1
|
Lee TL, Fang WC, Lee IC, Lirng JF, Chang CF, Hsu YB, Chu PY, Wang YF, Yang MH, Chang PMH, Wang LW, Tai SK. Enhancing regional control in p16-negative oropharyngeal cancer: A propensity score-matched analysis of upfront neck dissection and definitive chemoradiotherapy. J Chin Med Assoc 2024; 87:516-524. [PMID: 38501795 DOI: 10.1097/jcma.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The presence of p16 and neck disease is important predictors of prognosis for oropharyngeal squamous cell carcinoma (OPSCC). Patients who are p16-negative and have clinically node-positive (cN+) disease generally have worse oncologic outcomes. This study aimed to investigate whether upfront neck dissection (UFND) could provide potential benefits for patients with cN+ p16-negative OPSCC. METHODS Through this retrospective study, 76 patients with cN+ p16-negative OPSCC were analyzed, those who received either definite concurrent chemoradiotherapy (CCRT group) or UFND followed by chemoradiotherapy (UFND group). The primary endpoints were regional recurrence-free survival (RRFS), disease-specific survival (DSS), and overall survival (OS). Factors associated with survival were evaluated by univariate and multivariate analysis. Survival between the two groups was compared by propensity score-matched analysis. RESULTS Matched 23 patients in each group through propensity analysis, the UFND group showed a significantly better 5-year RRFS (94.1% vs 61.0%, p = 0.011) compared to the CCRT group. Univariate analysis revealed that UFND was the sole factor associated with regional control (hazard ratio [HR] = 0.110; 95% CI, 0.014-0.879; p = 0.037). Furthermore, the study found that the CCRT group was associated with a higher dose of radiotherapy and exhibited a significantly higher risk of mortality due to pneumonia. CONCLUSION The study indicated that UFND followed by CCRT may be a potential treatment option for patients with cN+ p16-negative OPSCC, as it can reduce the risk of regional recurrence. Additionally, the study highlights that definite CCRT is connected to a larger dose of radiotherapy and a higher risk of fatal pneumonia. These findings could be beneficial in informing clinical decision-making and improving treatment outcomes for patients with OPSCC.
Collapse
Affiliation(s)
- Tsung-Lun Lee
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Chen Fang
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - I-Cheng Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jiing-Feng Lirng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Fan Chang
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Bin Hsu
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pen-Yuan Chu
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Fen Wang
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Muh-Hwa Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Peter Mu-Hsin Chang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Wei Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shyh-Kuan Tai
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Infection and Immunity Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
2
|
Matos LL, Kowalski LP, Chaves ALF, de Oliveira TB, Marta GN, Curado MP, de Castro Junior G, Farias TP, Bardales GS, Cabrera MA, Capuzzo RDC, de Carvalho GB, Cernea CR, Dedivitis RA, Dias FL, Estefan AM, Falco AH, Ferraris GA, Gonzalez-Motta A, Gouveia AG, Jacinto AA, Kulcsar MAV, Leite AK, Lira RB, Mak MP, De Marchi P, de Mello ES, de Matos FCM, Montero PH, de Moraes ED, de Moraes FY, Morais DCR, Poenitz FM, Poitevin A, Riveros HO, Sanabria Á, Ticona-Castro M, Vartanian JG, Viani G, Vines EF, William Junior WN, Conway D, Virani S, Brennan P. Latin American Consensus on the Treatment of Head and Neck Cancer. JCO Glob Oncol 2024; 10:e2300343. [PMID: 38603656 DOI: 10.1200/go.23.00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.
Collapse
Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Andrés Munyo Estefan
- Profesor Adjunto Catedra de Otorrinolaringologia del Hospital de Clínicas, Montevidéu, Uruguay
| | | | | | | | - Andre Guimarães Gouveia
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Marco Aurelio Vamondes Kulcsar
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Ana Kober Leite
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Renan Bezerra Lira
- AC Camargo Cancer Center and Hospital Albert Einstein, São Paulo, Brazil
| | - Milena Perez Mak
- 3Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | - Pablo H Montero
- Department of Surgical Oncology and Head and Neck Surgery, Division of Surgery, P. Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | - Álvaro Sanabria
- 4Department of Surgery, Universidad de Antioquia, Hospital Alma Mater, Medellin, Colombia
| | - Miguel Ticona-Castro
- 5ESMO Member, Peruvian Society of Medical Oncology (S.P.O.M.) Member, La Molina, Peru
| | - José Guilherme Vartanian
- 6Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gustavo Viani
- 7Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Eugenio F Vines
- Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | - Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| |
Collapse
|
3
|
Abdel-Halim CN, O'Byrne TJ, Graves JP, Akpala CO, Moore EJ, Price DL, Tasche KT, Ma DJ, Neben-Wittich MA, Lester SC, Gamez M, Price KA, Bayne HEF, Rwigema JCM, Patel SH, McGee LA, Janus JR, Nagel TH, Hinni ML, Savvides PS, Van Abel KM, Routman DM. Patterns and distribution of regional nodal involvement and recurrence in a surgically treated oropharyngeal squamous cell carcinoma cohort at a tertiary center. Oral Oncol 2023; 146:106569. [PMID: 37734203 DOI: 10.1016/j.oraloncology.2023.106569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES To investigate and describe the patterns of regional metastases and recurrences after surgical treatment of oropharyngeal squamous cell cancer (OPSCC). MATERIALS AND METHODS Retrospective study of patients diagnosed with OPSCC from 2006 to 2021 at a tertiary referral center. Only patients treated with surgery including a neck dissection were included. Patients with unknown human papillomavirus (HPV) status, prior head and neck cancer, distant metastases, or synchronous head and neck cancer were excluded. RESULTS A total of 928 patients were included. 89% were males, the average age was 58.6 years (range: 25.2-87.5), 874 (94%) were HPV(+), and 513 (55.3%) had a tonsil cancer. Among cN + patients, the most commonly involved levels at presentation were level II (85.2%), level III (33.3%), and level IV (9.4%). In cN0 patients, metastases were only observed in level II (16.2%) and level III (9.2%). Nodal recurrence occurred in 48 (5.2%) patients after a median time of 1.0 years (interquartile range: 0.6-2.0). Nodal recurrence incidence was similar in HPV(+) and HPV(-) patients (5.0% vs. 7.4%, p = 0.44). The most common levels for regional recurrence were ipsilateral level II (45.8%), contralateral level II (43.8%), and ipsilateral level V (25.0%). Multivariable analysis revealed that pN was a significant predictor for regional recurrence (p = 0.02). CONCLUSION There is no difference in the distribution of regional metastases and recurrences in HPV(+) and HPV(-) OPSCC patients. Our findings align with the established understanding that regional metastases predominantly manifest in the ipsilateral level II-IV at presentation. Moreover, the data support the clinical recommendation to restrict elective neck dissection in cN0 patients to ipsilateral levels IIa and III, excluding level IIb. Regional recurrence is significantly associated with pN status.
Collapse
Affiliation(s)
- Chadi N Abdel-Halim
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Thomas J O'Byrne
- Department of Quantitative Health Sciences, Rochester, MN, United States
| | - Jeffrey P Graves
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Christeebella O Akpala
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel L Price
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kendall T Tasche
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Mauricio Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Katharine A Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Thomas H Nagel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ, United States
| | - Michael L Hinni
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ, United States
| | | | - Kathryn M Van Abel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States.
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
4
|
Chiesa-Estomba CM, Urazan JD, Cammaroto G, Mannelli G, Molteni G, Dallari V, Lechien JR, Mayo-Yanez M, González-García JÁ, Sistiaga-Suarez JA, Tucciarone M, Ayad T, Meccariello G. Lymph node metastasis in level IIb in oropharyngeal squamous cell carcinoma: a multicentric, longitudinal, retrospective analysis. Eur Arch Otorhinolaryngol 2023; 280:869-876. [PMID: 36102986 DOI: 10.1007/s00405-022-07647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 09/05/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Nowadays, 70% of patients in Europe and the USA are affected by a p16 + , potentially HPV driven oropharyngeal squamous cell carcinoma. However, despite the improved survival rate in this group, the quality-of-life remains low in cases which neck dissection took place. In this vein, in recent years, some surgeons have considered to avoid dissection of level IIB, proposing a supra-selective non-IIb neck dissection. MATERIALS AND METHODS A retrospective, longitudinal, multicentric study was conducted, including patients with pathologically confirmed primary HPV + or HPV - OPSCC who went through surgical treatment for the primary lesion and neck dissection. RESULTS 141 patients were included. Among them, 99 (70.2%) were male and 42 (29.8%) were female. The mean age was 62 ± 9 years (range 36-81). The most frequent anatomical location was the tonsil in 63 (44.7%) of patients. The most common approach was the classic transoral oropharyngectomy in 51 (36.2%) patients. Immunohistochemistry for p16 was positive in 62 (44%) patients. One-hundred and five (74.5%) patients received a unilateral ND, and a 36 (25.5%) a bilateral ND. Of those, a 12.8% (18/141) of patients were level IIb LN + . According to our results, level IIb ND should be considered in patients underwent therapeutic ND with positive LN metastasis in level IIa (OR = 9.83; 95% CI 3.463-27.917) or III (OR = 6.25; 95% CI 2.158-18.143), advanced (T3/T4) oropharyngeal primary tumors (OR = 3.38; 95% CI 1.366-8.405), and patients with ENE (OR = 6.56; 95% CI 2.182-19.770), regardless of p16 status. CONCLUSIONS According to our results, level IIb ND should be considered in patients who underwent therapeutic ND with positive LN metastasis in level IIa or III, advanced oropharyngeal primary tumors, and patients with ENE, independently of p16 status. Prospective data are necessary to definitively ensure the safety of omitting ipsilateral or contralateral level IIb ND in cN - patients with early stage disease.
Collapse
Affiliation(s)
- Carlos Miguel Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Calle Doctor Begiristain #1, CP 20014, San Sebastian, Guipuzkoa, Basque Country, Spain. .,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
| | - Juan David Urazan
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Calle Doctor Begiristain #1, CP 20014, San Sebastian, Guipuzkoa, Basque Country, Spain
| | - Giovanni Cammaroto
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL Della Romagna, Forlì, Italy.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Giuditta Mannelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Gabriele Molteni
- Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, University of Verona, Verona, Italy.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Virginia Dallari
- Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Jerome R Lechien
- Department of Otolaryngology, Elsan Hospital, Paris, France.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Miguel Mayo-Yanez
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006, Galicia, A Coruña, Spain.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - José Ángel González-García
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Calle Doctor Begiristain #1, CP 20014, San Sebastian, Guipuzkoa, Basque Country, Spain
| | - Jon Alexander Sistiaga-Suarez
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Calle Doctor Begiristain #1, CP 20014, San Sebastian, Guipuzkoa, Basque Country, Spain
| | - Manuel Tucciarone
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario de Jerez, Jerez de La Frontera, Cádiz, Spain.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Tareck Ayad
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L'Université de Montréal, Montreal, Canada.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Giuseppe Meccariello
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL Della Romagna, Forlì, Italy
| |
Collapse
|
5
|
Miller LE, Au VH, Sivarajah S, Lin DT, Deschler DG, Varvares MA, Faden DL, Feng AL, Sadow PM, Richmon JD. Rate of atypical nodal metastases in surgically treated HPV-associated oropharyngeal squamous cell carcinoma. Head Neck 2023; 45:409-416. [PMID: 36416254 PMCID: PMC9875888 DOI: 10.1002/hed.27256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/19/2022] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Understanding of nodal metastasis in patients with HPV+ oropharyngeal squamous cell carcinoma (OPSCC) is warranted. METHODS Patients with HPV+ OPSCC who underwent neck dissection (ND) between 2016 and 2021 were reviewed. Pathology reports were reviewed for lymph node (LN) metastases. Noncontiguous metastases were defined as pathologic evidence of level II disease with another involved LN in a noncontiguous neck level. Skip metastases were defined as pathologic lymph node(s) in the neck without disease in level II. RESULTS One hundred and thirty-one patients underwent levels II-IV ND with a mean (SD) LN yield of 33.3 (±13.5). The rate of atypical metastases in both the therapeutic and elective ND cohort was 5%. The noncontiguous and skip metastases were in level IV (n = 2) and level III (n = 4), respectively. CONCLUSIONS Skip and noncontiguous metastases were rare in patients with HPV+ OPSCC undergoing surgical treatment. Surgeons may consider a selective ND omitting Level IV in select patients with HPV+ OPSCC undergoing surgery.
Collapse
Affiliation(s)
- Lauren E. Miller
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Shanmugappiriya Sivarajah
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick T. Lin
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G. Deschler
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A. Varvares
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel L. Faden
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen L. Feng
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy D. Richmon
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Level IV neck dissection in cN0 HPV-negative oropharyngeal squamous cell carcinoma: a retrospective cohort study. BMC Cancer 2022; 22:535. [PMID: 35549914 PMCID: PMC9097444 DOI: 10.1186/s12885-022-09609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As opposed to observation of the neck, elective neck dissection has a survival benefit for cN0 oropharyngeal squamous cell carcinoma (OPSCC). However, there are limited date on level IV neck dissection in human papillomavirus (HPV)-negative OPSCC because most earlier studies did not stratify by P16 or HPV status. Thus, whether to exclude level IV from selective dissection (SND) of cN0 HPV-negative OPSCC remains controversial. METHODS In this single-center retrospective cohort study, disease-free survival (DFS) was estimated as the primary endpoint for 124 cN0 HPV-negative OPSCC patients who received SND of levels I-III (Group A) and I-IV (Group B). Overall survival (OS) and disease-specific survival (DSS) were considered secondary endpoints. RESULTS For the entire cohort, the 5-year DFS rates of Groups A and B were 55.0% and 60.1%, respectively. Five-year OS rates were 58.9% and 61.5%, and 5-year DSS rates were 74.0% and 64.8%, respectively. Group B did not show higher 5-year DFS, OS, or DSS than Group A. CONCLUSIONS This retrospective cohort study validated that in cN0 HPV-negative OPSCC, SND including level IV does not have substantial benefits regarding DFS, OS or DSS.
Collapse
|
7
|
Prophylactic contralateral neck dissection has no advantage in patients with early stage HPV-positive tonsil cancer. Acta Otolaryngol 2022; 142:345-349. [PMID: 35380481 DOI: 10.1080/00016489.2022.2053200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients with locally advanced HPV-positive tonsil cancer would benefit from prophylactic contralateral neck dissection (pCND). AIMS/OBJECTIVES The aim of this study was to analyze rates of contralateral lymph node metastases (LNM) and their prognostic effects on locally advanced HPV-positive tonsillar squamous cell carcinoma. MATERIALS AND METHODS Medical records of 54 patients who underwent upfront primary surgery and pCND were retrospectively reviewed. RESULTS Six (11.1%) patients had contralateral LNM in 54 locally advanced HPV-positive tonsil cancer. Of these, five patients had contralateral level II LNM and one patient had contralateral level II and III LNM. Contralateral LNM showed significant positive correlations with advanced T stage (p = .017) and the presence of extracapsular spread (p = .007). Contralateral lymph node metastasis had no significant association with five-year disease-specific survival. CONCLUSIONS AND SIGNIFICANCE This study demonstrated no advantage in performing pCND in early stage HPV-positive tonsil cancer.
Collapse
|
8
|
Babjee K, Bangeennavar B, Barbi W, Nayan K, Kumari L, Sonali P. Clinical assessment of anatomic origin effect on the clinical outcomes in primary squamous cell carcinomas affecting nasoethmoidal complex. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S1004-S1008. [PMID: 36110728 PMCID: PMC9469291 DOI: 10.4103/jpbs.jpbs_811_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Sinonasal squamous cell carcinomas (SCCs) present a great challenge in their diagnosis and management owing to their rapid growth, regional recurrence, local recurrence, and aggressive spread locally. Aims: The present clinical trial was conducted to evaluate anatomic subsites' impact on the outcomes concerning SCCs affecting ethmoid sinuses and nasal cavity. Materials and Methods: Medical records for tumor staging, tumor classification, grading (histologic) clinical features, symptoms, anatomic subsite, p16 results, treatment provided, and the Tumor-related outcomes were obtained for 28 subjects. Following staging and grading, p16 assays were evaluated along with disease-specific survival and disease-free survival. The collected data were subjected to the statistical evaluation and the results were formulated by keeping the level of significance at P < 0.05. Results: Origin was seen from nasal septum, nasal floor, lateral wall, ethmoid sinus, and edge of naris to mucocutaneous junction in 21.4% (n = 6), 7.14% (n = 2), 35.71% (n = 10), 7.14% (n = 2), and 28.57% (n = 8) subjects, respectively. For tumor staging, Stages I, II, III, and IV tumors were seen in, respectively, 39.28% (n = 11), 21.42% (n = 6), 10.71% (n = 3), and 28.57% (n = 8) study subjects. Node status was N0, N1, N2, and N3 in 78.57% (n = 22), 3.57% (n = 1), 7.14% (n = 2), and 10.71% (n = 3) subjects. Carcinoma arising from nasal septum had statistically significant worse disease-specific survival compared to carcinomas arising from other sites (P < 0.001). Conclusion: The present study concludes that anatomic subsites largely govern the outcomes and tumor behavior. Also, squamous cell carcinoma affecting the nasal septum is an aggressive tumor with more compromised outcomes and more lymph node involvement.
Collapse
|
9
|
Kałafut J, Czerwonka A, Anameriç A, Przybyszewska-Podstawka A, Misiorek JO, Rivero-Müller A, Nees M. Shooting at Moving and Hidden Targets-Tumour Cell Plasticity and the Notch Signalling Pathway in Head and Neck Squamous Cell Carcinomas. Cancers (Basel) 2021; 13:6219. [PMID: 34944837 PMCID: PMC8699303 DOI: 10.3390/cancers13246219] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 12/15/2022] Open
Abstract
Head and Neck Squamous Cell Carcinoma (HNSCC) is often aggressive, with poor response to current therapies in approximately 40-50% of the patients. Current therapies are restricted to operation and irradiation, often combined with a small number of standard-of-care chemotherapeutic drugs, preferentially for advanced tumour patients. Only very recently, newer targeted therapies have entered the clinics, including Cetuximab, which targets the EGF receptor (EGFR), and several immune checkpoint inhibitors targeting the immune receptor PD-1 and its ligand PD-L1. HNSCC tumour tissues are characterized by a high degree of intra-tumour heterogeneity (ITH), and non-genetic alterations that may affect both non-transformed cells, such as cancer-associated fibroblasts (CAFs), and transformed carcinoma cells. This very high degree of heterogeneity likely contributes to acquired drug resistance, tumour dormancy, relapse, and distant or lymph node metastasis. ITH, in turn, is likely promoted by pronounced tumour cell plasticity, which manifests in highly dynamic and reversible phenomena such as of partial or hybrid forms of epithelial-to-mesenchymal transition (EMT), and enhanced tumour stemness. Stemness and tumour cell plasticity are strongly promoted by Notch signalling, which remains poorly understood especially in HNSCC. Here, we aim to elucidate how Notch signal may act both as a tumour suppressor and proto-oncogenic, probably during different stages of tumour cell initiation and progression. Notch signalling also interacts with numerous other signalling pathways, that may also have a decisive impact on tumour cell plasticity, acquired radio/chemoresistance, and metastatic progression of HNSCC. We outline the current stage of research related to Notch signalling, and how this pathway may be intricately interconnected with other, druggable targets and signalling mechanisms in HNSCC.
Collapse
Affiliation(s)
- Joanna Kałafut
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodzki 1, 20-093 Lublin, Poland; (J.K.); (A.C.); (A.A.); (A.P.-P.); (A.R.-M.)
| | - Arkadiusz Czerwonka
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodzki 1, 20-093 Lublin, Poland; (J.K.); (A.C.); (A.A.); (A.P.-P.); (A.R.-M.)
| | - Alinda Anameriç
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodzki 1, 20-093 Lublin, Poland; (J.K.); (A.C.); (A.A.); (A.P.-P.); (A.R.-M.)
| | - Alicja Przybyszewska-Podstawka
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodzki 1, 20-093 Lublin, Poland; (J.K.); (A.C.); (A.A.); (A.P.-P.); (A.R.-M.)
| | - Julia O. Misiorek
- Department of Molecular Neurooncology, Institute of Bioorganic Chemistry Polish Academy of Sciences, ul. Noskowskiego 12/14, 61-704 Poznan, Poland;
| | - Adolfo Rivero-Müller
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodzki 1, 20-093 Lublin, Poland; (J.K.); (A.C.); (A.A.); (A.P.-P.); (A.R.-M.)
| | - Matthias Nees
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, ul. Chodzki 1, 20-093 Lublin, Poland; (J.K.); (A.C.); (A.A.); (A.P.-P.); (A.R.-M.)
- Western Finland Cancer Centre (FICAN West), Institute of Biomedicine, University of Turku, 20101 Turku, Finland
| |
Collapse
|
10
|
Meccariello G, Maniaci A, Bianchi G, Cammaroto G, Iannella G, Catalano A, Sgarzani R, De Vito A, Capaccio P, Pelucchi S, Vicini C. Neck dissection and trans oral robotic surgery for oropharyngeal squamous cell carcinoma. Auris Nasus Larynx 2021; 49:117-125. [PMID: 34092436 DOI: 10.1016/j.anl.2021.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Trans Oral Robotic Surgery (TORS) is a modality in the management of oropharyngeal squamous cell carcinoma(OPSCC). This study was planned to determine whether Selective Neck Dissection (SND) is oncological safe procedure even in patients with lymph node metastases. METHODS OPSCC patients were divided into Modified Radical Neck Dissection (MRND) and SND groups. The outcome measures were overall survival (OS), disease-free survival (DFS) and regional recurrence free survival (RRFS). RESULTS Thirty-seven SNDs and 18 MRNDs were performed. Regional relapse rate was 6.1% in SND group whilst 18.8% in MRND group(p=0.19). The 5-year OS, DFS and RRFS rates' differences were not statistically significant between SND and MRND groups (p=0.40, p=0.42 and p=0.18, respectively). At multivariate analysis, advanced stage impacted the 5-year OS and DFS(HR=9.39, p<0.01 and HR=11.03, p=0.04). CONCLUSIONS The SND seems to be effective in a TORS framework. The indication should be accurately discussed by the multidisciplinary tumor board.
Collapse
Affiliation(s)
- Giuseppe Meccariello
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Giulia Bianchi
- Otolaryngology Unit, University of Ferrara, Ferrara, Italy
| | - Giovanni Cammaroto
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Giannicola Iannella
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | | | - Rossella Sgarzani
- Burn Unit, Maurizio Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - Andrea De Vito
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Pasquale Capaccio
- Department of Biomedical, Surgical and Dental Sciences - University of Milan, Milan, Italy
| | - Stefano Pelucchi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Claudio Vicini
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| |
Collapse
|
11
|
Chen SY, Sinha P, Last A, Ettyreddy A, Kallogjeri D, Pipkorn P, Rich JT, Zevallos JP, Paniello R, Puram SV, Van Abel K, Moore EJ, Oppelt P, Palka K, Adkins D, Daly M, Gay H, Thorstad WL, Jackson RS. Outcomes of Patients With Single-Node Metastasis of Human Papillomavirus-Related Oropharyngeal Cancer Treated With Transoral Surgery. JAMA Otolaryngol Head Neck Surg 2021; 147:16-22. [PMID: 33151273 DOI: 10.1001/jamaoto.2020.3870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Regional lymph node metastasis remains an important prognostic factor in patients with oropharyngeal squamous cell carcinoma (OPSCC). Although survival among patients with regional metastasis in human papillomavirus (HPV)-related OPSCC is more favorable compared with patients who are HPV negative, prognostic variables associated with failure in patients with single-node metastasis are not known. Objective To evaluate recurrence and survival in patients with HPV-related OPSCC with single-lymph node metastasis treated with transoral surgery. Design, Setting, and Participants A retrospective cohort study was conducted of 207 adults with newly diagnosed p16-positive OPSCC and pathology-confirmed single-node disease who underwent surgical resection with or without adjuvant therapy at 2 tertiary academic medical centers from January 1, 2007, to December 31, 2016. Statistical analysis was performed from September 1, 2018, to September 1, 2020. Interventions Surgery alone (n = 59), surgery with adjuvant radiation (n = 75), or surgery with adjuvant chemoradiation (n = 73). Main Outcomes and Measures The primary outcome was regional recurrence. Secondary outcomes included overall survival, any recurrence, and identification of factors associated with regional recurrence and overall survival. Results Among 207 patients, 178 (86%) were men, with a median age of 57 years (range, 35-82 years) at the time of surgery. Median follow-up was 36.2 months (range, 7-127 months). Regional recurrence occurred in 11 patients (5%). Of these, 1 patient (9%) was lost to follow-up after diagnosis, 1 (9%) was treated with palliative chemotherapy, and 9 (82%) were treated with curative intent. Ultimately, 7 patients received successful salvage treatment, and 3 died with disease. Overall, there were 21 patients (10%) with any recurrence, with 4 patients (19%) experiencing local recurrence, 11 (52%) experiencing regional recurrence, and 6 (29%) experiencing distant metastasis. The 5-year overall survival was 95% (95% CI, 89%-98%) for all patients. Older age (odds ratio [OR], 1.2; 95% CI, 1.1-1.2), advanced T stage (OR, 3.5; 95% CI, 0.9-14.0), and positive margins (OR, 10.9; 95% CI, 1.8-67.5) were associated with increased regional recurrence. Extranodal extension (OR, 0.2; 95% CI, 0.04-0.8), lymph node size greater than 3 cm (OR, 0.2; 95% CI, 0.1-0.7), and adjuvant therapy (OR, 0.08; 95% CI, 0.02-0.4) were associated with decreased regional recurrence. Advanced comorbidities (hazard ratio, 6.20; 95% CI, 1.4-27.7), lymphovascular invasion (hazard ratio, 4.7; 95% CI, 1.0-21.2), and regional recurrence (hazard ratio, 16.0; 95% CI, 3.1-82.0) were associated with worse overall survival. Conclusions and Relevance The findings of this cohort study suggest that patients with HPV-related OPSCC and single-node disease undergoing surgical resection with or without adjuvant treatment have excellent survival. Adjuvant therapy appears to improve regional control. Among patients with regional recurrence of OPSCC, there is a high rate of successful salvage treatment.
Collapse
Affiliation(s)
- Stephanie Y Chen
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Aisling Last
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Abhinav Ettyreddy
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.,Statistics Editor, JAMA Otolaryngology-Head & Neck Surgery
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Randal Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Katheryn Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Peter Oppelt
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Kevin Palka
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Douglas Adkins
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Mackenzie Daly
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| |
Collapse
|
12
|
Green FR, Moustafa AE, Chengot P, Prasai A, Moor JW. The frequency of lymph node metastases by neck level in p16 positive oropharyngeal squamous cell carcinoma. Clin Otolaryngol 2020; 46:91-95. [PMID: 33113254 DOI: 10.1111/coa.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/22/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Frederick R Green
- Department of Ear, Nose and Throat, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ali E Moustafa
- Department of Ear, Nose and Throat, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Preetha Chengot
- Department of Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Amit Prasai
- Department of Ear, Nose and Throat, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James W Moor
- Department of Ear, Nose and Throat, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
13
|
Virk JS, Ingle M, Podesta CM, Gujral DM, Awad Z. Survival outcomes for head and neck cancer patients with N3 cervical nodal metastases. Clin Otolaryngol 2020; 45:342-349. [PMID: 31869000 DOI: 10.1111/coa.13501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/14/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Management of metastatic N3 nodal disease from primary head and neck squamous cell carcinoma (HNSCC) is controversial. Recently, there has been a move to observation of the neck for those who achieve complete response (CR) after chemoradiotherapy (CRT). We sought to determine survival outcomes for N3 nodal disease, particularly for patients with human papilloma virus (HPV)-positive HNSCC. METHODS We carried out a systematic search of MEDLINE and Embase for articles between 01/2008 and 12/2017. Articles on N3 nodal disease in HNSCC patients treated with CRT or surgery + adjuvant RT/CRT were included if they reported on oropharyngeal or HPV+ subgroups. Local control (LC), nodal control (NC), distant metastasis-free survival (DMFS), disease-free survival (DFS) or overall survival (OS) was assessed. RESULTS Nine studies met the inclusion criteria. Eight of these studies (N = 5304) allowed further comparison: 4 were on CRT, 2 on surgery + RT/CRT and 2 on both. Four of these eight studies and the remaining included study reported on residual nodal disease on histology after neck dissection (ND) following CRT. Patients treated with CRT achieved LC rates of 77%-94% at 2-3 years; those who had a CR had LC of >90%. Better NC was noted in patients who achieved a CR. Three-year OS was better for HPV+ HNSCC (range, 55.2%-81%). Patients with CR had better survival outcomes (DMFS 77% at 3 years vs 69.8% for HPV+; OS 68.9% at 3 years vs 55.2% for HPV+). Primary surgery demonstrated similar survival for HPV+ vs HPV- and better survival in oropharyngeal cancers. Five-year DFS rates varied from 30% to 87%, and OS from 26.6% to 84%. For patients with non-CR, positive histology rates varied from 27.3% to 100%, with average positive histology rates of 27.3% in HPV+ patients with non-CR vs 60% for HPV- patients with non-CR. CONCLUSION The current literature does not support the de-escalation of treatment with HPV- N3 disease. Observation of HPV+ patients who achieve a CR post-CRT is reasonable but further prospective studies are required given the heterogeneity and risk of bias within these current studies. Planned ND should remain standard of care for non-CR cohort.
Collapse
Affiliation(s)
- Jagdeep S Virk
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Manasi Ingle
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Clinical oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Christine M Podesta
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Clinical oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Dorothy M Gujral
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Clinical oncology, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Zaid Awad
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| |
Collapse
|
14
|
Yin X, Shan C, Wang J, Zhang H. Factors associated with the quality of life for hospitalized patients with HPV-associated oropharyngeal squamous cell carcinoma. Oral Oncol 2020; 103:104590. [PMID: 32050152 DOI: 10.1016/j.oraloncology.2020.104590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/24/2019] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Oropharynx squamous cell cancer (OPSCC) is a type of head and neck squamous cell carcinoma. The raising OPSCC incidence is mainly attributed to human papillomavirus (HPV). HPV-related OPSCC has a relatively good prognosis, the concerns are focused on the improvement of quality-of-life (QOL). We aimed to figure out the factors which may affect the QOL of HPV-related OPSCC patients after treatment. METHODS This study included patients with HPV-related OPSCC. The QOL of the patients were analyzed through the administration of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30)-Chinese version, the European Organization for Research and Treatment of Cancer Head and Neck Cancer Module-35 (EORTC QLQ-H&N-35)-Chinese version, and Eating Assessment Tool-10 (EAT-10). Multivariable regression analysis was employed to detect the influence of predictor variables on the QOL of patients. RESULTS A total of 294 HPV-related OPSCC patients were involved in this research. The results of EORTC QLQ-C30, EORTC QLQ-H&N-35, and EAT-10 demonstrated that the treatment decreased the QOL of HPV-related OPSCC patients. Several different factors including marital status, consumption of tobacco and alcohol, tumor sites, clinical stages, therapeutic strategies, and neck dissection were proved to have influence on QOL of HPV-related OPSCC after treatment. CONCLUSION Based on the analyzation of the QOL at baseline and after treatment, we demonstrated several factors which influenced the QOL of HPV-associated OPSCC patients after treatment. These results can make a great contribution to the improvement of the QOL after treatment.
Collapse
Affiliation(s)
- Xiaoyan Yin
- Department of Otolaryngology, The Second Hospital of Hebei Medical University, No.215 Heping West Road, Shijiazhuang 050000, Hebei, China
| | - Chunguang Shan
- Department of Otolaryngology, The Second Hospital of Hebei Medical University, No.215 Heping West Road, Shijiazhuang 050000, Hebei, China
| | - Jingmiao Wang
- Department of Otolaryngology, The Second Hospital of Hebei Medical University, No.215 Heping West Road, Shijiazhuang 050000, Hebei, China
| | - Haizhong Zhang
- Department of Otolaryngology, The Second Hospital of Hebei Medical University, No.215 Heping West Road, Shijiazhuang 050000, Hebei, China.
| |
Collapse
|
15
|
Chung J, Bender-Heine A, Lambert HW. Improving exposure for transoral oropharyngeal surgery with the floor of mouth window: a cadaveric feasibility study. J Otolaryngol Head Neck Surg 2019; 48:62. [PMID: 31718714 PMCID: PMC6852948 DOI: 10.1186/s40463-019-0383-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/18/2019] [Indexed: 01/29/2023] Open
Abstract
Background Transoral robotic and laser surgery is rising in popularity due to the increasing incidence of Human Papilloma Virus (HPV) related oropharyngeal cancer. However, adequate exposure of the tongue base remains a major hurdle in many cases. This study introduces a novel surgical technique called the Floor of Mouth Window, which can be used to improve tongue base exposure at the time of transoral surgery. Methods This is a preclinical anatomic cadaver study. Seven fresh cadavers were used for this study. Exposure of the tongue base was compared between conventional mouth gags – the Feyh-Kastenbauer and McIvor – and our novel procedure, the Floor of Mouth Window. Exposure was compared subjectively using endoscopic and extracorporeal photographs, as well as objective measurements of inter-incisor distance, and oral cavity volume. Results The exposure achieved by the Floor of Mouth Window technique was superior to the mouth gags. Inter-incisor distance and oral cavity volume measurements were all more favorable with the Floor of Mouth Window. This technique allowed for successful transoral laser tongue base and tonsil resection without the use of gags or scopes. Conclusion The Floor of Mouth Window is an adjunctive procedure that simply and reliably improved exposure for transoral oropharyngeal surgery in this cadaveric feasibility study. This improved exposure may help increase the adoption of transoral surgery and reduce the number of aborted cases due to anatomic limitations.
Collapse
Affiliation(s)
- Jeffson Chung
- Department of Otolaryngology - Head & Neck Surgery, West Virginia University, 1 Medical Center Drive, Health Sciences South, Rm 4532, Morgantown, WV, 26506, USA.
| | - Adam Bender-Heine
- Department of Otolaryngology - Head & Neck Surgery, West Virginia University, 1 Medical Center Drive, Health Sciences South, Rm 4500, Morgantown, WV, 26506, USA
| | - H Wayne Lambert
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, 1 Medical Center Drive, Health Sciences North, Rm 4054, Morgantown, WV, 26506, USA
| |
Collapse
|
16
|
Zenga J, Stadler M, Massey B, Campbell B, Shukla M, Awan M, Schultz CJ, Wong S, Jackson RS, Pipkorn P. Lymph node yield from neck dissection in HPV‐associated oropharyngeal cancer. Laryngoscope 2019; 130:666-671. [DOI: 10.1002/lary.28102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Michael Stadler
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Becky Massey
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Bruce Campbell
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Monica Shukla
- Department of Radiation OncologyMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Musaddiq Awan
- Department of Radiation OncologyMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | | | - Stuart Wong
- Department of Medical OncologyMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine Saint Louis Missouri U.S.A
| | - Patrick Pipkorn
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine Saint Louis Missouri U.S.A
| |
Collapse
|
17
|
Franzese C, Fogliata A, Franceschini D, Navarria P, Cozzi L, Tomatis S, De Virgilio A, Spriano G, Scorsetti M. Impact of hypofractionated schemes in radiotherapy for locally advanced head and neck cancer patients. Laryngoscope 2019; 130:E163-E170. [PMID: 31063588 DOI: 10.1002/lary.28048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/21/2019] [Accepted: 04/16/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To analyze two cohorts of locally advanced head and neck cancer (LAHNC) patients treated with two schedules of hypofractionated radiotherapy and 5 versus 3 mm clinical target volume-planning target volume (CTV-PTV) margins. METHODS 145 patients were included. The patient cohort was divided into two groups. Group A included 97 patients treated with 69.96/54.45 grays (Gy) to the high-risk and low-risk volumes, respectively, in 33 fractions, with 5 mm margins. Group B included 48 patients treated with 66/54 Gy in 30 fractions using 3 mm margins. Toxicity was recorded according to the Common Toxicity Criteria version 3. Patient outcomes for locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) were determined. RESULTS Median follow-up was 26 months. In terms of toxicity, acute dysphagia worsened significantly (P = 0.003) in group B, whereas acute salivary toxicity tended to significance (P = 0.071). No significant late toxicity differences were recorded. Rates of LRC at 1 and 2 years were 90.1% ± 2.6% and 84.2% ± 3.4%, respectively, with superiority for group A (P = 0.045). The statistical significance remained for the low-dose level (P = 0.007) but not for high dose (P = 0.110). Rates of DFS at 1 and 2 years were 84.9% ± 3.1% and 76.5% ± 3.9%, respectively, whereas rates of OS were 95.9% ± 1.8% and 91.6% ± 2.7%, respectively. No differences were observed between the two groups in terms of DFS (P = 0.270) and OS (P = 0.152). CONCLUSION The use of reduced CTV to PTV margins and dose reduction with hypofractionation schedule can improve the pattern of toxicity in LAHNC patients. This approach resulted in an increased rate of locoregional progression, particularly in low-risk regions. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E163-E170, 2020.
Collapse
Affiliation(s)
- Ciro Franzese
- Radiation Oncology Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Antonella Fogliata
- Radiation Oncology Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Davide Franceschini
- Radiation Oncology Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Pierina Navarria
- Radiation Oncology Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Luca Cozzi
- Radiation Oncology Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy.,Biomedical Science Department, Humanitas University, Milan-Rozzano, Italy
| | - Stefano Tomatis
- Radiation Oncology Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Armando De Virgilio
- Otolaryngology Head and Neck Surgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Giuseppe Spriano
- Otolaryngology Head and Neck Surgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy.,Biomedical Science Department, Humanitas University, Milan-Rozzano, Italy
| | - Marta Scorsetti
- Radiation Oncology Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy.,Biomedical Science Department, Humanitas University, Milan-Rozzano, Italy
| |
Collapse
|
18
|
Koyfman SA, Ismaila N, Crook D, D'Cruz A, Rodriguez CP, Sher DJ, Silbermins D, Sturgis EM, Tsue TT, Weiss J, Yom SS, Holsinger FC. Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: ASCO Clinical Practice Guideline. J Clin Oncol 2019; 37:1753-1774. [PMID: 30811281 DOI: 10.1200/jco.18.01921] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of the current work is to provide evidence-based recommendations to practicing physicians and others on the management of the neck in patients with squamous cell carcinoma of the oral cavity and oropharynx. METHODS ASCO convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2018. Outcomes of interest included survival, regional disease control, neck recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 124 relevant studies to inform the evidence base for this guideline. Six clinical scenarios were devised; three for oral cavity cancer and three for oropharynx cancer, and recommendations were generated for each one. RECOMMENDATIONS For oral cavity cancers, clinical scenarios focused on the indications for and the hallmarks of a high-quality neck dissection, indications for postoperative radiotherapy or chemoradiotherapy, and whether radiotherapy alone is sufficient elective treatment of an undissected neck compared with high-quality neck dissection. For oropharynx cancers, clinical scenarios focused on hallmarks of a high-quality neck dissection, factors that would favor operative versus nonoperative primary management, and clarifying criteria for an incomplete response to definitive chemoradiation for which salvage neck dissection would be recommended. Consensus was reached and recommendations were made for all six clinical scenarios. Additional information is available at www.asco.org/head-neck-cancer-guidelines .
Collapse
Affiliation(s)
| | | | - Doug Crook
- 3 Patient representative, Indianapolis, IN
| | | | | | | | | | | | | | - Jared Weiss
- 10 University of North Carolina, Chapel Hill, NC
| | - Sue S Yom
- 11 University of California, San Francisco, San Francisco, CA
| | | |
Collapse
|
19
|
Plonowska KA, Strohl MP, Wang SJ, Ha PK, George JR, Heaton CM, El-Sayed IH, Mallen-St. Clair J, Ryan WR. Human Papillomavirus–Associated Oropharyngeal Cancer: Patterns of Nodal Disease. Otolaryngol Head Neck Surg 2018; 160:502-509. [DOI: 10.1177/0194599818801907] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To characterize patterns of neck lymph node (LN) metastases in human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma, represented by p16 positivity (p16+OPSCC). Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Neck dissection (ND) specimens of nonirradiated p16+OPSCC patients were analyzed for frequencies of clinically evident and occult LNs by neck level. Local, regional, and distant recurrences were reviewed. Results Seventy p16+OPSCC patients underwent primary site transoral robotic surgery and 82 NDs of varying levels. Metastatic pathologic LNs were found at the following frequencies: 0% (0/28) in level I, 75.6% (62/82) in level II with 57.4% (35/61) in level IIA and 13.1% (8/61) in level IIB, 22.0% (18/82) in level III, 7.0% (5/71) in level IV, and 6.3% (1/16) in level V. The level V LN was clinically evident preoperatively. Five of 21 (23.8%) elective NDs contained occult LNs, all of which were in level II and without extranodal extension. Twenty-seven (38.6%) patients underwent adjuvant radiation; 19 (27.1%) patients underwent adjuvant chemoradiation. With a mean follow-up of 29 months, 3 patients had developed recurrences, with all but 1 patient still alive. All patients who recurred had refused at least a component of indicated adjuvant treatment. Conclusions For p16+OPSCC, therapeutic NDs should encompass any levels bearing suspicious LNs and levels IIA-B, III, and IV, while elective NDs should be performed and encompass at least levels IIA-B and III. These selective ND plans, followed by indicated adjuvant treatment, are associated with a low nodal recurrence rate.
Collapse
Affiliation(s)
- Karolina A. Plonowska
- School of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Madeleine P. Strohl
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Steven J. Wang
- Department of Otolaryngology–Head and Neck Surgery, University of Arizona, Phoenix, Arizona, USA
| | - Patrick K. Ha
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Jonathan R. George
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Chase M. Heaton
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Ivan H. El-Sayed
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Jon Mallen-St. Clair
- Department of Otolaryngology–Head and Neck Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - William R. Ryan
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| |
Collapse
|
20
|
Hobelmann KC, Topf MC, Bar-Ad V, Luginbuhl AJ, Keane WM, Curry JM, Cognetti DM. AJCC-8ed nodal staging does not predict outcomes in surgically managed HPV-associated oropharyngeal cancer. Oral Oncol 2018; 82:138-143. [DOI: 10.1016/j.oraloncology.2018.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/19/2018] [Accepted: 05/17/2018] [Indexed: 01/20/2023]
|
21
|
Haughey BH, Sinha P, Kallogjeri D, Goldberg RL, Lewis JS, Piccirillo JF, Jackson RS, Moore EJ, Brandwein-Gensler M, Magnuson SJ, Carroll WR, Jones TM, Wilkie MD, Lau A, Upile NS, Sheard J, Lancaster J, Tandon S, Robinson M, Husband D, Ganly I, Shah JP, Brizel DM, O'Sullivan B, Ridge JA, Lydiatt WM. Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncol 2016; 62:11-19. [PMID: 27865363 PMCID: PMC5523818 DOI: 10.1016/j.oraloncology.2016.09.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/06/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC. METHODS Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, "HPVpath" staging system that combines features of the primary tumor and nodal metastases. RESULTS A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort. CONCLUSIONS Three loco-regional "HPVpath" stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC.
Collapse
Affiliation(s)
- B H Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA; Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand.
| | - P Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D Kallogjeri
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R L Goldberg
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J S Lewis
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J F Piccirillo
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R S Jackson
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - E J Moore
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Brandwein-Gensler
- Pathology and Anatomical Sciences, SUNY at the University at Buffalo, Buffalo, NY, USA
| | - S J Magnuson
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA
| | - W R Carroll
- Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA
| | - T M Jones
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M D Wilkie
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - A Lau
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N S Upile
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jon Sheard
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK; Pathology, University of Liverpool, UK
| | - J Lancaster
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Tandon
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Robinson
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK
| | - D Husband
- Clatterbridge Cancer Centre, Wirral, UK
| | - I Ganly
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D M Brizel
- Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - B O'Sullivan
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J A Ridge
- Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - W M Lydiatt
- Clinical Professor, Creighton Department of Surgery, Omaha, NE, USA
| |
Collapse
|