bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional and Oncologic Outcomes of Hypopharyngeal Cancer by Treatment Modality
Authors: Momin Suhael , Khan Mumtaz 
Published: August 2013

Objectives:1) Describe functional and oncologic outcomes of patients with hypopharyngeal cancer treated with various treatment modalities. 2) Recognize advantages and limitations of different management options for hypopharyngeal cancer.Methods:A retrospective chart review was completed to include all patients with a diagnosis of hypopharyngeal cancer between 1998‐2012. The primary outcome measure was overall survival, with secondary outcome measures including disease free survival, feeding tube dependence, and tracheostomy dependence. Tumor stage at presentation and history of previous or subsequent malignancy were also included. Data were grouped by primary treatment modality (surgical vs non‐surgical). Kaplan Meier curves were generated. Student's t test and Chi‐square test were also used.Results:One hundred and eight patients with hypopharyngeal cancer were included. Patients were 79% male, with an average age of 61.9 years and average follow‐up of 36 months. Sixty‐four were treated with non‐surgical modalities, and 44 were treated with surgery with or without adjuvant therapy. Initial analysis demonstrated more locoregional recurrences in those treated without surgery. Among those patients, loco‐regional recurrence occurred in 40% vs 20% of those managed surgically (P = 0.04). Of those patients initially treated non‐surgically, 11 (19%) progressed to require total laryngectomy. Long term feeding tube dependence was not significantly different between treatment modalities (34% surgical vs 30% non‐surgical, P = 0.62).Conclusions:Hypopharyngeal cancer remains a challenging clinical problem. In early analysis of our data, rates of locoregional recurrence are higher in patients treated non‐surgically. There is no difference in long‐term feeding‐tube dependence.
Hardware Failure after Osseous Free Flap Reconstruction
Authors: Magnuson Scott , Day Kristine E. , Carroll William R. , Rosenthal Eben L. 
Published: August 2013

Objectives:Understand the underlying reasons for hardware failure after osseous free flap reconstruction.Methods:A retrospective chart review of 224 patients undergoing 241 vascularized osseous mandibular reconstructions between the years of 2004‐2012 was conducted with a minimum of 6 months follow‐up.Results:There were 33 (14.7%) patients who underwent removal of the support implant with the most common reason being infection, exposure, or both. The average length of time to removal was 16.3 months, with a bimodal distribution: the majority of removals occurred within the first year, and the second group occurred in the third year. Of patients who had the hardware removed after 3 months, there were 12 (36.4%) who had malunion at the time of removal. In those patients, the inciting factor was resolved upon removal for 18.2% (n = 6) of cases.Conclusions:Removal of the supporting hardware most commonly occurs from infection or exposure in the first year. In the majority of cases, the bone is well healed and the problem resolves with removal.
Human Papillomavirus and p16 in Oropharyngeal Cancer and Their Relationship to Tobacco Use
Authors: Saunders James , Losavio Phillip , Gattuso Paolo , Lamzabi Ihab , Fogg Louis , Petruzzelli Guy J. 
Published: August 2013

Objectives:Over the last decade, there has been a vast amount of research establishing the link between human papillomavirus (HPV) and oropharyngeal cancer. It has been hypothesized now that two distinct forms of oropharynx cancer exist: HPV associated disease and carcinogen induced. Correlation between oncologic outcomes and HPV status is ongoing. The objective of this study is to investigate the relationship between HPV markers and carcinogen status.Methods:Clinical data were collected both retrospectively and prospectively for 151 patients with squamous cell carcinoma of the oropharynx. Main clinical outcome measures included tobacco status (pack‐years and CMS tobacco groupings) and alcohol use history. All tumors were evaluated for p16 by monoclonal antibody immunohistochemistry assay. HPV DNA was detected by in‐situ hybridation probes for low and high risk subtypes. Statistical analysis was done by Pearson's Chi‐Squared analysis for tobacco use.Results:Patients with p16+ tumors or HPV+ tumors had significantly lower tobacco exposure (P <. 001, P =. 001 respectively) with p16 having higher significance. These relationships were enhanced in both circumstances when taking both HPV DNA and p16 positive status into account in combination.Conclusions:This study demonstrates that HPV+/p16+ tumors show the strongest correlation with low tobacco exposure. It has been hypothesized that p16+, HPV ‐ tumors may represent a distinct subset of oropharynx cancers, with p16 having its own unique clinical relevancy. Further studies should be done to evaluate whether there is a difference in outcome measures for p16+, HPV ‐ tumors relative to p16+, HPV+ tumors.
The Impact of Tumor Volume on Treatment Outcomes for T4a Laryngeal Cancers
Authors: Hsin Li‐Jen , Fang Tuan‐Jen 
Published: August 2013

Objectives:Investigates the impact of tumor volume on treatment outcomes for T4a laryngeal cancer patients.Methods:A retrospective chart review was conducted from October 2002 to September 2010. Sixty‐two T4a laryngeal cancer patients treated with laryngectomy or concurrent chemo‐radiotherapy (CRT) were enrolled. Tumor volume was calculated using imaging software and was correlated with the survival data.Results:In the CRT group, the 5‐year overall survival (OS) and progression‐free survival (PFS) were significantly lower in those patients whose tumor was larger than 14 cm3 (20.7% vs. 52.6%, P = 0.008; 35.5% vs. 63.4%, P = 0.008). For patients whose tumor volume was larger than 14 cm3, laryngectomy provided a significantly higher 5‐year OS (72.7% vs. 20.7%, P = 0.039) than CRT.Conclusions:Patients with T4a laryngeal tumors larger than 14 cm3 had a poorer treatment outcome after CRT than total laryngectomy. Thus, laryngectomy is preferable for this subset of patients.
Microbiological Sampling of Common Otolaryngological Office Equipment: What Lessons Can We Learn?
Authors: Bhatt Jay M. , Verma Sunil P. 
Published: August 2013

Objectives:Analyze whether standard decontamination protocols were effective in cleaning integral components of common otolaryngological office equipment, including flexible fiberoptic laryngoscopes, detachable light cables, and otoscope handles.Methods:A random microbiological sampling of 6 flexible fiberoptic laryngoscopes including the eye piece and the driver handle, 3 light cables, and 5 otoscope handles was performed. All equipment was sampled in the middle of a busy office session. Samples were then subjected to standard aerobic growth culture analysis.Results:From a total of 20 samples collected, 7 (35%) demonstrated contamination with bacterial organisms. 4 of the 20 sample sites (20%) exhibited human contamination, 2 of which were from light cables, 1 from a laryngoscope eye piece, and 1 from an otoscope handle.Conclusions:This microbiological evaluation of common office instruments demonstrates that there are numerous potential contaminates which may be present in the office setting. These include flexible laryngoscope eyepieces, light cables, and otoscopes, which are commonly overlooked in the cleaning protocols of a standard otolaryngology clinic.
Hypocalcemia after Total and Completion Thyroidectomy: Analysis of 100 Consecutive Patients
Authors: Gurunathan Ramesh K. , McCadden Luke , McBride Greg , Nadig Shrinath 
Published: August 2013

Objectives:Evaluate incidence of hypocalcemia (time‐course) after thyroid surgery in 100 consecutive cases who underwent total/completion thyroidectomy.Methods:Retrospective case note analysis of 100 cases from 2009 ‐2012. We assessed ionic calcium preoperatively and postoperatively at 6‐24‐48 hours, 1 week, 6 weeks and 6 months. Serum parathormone level 24 hours post‐surgery (and later if persistent hypocalcaemia), patient demographics, details of surgery, duration of stay, histopathological diagnosis were also analyzed.Results:79/100 patients were female, 21 male. Mean age was 55 (range 14‐87). 74/100 had total thyroidectomy and 26 had completion. Preoperative mean calcium was 2.39 (range 2.1‐3.86) and at 6 hours post‐operatively dropped to 2.1 (1.84‐2.53), 24 hours 2.16 (1.6‐2.5), 48 hours 2.24 (1.7‐2.7) and 1 week 2.3 (1.74‐2.67) and stabilized at 6 weeks and 6 months 2.3 (1.9‐2.66). 18/100 patients had hypocalcemia (below 1.99) and parathormone at 24 hours post‐operation measured below 5. Delayed hypocalcemia was seen in 4 of 18 patients (after 24‐48 hours) and 2 of them had parathyroid adenoma with pre‐op high calcium. Persistent hypocalcemia at 6 weeks was seen in 7/18 patients and at 6 months in 5/18 patients (necessitating long term calcium/Vitamin D supplement) despite parathormone levels measuring above 5 (mean:7 range:2‐20). Of 18 patients who had hypocalcemia, 10 had surgery for malignancy (with level‐6 neck dissection), 2 had Graves disease, and 2 had Hashimoto's thyroiditis.Conclusions:Extensive surgery with neck dissection, elderly patients and peri‐glandular fibrosis predict high risk for post‐operative hypocalcemia. Patients should be warned about risk of delayed hypocalcemia occurring late (after 48 hrs) and seek immediate medical attention.
Immunohistochemical Expression of E‐Cadherin, Survivin and VEGF in Nonexophytic Nasopharyngeal Carcinoma
Authors: Tay Joshua K. , Jeevanandam Madana , Petersson Frederik , Loh Kwok‐Seng 
Published: August 2013

Objectives:E‐cadherin, survivin and vascular endothelial growth factor (VEGF) have been suggested to be prognostic markers for nasopharyngeal carcinoma (NPC). Patients with biopsy‐proven NPC sometimes present with a normal‐appearing nasopharynx (nonexophytic NPC). These patients have been reported to have higher risk of N3 and M1 disease. The authors aim to compare the immunohistochemical expression of the above markers for nonexophytic and exophytic NPC.Methods:From 2003 to 2011, 30 patients with nonexophytic NPC were diagnosed in a single institution. Thirty patients diagnosed with exophytic NPC were selected for comparison, matched for age, gender and TNM stage. Expressions of E‐cadherin, survivin and VEGF in tumor tissues were investigated by immunohistochemistry. Expression levels were evaluated by a pathologist blinded to the clinical data, using a semiquantitative scoring scheme.Results:The majority of nonexophytic NPC patients had late stage disease (Stage I: 13.3%, II: 23.3%, III: 33.3%, IV: 30%), even though 67% had T1 disease of the nasopharynx. A borderline significant result was obtained for cytoplasmic E‐cadherin, with positive expression in 12% of nonexophytic NPC patients compared to 35.7% of exophytic NPC patients (P =. 059). There was no difference in overall expression of survivin and VEGF between both groups (P =. 612 and P =. 653 respectively, Mann‐Whitney U test).Conclusions:Reduced cytoplasmic E‐cadherin suggests downregulation and provides a possible explanation for the higher risk of nodal and distant metastasis in nonexophytic NPC. The evaluation of other immunohistochemical markers should be considered to explain this phenomenon.
Incidence of Occult Nodal Disease in Patients Treated with Salvage Laryngectomy with Radiologically Negative Neck
Authors: Ojo Rosemary B. , Freiser Monika , Saint‐Victor Sandra , Bollig Craig , Mantravadi Avinash V. , Sargi Zoukaa B. 
Published: August 2013

Objectives:The National Comprehensive Cancer Network guidelines address neck dissection in the setting of primary tumor treatment but do not provide a clear guideline for negative nodal disease in recurrent advanced laryngeal cancer. We often extrapolate the indication of neck dissection for recurrent disease based on the guidelines of primary disease. It is controversial whether there is a survival benefit for patients with clinically and radiologically negative (N0) necks to receive a neck dissection versus conservative management. This study aims to determine survival outcomes and incidence of post‐operative complications in patients who underwent neck dissection at the time of salvage laryngectomy with clinically and radiologically negative neck.Methods:Single institution case series at a tertiary care university hospital. We identified 424 cases of total laryngectomy between 2000‐2010. We reviewed the subset of N0 patients who had salvage laryngectomy and divided them into neck dissection versus conservative management. We reviewed demographic variables, final pathological stage of dissected neck specimen, and post‐operative course and survival.Results:Patients who had a neck dissection at salvage laryngectomy with clinically N0 disease as compared to those treated conservatively may have no significant difference in survival; there may be a significant difference in the complication rate and perioperative mortality rate between the two groups.Conclusions:The data reviewed in this large series of patients will be useful for clinicians to determine the survival and complications that are frequently experienced by patients following neck dissection with salvage laryngectomy in the setting of previous radiation.
Incidence of Synchronous Bilateral Tonsillar Carcinoma in a Cohort of T1/T2 Primary Tonsil Cancer
Authors: Saunders James , Losavio Phillip , Petruzzelli Guy J. 
Published: August 2013

Objectives:The most recent review of bilateral synchronous tonsillar carcinoma published in 2012 identified 12 previously described cases in the literature. It has been estimated that there is a 10% incidence of contralateral nodal metastasis from tonsillar carcinoma. However, the true incidence of bilateral synchronous occult disease is unknown. This study aims to describe the incidence of bilateral tonsillar carcinoma in early stage disease.Methods:The study design consisted of a retrospective cohort study of 120 patients with T1 or T2 primary tonsillar squamous cell carcinoma treated between 1995 to 2012. All patients were treated with primary radical surgical therapy and had the contralateral tonsil removed at the time of surgery. Data was extracted from an institutional review board approved department database. All cases were reviewed for evidence of an occult tumor in the contralateral tonsil.Results:Out of 120 patients, 3 patients were identified to have an occult primary cancer in the contralateral tonsil. This resulted in a 2.5% incidence of disease in this cohort of patients. Compared to the incidence of tonsillar carcinoma in the general population 2.1 x 10‐5, (95% CI: 2 x 10‐5, 2.2 x 10‐5) this is significantly elevated.Conclusions:This is the first study attempting to establish the incidence of bilateral tonsillar carcinoma in a large cohort of early stage tonsillar carcinoma patients. Given the increasing use of transoral robotic surgery to treat these patients, it is important to be aware that there is likely a small but slightly elevated risk of contralateral occult disease.
Inhibition of Novel Cetuximab Resistance Pathway Leads to Improved Outcomes in Head and Neck Cancer
Authors: Lajud Shayanne A. , Nagda Danish , Kumar Sanjeev , Qiao Peter , Zheng Jun , O'Malley Bert W. , Li Daqing 
Published: August 2013

Objectives:1) Determine if cetuximab resistance in head and neck squamous cell carcinoma (HNSCC) is regulated by increased nuclear translocation of Epidermal Growth Factor Receptor (EGFR) through an MRN‐dependent Akt phosphorylation pathway. 2) Determine if targeted inhibition of the MRN complex, a key mediator of DNA damage response, can improve cetuximab sensitivity in HNSCC.Methods:Two well‐characterized human HNSCC tumor cell lines, with differential resistance to cetuximab, were chosen for this study. Mirin, a novel molecular MRN inhibitor was used for this study. MTT and clonogenic assays were used to evaluate in vitro cytotoxicity. Western blot analysis was performed to evaluate protein expression. In vivo tumor growth was evaluated using molecular imaging.Results:As compared with sensitive cells, cetuximab resistant cells demonstrated increased MRN expression, increased Akt phosphorylation, and increased nuclear EGFR. The inhibition of MRN led to a dose‐dependent decrease in Akt phosphorylation and nuclear EGFR translocation. Furthermore, MRN inhibition synergistically enhanced the cytotoxic effect of cetuximab in resistant cells (P < 0.01).Conclusions:The findings from this study suggest a novel cetuximab resistance pathway involving MRN‐mediated Akt phosphorylation, leading to increased nuclear translocation of EGFR. Furthermore, inhibition of MRN led to decreased Akt‐phosphorylation, subsequently decreasing nuclear EGFR translocation, a key molecular mechanism involved in cetuximab resistance. Based on this discovery, inhibition of this pathway may serve as an effective therapeutic approach for HNSCC patients resistant to cetuximab.
Inositol Polyphosphate‐5‐Phosphatase in the Development of Head and Neck Squamous Cell Carcinoma
Authors: Patel Alpen B. , Landry April M. , Sekulic Aleksandar , Hayden Richard E. 
Published: August 2013

Objectives:1) Evaluate the expression patterns of inositol polyphosphate‐5‐phosphatase (INPP5A), a negative regulator of inositol signaling, in the development and progression of head and neck mucosal squamous cell carcinoma (SCCA). 2) Compare and contrast previously reported reduction in INPP5A protein levels seen in the progression of cutaneous SCCA with that of mucosal head and neck SCCA.Methods:We analyzed a series of mucosal oropharyngeal lesions ranging from normal mucosa to invasive SCCA in order to identify genetic changes associated with SCCA development. Immunohistochemistry (IHC) was performed to evaluate INPP5A protein levels in primary SCCA tumors. Formalin fixed, paraffin embedded tissues were sectioned and incubated with anti‐INPP5A antibody and the INPP5A protein expression levels quantified.Results:Deletions of a region on chromosome 10q harboring the INPP5A gene in cutaneous SCCA have previously been reported. INPP5A protein levels have been found to be frequently reduced in primary cutaneous SCCA tissues and demonstrate an early event in the progression of SCCA with further reduction in metastatic disease. A direct comparison of INPP5A protein levels in oropharyngeal mucosal head and neck SCCA has been made with data previously seen with cutaneous SCCA.Conclusions:Previous studies have shown that INPP5A loss is seen with cutaneous SCCA proliferation. This study provides a comparison of INPP5A protein levels in progressive mucosal oropharyngeal SCCA with that seen in cutaneous SCCA.
An Institutional Experience with the Development of Pharyngocutaneous Fistulas following Total Laryngectomy with Free Flaps
Authors: Masroor Farzad , Newman Jason G. 
Published: August 2013

Objectives:Pharyngocutaneous fistulas (PCF) are common after salvage total laryngectomies (TL). Prior studies examining the role of fistula formation (FF) at the time of TL to reduce the incidence of PCF are conflicting. We studied our institutional experience, where in the last few years a more routine approach to using FFs with TLs has been adopted irrespective of the size of the mucosal defect resulting from the TL. It is hypothesized that this routine approach reduces the incidence of PCFs.Methods:This is a retrospective study reviewing the records of patients who had TLs with FF between 2007‐2012. The date of surgery, site of recurrent disease, and whether the TL was primary or salvage were recorded. The primary outcome was the presence of PCF.Results:50 patients had a FF at the time of TL. Nine of these developed a PCF. The overall PCF incidence was 18%. The incidence following salvage TL was 22% (8/36), and that after primary TL was 7% (1/14). Between 2007‐2009, the PCF incidence was 36% (7/19), while from 2010‐2012 it was 3% (1/31).Conclusions:Our institutional experience with the use of FFs for TLs shows an overall PCF incidence comparable to rates reported in the literature. Over the last two years a statistically significant lower PCF incidence is seen (3% vs 36%), which reflects our gradual change in approach from a less to more routine use of FF. The routine use of FFs at the time of TLs reduces the incidence of PCF.
Isolation of Mesenchymal Stem Cells (MSC) from Human Adenoid Tissue
Authors: Lee Yoon‐Se , Lee Jae‐Eun , Park Young‐Min , Park Chan‐Whi , Wang Soo‐Geun , Lee Byung‐Joo 
Published: August 2013

Objectives:Mesenchymal stem cells (MSCs) are multipotent progenitor cells that originally derived from bone marrow. Clinical use of bone marrow‐derived MSC is difficult due to morbidity and low MSC abundance and isolation efficiency. Recently, MSCs have been isolated from various adult tissues. Here we report the isolation of adenoid tissue‐derived MSCs (A‐MSCs) and their characteristics.Methods:We compared the surface markers, morphologies, and differentiation and proliferation capacities of previously established tonsil‐derived MSCs (T‐MSCs) with cells isolated from adenoid tissue. The immunophenotype of A‐MSCs was investigated upon interferon (IFN)‐Î3 stimulation.Results:Both T‐MSCs and A‐MSCs showed negative CD45, CD31 HLA‐DR, and positive CD 90, CD44, and CD73 expression. A‐MSCs were fibroblast‐like, spindle‐shaped non‐adherent cells, similar to T‐MSCs. Adipogenesis was observed in A‐MSCs by the formation of lipid droplets after Oil Red O staining. Osteogenesis was observed by the formation of the matrix mineralization in Alizarin Red staining. Chondrogenesis was observed by the accumulation of sulfated glycosaminoglycan‐rich matrix in collagen type II staining. These data were similar to those of T‐MSCs. Expression of marker genes (ie, adipogenesis; lipoprotein lipase, proliferator‐activator receptor‐gamma, osteogenesis; osteocalcin, alkaline phasphatase, chondrogenesis; aggrecan, collagen type II Î±1) in A‐MSCs were not different from those in T‐MSCs.Conclusions:A‐MSCs possess the characteristics of MSCs in terms of morphology, multipotent differentiation capacity, cell surface markers, and immunogeneity. Therefore, A‐MSCs fulfill the definition of MSCs and represent an alternate source of MSCs.
Long‐term Change of Body Mass Index after Head and Neck Cancer Treatment
Authors: Zhang Zi , Brown Justin C. , O'Malley Bert W. , Weinstein Gregory S. , Schmitz Kathryn H. 
Published: August 2013

Objectives:Although head and neck cancer (HNC) is associated with weight loss, little is known about the long‐term body mass index (BMI) change in HNC survivors. Our goal was to determine the long‐term BMI change after HNC treatment.Methods:Retrospective cohort study on patients with oral cavity and pharyngeal squamous cell carcinoma who received initial treatment at the University of Pennsylvania Health System in 2009, and were then followed for 3 years. Patient demographics, height, tobacco and alcohol use, cancer type, AJCC stage, treatments, and weight at all visits were collected from medical records. Underweight was defined as BMI<18.5, normal was BMI 18.5‐24.9, overweight was BMI 25.0‐29.9, and obesity was BMI > 30. Logistic regression was performed to identify factors associated with long‐term BMI changes.Results:We identified 211 patients with complete data and follow‐up visits. At the time of diagnosis, 7% patients were underweight (n = 15), 34% had normal‐weight (n = 72), 36% were overweight (n = 75) and 23% were obese (n = 49). At the last follow‐up visit, 7% were underweight (n = 14), 42% were normal‐weight (n = 82), 33% were overweight (n = 65) and 18% were obese (n = 36). Thus, 17% patients (n = 21) who were overweight or obese at diagnosis improved to normal weight at the end of 3‐year follow‐up, and this change was not significantly affected by patients’ age, gender, race, tobacco and alcohol use, cancer site, AJCC stage, and treatment type.Conclusions:Our study suggests BMI improves in overweight or obese HNC survivors after 3‐year follow‐up, and this change is independent of cancer severity and treatment type.