bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cyclin D1 and FADD as Biomarkers in Head and Neck Squamous Cell Carcinoma
Authors: Rasamny J. K. J. , Allak Amir , Frierson Henry , Policarpio‐Nicolas Maria , Jo Vickie , Jameson Mark J. 
Published: September 2011

ObjectiveCyclin D1 and FADD (Fas‐associated protein with death domain) regulate the cell cycle and apoptosis, respectively, and are located on chromosome 11q13.3, which is frequently amplified in head and neck squamous cell carcinoma (HNSCC). This study evaluates these proteins as predictors of clinical outcomes for HNSCC.MethodImmunohistochemical assessment of 366 archival HNSCC specimens in tissue microarrays and correlation with retrospectively collected clinical data. Outcomes for patients with tumors that exhibited strong cyclin D1 or FADD staining were compared with outcomes for patients with weakly or non‐staining tumors.ResultsPatients with tumors that were strongly positive for cyclin D1 had reduced overall (P =. 010) and disease‐free (P =. 040) survival, while patients with tumors that were strongly positive for FADD had reduced overall (P =. 019) and disease‐specific (P =. 049) survival. Together, the 2 markers effectively stratified overall (P =. 002), disease‐specific (P =. 032), and disease‐free (P =. 059) survival. Strong cyclin D1 positivity correlated with higher overall stage (P =. 023) and T‐stage (P =. 016), while strong FADD staining correlated with T‐stage (P =. 041). In multivariate analysis strong cyclin D1 staining was a better predictor of recurrence (P =. 018) than strong FADD positivity, overall stage, and T‐stage, and was independent of N‐stage (P =. 005).ConclusionCyclin D1 and FADD may have utility as predictors of long‐term outcomes for patients with HNSCC. Further study is needed to determine if these proteins predict response to different treatment approaches or assist in selecting patients for multi‐modality therapy.
Decision Making in Post‐chemoradiotherapy Neck Dissections
Authors: Tulunay‐Ugur Ozlem E. , Stack Brendan C. , Vural Emre A. , Suen James Y. , Archer Kaete , Young Zachary 
Published: September 2011

ObjectiveThere is continued debate as to whether to perform a neck dissection as a planned vs “wait and see” procedure in patients with head and neck cancer treated with chemoradiotherapy. In this study we aimed to review our results to help with the decision making process.MethodA retrospective review of 140 oropharyngeal cancer cases treated with chemoradiotherapy was performed. Demographic data and treatment outcomes were extracted. The patients who underwent neck dissections were selected and evaluated as to how the decision was made; this included clinical examination, imaging studies, and fine needle aspiration biopsy.ResultsOf the 140 patients, 19 underwent ND for persistent disease. This included 9 patients with tonsil and 10 with base of tongue cancer. The decision for a ND was made according to CT scan findings in 7 patients, FNAB in 2 patients, PET imaging in 3 patients, clinical examination in 4 patients, and the combination of imaging and clinical findings in three patients. The dissections were performed at an average of 10 weeks (range, 4‐20 weeks). Seven patients (37%) had no viable cancer in the ND specimen. The pre‐treatment neck staging showed no significant difference.ConclusionHead and neck surgeons are in search of reliable methods to determine patients at risk of persistent disease. In this series, 37% of the patients had no viable tumor in the ND specimen. Further studies are needed to identify patients who are not in need of a ND.
Differences between 2 Robotic Thyroidectomy Techniques
Authors: Terris David J. , Seybt Melanie W. , Singer Michael C. 
Published: September 2011

ObjectiveTwo distinct remote access robotic thyroidectomy techniques were implemented in a high‐volume endocrine surgery practice. Important technical and clinical differences were observed and are described.MethodDemographic and clinical parameters were prospectively captured in a series of patients undergoing 1 of 2 robotic thyroidectomy techniques (robotic axillary thyroidectomy [RAT] or robotic facelift thyroidectomy [RFT]). Attention was paid to time of surgery, ease of dissection, complications, use of drains, and length of stay.ResultsFifteen robotic hemithyroidectomies were accomplished by either RAT (n = 5) or RFT (n = 10). The duration of surgery for the 5 RATs averaged 196 ± 38.1 minutes, with no clear downward trend observed; time of surgery for RFT was 156.9 ± 16.3 minutes with a steady trend towards shorter surgical times. All 5 RAT patients were managed with drains and on an inpatient basis (LOS = 1.0 days); 9 of 10 RFT patients were managed without drains and on an outpatient basis. Ease of surgery, familiarity with anatomic dissection planes, and surgeon comfort level all favored RFT.ConclusionIn the implementation phase, a more rapid learning curve, reflected by shorter operative times, was observed with RFT compared with RAT. Furthermore, the vast majority of patients could be managed as outpatients even early in the experience, which represents one of several apparent advantages.
Differences in Head and Neck Cancer Risk Perception between Smoking and Nonsmoking NASCAR Attendees
Authors: White Laura , Quee Anthony Chin , Berg Carla , Wise Justin , Hapner Edie 
Published: September 2011

ObjectiveThere is a lack of knowledge regarding the risk of head and neck cancer. Studies have demonstrated a difference in cancer risk perception between smokers and nonsmokers. The aim of this study was to determine differences in risk perception among smokers and nonsmokers in an at‐risk population.MethodA 28‐item questionnaire was utilized to survey NASCAR attendees at Atlanta Motor Speedway. The survey collected demographic information, highest education level, smoking status, cigarettes smoked in the past 30 days, and psychosocial factors related to concern about head and neck cancer.ResultsFive hundred and seven participants completed the questionnaire. MANCOVA analysis using dependent variables related to risk perceptions of head and neck cancer, and covariates of age and education, evidenced a significant main effect, such that smokers (M = 1.10, SD = 0.07) worried about head and neck cancer significantly more than nonsmokers (M = 0.64, SD = 0.06), F (1,459) = 26.9.ConclusionFindings indicated differences in perception of risk between smokers and non‐smokers. Gaining a better understanding of the psychosocial factors related to perceived risk of head and neck cancer, otolaryngologists may better tailor interventions aimed at increasing awareness within the clinic setting.
Disparate Molecular, Histopathology, and Clinical Factors in HNSCC Racial Groups
Authors: Worsham Maria J. , Stephen Josena K. , Schweitzer Vanessa , Shah Veena , Mei Lu , Havard Shaleta , Chen Kang‐Mei 
Published: September 2011

ObjectiveCauses of differences in the higher incidence of and mortality from squamous head and neck cancer (HNSCC) in African American (AA) vs Caucasian Americans (CA) lack a consensus. We examined a comprehensive array of risk factors influencing health and disease in an access to care, racially diverse, primary HNSCC cohort.MethodThe study cohort of 673 primary HNSCC comprised 391 CA and 282 AA. Risk variables included demographic, histopathology, and clinical/epidemiologic risk factors. Tumor DNA was interrogated for loss and gain of 113 genes with known involvement in HNSCC/cancer. Univariate analysis was followed by multivariate modeling with determination of c‐index.ResultsOf the 39 univariate differences in race as AA and CA, multivariate modeling (c‐index = 0.81) retained 6 variables (pCDKN2A) and aneupoidy of SCYA3 than CA tumors. AA were more likely to be unmarried, to have radiation treatment, and be more likely to be current and past smokers. Insurance type as HAP (Health Alliance Plan), Blue Cross, Medicaid, Medicare, and other was a significant determinant of race. AA were more likely to have Medicaid and Medicare. Insurance status by stage and radiation by stage were not significant.ConclusionMolecular modeling indicated significant differences between AA and CA for histopathology, patient factors, and tumor gene copy number alterations. Our data reiterate that for HNSCC, as in the case of other complex diseases, tumor genetics or biology is only one of many potential contributors to differences among racial groups.
Dual Time Point Positron Emission Tomography Imaging in the Head and Neck
Authors: Harirchian Sanaz , Chesani Nasrin , Cohen Erik 
Published: September 2011

ObjectiveDual time point 18F‐fluorodeoxyglucose‐positron emission tomography (DTP‐PET) is a new modality which may detect malignancy more accurately than standard PET/CT. Our main objective was to perform a pilot study to evaluate the characteristics of DTP‐PET in primary head and neck squamous cell carcinomas (HNSCC) and lymph node metastases.MethodA total of 36 patients with previously untreated HNSCC underwent preoperative PET/CT at 2 time points (mean 41‐minute time difference) from 2007 to 2010. Mean and maximum standardized uptake values (SUV) were measured for the primary lesion and cervical lymph node metastases at both time points, and change in SUV over time was calculated.ResultsA total of 32 of 36 primary tumors (89%) had an increase in maximum SUV, between 13.93% and 264.65% (mean 43.7%) normalized to a 1‐hour time difference. A total of 16 of 21 lymph node metastases (76%) had an increase in maximum SUV, between 13.49% and 284.15% (mean 57.1%). Change in mean SUV did not correlate as well with the presence of tumor.ConclusionThis is the first description of DTP‐PET in HNSCC. A total of 89% of primary tumors showed an increase in maximum SUV over time. These findings justify further study of DTP‐PET as a method of detecting tumor in initial staging and after treatment.
EGFR and IGF1R Inhibition in Head and Neck Cutaneous Squamous Cell Carcinoma
Authors: Clayburgh Daniel R. , Proby Charlotte , Wong Melissa , Gross Neil D. 
Published: September 2011

Objective1) Determine if upregulation of insulin‐like growth factor receptor (IGF1R) correlates with resistance to epidermal growth factor receptor (EGFR) inhibitors in patients with head and neck cutaneous squamous cell carcinoma (cSCCHN). 2) Evaluate the effect of combined inhibition of EGFR and IGF1R with tyrosine kinase inhibitors in cSCCHN.MethodcSCC cell lines MET1, MET4, SCC12, and SCC13 were treated with the EGFR inhibitor erlotinib and/or the IGF1R inhibitor picropodophyllin, then evaluated for cell growth and expression of EGFR, IGF1R, and downstream signaling molecules. cSCCHN patient specimens were evaluated with antibodies for EGFR, IGF1R, phospho‐Akt, and phospho‐MAPK.ResultsComparison of normal skin to cSCCHN specimens showed overexpression of EGFR (P =. 0008) and IGF1R (P =. 041). Treatment with erlotinib or picropodophyllin inhibited receptor phosphorylation (P <. 01) and showed dose‐dependent inhibition of cell growth in all cell lines. At intermediate concentrations, treatment with both inhibitors inhibited cell growth more effectively than either inhibitor alone (P <. 05). Dual inhibition also decreased downstream activation of both Akt (P <. 006) and p42/44 MAPK (P <. 01). Specimens from a patient whose cSCCHN developed resistance to an EGFR inhibitor showed upregulation of IGF1R (P <. 0001) and phosphorylated Akt (P <. 01) compared to this same tumor prior to treatment with EGFR inhibitor.ConclusionUpregulation of IGF1R may be a pathway for resistance to EGFR inhibition in cSCCHN, possibly via increased Akt activation. Dual inhibition of EGFR and IGF1R inhibits cSCCHN cell growth more effectively than either inhibitor alone, suggesting that combination therapy with both inhibitors may be a promising therapeutic strategy for cSCCHN.
Endoscopic Surgery and IMRT Are Effective in Recurrent NPC
Authors: Chen Ming‐Yuan , Jiang Rou 
Published: September 2011

ObjectiveSalvage surgery and radiotherapy showed positive and similar survival outcomes in rT1/2 local recurrent nasopharyngeal carcinoma (rNPC) but no curative value in rT3/4 ones in the past. We will evaluate new techniques such as endoscopic surgery and intensity‐modulated radiotherapy (IMRT) to compare with conventional radiotherapy (CRT) and chemotherapy in rNPC.MethodWe did a retrospective review of 493 rNPC patients from January 2000 to December 2009. IMRT, CRT, and/or chemotherapy were suitable to all rT stage cases, but endoscopic surgery was applied to rT1 and some selected rT2/T3 cases. The 5‐year overall survival rate (OS) and other oncological outcomes were summarized.ResultsAmong 493 cases, 120, 82, 132, and 159 were restaged in rT1N0M0, rT2N0M0, rT3N0M0, and rT4N0M0 according to AJCC/UICC 2002 TNM stage system. The 5‐year OS was 73.0%, 37.0%, 17.3%, and 16.5% in rT1, rT2, rT3, and rT4 patients (P <. 05). Adjusted for rT stages, the salvage surgery and IMRT showed a better survival curve than conventional radiotherapy and chemotherapy (P <. 01). In rT1 patients, the 5‐year OS of patients who received salvage endoscopic surgery was better than that of ones who received IMRT (89.3% vs 69.0%, P <. 01). Cox analysis showed that age, stage, and salvage treatment were significant independent predictors for OS.ConclusionAlthough patients in the earlier rT stage showed better survival than ones in the advanced rT stage, new salvage treatments based on endoscopic surgery and IMRT benefited all rT stage rNPC compared with CRT and chemotherapy. Futhermore, salvage endoscopic surgery may be a more promising option than IMRT in rT1 patients.
Unplanned Re‐admissions in ENT: How Much Do They Cost?
Authors: Rashid Mamun , Khalil Hisham 
Published: September 2011

ObjectiveUnplanned hospital re‐admissions are a significant source of morbidity and mortality and are a major fiscal burden to the National Health Service. The cost of re‐admissions to ENT services has not previously been described. We present an audit, evaluating the cost per patient for ENT re‐admissions in our department.MethodA prospective audit of all ENT patients who were re‐admitted within 28 days of initial discharge over a 3‐month period was observed. Cost was calculated using the Department of Health reference books.Resultsn = 24 (17 emergencies, 7 elective) Emergencies: 53% otitis externa (7/17) and tonsillitis (2/17); all returned due to pain. Elective: 86% posttonsillectomy, including hemorrhage (3/7) and pain (3/7). Cost: Total: £25’237.50 (£1051.56 per patient) Otitis externa: £8983.61 (£1122.95 per patient) Post‐tonsillectomy bleed/pain: £4670.21 (£778.37 per patient) Otitis externa/post tonsillar combo: £9761 (39% of total cost).ConclusionUnplanned re‐admissions to ENT cost £25,237.50 over three months. Nearly 40% of this was due to otitis externa, tonsillitis, or as a postoperative complication of tonsillectomy due to suboptimal analgesia. We would recommend greater awareness of departmental caseloads as a means to develop targeted strategies in reducing re‐admissions.
Extracapsular Extension in Lymph Node Metastasis from HPV‐Associated Squamous Cell Carcinoma of the Oropharynx
Authors: Smith Ian , Rosenblatt Elizabeth , Sanguineti Giuseppe , Bishop Justin A. , Richmon Jeremy D. , Pai Sara 
Published: September 2011

ObjectiveOropharyngeal cancer understanding has been greatly advanced with the discovery of the role of HPV. Nonsurgical approaches that utilize chemotherapy‐radiotherapy have become common treatment. However, upfront surgery has recently gained momentum with the introduction of transoral approaches (laser/robotic). These approaches have been applied to all stages with excellent results.MethodDetermine the rate of extracapsular extension (ECE) in all patients with HPV+ oropharyngeal cancer (70 patients) treated with a neck dissection at our institution since pathologic HPV testing was first instituted (2006 to present).ResultsWe looked at clinical features such as: T stage, primary site, clinical N‐stage, node count, staging, sex, race, smoking, and features on preoperative imaging (cystic?, matted?, multiple nodes, number of nodes, and laterality). Of note we found a relationship between patients with lymph nodes >4 cm on pretreatment imaging having a statistically significant (P =. 019) higher rate of extracapsular extension 47% (4cm). Clinical nodal stages related to rates of extracapsular extension with N1 (28.5% ECE), N2A (50% ECE), N2B (68.9% ECE), and N2C (75% ECE). We also noted that multiple nodes on final pathology also were associated with ECE. In specimens with one positive node, the incidence of ECE was 40.7% (P =. 007).ConclusionOne question in treating these patients with initial surgical approach is predicting who can avoid the toxic effects of radiation and/or chemotherapy. Chemotherapy is often added to the treatment in patients with positive margins and/or ECE. This information will assist in predicting which patients may benefit from a transoral surgery.
Genetic Testing in Head and Neck Paragangliomas: Who, What, and Why?
Authors: Sridhara Shankar K. , Rich Thereasa , Jimenez Camilo , Hanna Ehab Y. N. , Kupferman Michael E. 
Published: September 2011

ObjectiveUnderstand the role of genetic testing in patients with paragangliomas (PG), we studied a cohort of patients treated at a single institution and characterized the patterns of treatment and genetic mutations.MethodA retrospective review was performed of all patients with paraganglioma who were evaluated at MD Anderson Cancer Center from 1970 to present. Patient demographics, disease patterns, outcomes, and genetic mutations were analyzed.ResultsWe identified 177 patients with head and neck paragangliomas (HNPG). Genetic testing was performed on 26 patients, of whom 16 had mutations. SDHD accounted for 75% of the mutations, of which P81L [ProlineàLeucine] accounted for 75%. The remainder had SDHB mutations. Of patients with mutations, average age was 39.5 years (vs 48.4 years in those without mutation), 63% (vs 40%) had multiple tumors, 94% (60%) had at least one carotid body tumor, and family history was positive in 38% (20%). Concurrent sites outside the head and neck included adrenal pheochromocytoma, mediastinum, retroperitoneum, and spinal metastasis.ConclusionOur results suggest patients suspected of heritable HNPG should undergo testing first at the SDHD and SDHB loci, unlike familial PGs at other sites, which are also associated with VHL mutations. Our findings have implications for long‐term monitoring for secondary tumors, counseling family members, and cost‐efficient mutational screening.
HPV and Head and Neck Cancer in Canada: Trends 1992 to 2008
Authors: Corsten Martin , Rourke Ryan , Johnson Stephanie Elin , McDonald Ted 
Published: September 2011

Objective1) Learn how the incidence of HPV‐related and non‐HPV‐related Head and Neck Cancers (HNC) in Canada has changed in the time period 1992 to 2008. 2) Learn how the age at diagnosis and overall survival for these cancers in Canada has changed over that period.MethodWe used Canadian Cancer Registry Data (1992‐2008), categorizing HNCs into 3 groups: (High (HHPV), ie, oropharynx; Moderate (MHPV), ie, oral cavity; and Low (LHPV), ie, larynx); based on the probability that HPV causes the cancer. We calculated age‐adjusted incidence, median age at diagnosis, and survival for each category.ResultsHHPV cancers increased in incidence at an average annual rate (AAR) of 1.02% (P =. 010); MHPV and LHPV cancers decreased at an AAR of 2.38% (P =. 000) and 3.67% (P =. 000) respectively. The median age at diagnosis for HHPV cancers decreased by an average of 0.23 years/year (P =. 000). There was no change for MHPV and an increase for LHPV of 0.10 years/year (P =. 008). Survival for patients with HHPV cancers increased by 2.1%/year (P =. 000), compared with an increase of 1.6% per year for MHPV (P =. 003) and a marginal increase in LHPV of 0.6% per year (P =. 002).ConclusionThe prevalence of HPV‐related head and neck cancers in Canada is increasing, while the prevalence of non‐HPV–related head and neck cancers is decreasing. This has been accompanied by a decrease in both age at diagnosis and mortality in HPV related head and neck cancers.
Impact of XPC LL Variant on Head and Neck Cancer Survival
Authors: Torre Carlos A. , Strom Sara , Baez Adriana 
Published: September 2011

ObjectiveHead and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. Several genetic polymorphisms have been shown to increase the risk of HNSCC. In this study we investigated how these genetic variations affect survival of HNSCC patients.MethodDNA from blood lymphocytes of 180 HNSCC patients were analyzed for polymorphisms of DNA repair and carcinogen‐metabolizing genes. The association between polymorphisms with time to recurrence and survival were analyzed.ResultsThere was no association between the variants analyzed and time to disease recurrence. However, increased survival that approached statistical significance was observed in patients with XPC LL genotype. They had a longer survival compared with patients with XPC LS and XPC SS genotypes (mean survival LL = 283 months, LS = 60 months, SS = 72 months; log rank P =. 06), especially in men (P =. 047).ConclusionThe genetic variant XPC LL of the DNA repair gene XPC is associated with increased survival of HNSCC in those patients managed with treatment modalities that target DNA (ie, cisplatin and radiation). Larger and more comprehensive studies are needed to validate these findings.
Incidence and Outcomes of Stricture Formation Post‐laryngectomy
Authors: Sweeny Larissa , Golden Blake , Rosenthal Eben L. , White Hilliary , Magnuson J. Scott , Carroll William R. 
Published: September 2011

ObjectivePostlaryngectomy stricture formation and dysphagia negatively impact the quality of life and result in nutritional compromise. Understanding risk factors and successful treatment strategies may improve treatment outcomes.MethodPatients at a tertiary care center who underwent a total laryngectomy between 2003 and 2009 (n = 263) were evaluated in a retrospective manner. Patient demographics, comorbidities, tobacco and alcohol usage, dietary outcomes, feeding tube dependence, and treatment modalities were assessed. Management strategies and outcomes were evaluated.ResultsStrictures developed in 19% (n = 49) of 263 laryngectomies and the majority (82%) occurred in the first year. Stricture formation rates were similar for primary (19%) and salvage laryngectomy (18%) patients. Tubed flap reconstruction significantly increased the incidence of stricture formation (P ≤. 01) in salvage laryngectomy cases. In primary laryngectomy patients, stricture formation was not correlated with flap reconstruction or adjuvant radiation therapy. Patients requiring only a single dilation had better dietary outcomes (semi‐solid) compared to patients requiring serial dilations. Stricture formation was associated with improved overall disease free survival (P ≤. 01) and recurrence rates (P =. 06).ConclusionStricture formation occurs equally in salvage and primary laryngectomies and is associated with an improved disease‐free survival.