bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.