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Verma A, Chen AY. Indications and outcomes of superselective neck dissection: A review and analysis of the literature. Laryngoscope Investig Otolaryngol 2020; 5:672-676. [PMID: 32864437 PMCID: PMC7444773 DOI: 10.1002/lio2.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/23/2020] [Accepted: 06/02/2020] [Indexed: 11/27/2022] Open
Abstract
Superselective neck dissection, defined as dissection of two or less contiguous neck levels, has recently been introduced to reduce surgical morbidity of neck dissection while maintaining favorable oncologic outcomes. The purpose of this review is to report the results of superselective neck dissection when applied to specific settings: the management of regional disease after chemoradiation, head and neck squamous cell carcinoma with clinical N0 necks, and high risk papillary thyroid carcinoma.
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Affiliation(s)
- Avanti Verma
- Department of Otolaryngology‐Head and Neck SurgeryEmory UniversityAtlantaGeorgiaUSA
| | - Amy Y. Chen
- Department of Otolaryngology‐Head and Neck SurgeryEmory UniversityAtlantaGeorgiaUSA
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Applebaum J, Lee E, Harun A, Davis A, Hillel AT, Best SR, Akst LM. Characterization of Geriatric Dysphagia Diagnoses in Age-Based Cohorts. OTO Open 2020; 4:2473974X20939543. [PMID: 32685871 PMCID: PMC7346702 DOI: 10.1177/2473974x20939543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE An aging population requires increased focus on geriatric otolaryngology. Patients aged ≥65 years are not a homogenous population, and important physiologic differences have been documented among the young-old (65-74 years), middle-old (75-84), and old-old (≥85). We aim to analyze differences in dysphagia diagnoses and swallowing-related quality-of-life among these age subgroups. STUDY DESIGN Retrospective chart review. SETTING Tertiary care laryngology clinic. SUBJECTS AND METHODS We identified chief complaint, diagnosis, and self-reported swallowing handicap (Eating Assessment Tool [EAT-10] score) of all new patients aged ≥65 years presenting to the Johns Hopkins Voice Center between April 2015 and March 2017. Dysphagia diagnoses were classified by physiologic etiology and anatomic source. Diagnostic categories and EAT-10 score were evaluated as functions of patient age and sex. RESULTS Of 839 new patients aged ≥65 years, 109 (13.0%) reported a chief complaint of dysphagia and were included in this study. The most common dysphagia etiologies were neurologic and esophageal. Most common diagnoses were diverticula (15.6%), reflux (13.8%), and radiation induced (8.3%). Diverticula, cricopharyngeal hypertonicity, and radiation-induced changes were associated with higher EAT-10 score (P < .001). Significant differences by sex were found in anatomic source of dysphagia, as men and women were more likely to present with oropharyngeal and esophageal disease, respectively (P = .023). Dysphagia etiology and EAT-10 score were similar across age subgroups. CONCLUSION Important differences among dysphagia diagnosis and EAT-10 score exist among patients aged ≥65 years. Knowledge of these differences may inform diagnostic workup, management, and further investigations in geriatric otolaryngology.
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Affiliation(s)
- Jeremy Applebaum
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emerson Lee
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aisha Harun
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Ashley Davis
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alexander T. Hillel
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Simon R. Best
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Harris A, Lyu L, Wasserman-Winko T, George S, Johnson JT, Nilsen ML. Neck Disability and Swallowing Function in Posttreatment Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2020; 163:763-770. [DOI: 10.1177/0194599820923630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To examine the relationship between symptoms of neck disability and swallowing dysfunction among head and neck cancer (HNC) survivors. Study Design Cross-sectional analysis. Setting Single-center, university-affiliated HNC survivorship clinic. Subjects and Methods Survivors’ patient-reported symptoms of neck disability and swallowing dysfunction were prospectively collected from March 2017 to May 2018. Neck disability and swallowing dysfunction were measured using the Neck Disability Index and Eating Assessment Tool (EAT-10), respectively. Linear regression was used to analyze the association between neck disability and swallowing dysfunction. Results A total of 179 survivors, predominantly male (n = 130, 72.6%) with an average age of 64.64 ± 9.91 years, were included in the analysis. Primary cancer sites were oropharynx (n = 85, 47.5%), oral cavity (n = 59, 33.0%), and larynx/hypopharynx (n = 35, 19.5%). Mean EAT-10 score was 10.07 ± 10.89 (range = 0-40; >2 indicative of swallowing dysfunction). Survivors treated for early stage cancer had lower EAT-10 scores than those with advanced stage (early = 3.55 ± 7.46; advanced = 11.95 ± 11.02, P < .001). After controlling for age, time since treatment, American Joint Committee on Cancer stage, and treatment modality, the EAT-10 score for patients with mild neck disability was 6.88 (95% confidence interval [CI], 3.71-10.06; P < .001) points higher than those without neck disability, and the score for those with moderate-complete neck disability was 13.65 (95% CI, 9.47-17.83; P < .001) points higher than those without neck disability. Conclusions Swallowing dysfunction is a commonly recognized effect of HNC treatment. The prevalence and burden of neck disability are shown to be highly correlated with swallowing dysfunction. These results support the need for comprehensive, multidisciplinary rehabilitation interventions for patients with HNC.
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Affiliation(s)
- Alexandria Harris
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lingyun Lyu
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tamara Wasserman-Winko
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan George
- Centers for Rehab Services, UPMC, Pittsburgh, Pennsylvania, USA
| | - Jonas T. Johnson
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marci Lee Nilsen
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Amdur RJ, Chera BS. Misuse of Quality of Life Evaluation in Oncology Studies: Reification, Adaptation, and the U-shaped Curve. Pract Radiat Oncol 2019; 9:191-192. [DOI: 10.1016/j.prro.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/18/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
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Pearlstein KA, Wang K, Amdur RJ, Shen CJ, Dagan R, Weiss J, Grilley-Olson JE, Zanation A, Hackman TG, Thorp BD, Blumberg JM, Patel S, Sheets N, Weissler MC, Mendenhall WM, Chera BS. Quality of Life for Patients With Favorable-Risk HPV-Associated Oropharyngeal Cancer After De-intensified Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2019; 103:646-653. [DOI: 10.1016/j.ijrobp.2018.10.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/24/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
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Wang K, Moon DH, Amdur RJ, Dagan R, Sheets NC, Shen CJ, Green R, Patel SN, Zanation AM, Thorp BD, Hackman TG, Weissler MC, Mendenhall WM, Chera BS. Shoulder symptoms and quality of life impact of limited neck dissection after de‐intensified chemoradiotherapy: Secondary analysis of two prospective trials. Head Neck 2018; 41:1213-1219. [DOI: 10.1002/hed.25535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/07/2018] [Accepted: 10/06/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kyle Wang
- Department of Radiation OncologyUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | - Dominic H. Moon
- Department of Radiation OncologyUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | - Robert J. Amdur
- Department of Radiation OncologyUniversity of Florida Hospitals Gainesville Florida
| | - Roi Dagan
- Department of Radiation OncologyUniversity of Florida Hospitals Gainesville Florida
| | - Nathan C. Sheets
- Department of Radiation OncologyUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | - Colette J. Shen
- Department of Radiation OncologyUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | - Rebecca Green
- Department of Radiation OncologyUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | - Samip N. Patel
- Department of Otolaryngology, Division of Head and Neck SurgeryUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | - Adam M. Zanation
- Department of Otolaryngology, Division of Head and Neck SurgeryUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | - Brian D. Thorp
- Department of Otolaryngology, Division of Head and Neck SurgeryUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | - Trevor G. Hackman
- Department of Otolaryngology, Division of Head and Neck SurgeryUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | - Mark C. Weissler
- Department of Otolaryngology, Division of Head and Neck SurgeryUniversity of North Carolina Hospitals Chapel Hill North Carolina
| | | | - Bhishamjit S. Chera
- Department of Radiation OncologyUniversity of North Carolina Hospitals Chapel Hill North Carolina
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Chera BS, Amdur RJ, Tepper JE, Tan X, Weiss J, Grilley-Olson JE, Hayes DN, Zanation A, Hackman TG, Patel S, Sheets N, Weissler MC, Mendenhall WM. Mature results of a prospective study of deintensified chemoradiotherapy for low-risk human papillomavirus-associated oropharyngeal squamous cell carcinoma. Cancer 2018; 124:2347-2354. [PMID: 29579339 DOI: 10.1002/cncr.31338] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/29/2018] [Accepted: 02/03/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of the current study was to determine quality of life and tumor control from a prospective phase 2 clinical trial evaluating deintensified chemoradiotherapy for favorable risk, human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma. METHODS Patients with T0-T3, N0-N2c, M0, p16-positive disease and a minimal smoking history were treated with 60 grays of intensity-modulated radiotherapy with concurrent weekly intravenous cisplatin (30 mg/m2 ). The primary study endpoint was the pathologic complete response rate based on biopsy of the primary site and dissection of pretreatment positive lymph node regions. The pathologic complete response rate as previously reported was 86%. Herein, the authors report secondary endpoint measures of local control, regional control, cause-specific survival, distant metastasis-free survival, and overall survival, and patient-reported outcomes (European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire [EORTC QLQ-C30] and the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events [PRO-CTCAE]). RESULTS A total of 44 patients enrolled with a median follow-up of 36 months (88% with ≥2 years). The 3-year local control, regional control, cause-specific survival, distant metastasis-free survival, and overall survival rates were 100%, 100%, 100%, 100%, and 95%, respectively. The mean before and 3-year after EORTC QOL scores were: global: 80 of 78; swallowing: 11 of 11; dry mouth: 16 of 41; and sticky saliva: 6 of 29. The mean before and 3-year after PRO-CTCAE scores were: swallowing: 0.4 of 0.7; and dry mouth: 0.4 of 1.4. Approximately 39% of patients required a feeding tube (median duration, 15 weeks; none were permanent). There were no ≥grade 3 late adverse events reported. CONCLUSIONS For patients with favorable-risk human papillomavirus-associated oropharyngeal squamous cell carcinoma, a substantially decreased intensity of therapy with 60 grays of intensity-modulated radiotherapy and weekly low-dose cisplatin produced better preservation of quality of life compared with standard therapies while maintaining excellent 3-year tumor control and survival. Cancer 2018;124:2347-54. © 2018 American Cancer Society.
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Affiliation(s)
- Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida.,UF Health Shands Cancer Center, University of Florida Hospitals, Gainesville, Florida
| | - Joel E Tepper
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Xianming Tan
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Jared Weiss
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina.,Division of Hematology Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Juneko E Grilley-Olson
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina.,Division of Hematology Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - D Neil Hayes
- Division of Hematology Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Adam Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Samip Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida.,UF Health Shands Cancer Center, University of Florida Hospitals, Gainesville, Florida
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Albergotti WG, Jordan J, Anthony K, Abberbock S, Wasserman-Wincko T, Kim S, Ferris RL, Duvvuri U. A prospective evaluation of short-term dysphagia after transoral robotic surgery for squamous cell carcinoma of the oropharynx. Cancer 2017; 123:3132-3140. [PMID: 28467606 DOI: 10.1002/cncr.30712] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) has been associated with improved long-term dysphagia symptomatology compared with chemoradiation. Dysphagia in the perioperative period has been inadequately characterized. The objective of this study was to characterize short-term swallowing outcomes after TORS for OPSCC. METHODS Patients undergoing TORS for OPSCC were enrolled prospectively. The Eating Assessment Tool 10 (EAT-10) was used as a measure of swallowing dysfunction (score >2) and was administered on postoperative day (POD) 1, 7, and 30. Patient demographics, weight, pain level, and clinical outcomes were recorded prospectively and focused on time to oral diet, feeding tube placement, and dysphagia-related readmissions. RESULTS A total of 51 patients were included with pathologic T stages of T1 (n = 24), T2 (n = 20), T3 (n = 3), and Tx (n = 4). Self-reported preoperative dysphagia was unusual (13.7%). The mean EAT-10 score on POD 1 was lower than on POD 7 (21.5 vs 26.6; P = .005) but decreased by POD 30 (26.1 to 12.2; P < .001). Forty-seven (92.1%) patients were discharged on an oral diet, but 57.4% required compensatory strategies or modification of liquid consistency. Ninety-eight percent of patients were taking an oral diet by POD 30. There were no dysphagia-related readmissions. CONCLUSION This prospective study shows that most patients who undergo TORS experience dysphagia for at least the first month postoperatively, but nearly all can be started on an oral diet. The dysphagia-associated complication profile is acceptable after TORS with a minority of patients requiring temporary feeding tube placement. Aggressive evaluation and management of postoperative dysphagia in TORS patients may help prevent dysphagia-associated readmissions. Cancer 2017;123:3132-40. © 2017 American Cancer Society.
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Affiliation(s)
- William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jessica Jordan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Keely Anthony
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shira Abberbock
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Tamara Wasserman-Wincko
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania
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