐ and 5‐year disease‐free survival was for all group adequately 83% and 76%. Two‐ and 5‐year disease‐free survival in cases T3 and T4 was adequately 88% and 76%. In patients with primary localization in glottis 2‐ and 5‐year disease‐free survival was adequately 81% and 73% in cases supraglottis 88% and 81%.ConclusionThe primary cancer localization, feature G and T, unradical result of the surgery does not statistically relate to the result of the treatment by laryngectomy with complementary radiotherapy. Total laryngectomy with complementary radiotherapy has high finish result of treatment cancer of the larynx in stage T3‐T4 N0 M0.