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Morisada MV, Bewley AF, Broadhead K, Assadsangabi R, Paydar A, Birkeland AC, Abouyared M, Qi L, Ivanovic V. CT predictors of sub-centimeter occult lymph node metastases in oral cavity squamous cell carcinoma: A case-control study. Neuroradiol J 2024; 37:214-220. [PMID: 38148295 PMCID: PMC10973826 DOI: 10.1177/19714009231224447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance. OBJECTIVE To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology. METHODS Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS 26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, p = .01), asymmetric number (OR = 7.20, p = .005), and disrupted fatty hilum (OR = 3.31, p = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%. CONCLUSIONS In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.
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Affiliation(s)
- Megan V Morisada
- Department of Otolaryngology, University of California Davis, USA
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California Davis, USA
| | | | - Reza Assadsangabi
- Department of Radiology, Keck School of Medicine, University of Southern California, USA
| | - Alireza Paydar
- Department of Radiology, Cleveland Clinic Foundation, USA
| | | | | | - Lihong Qi
- Department of Public Health Sciences, School of Medicine, University of California Davis, USA
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Evangelista L, Nativ-Zeltzer N, Bewley A, Birkeland AC, Abouyared M, Kuhn M, Cates DJ, Farwell DG, Belafsky P. Functional Laryngectomy and Quality of Life in Survivors of Head and Neck Cancer With Intractable Aspiration. JAMA Otolaryngol Head Neck Surg 2024; 150:335-341. [PMID: 38451502 PMCID: PMC10921343 DOI: 10.1001/jamaoto.2024.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/15/2024] [Indexed: 03/08/2024]
Abstract
Importance Late effects of head and neck cancer (HNC) treatment include profound dysphagia, chronic aspiration, and death. Functional laryngectomy (FL) can improve patient survival and quality of life (QoL); however, removing a failing larynx for a noncancer reason is a difficult decision. Data regarding the ability of FL to improve self-perceptions of voice, swallowing, and QOL in survivors of HNC with intractable aspiration are inconclusive. Objective To investigate the association of FL with changes in self-reported perceptions of voice, swallowing, oral intake, QoL, and mood in survivors of HNC experiencing profound dysphagia and intractable aspiration. Design, Settings, and Participants This cohort study was conducted at a single academic institution and included survivors of HNC with profound swallowing dysfunction and intractable aspiration who underwent FL from July 2016 through March 2022. Of the initial 22 patients enrolled, 2 patients (15%) died of aspiration pneumonia before receiving FL. Data analyses were performed from July 2016 through March 2023. Main Outcomes and Measures Self-reported measures of voice using the VHI (30-item Voice Handicap Index), swallowing using the EAT-10 (10-item Eating Assessment Tool), functional oral intake scale using the FOIS (Functional Oral Intake Scale), and quality of life using the FACT-H&N (Functional Assessment of Cancer Therapy-Head & Neck) were assessed before FL and at 1, 3, and 6 months after FL. Mood states were evaluated using the POMS (Profile of Mood States, second edition), before FL and at 6 months after FL. Results The study analyses included 20 patients (mean [SD] age, 72.4 (7.0) years; 19 [95%] males and 1 [5%] female) who underwent FL and had complete data across all time points. Among these, 12 patients (60%) had received chemoradiation for oropharyngeal, 7 (35%) for laryngeal, or 1 (5%) for nasopharyngeal cancer. The mean (SD) time from completion of oncologic treatment to FL was 15.5 (5.5) years. Mean (SD) score on the EAT-10 improved from 33.2 (7.4) to 23.1 (10.8) at 1 month; 12.1 (9.1) at 3 months; and 8.3 (7.4) at 6 months, with a large effect size (η2 = 0.72; 95% CI, 0.54-0.80). Mean (SD) score on the FOIS improved from 2.0 (1.5) to 2.9 (1.7) at 1 month; 4.8 (2.5) at 3 months; and 5.2 (1.7) at 6 months, with a large effect size (η2 = 0.6; 95% CI, 0.38-0.71). Improvement in oral intake was achieved in 19 patients (95%), and feeding tubes were removed in 10 of 16 patients (63%) who were feeding tube-dependent; 6 patients (27%) continued to require supplemental tube feedings. Mean (SD) score on the VHI improved from 63.6 (34.0) to 86.9 (33.7) at 1 month; 71.3 (36.1) at 3 months; and 39.7 (26.9) at 6 months, with a large effect size (η2 = 0.42; 95% CI, 0.19-0.56). Seventeen patients (85%) were able to use a tracheoesophageal voice prosthesis for alaryngeal communication. Mean (SD) score on the FACT-H&N improved from 86.2 (17.8) to 93.6 (18.4) at 1 month; 109.0 (18.4) at 3 months; and 121.0 (16.8) at 6 months, with a large effect size (η2 = 0.64; 95% CI, 0.42-0.74). Mean (SD) score on the POMS improved from 58.9 (13.2) at baseline to 44.5 (9.9) at 6 months, with a large effect size (Cohen d = 1.04; 95% CI, 0.48-1.57). None of the patients experienced major complications of FL; 1 patient (5%) had a postoperative pharyngocutaneous fistula. Conclusions and Relevance The findings of this cohort study indicate that FL was associated with marked improvements in self-perception of voice and swallowing, functional oral intake, QoL, and mood state among survivors of HNC. These findings can serve as a framework for FL counseling among HNC survivors experiencing profound dysphagia and intractable aspiration.
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Affiliation(s)
- Lisa Evangelista
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Nogah Nativ-Zeltzer
- Department of Communication Disorders, Tel Aviv University, Tel Aviv, Israel
| | - Arnaud Bewley
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Andrew C. Birkeland
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Marianne Abouyared
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Maggie Kuhn
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Daniel J. Cates
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - D. Gregory Farwell
- Department of Otolaryngology–Head & Neck Surgery, Hospital of the University of Pennsylvania
| | - Peter Belafsky
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
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Ludwig ML, Michmerhuizen NL, Wang J, Birkeland AC, Majchrowski BK, Nimmagadda S, Zhai J, Bhangale A, Kulkarni A, Jiang H, Swiecicki PL, Brenner JC. Multi-kinase compensation rescues EGFR knockout in a cell line model of head and neck squamous cell carcinoma. Arch Oral Biol 2023; 156:105822. [PMID: 37844343 DOI: 10.1016/j.archoralbio.2023.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is a debilitating disease with poor survival rates. While the epidermal growth factor receptor (EGFR)-targeting antibody Cetuximab is approved for treatment, responses are limited and the molecular mechanisms driving resistance remain incompletely understood. METHODS To better understand how cells survive without EGFR activity, we developed an EGFR knockout derivative of the UM-SCC-92 cell line using CRISPR/Cas9 technology. We then characterized changes to the transcriptome with RNAseq and changes in response to kinase inhibitors with resazurin cell viability assays. Finally, we tested if inhibitors with activity in the EGFR knockout model also had synergistic activity in combination with EGFR inhibitors in either wild type UM-SCC-92 cells or a known Cetuximab-resistant model. RESULTS Functional and molecular analysis showed that knockout cells had decreased cell proliferation, upregulation of FGFR1 expression, and an enhanced mesenchymal phenotype. In fact, expression of common EMT genes including VIM, SNAIL1, ZEB1 and TWIST1 were all upregulated in the EGFR knockout. Surprisingly, EGFR knockout cells were resistant to FGFR inhibitor monotherapies, but sensitive to combinations of FGFR and either XIAP or IGF-1R inhibitors. Accordingly, both wild type UM-SCC-92 and Cetuximab-resistant UM-SCC-104 cells with were sensitive to combined inhibition of EGFR, FGFR and either XIAP or IGF-1R. CONCLUSIONS These data offer insights into EGFR inhibitor resistance and show that resistance to EGFR knockout likely occurs through a complex network of kinases. Future studies of cetuximab-resistant HNSCC tumors are warranted to determine if this EMT phenotype and/or multi-kinase resistance is observed in patients.
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Affiliation(s)
- Megan L Ludwig
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, United States; Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Nicole L Michmerhuizen
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI 48109, United States; Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Jiayu Wang
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI 48109, United States; Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Behirda K Majchrowski
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Sai Nimmagadda
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Jingyi Zhai
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, United States
| | - Apurva Bhangale
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Aditi Kulkarni
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Hui Jiang
- Rogel Cancer Center University of Michigan Medical School, Ann Arbor, MI 48109, United States; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, United States
| | - Paul L Swiecicki
- Department of Hematology Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, United States; Rogel Cancer Center University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - J Chad Brenner
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI 48109, United States; Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, MI 48109, United States; Rogel Cancer Center University of Michigan Medical School, Ann Arbor, MI 48109, United States.
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Hassan MA, Weyers BW, Bec J, Fereidouni F, Qi J, Gui D, Bewley AF, Abouyared M, Farwell DG, Birkeland AC, Marcu L. Anatomy-Specific Classification Model Using Label-Free FLIm to Aid Intraoperative Surgical Guidance of Head and Neck Cancer. IEEE Trans Biomed Eng 2023; 70:2863-2873. [PMID: 37043314 PMCID: PMC10833893 DOI: 10.1109/tbme.2023.3266678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Intraoperative identification of head and neck cancer tissue is essential to achieve complete tumor resection and mitigate tumor recurrence. Mesoscopic fluorescence lifetime imaging (FLIm) of intrinsic tissue fluorophores emission has demonstrated the potential to demarcate the extent of the tumor in patients undergoing surgical procedures of the oral cavity and the oropharynx. Here, we report FLIm-based classification methods using standard machine learning models that account for the diverse anatomical and biochemical composition across the head and neck anatomy to improve tumor region identification. Three anatomy-specific binary classification models were developed (i.e., "base of tongue," "palatine tonsil," and "oral tongue"). FLIm data from patients (N = 85) undergoing upper aerodigestive oncologic surgery were used to train and validate the classification models using a leave-one-patient-out cross-validation method. These models were evaluated for two classification tasks: (1) to discriminate between healthy and cancer tissue, and (2) to apply the binary classification model trained on healthy and cancer to discriminate dysplasia through transfer learning. This approach achieved superior classification performance compared to models that are anatomy-agnostic; specifically, a ROC-AUC of 0.94 was for the first task and 0.92 for the second. Furthermore, the model demonstrated detection of dysplasia, highlighting the generalization of the FLIm-based classifier. Current findings demonstrate that a classifier that accounts for tumor location can improve the ability to accurately identify surgical margins and underscore FLIm's potential as a tool for surgical guidance in head and neck cancer patients, including those subjects of robotic surgery.
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Farber NI, Li Y, Solis RN, Chen J, Masheeb Z, Wilson M, Bewley AF, Abouyared M, Rao S, Rong Y, Birkeland AC. Tumor and Nodal Disease Growth Rates in Patients with Oropharyngeal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:3865. [PMID: 37568681 PMCID: PMC10416867 DOI: 10.3390/cancers15153865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Though specific growth rate (SGR) has potential prognostic value for oropharyngeal squamous cell carcinoma (OPSCC), there is sparse literature defining these rates. Our aims were to establish the SGRs of primary tumors (PTs) and lymph nodes (LNs) in OPSCC and to correlate SGR with oncologic outcome. A pilot study was designed with a retrospective analysis examining 54 patients from the University of California, Davis with OPSCC (diagnosed 2012-2019). Radiation oncology software and pretreatment serial CT scans were used to measure PT and LN volumes to calculate SGR and doubling time (DT). The mean PT-SGR was 1.2 ± 2.2%/day and the mean LN-SGR was 1.6 ± 1.9%/day. There was no statistically significant difference between slow-growing and fast-growing cohorts in terms of age, gender, smoking status, tumor subsite, HPV status (as determined with p16 staining), initial volume, or overall stage. SGR had no impact on 2-year overall survival, disease-free survival, or disease-specific survival. We found the average daily growth rates for OPSCC to be 1.2%/day and 1.6%/day. Our findings suggest PT- and LN-SGR are independent factors, not heavily influenced by known biomarkers and patient characteristics, without a statistical impact on prognosis. This information has value in patient counseling regarding tumor growth and in providing patients worried about fast-growing tumors the appropriate reassurance.
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Affiliation(s)
- Nicole I. Farber
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Yimin Li
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361005, China
| | - Roberto N. Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Joy Chen
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Zahrah Masheeb
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Machelle Wilson
- Davis-School of Medicine, University of California, Sacramento, CA 94720, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Shyam Rao
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
- Department of Radiation Oncology, Mayo Clinic, Pheonix, AZ 85054, USA
| | - Andrew C. Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
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Done AJ, Birkeland AC. Organoids as a tool in drug discovery and patient-specific therapy for head and neck cancer. Cell Rep Med 2023; 4:101087. [PMID: 37343518 DOI: 10.1016/j.xcrm.2023.101087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
Organoids more accurately reflect tumor microenvironment than traditional models. Millen et al. demonstrated organoids replicated from patient tissues may predict patient-specific response to radiation therapy and have potential to be utilized for validation of biomarkers in drug discovery and treatment planning.
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Affiliation(s)
- Aaron J Done
- Department of Otolaryngology - Head & Neck Surgery, University of California - Davis, Sacramento, CA, USA
| | - Andrew C Birkeland
- Department of Otolaryngology - Head & Neck Surgery, University of California - Davis, Sacramento, CA, USA.
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7
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Young K, Bulosan H, Kida CC, Bewley AF, Abouyared M, Birkeland AC. Stratification of surgical margin distances by the millimeter on local recurrence in oral cavity cancer: A systematic review and meta-analysis. Head Neck 2023; 45:1305-1314. [PMID: 36891759 PMCID: PMC10079646 DOI: 10.1002/hed.27339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
There are limited data supporting the commonly suggested 5 mm margin cutoff as the optimum value in defining clear margins in oral cancer. A database search of Pubmed/Medline, Web of Science, and EBSCOhost was performed from inception to June 2022. A random-effects model was chosen for this meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed throughout this study. Seven studies met study criteria (2215 patients). The risk ratio was significantly higher for margins <5 mm when compared to those ≥5 mm (2.09 (95%CI: 1.53-2.86, I2 = 0.47)). Subgroup analysis (I2 = 0.15) of margin distances of 0.0-0.9, 1.0-1.9, 2.0-2.9, 3.0-3.9, and 4.0-4.9 mm calculated risk ratios for local recurrence of 2.96, 2.01, 2.17, 1.8, and 0.98, respectively. Margins between 4.0 and 4.9 mm had similar risk ratios for local recurrence compared to ≥5 mm, while margins <4.0 were significantly higher.
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Affiliation(s)
- Kurtis Young
- University of Hawaii at Manoa, John A. Burns School of Medicine
| | - Hannah Bulosan
- University of Hawaii at Manoa, John A. Burns School of Medicine
| | - Carley C. Kida
- University of Hawaii at Manoa, John A. Burns School of Medicine
| | - Arnaud F. Bewley
- Department of Otolaryngology - Head and Neck Surgery, University of California, Davis
| | - Marianne Abouyared
- Department of Otolaryngology - Head and Neck Surgery, University of California, Davis
| | - Andrew C. Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of California, Davis
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Garber BB, Chen J, Beliveau A, Farwell DG, Bewley AF, Birkeland AC, Abouyared M. Using the Patient Health Questionnaire-2 to improve depression screening in head and neck cancer patients. Am J Otolaryngol 2023; 44:103724. [PMID: 36493469 DOI: 10.1016/j.amjoto.2022.103724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE The purpose of this study is to examine the use of the Patient Health Questionnaire-2 (PHQ-2) to screen for depression in patients undergoing treatment for head and neck cancer and to evaluate potential patient-specific risk factors that may contribute to depression. MATERIALS AND METHODS This is a retrospective study at a tertiary-level hospital of outpatient adult patients with head and neck cancer who completed the PHQ-2/9 from 2019 to 2020. Patients were given a PHQ-2 during a surveillance visit. A positive PHQ-2 screen (score ≥ 3) prompted further evaluation with a PHQ-9. Patients were stratified into either low risk (PHQ-2 score < 3) or high risk (PHQ-2 score ≥ 3) for depression. Univariate regression was performed on all variables, and a multivariate logistic regression was performed on statistically significant variables (P < 0.05). RESULTS In total, 110 patients were included in this study. Fifteen (14 %) patients had a positive PHQ-2 screen with a score ≥ 3 and underwent evaluation with a PHQ-9. The median PHQ-9 score was 15 (6-26). The PHQ-2 ≥ 3 group were significantly younger (59 years vs. 67 years; P = 0.03) and had a greater number of patients with a psychiatric history (33 % vs. 8 %; P < 0.01). CONCLUSIONS There is a strong association between a PHQ-2 score ≥ 3 and detection of depressive symptoms among patients with head and neck cancer. Younger age and pretreatment mental illness are significant risk factors for developing depression following treatment. Early screening and treatment should be considered for all patients to mitigate the burden of depression and suicide in this patient population. Further research is warranted to investigate utilization of the PHQ-2/9 to detect depression and barriers that exist for timely screening and interventions.
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Affiliation(s)
- Beverly B Garber
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - Joy Chen
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - Angela Beliveau
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - D Gregory Farwell
- University of Pennsylvania, Department of Otorhinolaryngology-Head and Neck Surgery, Philadelphia, PA, United States of America
| | - Arnaud F Bewley
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - Andrew C Birkeland
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - Marianne Abouyared
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America.
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Birkeland AC, Kademani D, Moore MG, Blair EA. Practice patterns for initial management of oral leukoplakia amongst otolaryngologists and oral and maxillofacial surgeons. Oral Oncol 2023; 139:106341. [PMID: 36842197 DOI: 10.1016/j.oraloncology.2023.106341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/04/2023] [Accepted: 02/14/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE Oral leukoplakia is encountered frequently by otolaryngologists and oral and maxillofacial surgeons (OMFS). There are no consensus practice management guidelines for oral leukoplakia, resulting in heterogeneity in practice patterns. Characterization of practice patterns of providers who treat oral leukoplakia will be valuable to establish standards of care and future practice guidelines. MATERIAL AND METHODS A survey was designed by the American Head and Neck Society Cancer Prevention Service collecting demographic and practice management data for treating oral leukoplakia. The survey was approved and distributed to members of the American Academy of Otolaryngology-Head and Neck Surgery and American Association of Oral and Maxillofacial Surgeons. Data analysis was performed using chi square and t-test where appropriate. RESULTS 396 responses were collected: 83 OMFS, 81 head and neck fellowship-trained providers, and 232 otolaryngologists (non-head and neck fellowship-trained). Providers saw a wide volume of oral leukoplakia (23.0% >30 cases/year, 35.1% 11-30 cases/year, 41.2% 10 or less cases/year), with OMFS seeing more cases of oral leukoplakia. Factors most associated with consideration of initial biopsy included physical exam findings (94.4%), erythroplakia (82.3%), and smoking status (81.6%). The majority of respondents saw patients in follow-up within 1 month (24.8%) or within 1-3 months (46.5%). CONCLUSION This survey identifies a range of practice patterns in initial management of oral leukoplakia, including indications for biopsy, and time for follow-up. This data provide insight into practice patterns amongst different groups of providers and can potentially lead to consensus guidelines for initial management of oral leukoplakia.
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Affiliation(s)
- Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Sacramento, CA, USA.
| | - Deepak Kademani
- Department of Oral and Maxillofacial Surgery, North Memorial Medical Center, Robbinsdale, MN, USA
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth A Blair
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, IL, USA
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Young K, Bulosan H, Kejriwal S, Liang J, Wu AW, Tang DM, Birkeland AC, Steele TO. Efficacy of Cryoablation on Chronic Rhinitis Management: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2023:19458924231152331. [PMID: 36691694 DOI: 10.1177/19458924231152331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND ClariFix for posterior nasal nerve ablation has been approved for use since 2017, and this is the first study attempting to synthesize and assess the efficacy of this new device on the management of chronic rhinitis. OBJECTIVE The primary objective of this meta-analysis is to assess the efficacy of ClariFix in the symptomatic management of patients with chronic rhinitis. The main outcome measure is the mean difference in the reflective total nasal symptom score (rTNSS). METHODS A systematic search of Pubmed/Medline, Web of Science, and EBSCOhost was conducted from inception to May 2022. Peer-reviewed clinical trials reporting postcryotherapy rTNSS at both 1- and 3-month intervals for patients with chronic rhinitis were included. A random-effects model was utilized for meta-analysis. Study heterogeneity, bias, and overall quality were all assessed. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The primary outcome measures included mean differences in rTNSS from baseline to both 1- and 3-month postoperative time points. Secondary measures included other questionnaires including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS There were 5 studies that met the criteria (247 individuals). The pooled rTNSS mean difference from baseline to 1 and 3 months postoperatively was found to be -3.48 points (95% CI: -3.73 to -3.23, I2 = 0.13). and -3.50 (95% CI: -3.71 to -3.29, I2 = 0.00), respectively. The mean difference from baseline to 3 months postoperatively regarding the RQLQ was found to be -1.53 (95% CI: -1.74 to -1.31, I2 = 0.00). The most common adverse effects included facial or surgical site pain (40.4%), followed by headache (18.2%), oral numbness (11.1%), and sinusitis (4.0%). CONCLUSIONS The findings of this systematic review suggest that cryoablation with Clarifix is an effective treatment modality for chronic rhinitis. However, higher-quality randomized controlled trials will need to be performed to affirm the findings of this study.
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Affiliation(s)
- Kurtis Young
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Hannah Bulosan
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Sameer Kejriwal
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Northern California, Oakland, California, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dennis M Tang
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
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Ershadifar S, Young K, Birkeland AC. Utility of miRNA biomarkers for detection of early head and neck squamous cell carcinoma. Transl Cancer Res 2023; 12:673-675. [PMID: 37033337 PMCID: PMC10080314 DOI: 10.21037/tcr-22-2924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Affiliation(s)
| | - Kurtis Young
- John A. Burns School of Medicine, Honolulu, HI, USA
| | - Andrew C. Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA, USA
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12
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Smith JD, Bellile EL, Ellsperman SE, Heft-Neal ME, Mann JE, Birkeland AC, Hoesli RC, Swiecicki PL, Worden FP, Schonewolf C, Shah JL, Mierzwa ML, Rosko AJ, Stucken CL, Chinn SB, Shuman AG, Casper KA, Malloy KM, Prince MEP, Wolf GT, Thomas DG, McHugh JB, Chad Brenner J, Spector ME. Prognostic value of CD103 + tumor-infiltrating lymphocytes and programmed death ligand-1 (PD-L1) combined positive score in recurrent laryngeal squamous cell carcinoma. Oral Oncol 2022; 135:106226. [PMID: 36323071 PMCID: PMC10099383 DOI: 10.1016/j.oraloncology.2022.106226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In an evolving era of immunotherapeutic options for persistent or recurrent laryngeal squamous cell carcinoma (LSCC), there is a need for improved biomarkers of treatment response and survival to inform optimal treatment selection and prognostication. Herein, our primary objective was to explore correlations between tumor infiltrating lymphocytes (TILs) and PD-L1 Combined Positive Score (CPS). Secondarily, we sought to explore their combined association with survival outcomes in patients with persistent or recurrent LSCC treated with salvage surgery. MATERIALS AND METHODS This was a retrospective cohort study at a single academic medical center. Immunohistochemistry staining for TILs and PD-L1 was performed on a tissue microarray of persistent or recurrent LSCC pathologic specimens. Correlations between TIL subsets and PD-L1 CPS were examined using Pearson's correlation coefficient and survival outcomes were analyzed with the Kaplan-Meier method and log-rank tests. RESULTS Only CD103+ TILs showed a statistically significant, weakly-positive correlation with PD-L1 CPS (r2 = 0.264, p < 0.015). No other TIL subsets correlated with PD-L1 CPS in our cohort. The most favorable survival outcomes were seen in patients with pathologic N0 tumors showing high CD103+ TILs and/or high PD-L1 CPS staining. CONCLUSION Among patients with persistent or recurrent LSCC, CD103+ TILs only modestly correlated with PD-L1 CPS. A combined biomarker score incorporating CD103+ TILs and PD-L1 CPS greatly enhanced survival discrimination. This model may have additional utility in predicting the clinical benefit of immunotherapies in persistent or recurrent LSCC in the future.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Emily L Bellile
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
| | - Susan E Ellsperman
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Molly E Heft-Neal
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jacqueline E Mann
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States; Department of Pathology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Andrew C Birkeland
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Rebecca C Hoesli
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Paul L Swiecicki
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States; Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, United States
| | - Francis P Worden
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States; Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, United States
| | - Caitlin Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jennifer L Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Andrew J Rosko
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Chaz L Stucken
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Steven B Chinn
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States; Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, United States
| | - Andrew G Shuman
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Keith A Casper
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Kelly M Malloy
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Mark E P Prince
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Gregory T Wolf
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Dafydd G Thomas
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, United States
| | - J Chad Brenner
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States; Department of Pathology, University of Michigan, Ann Arbor, MI 48109, United States; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Matthew E Spector
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, United States; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States.
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13
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Koster HJ, Guillen-Perez A, Gomez-Diaz JS, Navas-Moreno M, Birkeland AC, Carney RP. Fused Raman spectroscopic analysis of blood and saliva delivers high accuracy for head and neck cancer diagnostics. Sci Rep 2022; 12:18464. [PMID: 36323705 PMCID: PMC9630497 DOI: 10.1038/s41598-022-22197-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022] Open
Abstract
As a rapid, label-free, non-destructive analytical measurement requiring little to no sample preparation, Raman spectroscopy shows great promise for liquid biopsy cancer detection and diagnosis. We carried out Raman analysis and mass spectrometry of plasma and saliva from more than 50 subjects in a cohort of head and neck cancer patients and benign controls (e.g., patients with benign oral masses). Unsupervised data models were built to assess diagnostic performance. Raman spectra collected from either biofluid provided moderate performance to discriminate cancer samples. However, by fusing together the Raman spectra of plasma and saliva for each patient, subsequent analytical models delivered an impressive sensitivity, specificity, and accuracy of 96.3%, 85.7%, and 91.7%, respectively. We further confirmed that the metabolites driving the differences in Raman spectra for our models are among the same ones that drive mass spectrometry models, unifying the two techniques and validating the underlying ability of Raman to assess metabolite composition. This study bolsters the relevance of Raman to provide additive value by probing the unique chemical compositions across biofluid sources. Ultimately, we show that a simple data augmentation routine of fusing plasma and saliva spectra provided significantly higher clinical value than either biofluid alone, pushing forward the potential of clinical translation of Raman spectroscopy for liquid biopsy cancer diagnostics.
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Affiliation(s)
- Hanna J. Koster
- grid.27860.3b0000 0004 1936 9684Biomedical Engineering, University of California, Davis, CA USA
| | - Antonio Guillen-Perez
- grid.27860.3b0000 0004 1936 9684Electrical and Computer Engineering, University of California, Davis, CA USA
| | - Juan Sebastian Gomez-Diaz
- grid.27860.3b0000 0004 1936 9684Electrical and Computer Engineering, University of California, Davis, CA USA
| | | | - Andrew C. Birkeland
- grid.27860.3b0000 0004 1936 9684Department of Otolaryngology, University of California, CA Davis, USA
| | - Randy P. Carney
- grid.27860.3b0000 0004 1936 9684Biomedical Engineering, University of California, Davis, CA USA
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14
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Young K, Bulosan H, Baksa J, Jeong Y, Buenconsejo-Lum LE, Birkeland AC. Oral Cancer Disparities in the Outer US-affiliated Pacific Islands. Laryngoscope 2022. [PMID: 36165583 PMCID: PMC10040458 DOI: 10.1002/lary.30419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE/HYPOTHESIS Oral cancers in the US-affiliated Pacific Islands are poorly described despite disproportionately higher incidences in certain jurisdictions. This study attempts to better characterize the incidence, staging, and management of oral cancers in this region. STUDY DESIGN Retrospective Epidemiological Study. METHODS A retrospective review was conducted across the US-affiliated Pacific Islands between 2007 and 2019. Patient data were obtained for individuals with primary head and neck cancers from the Pacific Regional Central Cancer Registry database. All cohorts were age-adjusted to the 2000 US Standard Population. Further analysis was performed on oral cavity cancers due to their clear predominance within the sample. RESULTS A total of 585 patients with primary head and neck cancers were included. The average age was 54.5 ± 12.9 years, and most patients were male (76.8%). Oral cancer subsite analysis revealed the proportional incidence of buccal mucosa was higher in 5 of 9 jurisdictions when compared with the United States (p < 0.001). Tongue and lip cancers were not found to have significantly higher incidence proportions. Patients in the Pacific Islander group were less likely to be detected at earlier stages for cancers of the cheek and other mouth (p < 0.001), tongue (p < 0.001), and lips (p < 0.001) compared with the United States. CONCLUSIONS Many Pacific Island populations are burdened with higher incidences of oral cancer with later staging. Further investigation is recommended to evaluate oral cancer-related outcomes and mortality in this region. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Kurtis Young
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Hannah Bulosan
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Janos Baksa
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Youngju Jeong
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Lee E Buenconsejo-Lum
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Andrew C Birkeland
- Division of Otolaryngology, University of California Davis Medical Center, Sacramento, California, USA
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15
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Faiq S, Solis RN, Sekhon HK, Morisada MV, Wilson M, Abouyared M, Bewley AF, Birkeland AC. Predictors of Health Care Utilization Following Major Head and Neck Oncologic Surgery in Older Patients. Otolaryngol Head Neck Surg 2022:1945998221124828. [PMID: 36125882 DOI: 10.1177/01945998221124828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify patient factors in older patients associated with making posttreatment visits in the first year after major head and neck oncologic surgery. STUDY DESIGN Retrospective cohort study. SETTING Academic institution. METHODS Patients aged ≥60 years who underwent a neck dissection with or without a free flap reconstruction were retrospectively analyzed. Data collected included patient demographics, comorbidities, social variables, perioperative course, and clinical visits. RESULTS Within a 1-year postoperative period, the 181 patients in our cohort had a mean ± SD 6.37 ± 3.6 postoperative clinic visits; 70% attended at least 4 visits. Multivariable regression analysis showed a significant association with distance closer to the hospital (P = .013): for every 10-mile increase in distance, the number of visits decreased by 0.15 (SE = 0.06). Additionally, receiving adjuvant radiation therapy (P = .0096) demonstrated significant associations: when compared with no adjuvant therapy, radiation therapy had on average 1.5 (SE = 0.56) more visits, and chemoradiation had 0.04 (SE = 0.73) more visits. CONCLUSION Older patients who undergo major head and neck oncology surgery are more likely to attend posttreatment visits in the 1 year following surgery if they are discharged home rather than to a skilled nursing facility, live closer to the hospital, and undergo adjuvant radiation therapy.
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Affiliation(s)
- Samya Faiq
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Harveen K Sekhon
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Megan V Morisada
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Machelle Wilson
- Department of Biostatistics, Epidemiology, and Research Design, Clinical and Translational Science Center, University of California-Davis, Sacramento, California, USA
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Arnaud F Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
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Young K, Nielsen T, Bulosan H, Thorne TJ, Ogasawara CT, Birkeland AC, Tang DM, Wu AW, Steele TO. Metastatic skull base chordoma: A systematic review. Laryngoscope Investig Otolaryngol 2022; 7:1280-1291. [PMID: 36258855 PMCID: PMC9575061 DOI: 10.1002/lio2.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
Objective/Hypothesis To investigate the clinical features, management strategies and outcomes for patients with metastatic primary skull base chordomas. Study Design Systematic review. Methods A systematic search through Pubmed/Medline, Web of Science, and EBSCOhost (CINAHL) was conducted without restriction on dates. After study screening and full‐text assessment, two authors independently extracted all data using a pre‐established abstraction form. Results Forty cases were included from 38 studies. The average age (standard deviation [SD]) of the sample at presentation was 28.5 (23.3) and was equally distributed across genders. The average time (SD) between initial diagnosis to local recurrence was 40.1 (60.3) months. The average time (SD) from primary tumor detection to the diagnosis of metastatic disease was 55.2 (49.0) months. The most common subsite for metastatic spread were the lungs (32.5%). Of the 33 patients with data on outcomes, 48.5% were found to have expired by the time of publication. The median overall survival was estimated to be 84 months (95% confidence interval [CI] 62.3–105.7). Conclusions The most common subsites for metastatic spread of skull base chordoma were the lungs and bone. Overall survival for patients in the current cohort was a median of 84 months, with no significant differences noted when stratifying by the extent of surgery or the site of metastases. Level of Evidence 3a
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Affiliation(s)
- Kurtis Young
- University of Hawai'i at Mānoa John A. Burns School of Medicine Honolulu Hawaii USA
| | - Torbjoern Nielsen
- University of Hawai'i at Mānoa John A. Burns School of Medicine Honolulu Hawaii USA
| | - Hannah Bulosan
- University of Hawai'i at Mānoa John A. Burns School of Medicine Honolulu Hawaii USA
| | - Tyler J. Thorne
- University of Hawai'i at Mānoa John A. Burns School of Medicine Honolulu Hawaii USA
| | - Christian T. Ogasawara
- Department of Neurosurgery University of Texas Medical Branch at Galveston Galveston Texas USA
| | - Andrew C. Birkeland
- Department of Otolaryngology‐Head and Neck Surgery University of California Davis Medical Center Sacramento California USA
| | - Dennis M. Tang
- Department of Otolaryngology‐Head and Neck Surgery Cedars‐Sinai Medical Center Los Angeles California USA
| | - Arthur W. Wu
- Department of Otolaryngology‐Head and Neck Surgery Cedars‐Sinai Medical Center Los Angeles California USA
| | - Toby O. Steele
- Department of Otolaryngology‐Head and Neck Surgery University of California Davis Medical Center Sacramento California USA
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17
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Weyers BW, Birkeland AC, Marsden MA, Tam A, Bec J, Frusciante RP, Gui D, Bewley AF, Abouyared M, Marcu L, Farwell DG. Intraoperative delineation of p16+ oropharyngeal carcinoma of unknown primary origin with fluorescence lifetime imaging: Preliminary report. Head Neck 2022; 44:1765-1776. [PMID: 35511208 PMCID: PMC9979707 DOI: 10.1002/hed.27078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/23/2022] [Accepted: 04/22/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study evaluated whether fluorescence lifetime imaging (FLIm), coupled with standard diagnostic workups, could enhance primary lesion detection in patients with p16+ head and neck squamous cell carcinoma of the unknown primary (HNSCCUP). METHODS FLIm was integrated into transoral robotic surgery to acquire optical data on six HNSCCUP patients' oropharyngeal tissues. An additional 55-patient FLIm dataset, comprising conventional primary tumors, trained a machine learning classifier; the output predicted the presence and location of HNSCCUP for the six patients. Validation was performed using histopathology. RESULTS Among the six HNSCCUP patients, p16+ occult primary was surgically identified in three patients, whereas three patients ultimately had no identifiable primary site in the oropharynx. FLIm correctly detected HNSCCUP in all three patients (ROC-AUC: 0.90 ± 0.06), and correctly predicted benign oropharyngeal tissue for the remaining three patients. The mean sensitivity was 95% ± 3.5%, and specificity 89% ± 12.7%. CONCLUSIONS FLIm may be a useful diagnostic adjunct for detecting HNSCCUP.
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Affiliation(s)
- Brent W. Weyers
- Department of Biomedical Engineering, University of California, Davis, Davis, California, USA
| | - Andrew C. Birkeland
- Department of Otolaryngology – Head & Neck Surgery, University of California, Davis, Davis, California, USA
| | - Mark A. Marsden
- Department of Biomedical Engineering, University of California, Davis, Davis, California, USA
| | - Athena Tam
- Department of Biomedical Engineering, University of California, Davis, Davis, California, USA
| | - Julien Bec
- Department of Biomedical Engineering, University of California, Davis, Davis, California, USA
| | - Roberto P. Frusciante
- Department of Biomedical Engineering, University of California, Davis, Davis, California, USA
| | - Dorina Gui
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, California, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology – Head & Neck Surgery, University of California, Davis, Davis, California, USA
| | - Marianne Abouyared
- Department of Otolaryngology – Head & Neck Surgery, University of California, Davis, Davis, California, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, Davis, California, USA
| | - Donald Gregory Farwell
- Department of Otolaryngology – Head & Neck Surgery, University of California, Davis, Davis, California, USA,Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Young K, Ma E, Kejriwal S, Nielsen T, Aulakh SS, Birkeland AC. Intraoperative In Vivo Imaging Modalities in Head and Neck Cancer Surgical Margin Delineation: A Systematic Review. Cancers (Basel) 2022; 14:cancers14143416. [PMID: 35884477 PMCID: PMC9323577 DOI: 10.3390/cancers14143416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Surgical margin status is one of the strongest prognosticators in predicting patient outcomes in head and neck cancer, yet head and neck surgeons continue to face challenges in the accurate detection of these margins with the current standard of care. Novel intraoperative imaging modalities have demonstrated great promise for potentially increasing the accuracy and efficiency in surgical margin delineation. In this current study, we collated and analyzed various intraoperative imaging modalities utilized in head and neck cancer to evaluate their use in discriminating malignant from healthy tissues. The authors conducted a systematic database search through PubMed/Medline, Web of Science, and EBSCOhost (CINAHL). Study screening and data extraction were performed and verified by the authors, and more studies were added through handsearching. Here, intraoperative imaging modalities are described, including optical coherence tomography, narrow band imaging, autofluorescence, and fluorescent-tagged probe techniques. Available sensitivities and specificities in delineating cancerous from healthy tissues ranged from 83.0% to 100.0% and 79.2% to 100.0%, respectively, across the different imaging modalities. Many of these initial studies are in small sample sizes, with methodological differences that preclude more extensive quantitative comparison. Thus, there is impetus for future larger studies examining and comparing the efficacy of these intraoperative imaging technologies.
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Affiliation(s)
- Kurtis Young
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Enze Ma
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Sameer Kejriwal
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Torbjoern Nielsen
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | | | - Andrew C. Birkeland
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA
- Correspondence:
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Aulakh SS, Silverman DA, Young K, Dennis SK, Birkeland AC. The Promise of Circulating Tumor DNA in Head and Neck Cancer. Cancers (Basel) 2022; 14:cancers14122968. [PMID: 35740633 PMCID: PMC9221491 DOI: 10.3390/cancers14122968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 12/17/2022] Open
Abstract
As the seventh most common cancer globally, head and neck cancers (HNC) exert considerable disease burden, with an estimated 277,597 deaths worldwide in 2020 alone. Traditional risk factors for HNC include tobacco, alcohol, and betel nut; more recently, human papillomavirus has emerged as a distinct driver of disease. Currently, limitations of cancer screening and surveillance methods often lead to identifying HNC in more advanced stages, with associated poor outcomes. Liquid biopsies, in particular circulating tumor DNA (ctDNA), offer the potential for enhancing screening, early diagnosis, and surveillance in HNC patients, with potential improvements in HNC patient outcomes. In this review, we examine current methodologies for detecting ctDNA and highlight current research illustrating viral and non-viral ctDNA biomarker utilities in HNC screening, diagnosis, treatment response, and prognosis. We also summarize current challenges and future directions for ctDNA testing in HNC patients.
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Affiliation(s)
| | - Dustin A. Silverman
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA; (D.A.S.); (S.K.D.)
| | - Kurtis Young
- John A. Burns School of Medicine, Honolulu, HI 96813, USA;
| | - Steven K. Dennis
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA; (D.A.S.); (S.K.D.)
| | - Andrew C. Birkeland
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA; (D.A.S.); (S.K.D.)
- Correspondence:
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20
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Michmerhuizen NL, Ludwig ML, Birkeland AC, Nimmagadda S, Zhai J, Wang J, Jewell BM, Genouw D, Remer L, Kim D, Foltin SK, Bhangale A, Kulkarni A, Bradford CR, Swiecicki PL, Carey TE, Jiang H, Brenner JC. Small molecule profiling to define synergistic EGFR inhibitor combinations in head and neck squamous cell carcinoma. Head Neck 2022; 44:1192-1205. [PMID: 35224804 PMCID: PMC8986607 DOI: 10.1002/hed.27018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/18/2021] [Accepted: 02/17/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is a debilitating disease with poor survival. Although epidermal growth factor receptor (EGFR)-targeting antibody cetuximab improves survival in some settings, responses are limited suggesting that alternative approaches are needed. METHODS We performed a high throughput drug screen to identify EGFR inhibitor-based synergistic combinations of clinically advanced inhibitors in models resistant to EGFR inhibitor monotherapies, and then performed downstream validation experiments on prioritized synergistic combinations. RESULTS From our screen, we re-discovered known synergistic EGFR inhibitor combinations with FGFR or IGF-1R inhibitors that were broadly effective and also discovered novel synergistic combinations with XIAP inhibitor and DNMT inhibitors that were effective in only a subset of models. CONCLUSIONS Conceptually, our data identify novel synergistic combinations that warrant evaluation in future studies, and suggest that some combinations, although highly synergistic, will require parallel companion diagnostic development to be effectively advanced in patients.
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Affiliation(s)
- Nicole L. Michmerhuizen
- Department of PharmacologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Megan L. Ludwig
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Program in Cellular and Molecular BiologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Andrew C. Birkeland
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Sai Nimmagadda
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jingyi Zhai
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Jiayu Wang
- Department of PharmacologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Brittany M. Jewell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Dylan Genouw
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Lindsay Remer
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Daniel Kim
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan K. Foltin
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Apurva Bhangale
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Aditi Kulkarni
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Carol R. Bradford
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Paul L. Swiecicki
- Department of Hematology and OncologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Thomas E. Carey
- Department of PharmacologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Hui Jiang
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - J. Chad Brenner
- Department of PharmacologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Program in Cellular and Molecular BiologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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21
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Michmerhuizen NL, Ludwig ML, Birkeland AC, Nimmagadda S, Zhai J, Wang J, Jewell BM, Genouw D, Remer L, Kim D, Foltin SK, Bhangale A, Kulkarni A, Bradford CR, Swiecicki PL, Carey TE, Jiang H, Brenner JC. Cover Image. Head Neck 2022. [DOI: 10.1002/hed.27058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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22
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DeFelice BC, Fiehn O, Belafsky P, Ditterich C, Moore M, Abouyared M, Beliveau AM, Farwell DG, Bewley AF, Clayton SM, Archard JA, Pavlic J, Rao S, Kuhn M, Deng P, Halmai J, Fink KD, Birkeland AC, Anderson JD. Polyamine Metabolites as Biomarkers in Head and Neck Cancer Biofluids. Diagnostics (Basel) 2022; 12:diagnostics12040797. [PMID: 35453845 PMCID: PMC9024570 DOI: 10.3390/diagnostics12040797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Novel, non-invasive diagnostic biomarkers that facilitate early intervention in head and neck cancer are urgently needed. Polyamine metabolites have been observed to be elevated in numerous cancer types and correlated with poor prognosis. The aim of this study was to assess the concentration of polyamines in the saliva and urine from head and neck cancer (HNC) patients, compared to healthy controls. Methods: Targeted metabolomic analysis was performed on saliva and urine from 39 HNC patient samples and compared to 89 healthy controls using a quantitative, targeted liquid chromatography mass spectrometry approach. Results: The metabolites N1-acetylspermine (ASP), N8-acetylspermidine (ASD) and N1,N12-diacetylspermine (DAS) were detected at significantly different concentrations in the urine of HNC patients as compared to healthy controls. Only ASP was detected at elevated levels in HNC saliva as compared to healthy controls. Conclusion: These data suggest that assessment of polyamine-based metabolite biomarkers within the saliva and urine warrants further investigation as a potential diagnostic in HNC patients.
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Affiliation(s)
- Brian C. DeFelice
- West Coast Metabolomics Center, University of California, Davis, CA 95616, USA; (B.C.D.); (O.F.)
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California, Davis, CA 95616, USA; (B.C.D.); (O.F.)
| | - Peter Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Constanze Ditterich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Michael Moore
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Angela M. Beliveau
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - D. Gregory Farwell
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Arnaud F. Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Shannon M. Clayton
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Joehleen A. Archard
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Jordan Pavlic
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Shyam Rao
- Department of Radiation Oncology, University of California, Davis, CA 95616, USA;
| | - Maggie Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
| | - Peter Deng
- Department of Neurology, University of California, Davis, CA 95616, USA; (P.D.); (J.H.); (K.D.F.)
| | - Julian Halmai
- Department of Neurology, University of California, Davis, CA 95616, USA; (P.D.); (J.H.); (K.D.F.)
| | - Kyle D. Fink
- Department of Neurology, University of California, Davis, CA 95616, USA; (P.D.); (J.H.); (K.D.F.)
| | - Andrew C. Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
- Correspondence: (A.C.B.); (J.D.A.)
| | - Johnathon D. Anderson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95616, USA; (P.B.); (C.D.); (M.M.); (M.A.); (A.M.B.); (D.G.F.); (A.F.B.); (S.M.C.); (J.A.A.); (J.P.); (M.K.)
- Correspondence: (A.C.B.); (J.D.A.)
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23
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Caudell JJ, Gillison ML, Maghami E, Spencer S, Pfister DG, Adkins D, Birkeland AC, Brizel DM, Busse PM, Cmelak AJ, Colevas AD, Eisele DW, Galloway T, Geiger JL, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Mell LK, Mittal BB, Pinto HA, Rocco JW, Rodriguez CP, Savvides PS, Schwartz D, Shah JP, Sher D, St John M, Weber RS, Weinstein G, Worden F, Yang Bruce J, Yom SS, Zhen W, Burns JL, Darlow SD. NCCN Guidelines® Insights: Head and Neck Cancers, Version 1.2022. J Natl Compr Canc Netw 2022; 20:224-234. [PMID: 35276673 DOI: 10.6004/jnccn.2022.0016] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Head and Neck Cancers address tumors arising in the oral cavity (including mucosal lip), pharynx, larynx, and paranasal sinuses. Occult primary cancer, salivary gland cancer, and mucosal melanoma (MM) are also addressed. The specific site of disease, stage, and pathologic findings guide treatment (eg, the appropriate surgical procedure, radiation targets, dose and fractionation of radiation, indications for systemic therapy). The NCCN Head and Neck Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's most recent recommendations regarding management of HPV-positive oropharynx cancer and ongoing research in this area.
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Affiliation(s)
| | | | | | | | | | - Douglas Adkins
- 6Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | - David W Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Jessica L Geiger
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Debra Leizman
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Bharat B Mittal
- 20Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - James W Rocco
- 21The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - David Schwartz
- 24St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - David Sher
- 25UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | | | - Sue S Yom
- 30UCSF Helen Diller Family Comprehensive Cancer Center
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24
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Heft Neal ME, Smith JD, Birkeland AC, Haring CT, Chinn SB, Shuman AG, Casper KA, Malloy KM, Stucken CL, Mclean SA, Rosko AJ, Mierzwa ML, Shah J, Schonewolf C, Swiecicki PL, Worden FP, Wolf GT, Bradford CR, Prince MEP, Chad Brenner J, Spector ME. Tumor-Infiltrating Lymphocytes in Patients With Advanced Laryngeal Cancer Undergoing Bioselection. Otolaryngol Head Neck Surg 2022; 166:498-505. [PMID: 34030495 PMCID: PMC8613299 DOI: 10.1177/01945998211013765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bioselection to assess tumor response after induction chemotherapy has been introduced as an alternative treatment strategy to total laryngectomy for patients with advanced larynx squamous cell carcinoma (LSCC). Tumor-infiltrating lymphocytes (TILs) have proven to serve as prognostic biomarkers in head and neck cancer but have not been evaluated as a way to select patients for treatment paradigms. The aim of this study is to evaluate the role of pretreatment TILs in patients with advanced LSCC undergoing the bioselection paradigm. STUDY DESIGN Retrospective study. SETTING Tertiary care hospital. METHODS Patients with advanced LSCC treated with bioselection and available tissue were included (N = 76). Patients were stratified into CD8-low and CD8-high cohorts by using the median TIL count. Kaplan-Meier survival analysis and multivariate cox regression were performed with SPSS version 26 (IBM). RESULTS After controlling for tobacco use, tumor site, and stage, a high CD8 TIL count was an independent predictor of improved 5-year disease-specific survival (hazard ratio, 0.17 [95% CI, 0.03-0.84]; P = .03). CD8 TIL counts did not predict response to induction chemotherapy; however, subgroup analysis of patients treated with chemoradiation therapy revealed that CD8 TIL count was significantly associated with degree of response (P = .012). CONCLUSION These findings support prior data published by our group showing that TILs are predictive of disease-specific survival in patients with head and neck cancer. CD8 TIL counts were significantly associated with degree of clinical response after induction chemotherapy. These results suggest that pretreatment assessment of tumor-infiltrating CD8 cells could be useful in selecting patients.
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Affiliation(s)
- Molly E Heft Neal
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
| | - Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Scott A Mclean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | | | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - Paul L Swiecicki
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Francis P Worden
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH
| | - Mark EP Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
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25
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Solis RN, Silverman DA, Birkeland AC. Current Trends in Precision Medicine and Next-Generation Sequencing in Head and Neck Cancer. Curr Treat Options Oncol 2022; 23:254-267. [PMID: 35195839 PMCID: PMC9196261 DOI: 10.1007/s11864-022-00942-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 12/20/2022]
Abstract
OPINION STATEMENT As the field of oncology enters the era of precision medicine and targeted therapies, we have come to realize that there may be no single "magic bullet" for patients with head and neck cancer. While immune check point inhibitors and some targeted therapeutics have shown great promise in improving oncologic outcomes, the current standard of care in most patients with head and neck squamous cell carcinoma (HNSCC) remains a combination of surgery, radiation, and/or cytotoxic chemotherapy. Nevertheless, advances in precision medicine, next-generation sequencing (NGS), and targeted therapies have a potential future in the treatment of HNSCC. These roles include increased patient treatment stratification based on predictive biomarkers or targetable mutations and novel combinatorial regimens with existing HNSCC treatments. There remain challenges to precision medicine and NGS in HNSCC, including intertumor and intratumor heterogeneity, challenging targets, and need for further trials validating the utility of NGS and precision medicine. Additionally, there is a need for evidence-based practice guidelines to assist clinicians on how to appropriately incorporate NGS in care for HNSCC. In this review, we describe the current state of precision medicine and NGS in HNSCC and opportunities for future advances in this challenging but important field.
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Affiliation(s)
- Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, 2521 Stockton Blvd., Suite 7200, Sacramento, CA, 95817, USA
| | - Dustin A Silverman
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, 2521 Stockton Blvd., Suite 7200, Sacramento, CA, 95817, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, 2521 Stockton Blvd., Suite 7200, Sacramento, CA, 95817, USA.
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26
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Solis RN, Farber NI, Fairman N, Yang NT, Taylor SL, Abouyared M, Bewley AF, Farwell DG, Birkeland AC. Bereavement Practices Among Head and Neck Cancer Surgeons. Laryngoscope 2022; 132:1971-1975. [PMID: 35092314 DOI: 10.1002/lary.30037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 01/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Head and neck cancer surgeons frequently interact with dying patients with advanced disease and their families, but little is known about their bereavement practices after a patient's death. The aim of this study is to elucidate the frequency of common bereavement practices, cited barriers to bereavement, and predictive physician factors that lead to an increase in bereavement practices among head and neck cancer surgeons. METHODS A 20-item survey was sent to 827 active surgeons of the American Head and Neck Society. Approval was obtained and the survey was distributed through the American Head and Neck Society. Demographics, frequency of common bereavement practices, empathy, and barriers were assessed. Multiple linear regression was performed to determine physician factors associated with more frequent bereavement follow-up. RESULTS There were 156 respondents (18.9% response rate). Overall, surgeons were more likely to usually/always call (48.5%) or send a letter (42.4%) compared with other practices such as attending funerals (0%), offering family meetings (18.6%), or referring family members to counseling (7.7%). Many barriers were cited as being at least somewhat important: being unaware about a patient's death (67.3%) was the most cited, whereas 51.3% cited a lack of mentorship/training in this area. Scoring higher on empathy questions (P ≤ .001) was associated with more frequent surgeon bereavement follow-up with the family of deceased patients. CONCLUSION There is substantial practice variation among surgeons suggesting a lack of consensus on their roles in bereavement follow-up. Having higher empathy was predictive of higher engagement. LEVEL OF EVIDENCE NA Laryngoscope, 2022.
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Affiliation(s)
- Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Nicole I Farber
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Nathan Fairman
- Department of Psychiatry, University of California, Davis, Sacramento, California, U.S.A
| | - Nuen T Yang
- Division of Biostatistics, School of Medicine, University of California, Davis, Sacramento, California, U.S.A
| | - Sandra L Taylor
- Division of Biostatistics, School of Medicine, University of California, Davis, Sacramento, California, U.S.A
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Arnaud F Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - D Gregory Farwell
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
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Solis RN, Mehrzad M, Faiq S, Frusciante RP, Sekhon HK, Abouyared M, Bewley AF, Farwell DG, Birkeland AC. The Impact of COVID-19 on Head and Neck Cancer Treatment: Before and During the Pandemic. OTO Open 2022; 5:2473974X211068075. [PMID: 34993385 PMCID: PMC8725009 DOI: 10.1177/2473974x211068075] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives To describe the impact that the coronavirus disease 2019 (COVID-19) pandemic had on the presentation of patients with head and neck cancer in a single tertiary care center. Study Design Retrospective cohort study. Setting Academic institution. Methods We performed a retrospective review of patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC) who presented as new patients between September 10, 2019, and September 11, 2020. Patients presenting during the 6 months leading up to the announcement of the pandemic (pre–COVID-19 period) on March 11, 2020, were compared to those presenting during the first 6 months of the pandemic (COVID-19 period). Demographics, time to diagnosis and treatment, and tumor characteristics were analyzed. Results There were a total of 137 patients analyzed with newly diagnosed malignancies. There were 22% fewer patients evaluated during the COVID-19 timeframe. The groups were similar in demographics, duration of symptoms, time to diagnosis, time to surgery, extent of surgery, and adjuvant therapy. There was a larger proportion of tumors classified as T3/T4 (61.7%) in the COVID-19 period vs the pre–COVID-19 period (40.3%) (P = .024), as well as a larger median tumor size during the COVID-19 period (P = .0002). There were no differences between nodal disease burden (P = .48) and distant metastases (P = .42). Conclusion Despite similar characteristics, time to diagnosis, and surgery, our findings suggest that there was an increase in primary tumor burden in patients with HNSCC during the early COVID-19 pandemic.
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Affiliation(s)
- Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Mehrnaz Mehrzad
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Samya Faiq
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Roberto P Frusciante
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Harveen K Sekhon
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Arnaud F Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - D Gregory Farwell
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
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28
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Koster HJ, Rojalin T, Powell A, Pham D, Mizenko RR, Birkeland AC, Carney RP. Surface enhanced Raman scattering of extracellular vesicles for cancer diagnostics despite isolation dependent lipoprotein contamination. Nanoscale 2021; 13:14760-14776. [PMID: 34473170 PMCID: PMC8447870 DOI: 10.1039/d1nr03334d] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/20/2021] [Indexed: 05/20/2023]
Abstract
Given the emerging diagnostic utility of extracellular vesicles (EVs), it is important to account for non-EV contaminants. Lipoprotein present in EV-enriched isolates may inflate particle counts and decrease sensitivity to biomarkers of interest, skewing chemical analyses and perpetuating downstream issues in labeling or functional analysis. Using label free surface enhanced Raman scattering (SERS), we confirm that three common EV isolation methods (differential ultracentrifugation, density gradient ultracentrifugation, and size exclusion chromatography) yield variable lipoprotein content. We demonstrate that a dual-isolation method is necessary to isolate EVs from the major classes of lipoprotein. However, combining SERS analysis with machine learning assisted classification, we show that the disease state is the main driver of distinction between EV samples, and largely unaffected by choice of isolation. Ultimately, this study describes a convenient SERS assay to retain accurate diagnostic information from clinical samples by overcoming differences in lipoprotein contamination according to isolation method.
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Affiliation(s)
- Hanna J Koster
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616, USA.
| | - Tatu Rojalin
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616, USA.
| | - Alyssa Powell
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616, USA.
| | - Dina Pham
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616, USA.
| | - Rachel R Mizenko
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616, USA.
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | - Randy P Carney
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616, USA.
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29
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Heft Neal ME, Birkeland AC, Bhangale AD, Zhai J, Kulkarni A, Foltin SK, Jewell BM, Ludwig ML, Pinatti L, Jiang H, McHugh JB, Marentette L, McKean EL, Brenner JC. Genetic analysis of sinonasal undifferentiated carcinoma discovers recurrent SWI/SNF alterations and a novel PGAP3-SRPK1 fusion gene. BMC Cancer 2021; 21:636. [PMID: 34051734 PMCID: PMC8164750 DOI: 10.1186/s12885-021-08370-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sinonasal Undifferentiated Carcinoma (SNUC) is a rare and aggressive skull base tumor with poor survival and limited treatment options. To date, targeted sequencing studies have identified IDH2 and SMARCB1 as potential driver alterations, but the molecular alterations found in SMARCB1 wild type tumors are unknown. METHODS We evaluated survival outcomes in a cohort of 46 SNUC patients treated at an NCI designated cancer center and identify clinical and disease variables associated with survival on Kaplan-Meier and Cox multivariate survival analysis. We performed exome sequencing to characterize a series of SNUC tumors (n = 5) and cell line (MDA8788-6) to identify high confidence mutations, copy number alterations, microsatellite instability, and fusions. Knockdown studies using siRNA were utilized for validation of a novel PGAP3-SRPK1 gene fusion. RESULTS Overall survival analysis revealed no significant difference in outcomes between patients treated with surgery +/- CRT and CRT alone. Tobacco use was the only significant predictor of survival. We also confirmed previously published findings on IDH and SMARC family mutations and identified novel recurrent aberrations in the JAK/STAT and PI3K pathways. We also validated a novel PGAP3-SRPK1 gene fusion in the SNUC cell line, and show that knockdown of the fusion is negatively associated with EGFR, E2F and MYC signaling. CONCLUSION Collectively, these data demonstrate recurrent alterations in the SWI/SNF family as well as IDH, JAK/STAT, and PI3K pathways and discover a novel fusion gene (PGAP3-SRPK1). These data aim to improve understanding of possible driver mutations and guide future therapeutic strategies for this disease.
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Affiliation(s)
- Molly E Heft Neal
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - Apurva D Bhangale
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - Jingyi Zhai
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Aditi Kulkarni
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - Susan K Foltin
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - Brittany M Jewell
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - Megan L Ludwig
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA.,Program in Cellular and Molecular Biology, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - Lisa Pinatti
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA.,Program in Cancer Biology, University of Michigan, Ann Arbor, MI, USA
| | - Hui Jiang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan Medical School, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - Jonathan B McHugh
- Rogel Cancer Center, University of Michigan Medical School, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Lawence Marentette
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA.,Rogel Cancer Center, University of Michigan Medical School, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - Erin L McKean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA.,Rogel Cancer Center, University of Michigan Medical School, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA. .,Program in Cellular and Molecular Biology, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA. .,Rogel Cancer Center, University of Michigan Medical School, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA. .,Department of Pharmacology, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, MI, 48109-0602, USA.
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30
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Marsden M, Weyers BW, Bec J, Sun T, Gandour-Edwards RF, Birkeland AC, Abouyared M, Bewley AF, Farwell DG, Marcu L. Intraoperative Margin Assessment in Oral and Oropharyngeal Cancer Using Label-Free Fluorescence Lifetime Imaging and Machine Learning. IEEE Trans Biomed Eng 2021; 68:857-868. [PMID: 32746066 PMCID: PMC8960054 DOI: 10.1109/tbme.2020.3010480] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To demonstrate the diagnostic ability of label-free, point-scanning, fiber-based Fluorescence Lifetime Imaging (FLIm) as a means of intraoperative guidance during oral and oropharyngeal cancer removal surgery. METHODS FLIm point-measurements acquired from 53 patients (n = 67893 pre-resection in vivo, n = 89695 post-resection ex vivo) undergoing oral or oropharyngeal cancer removal surgery were used for analysis. Discrimination of healthy tissue and cancer was investigated using various FLIm-derived parameter sets and classifiers (Support Vector Machine, Random Forests, CNN). Classifier output for the acquired set of point-measurements was visualized through an interpolation-based approach to generate a probabilistic heatmap of cancer within the surgical field. Classifier output for dysplasia at the resection margins was also investigated. RESULTS Statistically significant change (P 0.01) between healthy and cancer was observed in vivo for the acquired FLIm signal parameters (e.g., average lifetime) linked with metabolic activity. Superior classification was achieved at the tissue region level using the Random Forests method (ROC-AUC: 0.88). Classifier output for dysplasia (% probability of cancer) was observed to lie between that of cancer and healthy tissue, highlighting FLIm's ability to distinguish various conditions. CONCLUSION The developed approach demonstrates the potential of FLIm for fast, reliable intraoperative margin assessment without the need for contrast agents. SIGNIFICANCE Fiber-based FLIm has the potential to be used as a diagnostic tool during cancer resection surgery, including Transoral Robotic Surgery (TORS), helping ensure complete resections and improve the survival rate of oral and oropharyngeal cancer patients.
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31
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Schuman AD, Birkeland AC, Farlow JL, Lyden T, Blakely A, Spector ME, Rosko AJ. Predictors of Stricture and Swallowing Function Following Salvage Laryngectomy. Laryngoscope 2020; 131:1229-1234. [PMID: 33152117 DOI: 10.1002/lary.29215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/26/2020] [Accepted: 10/15/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Long-term functional outcomes are poorly characterized for salvage laryngectomy. We identified predictors of esophageal stricture and swallowing function after salvage laryngectomy in a large cohort. METHODS A retrospective study of 233 patients who underwent salvage total laryngectomy for recurrent/persistent squamous cell carcinoma of the larynx or hypopharynx after radiation (XRT) or chemoradiation (CRT) was performed. Primary outcomes were esophageal dilation within 1 year, time to dilation, and gastrostomy tube dependence. Multivariate logistic and Cox regressions were used for statistical analysis. RESULTS Dilation was performed in 29.9% of patients. Dilation was twice as likely in patients with post-operative fistula compared to those without (Hazard Ratio (HR) 2.10, 95% Confidence Interval (CI) 1.06-4.13, P = .03). Every year between XRT/CRT and salvage was associated with 10% increase in dilation (HR 1.09, 95% CI 1.03-1.17, P = .01). No factors were associated with dilation by 1 year. About 10% of patients were at least partially gastrostomy tube-dependent 1 year post-operatively. At last follow-up (median 29 months), this rate was 13%. Patients with supraglottic recurrence had an increased risk of gastrostomy tube dependence at 1 year compared to glottic (OR 16.7, 95% CI 1.73-160, P = .02). For every 10 pack years pre-salvage, the OR of requiring tube feeds at last follow-up was 1.24 (95% CI 1.04-1.48, P = .02). CONCLUSIONS Fistula and pre-salvage smoking were associated with stricture post-salvage laryngectomy. No factors were associated with dilation by 1 year. Supraglottic recurrence and smoking were associated with gastrostomy tube dependence. These findings are important for pre-operative counseling prior to salvage laryngectomy. LEVEL OF EVIDENCE Level 4 Laryngoscope, 131:1229-1234, 2021.
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Affiliation(s)
- Ari D Schuman
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, U.S.A.,University of Michigan Medical School, Ann Arbor, MI, U.S.A
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Davis, CA, U.S.A
| | - Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, U.S.A
| | - Teresa Lyden
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, U.S.A
| | - Anna Blakely
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, U.S.A
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, U.S.A
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, U.S.A
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Marchiano EJ, Mathis NJ, Bellile EL, Lobo R, Ibrahim M, Smith JD, Birkeland AC, Casper KA, Malloy KM, Swiecicki PL, Worden FP, Mierzwa ML, Chad Brenner J, Bradford CR, Stucken CL, Prince ME, Rosko AJ, Shuman AG, McHugh JB, Spector ME, Chinn SB. Impact of extrinsic tongue muscle invasion on stage migration in AJCC 8th edition staging of oral cavity carcinoma. Oral Oncol 2020; 110:104888. [PMID: 32659738 DOI: 10.1016/j.oraloncology.2020.104888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/16/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Emily J Marchiano
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Noah J Mathis
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Emily L Bellile
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Remy Lobo
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Mohannad Ibrahim
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Davis, CA, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Paul L Swiecicki
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Francis P Worden
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Mark E Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jonathan B McHugh
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA; Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
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Farlow JL, Birkeland AC, Hardenbergh A, Lyden T, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Rosko AJ, Spector ME. Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx. Eur Arch Otorhinolaryngol 2020; 277:1459-1465. [PMID: 31989269 DOI: 10.1007/s00405-020-05809-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize outcomes of total laryngectomy for the dysfunctional larynx after radiation. METHODS Retrospective case series of all subjects who underwent total laryngectomy for the irradiated dysfunctional larynx between 2000 and 2018 at an NCI-designated comprehensive cancer center at a single tertiary care academic medical center. Main outcomes included enteral tube feeding dependency, functional tracheoesophageal speech, and number and timing of postoperative pharyngeal dilations. RESULTS Median time from radiation to laryngectomy was 2.8 years (range 0.5-27 years). Functional outcomes were analyzed for the 32 patients with 1-year follow-up. Preoperatively, 81% required at least partial enteral tube feeding, as compared to 34% 1-year postoperatively (p = 0.0003). At 1 year, 81% had achieved functional tracheoesophageal speech, which was associated with cricopharyngeal myotomy (p = 0.04, HR 0.04, 95% CI 0.002-0.949). There were 34% of subjects who required at least one pharyngeal dilation for stricture by 1 year postoperatively. Over half (60%) of the cohort were dilated over the study period. CONCLUSIONS Laryngectomy for the dysfunctional larynx improves speech and swallowing outcomes in many patients. Cricopharyngeal myotomy is associated with improved postoperative voice. While the need for enteral feeding is decreased, persistent postoperative swallowing dysfunction is common. Careful patient selection and education regarding functional expectations are paramount.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew C Birkeland
- Department of Otolaryngology, Head and Neck Surgery, University of California Davis, Sacramento, CA, 98517, USA
| | - Anna Hardenbergh
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Teresa Lyden
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - J Chad Brenner
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew G Shuman
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Steven B Chinn
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Chaz L Stucken
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Kelly M Malloy
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Keith A Casper
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Mark E P Prince
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Carol R Bradford
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Gregory T Wolf
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Andrew J Rosko
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
| | - Matthew E Spector
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
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Fakurnejad S, Krishnan G, van Keulen S, Nishio N, Birkeland AC, Baik FM, Kaplan MJ, Colevas AD, van den Berg NS, Rosenthal EL, Martin BA. Intraoperative Molecular Imaging for ex vivo Assessment of Peripheral Margins in Oral Squamous Cell Carcinoma. Front Oncol 2020; 9:1476. [PMID: 31998640 PMCID: PMC6965069 DOI: 10.3389/fonc.2019.01476] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: Complete surgical resection is the standard of care for treatment of oral cancer although the positive margin rate remains 15–30%. Tissue sampling from the resected specimen and from the wound bed for frozen section analysis (FSA) remains the mainstay for intraoperative margin assessment but is subject to sampling error and can require the processing of multiple samples. We sought to understand if an ex vivo imaging strategy using a tumor-targeted fluorescently labeled antibody could accurately identify the closest peripheral margin on the mucosal surface of resected tumor specimen, so that this “sentinel margin” could be used to guide pathological sampling. Materials and Methods: Twenty-nine patients with oral squamous cell carcinoma scheduled for surgical resection were consented for the study and received systemic administration of a tumor-targeted fluorescently labeled antibody (Panitumumab IRDye800CW). After surgical resection, the tumor specimen was imaged using a closed-field fluorescent imaging device. Relevant pathological data was available for five patients on retrospective review. For each of these five patients, two regions of highest fluorescence intensity at the peripheral margin and one region of lowest fluorescence intensity were identified, and results were correlated with histology to determine if the region of highest fluorescence intensity along the mucosal margin (i.e., the sentinel margin) was truly the closest margin. Results: Imaging acquisition of the mucosal surface of the specimen immediately after surgery took 30 s. In all of the specimens, the region of highest fluorescence at the specimen edge had a significantly smaller margin distance than other sampled regions. The average margin distance at the closest, “sentinel,” margin was 3.2 mm compared to a margin distance of 8.0 mm at other regions (p < 0.0001). Conclusions: This proof-of-concept study suggests that, when combined with routine FSA, ex vivo fluorescent specimen imaging can be used to identify the closest surgical margin on the specimen. This approach may reduce sampling error of intraoperative evaluation, which should ultimately improve the ability of the surgeon to identify the sentinel margin. This rapid sentinel margin identification improves the surgeon's orientation to areas most likely to be positive in the surgical wound bed and may expedite pathology workflow.
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Affiliation(s)
- Shayan Fakurnejad
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Giri Krishnan
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States.,The Department of Otorhinolaryngology, Head and Neck Surgery, The University of Adelaide, Woodville South, SA, Australia
| | - Stan van Keulen
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Naoki Nishio
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Fred M Baik
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael J Kaplan
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - A Dimitrios Colevas
- Division of Medical Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Nynke S van den Berg
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Eben L Rosenthal
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Brock A Martin
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
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Nishio N, van Keulen S, van den Berg NS, Lu G, LaRochelle EP, Davis SC, Martin BA, Fakurnejad S, Zhou Q, Birkeland AC, Kaplan MJ, Divi V, Colevas AD, Pogue BW, Rosenthal EL. Probe-based fluorescence dosimetry of an antibody-dye conjugate to identify head and neck cancer as a first step to fluorescence-guided tissue preselection for pathological assessment. Head Neck 2020; 42:59-66. [PMID: 31571335 DOI: 10.1002/hed.25964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/24/2019] [Accepted: 09/06/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Despite the rapid growth of fluorescence imaging, accurate sampling of tissue sections remains challenging. Development of novel technologies to improve intraoperative assessment of tissue is needed. METHODS A novel contact probe-based fluorescence dosimeter device, optimized for IRDye800CW quantification, was developed. After evaluation of the device in a phantom setup, its clinical value was defined ex vivo in patients with head and neck squamous cell carcinoma who received panitumumab-IRDye800CW. RESULTS Ten patients were enrolled with a total of 216 data points obtained. Final histopathology showed tumor in 119 spots and normal tissue in 97 spots. Fluorescence-to-excitation ratios in tumor tissue were more than three times higher than those in normal tissue. The area under the curve was 0.86 (95% CI: 0.81-0.91) for tumor detection. CONCLUSIONS Fluorescence-guided tissue preselection using a fluorescence dosimeter could have substantial impact on tissue sampling for frozen section analysis and potentially reduce sampling errors.
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Affiliation(s)
- Naoki Nishio
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.,Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Stan van Keulen
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.,Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Nynke S van den Berg
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Guolan Lu
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | | | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Brock A Martin
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Shayan Fakurnejad
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Quan Zhou
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Andrew C Birkeland
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael J Kaplan
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Vasu Divi
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - A Dimitrios Colevas
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, California
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Eben L Rosenthal
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Gao RW, Dugala A, Maxwell J, Falconer P, Birkeland AC, Divi V, Rosenthal EL. Effect of Medical Scribes on Outpatient Oncology Visits at a Multidisciplinary Cancer Center. JCO Oncol Pract 2019; 16:e139-e147. [PMID: 31804877 DOI: 10.1200/jop.19.00307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The use of medical scribes has emerged as a strategy to increase clinic workflow efficiency and reduce physician burnout. While oncology clinics may be ideally suited to scribe integration because of the high burden of documentation, oncology-specific scribe research has been limited. The objective of this study was to determine the effect of scribe integration on clinic workflow efficiency and physician satisfaction and quality of life in outpatient oncology clinics. METHODS We conducted a retrospective, concurrent qualitative and quantitative analysis of patient visit durations and survey data for 129 attending physicians affiliated with an academic hospital's cancer center between January 2017 and January 2019. Thirty-three physicians were paired with scribes in each physician's individual clinic or clinics. RESULTS In terms of clinic efficiency, physicians with scribes had a 12.1% decrease in their overall average patient visit duration compared with their own time before receiving a scribe (P < .0001) and spent significantly less time completing charts at the end of the day (P = .04). Compared with their peers, oncologists with scribes showed a 10%-20% decrease in the duration of all patient visits. Scribes also contributed to patient care, as shown by 90% of physicians surveyed who strongly agreed that they spent less time at the computer and more time with patients; 100% of physicians surveyed strongly agreed that scribes improved their quality of life. CONCLUSION The integration of medical scribes into oncology clinics across several oncologic disciplines has the potential to reduce burnout through increasing physician satisfaction and quality of life, improving patient care, and streamlining clinic workflow.
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Abstract
Head and neck squamous cell carcinoma (HNSCC) has a large global burden of disease and poor survival outcomes. Recent targeted therapies and immunotherapies have been explored in HNSCC, but there has been limited translation to clinical practice outside of recurrent or metastatic cases. Window of opportunity settings, where novel agents are administered between cancer diagnosis and planned definitive therapy, have begun to be employed in HNSCC. Tumor tissue biopsies are obtained at diagnosis and after the investigation treatment, along with other biospecimens and radiographic exams. Thus, this study design can characterize the safety profiles, pharmacodynamics, and initial tumor responses to novel therapies in a treatment-naïve subject. Early window studies have also identified potential biomarkers to predict sensitivity or resistance to treatments. However, these early investigations have revealed multiple challenges associated with this trial design. In this review, we discuss recent window of opportunity trials in HNSCC and how they inform design considerations for future studies.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA 94303, USA
| | - Paul L Swiecicki
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Internal Medicine, Division of Hematology and Oncology, Ann Arbor Veterans Medical Center, Ann Arbor, MI 48105, USA
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
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McKean EL, Birkeland AC, Neal MEH, Kulkarni A, Foltin SK, Jewell BM, McHugh JB, Marentette LJ, Brenner JC. Abstract 1688: Integrative sequencing discovers a novel PGAP3-SRPK1 gene fusion in sinonasal undifferentiated carcinoma. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Sinonasal Undifferentiated Carcinoma (SNUC), a rare and aggressive tumor arising from the sinonasal cavity, remains a difficult-to-treat disease with poor overall survival. There are no agreed upon treatment algorithms and research efforts have focused on identifying new genetic mutations for novel targeted therapies. To date, targeted sequencing studies have identified IDH2 and SMARCAB1 as potential SNUC driver alterations, however the molecular alterations found in SMARCAB1 wild type tumors are unknown. Here, using whole exome sequencing, we characterize a series of 7 SNUC tumors and a SNUC cell line and discover recurrent aberrations to the SWI/SNF, MAGE and FAT gene families. We also validate a novel ALK mutation, recurrent ERBB2 copy number amplifications and a previously undescribed PGAP3-SRPK1 gene fusion in the SNUC cell line. Further investigation of the PGAP-SRPK1 fusion gene reveals a change in the active site with loss of three of nine active site residues. Functional studies are ongoing to determine the importance of the PGAP3-SRPK1 gene fusion for oncogenic phenotypes. This discovery extends the need for comprehensive characterization of gene family mutation status in SNUC and supports a need to understand the downstream molecular mechanisms in order to improve therapeutic strategies for this disease.
Citation Format: Erin L. McKean, Andrew C. Birkeland, Molly E. Heft Neal, Aditi Kulkarni, Sue K. Foltin, Brittany M. Jewell, Jonathon B. McHugh, Lawence J. Marentette, John Chad Brenner. Integrative sequencing discovers a novel PGAP3-SRPK1 gene fusion in sinonasal undifferentiated carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1688.
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Kovatch KJ, Smith JD, Birkeland AC, Hanks JE, Jawad R, McLean SA, Durham AB, Srinivasan A, McHugh JB, Basura GJ. Institutional Experience of Treatment and Outcomes for Cutaneous Periauricular Squamous Cell Carcinoma. OTO Open 2019; 3:2473974X19875077. [PMID: 31656941 PMCID: PMC6791998 DOI: 10.1177/2473974x19875077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To report our institutional experience, management, and outcomes of cutaneous periauricular squamous cell carcinoma (SCC). STUDY DESIGN Retrospective chart review. SETTING Tertiary academic center. SUBJECTS Patients undergoing treatment of cutaneous periauricular SCC from 2000 to 2016. RESULTS A total of 112 patients had a median follow-up of 24.5 months, a mean ± SD age of 75.7 ± 10.6 years, and a strong male predominance (93.8%). Site distribution shows 87 (77.7%) auricular, 26 (23.2%) preauricular, and 10 (8.8%) postauricular lesions. Of auricular lesions, tumors involved the tragus (n = 3, 3.4%), helix/antihelix (n = 47, 54.0%), conchal bowl (n = 31, 35.6%), external auditory canal (n = 18, 16.1%), and lobule (n = 3, 3.4%). Most patients presented at stage I (52.7%) versus stages II (28.6%), III (6.3%), and IV (12.5%). Patients were largely treated surgically with primary tumor resection ranging from wide local excision to lateral temporal bone resection (± parotidectomy and neck dissection), with 17.0% and 5.4% receiving adjuvant radiation and chemoradiation, respectively. Metastatic spread was seen to the parotid (25.9%) and neck (26.8%), with most common cervical spread to level II. Overall survival, disease-specific survival, and disease-free survival at 3 years were 62%, 89%, and 56%, respectively. Nodal disease was associated with worse disease-specific survival (P < .001) and disease-free survival (P = .042). Pre- and postauricular sites were associated with worse overall survival (P = .007) relative to auricular sites. CONCLUSION Among cutaneous SCC, periauricular subsites pose treatment challenges related to surrounding anatomy and represent a unique tumor population. The reported propensity toward recurrence and patterns of metastasis may better guide treatment of aggressive tumors to include regional nodal dissection.
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Affiliation(s)
- Kevin J. Kovatch
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Joshua D. Smith
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew C. Birkeland
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - John E. Hanks
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rasha Jawad
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott A. McLean
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Alison B. Durham
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | | | - Gregory J. Basura
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Mann JE, Kulkarni A, Birkeland AC, Kafelghazal J, Eisenberg J, Jewell BM, Ludwig ML, Spector ME, Jiang H, Carey TE, Brenner JC. The molecular landscape of the University of Michigan laryngeal squamous cell carcinoma cell line panel. Head Neck 2019; 41:3114-3124. [PMID: 31090975 DOI: 10.1002/hed.25803] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 03/11/2019] [Accepted: 04/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Laryngeal squamous cell carcinomas (LSCCs) have a high risk of recurrence and poor prognosis. Patient-derived cancer cell lines remain important preclinical models for advancement of new therapeutic strategies, and comprehensive characterization of these models is vital in the precision medicine era. METHODS We performed exome and transcriptome sequencing as well as copy number analysis of a panel of LSCC-derived cell lines that were established at the University of Michigan and are used in laboratories worldwide. RESULTS We observed a complex array of alterations consistent with those reported in The Cancer Genome Atlas head and neck squamous cell carcinoma project, including aberrations in PIK3CA, EGFR, CDKN2A, TP53, and NOTCH family and FAT1 genes. A detailed analysis of FAT family genes and associated pathways showed disruptions to these genes in most cell lines. CONCLUSIONS The molecular profiles we have generated indicate that as a whole, this panel recapitulates the molecular diversity observed in patients and will serve as useful guides in selecting cell lines for preclinical modeling.
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Affiliation(s)
- Jacqueline E Mann
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Aditi Kulkarni
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Judy Kafelghazal
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julia Eisenberg
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brittany M Jewell
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Megan L Ludwig
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Hui Jiang
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Biostatistics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Thomas E Carey
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, Michigan.,Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
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Kain JJ, Birkeland AC, Udayakumar N, Morlandt AB, Stevens TM, Carroll WR, Rosenthal EL, Warram JM. Surgical margins in oral cavity squamous cell carcinoma: Current practices and future directions. Laryngoscope 2019; 130:128-138. [PMID: 31025711 DOI: 10.1002/lary.27943] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/09/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To discuss the current available techniques for intraoperative margin assessment in the surgical treatment of oral squamous cell carcinoma (OSCC) through a review of the available literature. METHODS A systematic review was undertaken of the available English literature between 2008 through 2018 regarding surgical margins in OCSS. A total of 893 relevant articles were returned; 144 met criteria for review; and 64 articles were included. RESULTS In this review, we discuss the data surrounding the use of frozen section in OCSS. Additionally, alternative techniques for margin assessment are discussed, including Mohs, molecular analysis, nonfluorescent dyes, fluorescent dyes, autofluorescent imaging, narrow-band imaging, optical coherence tomography, confocal microscopy, high-resolution microendoscopy, and spectroscopy. For each technique, particular emphasis is placed on the local recurrence, disease-free survival, and overall survival rates when available. CONCLUSION This review provides support for the practice of specimen-driven margin assessment when using frozen section analysis to improve the utility of the results. Finally, several alternatives for intraoperative margin assessment currently under investigation, including pathologic, wide-field imaging and narrow-field imaging techniques, are presented. We aim to fuel further investigation into methods for margin assessment that will improve survival for patients with OSCC through a critical analysis of the available techniques. LEVEL OF EVIDENCE NA Laryngoscope, 130:128-138, 2020.
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Affiliation(s)
- Joshua J Kain
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Andrew C Birkeland
- Department of Otolaryngology, Stanford University, Stanford, California, U.S.A
| | - Neha Udayakumar
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Anthony B Morlandt
- Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Todd M Stevens
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - William R Carroll
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford University, Stanford, California, U.S.A
| | - Jason M Warram
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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Farlow JL, Birkeland AC, Rosko AJ, VanKoevering K, Haring CT, Smith JD, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, McLean SA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Spector ME. Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy. Ann Surg Oncol 2019; 26:2542-2548. [PMID: 30830535 DOI: 10.1245/s10434-019-07270-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Indications for and efficacy of paratracheal nodal dissection (PTND) in patients undergoing laryngectomy (salvage) for persistent or recurrent laryngeal squamous cell carcinoma are not well-defined. METHODS A retrospective cohort study was performed for patients undergoing salvage laryngectomy with clinically and radiographically negative neck disease between 1998 and 2015 (n = 210). Univariate and multivariate Cox regression analyses were performed. RESULTS PTND was performed on 77/210 patients (36%). The PTND cohort had a greater proportion of advanced T classification (rT3/rT4) tumors (78%) than subjects without PTND (55%; p = 0.001). There was a 14% rate of occult nodal metastases in the paratracheal basin; of these, 55% did not have pathologic lateral neck disease. Multivariate analysis controlling for tumor site, tumor stage, and pathologic lateral neck disease demonstrated that PTND was associated with improved overall survival [OS] (p = 0.03; hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.38-0.96), disease-free survival [DFS] (p = 0.03; HR 0.55, 95% CI 0.31-0.96), and distant DFS survival (p = 0.01; HR 0.29, 95% CI 0.11-0.77). The rate of hypocalcemia did not differ between subjects who underwent bilateral PTND, unilateral PTND, or no PTND (p = 0.19 at discharge, p = 0.17 at last follow-up). CONCLUSIONS PTND at the time of salvage laryngectomy was more common in patients with rT3/rT4 tumors and was associated with improved OS and DFS, with no effect on hypocalcemia. In patients undergoing PTND, the finding of occult paratracheal metastases was often independent of lateral neck metastases.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kyle VanKoevering
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Catherine T Haring
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
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Hoesli R, Brennan JR, Rosko AJ, Birkeland AC, Malloy KM, Moyer JS, Prince MEP, Shuman AG, Chinn SB, Stucken CL, Casper KA, Spector ME. Intraoperative Fluorescent Angiography Predicts Pharyngocutaneous Fistula After Salvage Laryngectomy. Ann Surg Oncol 2019; 26:1320-1325. [PMID: 30805812 DOI: 10.1245/s10434-019-07262-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Technology to assess tissue perfusion is exciting with translational potential, although data supporting its clinical applications have been lagging. Patients who have undergone radiation are at particular risk of poor tissue perfusion and would benefit from this expanding technology. We designed a prospective clinical trial using intraoperative indocyanine green angiography to evaluate for wound-healing complications in patients undergoing salvage laryngectomy after radiation failure. PATIENTS AND METHODS This prospective trial included patients undergoing salvage laryngectomy at a National Cancer Institute-designated tertiary cancer center between 2016 and 2018. After tumor extirpation and prior to reconstruction, 10 mg indocyanine green dye was infused and the fluorescence (FHYPO) and ingress rate of the pharyngeal mucosa recorded. The primary outcome measure was formation of a pharyngocutaneous fistula (PCF). RESULTS Patients who developed a PCF had significantly lower FHYPO (87 vs 172, p < 0.001) and ingress rates (6.7 vs 15.8, p = 0.043) compared with those who did not develop a fistula. There were no fistulas in patients with FHYPO > 150 (n = 21) or ingress > 15 (n = 15). There was a 50% fistula rate in patients with FHYPO ≤ 103 (n = 10) and ingress rate ≤ 6 (n = 6). CONCLUSIONS Intraoperative indocyanine green angiography can assess hypoperfusion in patients and predict risk of PCFs after salvage laryngectomy, and can thus intraoperatively risk-stratify patients for postoperative wound-healing complications.
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Affiliation(s)
- Rebecca Hoesli
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
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Mann JE, Smith JD, Birkeland AC, Bellile E, Swiecicki P, Mierzwa M, Chinn SB, Shuman AG, Malloy KM, Casper KA, McLean SA, Moyer JS, Wolf GT, Bradford CR, Prince ME, Carey TE, McHugh JB, Spector ME, Brenner JC. Analysis of tumor-infiltrating CD103 resident memory T-cell content in recurrent laryngeal squamous cell carcinoma. Cancer Immunol Immunother 2019; 68:213-220. [PMID: 30361882 PMCID: PMC6375747 DOI: 10.1007/s00262-018-2256-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/04/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Recurrent laryngeal squamous cell carcinomas (LSCCs) are associated with poor outcomes, without reliable biomarkers to identify patients who may benefit from adjuvant therapies. Given the emergence of tumor-infiltrating lymphocytes (TIL) as a biomarker in head and neck squamous cell carcinoma, we generated predictive models to understand the utility of CD4+, CD8+ and/or CD103+ TIL status in patients with advanced LSCC. METHODS Tissue microarrays were constructed from salvage laryngectomy specimens of 183 patients with recurrent/persistent LSCC and independently stained for CD4+, CD8+, and CD103+ TIL content. Cox proportional hazards regression analysis was employed to assess combinations of CD4+, CD8+, and CD103+ TIL levels for prediction of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) in patients with recurrent/persistent LSCC. RESULTS High tumor CD103+ TIL content was associated with significantly improved OS, DSS, and DFS and was a stronger predictor of survival in recurrent/persistent LSCC than either high CD8+ or CD4+ TIL content. On multivariate analysis, an "immune-rich" phenotype, in which tumors were enriched for both CD103+ and CD4+ TILs, conferred a survival benefit (OS hazard ratio: 0.28, p = 0.0014; DSS hazard ratio: 0.09, p = 0.0015; DFS hazard ratio: 0.18, p = 0.0018) in recurrent/persistent LSCC. CONCLUSIONS An immune profile driven by CD103+ TIL content, alone and in combination with CD4+ TIL content, is a prognostic biomarker of survival in patients with recurrent/persistent LSCC. Predictive models described herein may thus prove valuable in prognostic stratification and lead to personalized treatment paradigms for this patient population.
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Affiliation(s)
- Jacqueline E Mann
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Paul Swiecicki
- Department of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Jeffery S Moyer
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
| | - Mark E Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
| | - Thomas E Carey
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA.
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA.
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1150 E. Medical Center Dr., 9301B MSRB3, Ann Arbor, 48109-0602, MI, USA.
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Dr., 1904 Taubman Center, 48109-5312, Ann Arbor, MI, USA.
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA.
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Smith JD, Birkeland AC, Rosko AJ, Hoesli RC, Foltin SK, Swiecicki P, Mierzwa M, Chinn SB, Shuman AG, Malloy KM, Casper KA, McLean SA, Wolf GT, Bradford CR, Prince ME, Brenner JC, Spector ME. Mutational profiles of persistent/recurrent laryngeal squamous cell carcinoma. Head Neck 2018; 41:423-428. [PMID: 30548484 DOI: 10.1002/hed.25444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/22/2018] [Accepted: 09/06/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We sought to describe targeted DNA sequencing data of persistent/recurrent laryngeal squamous cell carcinoma (LSCC) and to compare gene-specific alteration frequencies with that of primary, untreated LSCC specimens from The Cancer Genome Atlas (TCGA). METHODS The tumors of 21 patients with persistent/recurrent LSCC were subjected to targeted DNA sequencing using the Ion AmpliSeq Comprehensive Cancer Panel. Gene-specific alteration frequencies were compared (Chi-Square test) to primary, untreated LSCC sequencing data from TCGA using the cBioPortal platform. RESULTS Persistent/recurrent LSCC was characterized by a high rate of inactivating alterations in TP53 (38.1%) and CDKN2A (33%), amplification events of CCND1 (19.1%), and ERBB2 (14.3%), and NOTCH1 (19.1%) mutations. Comparison of primary vs persistent/recurrent LSCC revealed significant differences in alteration frequencies of eight critical genes: BAP1, CDKN2A, DCUN1D1, MSH2, MTOR, PIK3CA, TET2, and TP53. CONCLUSIONS Our results provide preliminary support for a distinct mutational profile of persistent/recurrent LSCC that requires validation in larger cohorts.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rebecca C Hoesli
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Susan K Foltin
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Paul Swiecicki
- Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michelle Mierzwa
- Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark E Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - John Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.,Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
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Ludwig ML, Kulkarni A, Birkeland AC, Michmerhuizen NL, Foltin SK, Mann JE, Hoesli RC, Devenport SN, Jewell BM, Shuman AG, Spector ME, Carey TE, Jiang H, Brenner JC. The genomic landscape of UM-SCC oral cavity squamous cell carcinoma cell lines. Oral Oncol 2018; 87:144-151. [PMID: 30527230 DOI: 10.1016/j.oraloncology.2018.10.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We sought to describe the genetic complexity of 14 UM-SCC oral cavity cancer cell lines that have remained uncharacterized despite being used as model systems for decades. MATERIALS AND METHODS We performed exome sequencing on 14 oral cavity UM-SCC cell lines and denote the mutational profile of each line. We used a SNP array to profile the multiple copy number variations of each cell line and use immunoblotting to compare alterations to protein expression of commonly amplified genes (EGFR, PIK3CA, etc.). RNA sequencing was performed to characterize the expression of genes with copy number alterations. RESULTS The cell lines displayed a highly complex network of genetic aberrations that was consistent with alterations identified in the HNSCC TCGA project including PIK3CA amplification, CDKN2A deletion, as well as TP53 and CASP8 mutations, enabling genetic stratification of each cell line in the panel. Copy number FISH and spectral karyotyping analysis demonstrate that cell lines retain chromosomal heterogeneity. CONCLUSIONS Collectively, we developed an important resource for future oral cavity HNSCC cell line studies and highlight the complexity of genomic aberrations in cell lines.
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Affiliation(s)
- Megan L Ludwig
- Department of Otolaryngology - Head and Neck Surgery, United States; Program in Cellular and Molecular Biology, United States
| | - Aditi Kulkarni
- Department of Otolaryngology - Head and Neck Surgery, United States
| | | | - Nicole L Michmerhuizen
- Department of Otolaryngology - Head and Neck Surgery, United States; Department of Pharmacology, United States
| | - Susan K Foltin
- Department of Otolaryngology - Head and Neck Surgery, United States
| | - Jacqueline E Mann
- Department of Otolaryngology - Head and Neck Surgery, United States; Department of Pathology, United States
| | - Rebecca C Hoesli
- Department of Otolaryngology - Head and Neck Surgery, United States
| | - Samantha N Devenport
- Department of Otolaryngology - Head and Neck Surgery, United States; Program in Cellular and Molecular Biology, United States
| | | | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, United States; Center for Bioethics and Social Sciences in Medicine, United States; Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI, United States
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, United States; Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI, United States
| | - Thomas E Carey
- Department of Otolaryngology - Head and Neck Surgery, United States; Department of Pharmacology, United States; Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI, United States
| | - Hui Jiang
- Department of Biostatistics, United States; Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI, United States
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, United States; Department of Pharmacology, United States; Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI, United States.
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Smith J, Kulkarni A, Birkeland AC, McHugh JB, Brenner JC. Whole-Exome Sequencing of Sinonasal Small Cell Carcinoma Arising within a Papillary Schneiderian Carcinoma In Situ. Otolaryngol Head Neck Surg 2018; 159:859-865. [PMID: 29734873 DOI: 10.1177/0194599818774004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The pathogenetic underpinnings of extrapulmonary small cell carcinomas (EPSCCs) of the head and neck are poorly understood. We sought to describe the clinical case and whole-exome DNA sequencing data of a patient with sinonasal Schneiderian carcinoma in situ whose tumor progressed to small cell carcinoma (SCC). STUDY DESIGN Case report and whole-exome sequencing of tumor DNA. SETTING Academic medical center. SUBJECTS AND METHODS A 52-year-old man with sinonasal Schneiderian carcinoma in situ whose tumor progressed to small cell carcinoma. We performed whole-exome genetic sequencing and copy-number variation (CNV) analysis of tumor and normal DNA extracted from flash-frozen, paraffin-embedded (FFPE) samples. RESULTS A total of 93 high-confidence, nonsynonymous somatic mutation events were identified in sinonasal SCC, including loss-of-function mutations in TP53, MAML3, a transcriptional coactivator of the Notch pathway, and GAS6, an activating ligand of the TAM family of tyrosine kinase receptors. Focal amplifications of chromosomal regions 6p25-11.1, containing SOX4 and VEGFA, and 14q32.1-32.3, containing AKT1 and the Notch inhibitory ligand DLK1, were also seen. Further CNV analysis revealed deletions in the critical cell cycle regulators CDKN2A, RB1, RBL1, and RBL2 and the chromatin modifier EP300. CONCLUSIONS Small cell carcinoma may rarely arise from sinonasal Schneiderian carcinoma in situ and exhibits similar genomic aberrations (eg, SOX amplification, Notch pathway inactivation) to pulmonary small cell carcinoma.
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Affiliation(s)
- Joshua Smith
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Aditi Kulkarni
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Andrew C Birkeland
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jonathan B McHugh
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,2 Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,3 Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - J Chad Brenner
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.,3 Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.,4 Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,5 Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Spector ME, Farlow JL, Haring CT, Brenner JC, Birkeland AC. The potential for liquid biopsies in head and neck cancer. Discov Med 2018; 25:251-257. [PMID: 29906408 PMCID: PMC6125134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Head and neck cancers consist of a heterogeneous group of cancers that are difficult to treat successfully. Limited screening options result in patients being diagnosed at advanced stages at presentation, and difficulty with treatment options and post-treatment surveillance can lead to poor outcomes. In this setting, tools for early and precise detection of disease will be highly valuable. Liquid biopsies, or use of analytes in blood, saliva, and other body fluid samples, provide new avenues for cancer screening with the potential for early detection, treatment modification, and surveillance of head and neck cancers. Early studies of liquid biopsies in specific head and neck cancers have had encouraging results. Nevertheless, various challenges remain before its routine adoption into clinical use is feasible. With continued advancement in the field of liquid biopsies, there is great promise for clinical implementation and significant improvement in head and neck cancer care.
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Affiliation(s)
- Matthew E. Spector
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI
- Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI
| | - Janice L. Farlow
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Catherine T. Haring
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - J. Chad Brenner
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI
- Rogel Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI
| | - Andrew C. Birkeland
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI
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Birkeland AC, McHugh JB, Bohm LA. A Pediatric Nasopharyngeal Mass. JAMA Otolaryngol Head Neck Surg 2018; 144:371-372. [PMID: 29392294 DOI: 10.1001/jamaoto.2017.3072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor
| | - Jonathan B McHugh
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor
| | - Lauren A Bohm
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor
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