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Sahovaler A, Valic MS, Townson JL, Chan HH, Zheng M, Tzelnick S, Mondello T, Pener-Tessler A, Eu D, El-Sayes A, Ding L, Chen J, Douglas CM, Weersink R, Muhanna N, Zheng G, Irish JC. Nanoparticle-mediated Photodynamic Therapy as a Method to Ablate Oral Cavity Squamous Cell Carcinoma in Preclinical Models. Cancer Res Commun 2024; 4:796-810. [PMID: 38421899 PMCID: PMC10941731 DOI: 10.1158/2767-9764.crc-23-0269] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/05/2023] [Accepted: 02/27/2024] [Indexed: 03/02/2024]
Abstract
Photodynamic therapy (PDT) is a tissue ablation technique able to selectively target tumor cells by activating the cytotoxicity of photosensitizer dyes with light. PDT is nonsurgical and tissue sparing, two advantages for treatments in anatomically complex disease sites such as the oral cavity. We have previously developed PORPHYSOME (PS) nanoparticles assembled from chlorin photosensitizer-containing building blocks (∼94,000 photosensitizers per particle) and capable of potent PDT. In this study, we demonstrate the selective uptake and curative tumor ablation of PS-enabled PDT in three preclinical models of oral cavity squamous cell carcinoma (OCSCC): biologically relevant subcutaneous Cal-33 (cell line) and MOC22 (syngeneic) mouse models, and an anatomically relevant orthotopic VX-2 rabbit model. Tumors selectively uptake PS (10 mg/kg, i.v.) with 6-to 40-fold greater concentration versus muscle 24 hours post-injection. Single PS nanoparticle-mediated PDT (PS-PDT) treatment (100 J/cm2, 100 mW/cm2) of Cal-33 tumors yielded significant apoptosis in 65.7% of tumor cells. Survival studies following PS-PDT treatments demonstrated 90% (36/40) overall response rate across all three tumor models. Complete tumor response was achieved in 65% of Cal-33 and 91% of MOC22 tumor mouse models 14 days after PS-PDT, and partial responses obtained in 25% and 9% of Cal-33 and MOC22 tumors, respectively. In buccal VX-2 rabbit tumors, combined surface and interstitial PS-PDT (200 J total) yielded complete responses in only 60% of rabbits 6 weeks after a single treatment whereas three repeated weekly treatments with PS-PDT (200 J/week) achieved complete ablation in 100% of tumors. PS-PDT treatments were well tolerated by animals with no treatment-associated toxicities and excellent cosmetic outcomes. SIGNIFICANCE PS-PDT is a safe and repeatable treatment modality for OCSCC ablation. PS demonstrated tumor selective uptake and PS-PDT treatments achieved reproducible efficacy and effectiveness in multiple tumor models superior to other clinically tested photosensitizer drugs. Cosmetic and functional outcomes were excellent, and no clinically significant treatment-associated toxicities were detected. These results are enabling of window of opportunity trials for fluorescence-guided PS-PDT in patients with early-stage OCSCC scheduled for surgery.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael S. Valic
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Biomedical Engineering (BME), University of Toronto, Toronto, Ontario, Canada
| | - Jason L. Townson
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Harley H.L. Chan
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mark Zheng
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sharon Tzelnick
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tiziana Mondello
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Alon Pener-Tessler
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Donovan Eu
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Abdullah El-Sayes
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lili Ding
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Juan Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Catriona M. Douglas
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Robert Weersink
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Nidal Muhanna
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, Tel Aviv Sourasky Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Gang Zheng
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Biomedical Engineering (BME), University of Toronto, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- TECHNA Institute, Guided Therapeutics (GTx) Program, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Laxague F, Sahovaler A, Fnais N, Tran C, Wehrli B, Matic D, Nichols A, Mendez A, Gill R, Yoo J. The Ansa Hypoglossi: Quantifying Axonal Density of a Donor Nerve for Facial Reinnervation. Facial Plast Surg Aesthet Med 2024; 26:47-51. [PMID: 37192498 DOI: 10.1089/fpsam.2022.0405] [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] [Indexed: 05/18/2023] Open
Abstract
Background: There are a number of nerve grafting options for facial reanimation and the ansa hypoglossi (AH) may be considered in select situations. Objective: To compare axonal density, area, and diameter of AH with other nerves more usually used for facial reanimation. Methods: AH specimens from patients undergoing neck dissections were submitted in formalin. Proximal to distal cross sections, nerve diameters, and the number of axons per nerve, proximally and distally, were measured and counted. Results: Eighteen nerve specimens were analyzed. The average manual axon count for the distal and proximal nerve sections was 1378 ± 333 and 1506 ± 306, respectively. The average QuPath counts for the proximal and distal nerve sections were 1381 ± 325 and 1470 ± 334, respectively. The mean nerve area of the proximal and distal nerve sections was 0.206 ± 0.01 and 0.22 ± 0.064 mm2, respectively. The mean nerve diameter for the proximal and distal nerve sections were 0.498 ± 0.121 and 0.526 ± 0.75 mm, respectively. Conclusion: The histological characteristics of the AH support clinical examination of outcomes as a promising option in facial reanimation.
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Affiliation(s)
- Francisco Laxague
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Department of Head and Neck Surgery, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Department of Head and Neck Surgery, University College London Hospitals, London, United Kingdom
| | - Naif Fnais
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Christopher Tran
- Department of Pathology, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Bret Wehrli
- Department of Pathology, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Damir Matic
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Rabia Gill
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
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Laxague F, Gualtieri T, Brahm G, Yoo J, MacNeil SD, Fung K, Mendez A, Sahovaler A, Nichols AC. Ultrasound-guided wire localisation: a GPS for hidden head and neck tumours? A case series. Acta Otorhinolaryngol Ital 2023; 43:375-381. [PMID: 37519136 PMCID: PMC10773541 DOI: 10.14639/0392-100x-n2280] [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] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/11/2023] [Indexed: 08/01/2023]
Abstract
Objectives Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate tumour identification and decrease potential complications. We describe five cases of pre-operative USGW localisation of non-palpable head and neck lesions to facilitate surgical localisation and resection. Methods All patients undergoing pre-operative USGW localisation for non-palpable tumours of the head and neck region at London Health and Sciences Center, London, Ontario, Canada, were included. All the USGW localisations were performed by the same interventional radiologist, and the surgeries were performed by fellowship trained head and neck surgeons. Results Five patients were included. All patients were undergoing revision surgery for recurrent or persistent disease. All successfully underwent a pre-operative USGW localisation of the non-palpable lesion before revision surgery. All lesions were localised intra-operatively with no peri-operative complications. Conclusions USGW localisation is a safe and effective pre-operative technique for the identification of small non-palpable head and neck tumours.
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Affiliation(s)
- Francisco Laxague
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Tommaso Gualtieri
- Department of Otorhinolaryngology - Head & Neck Surgery, “Nuovo Santo Stefano” Civil Hospital, Prato, PO, Italy
| | - Gary Brahm
- Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - S. Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Axel Sahovaler
- Department of Head & Neck Surgery, University College London Hospitals, London, United Kingdom
| | - Anthony C. Nichols
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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4
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Tzelnick S, Soroka HP, Tasnim N, Gilbert RW, Irish JC, Goldstein DP, Brown D, Gullane P, Chepeha DB, Yao CMKL, Sahovaler A, Witterick IJ, Monteiro E, Davies J, Huang SH, O'Sullivan B, Hahn E, Hosni A, Razak AA, Gupta AA, de Almeida JR. The impact of surgical resection margins on outcomes for adults with head and neck osteosarcomas: A Canadian sarcoma research and Clinical Collaboration (CanSaRCC) study. Oral Oncol 2023; 145:106495. [PMID: 37478572 DOI: 10.1016/j.oraloncology.2023.106495] [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: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE The aim of the study is to describe the factors that influence outcome in adults with head and neck osteosarcoma (HNO) with a specific focus on the margin status. METHODS Patients with a diagnosis of HNO between the years 1996-2021 were reviewed from the Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) Database. Baseline characteristics, pathology, treatment, and outcomes were analyzed. Univariable (UVA) and multivariable (MVA) Cox regression models were performed. 5-year locoregional control rate and overall survival (OS) were estimated using Kaplan-Meier method and Log-Rank test. RESULTS Of 50 patients with a median age of 40 years (range 16-80), 27 (54%) were male. HNO commonly involved the mandible (n = 21, 42%) followed by maxilla (n = 15, 30%). Thirteen (33.3%) had low-intermediate grade and 26 (66.6%) had high grade tumors. Three patients (6%) had negative resection margins (>5 mm), 24 (48%) had close margins (1-5 mm), 15 (30%) had positive margins (<1mm) and 7 (16%) had unknown margin status. In total, 39 (78%) received chemotherapy - 22 (44%) received neoadjuvant chemotherapy while 17 (34%) received adjuvant chemotherapy. A total of 12 (24%) patients received radiotherapy, of whom 8 (16%) had adjuvant and 3 (6%) had neo-adjuvant. Median follow-up time was 6.3 years (range 0.26-24.9). Disease recurred in 21 patients (42%), of whom 15 (30%) had local recurrence only, 4 (8%) had distant metastasis, and 2 (4%) had both local and distant recurrence. 5-year locoregional control rate and OS was 62% and 79.2% respectively. Resection margins <3 mm was associated with lower 5 years OS and locoregional control rate (Log-Rank p = 0.02, p = 0.01 respectively). CONCLUSION Osteosarcomas of the head and neck are rare and local recurrence remains a concern. Surgical resection with negative resection margins may improve survival, and a 3 mm resection margin threshold may optimize survival. Radiotherapy and/or chemotherapy should be considered in a multidisciplinary setting based on risk-features.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Hagit Peretz Soroka
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada
| | - Najifah Tasnim
- CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Dale Brown
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Joel Davies
- Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Albiruni Abdul Razak
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; Department of Medical Oncology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Abha A Gupta
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Ontario, Canada; Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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5
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Tzelnick S, Rampinelli V, Sahovaler A, Franz L, Chan HHL, Daly MJ, Irish JC. Skull-Base Surgery—A Narrative Review on Current Approaches and Future Developments in Surgical Navigation. J Clin Med 2023; 12:jcm12072706. [PMID: 37048788 PMCID: PMC10095207 DOI: 10.3390/jcm12072706] [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: 01/11/2023] [Revised: 03/10/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
Surgical navigation technology combines patient imaging studies with intraoperative real-time data to improve surgical precision and patient outcomes. The navigation workflow can also include preoperative planning, which can reliably simulate the intended resection and reconstruction. The advantage of this approach in skull-base surgery is that it guides access into a complex three-dimensional area and orients tumors intraoperatively with regard to critical structures, such as the orbit, carotid artery and brain. This enhances a surgeon’s capabilities to preserve normal anatomy while resecting tumors with adequate margins. The aim of this narrative review is to outline the state of the art and the future directions of surgical navigation in the skull base, focusing on the advantages and pitfalls of this technique. We will also present our group experience in this field, within the frame of the current research trends.
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Affiliation(s)
- Sharon Tzelnick
- Division of Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2M9, Canada
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, 25121 Brescia, Italy
| | - Axel Sahovaler
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
- Head & Neck Surgery Unit, University College London Hospitals, London NW1 2PG, UK
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35122 Padua, Italy
| | - Harley H. L. Chan
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Michael J. Daly
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Jonathan C. Irish
- Division of Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2M9, Canada
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
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6
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Lee JJW, Kunaratnam V, Kim CJH, Pienkowski M, Hueniken K, Sahovaler A, Lam ACL, Davies JC, Brown CM, De Almeida JR, Huang SH, Waldron JN, Spreafico A, Hung RJ, Xu W, Goldstein DP, Liu G. Cigarette smoking cessation, duration of smoking abstinence, and head and neck squamous cell carcinoma prognosis. Cancer 2023; 129:867-877. [PMID: 36653915 DOI: 10.1002/cncr.34620] [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: 05/25/2022] [Revised: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Tobacco use is a major risk factor for developing head and neck squamous cell carcinoma (HNSCC). However, the prognostic associations with smoking cessation are limited. The authors assessed whether smoking cessation and increased duration of abstinence were associated with improved overall (OS) and HNSCC-specific survival. METHODS Clinicodemographic and smoking data from patients with HNSCC at Princess Margaret Cancer Center (2006-2019) were prospectively collected. Multivariable Cox and Fine and Gray competing-risk models were used to assess the impact of smoking cessation and duration of abstinence on overall mortality and HNSCC-specific/noncancer mortality, respectively. RESULTS Among 2482 patients who had HNSCC, former smokers (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.58-0.87; p = .001; N = 841) had a reduced risk of overall mortality compared with current smokers (N = 931). Compared with current smokers, former smokers who quit >10 years before diagnosis (long-term abstinence; n = 615) had the most improved OS (aHR, 0.72; 95% CI, 0.56-0.93; p = .001). The 5-year actuarial rates of HNSCC-specific and noncancer deaths were 16.8% and 9.4%, respectively. Former smokers (aHR, 0.71; 95% CI, 0.54-0.95; p = .019) had reduced HNSCC-specific mortality compared with current smokers, but there was no difference in noncancer mortality. Abstinence for >10 years was associated with decreased HNSCC-specific death compared with current smoking (aHR, 0.64; 95% CI, 0.46-0.91; p = .012). Smoking cessation with a longer duration of quitting was significantly associated with reduced overall and HNSCC-specific mortality in patients who received primary radiation. CONCLUSIONS Smoking cessation before the time of diagnosis reduced overall mortality and cancer-specific mortality among patients with HNSCC, but no difference was observed in noncancer mortality. Long-term abstinence (>10 pack-years) had a significant OS and HNSCC-specific survival benefit.
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Affiliation(s)
- John J W Lee
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Vijay Kunaratnam
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Christina J H Kim
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martha Pienkowski
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Head and Neck Surgery, University College London Hospitals, London, UK
| | - Andrew C L Lam
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel C Davies
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Catherine M Brown
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - John R De Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - John N Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Rayjean J Hung
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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7
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Alzahrani F, Sahovaler A, Mundi N, Rammal A, Fnais N, MacNeil SD, Mendez A, Yoo J, Fung K, Laxague F, Warner A, Palma DA, Nichols A. Transoral robotic surgery for the identification of unknown primary head and neck squamous cell carcinomas: Its effect on the wait and the weight. Head Neck 2022; 44:1206-1212. [PMID: 35224796 DOI: 10.1002/hed.27023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Neck carcinoma of unknown primary (CUP) is a frequent scenario. Transoral robotic mucosectomies (TORM) of pharynx have increased rate of primary identification, but come with cost of treatment delay. METHODS We reviewed patients who underwent CUP protocol from 2014 to 2020. Patients with cervical nodes carcinoma and failure to localize a primary source were classified as CUP. We determined primary identification rate and postoperative complications. RESULTS We included 65 patients underwent TORM. Surgical approach consisted of lingual and/or palatine tonsillectomies. The primary detection rate was 49.2%. Average weight reduction was 2.5 ± 4.3 kg. The average number of days from consultation to definitive treatment was 52.2 ± 18.3. CONCLUSION A systematic approach to patients with CUP showed a promising primary identification rate compared to panendoscopy alone. TORM carries a small risk of complications. The benefits of primary identification must be weighed with the morbidity and delay to definitive treatment.
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Affiliation(s)
- Faisal Alzahrani
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Department Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Axel Sahovaler
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Neil Mundi
- Department of Otolaryngology, Southern Illinois University, Springfield, Illinois, USA
| | - Almoaidbellah Rammal
- Department Otolaryngology-Head and Neck Surgery, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Naif Fnais
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Department Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - S Danielle MacNeil
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Francisco Laxague
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Anthony Nichols
- Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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8
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Sahovaler A, Daly MJ, Chan HHL, Nayak P, Tzelnick S, Arkhangorodsky M, Qiu J, Weersink R, Irish JC, Ferguson P, Wunder JS. Automatic Registration and Error Color Maps to Improve Accuracy for Navigated Bone Tumor Surgery Using Intraoperative Cone-Beam CT. JB JS Open Access 2022; 7:JBJSOA-D-21-00140. [PMID: 35540727 PMCID: PMC9071254 DOI: 10.2106/jbjs.oa.21.00140] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Computer-assisted surgery (CAS) can improve surgical precision in orthopaedic oncology. Accurate alignment of the patient’s imaging coordinates with the anatomy, known as registration, is one of the most challenging aspects of CAS and can be associated with substantial error. Using intraoperative, on-the-table, cone-beam computed tomography (CBCT), we performed a pilot clinical study to validate a method for automatic intraoperative registration.
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Affiliation(s)
- Axel Sahovaler
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Head & Neck Surgery Unit, University College London Hospitals, London, United Kingdom
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Prakash Nayak
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgical Oncology, Bone and Soft Tissue Disease Management Group, Tata Memorial Centre, Mumbai, India
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sharon Tzelnick
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Michelle Arkhangorodsky
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert Weersink
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Peter Ferguson
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jay S Wunder
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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9
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Ferrari M, Taboni S, Carobbio ALC, Buffoli B, Rampinelli V, Mattavelli D, Schreiber A, Verzeletti V, Ravanelli M, Daly MJ, Chan HHL, Sahovaler A, Franz L, Gualtieri T, Rezzani R, Maroldi R, Signoroni A, Deganello A, Irish JC, Nicolai P. Development of a cadaveric head and neck cancer model and three-dimensional analysis of margins in surgical navigation-aided ablations. Eur J Surg Oncol 2021; 48:1235-1242. [PMID: 34916084 DOI: 10.1016/j.ejso.2021.12.012] [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: 11/14/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The adequacy of the surgical resection is the main controllable variable that is in the hands of the surgical team. There exists an unmet need to increase the rate of negative margins, particularly in cancers invading the craniofacial area. The study aimed 1) at developing a gross tumor model to be utilized for research, educational, and training purposes and 2) establishing the 3-dimensional relationship between the outer surface of the surgical specimen and tumor surface and test the effect of guiding ablations on cadavers with surgical navigation (SN). MATERIAL AND METHODS Seven cadaver heads were employed to create 24 craniofacial tumor models. Simulation of tumor resections was performed by 8 surgeons. Fourteen and 10 resections were performed with and without SN-guidance, respectively. Gross specimens underwent computed tomography and 3-dimensional analysis through dedicated software. Task load was assessed through a validated questionnaire. Tumor model reliability was studied based on visual analogue scale rate by surgeons and radiologists. RESULTS SN reduced the rate of margin involvement, particularly by decreasing the percentage of the gross specimen outer surface involvement in areas uncovered by normal bony structures. The workload of SN-aided ablations was found to be medium-to-somewhat-high. Tumor model reliability was deemed satisfactory except for the extension to bony structures. CONCLUSIONS A gross tumor model for head and neck cancers involving the craniofacial area was developed and resulted satisfactorily reliable from both a surgical and radiologic standpoint. SN reduced the rate of margin involvement, particularly by improving delineation of bone-uncovered areas.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea L C Carobbio
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Vincenzo Verzeletti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Head & Neck Surgery, University College London Hospitals, London, United Kingdom
| | - Leonardo Franz
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Tommaso Gualtieri
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Signoroni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Jonathan C Irish
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
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10
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Taboni S, Ferrari M, Daly MJ, Chan HHL, Eu D, Gualtieri T, Jethwa AR, Sahovaler A, Sewell A, Hasan W, Berania I, Qiu J, de Almeida J, Nicolai P, Gilbert RW, Irish JC. Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study. Front Oncol 2021; 11:747227. [PMID: 34858824 PMCID: PMC8632239 DOI: 10.3389/fonc.2021.747227] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background The resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical navigation with virtual endoscopy (3D-SNVE) may represent a step forward. This study aimed to demonstrate and quantify the benefits of this technology. Material and Method Four maxillary tumor models with critical posterior extension were created in four artificial skulls (Sawbones®). Images were acquired with cone-beam computed tomography and the tumor and carotid were contoured. Eight head and neck surgeons were recruited for the simulations. Surgeons delineated the posterior margin of resection through a transnasal approach and avoided the carotid while establishing an adequate resection margin with respect to tumor extirpation. Three simulations were performed: 1) unguided: based on a pre-simulation study of cross-sectional imaging; 2) tumor-guided: guided by real-time tool tracking with 3D tumor and carotid rendering; 3) carotid-guided: tumor-guided with a 2-mm alert cloud surrounding the carotid. Distances of the planes from the carotid and tumor were classified as follows and the points of the plane were classified accordingly: “red”: through the carotid artery; “orange”: <2 mm from the carotid; “yellow”: >2 mm from the carotid and within the tumor or <5 mm from the tumor; “green”: >2 mm from the carotid and 5–10 mm from the tumor; and “blue”: >2 mm from the carotid and >10 mm from the tumor. The three techniques (unguided, tumor-guided, and carotid-guided) were compared. Results 3D-SNVE for the transnasal delineation of the posterior margin in maxillary tumor models significantly improved the rate of margin-negative clearance around the tumor and reduced damage to the carotid artery. “Green” cuts occurred in 52.4% in the unguided setting versus 62.1% and 64.9% in the tumor- and carotid-guided settings, respectively (p < 0.0001). “Red” cuts occurred 6.7% of the time in the unguided setting versus 0.9% and 1.0% in the tumor- and carotid-guided settings, respectively (p < 0.0001). Conclusions This preclinical study has demonstrated that 3D-SNVE provides a substantial improvement of the posterior margin delineation in terms of safety and oncological adequacy. Translation into the clinical setting, with a meticulous assessment of the oncological outcomes, will be the proposed next step.
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Affiliation(s)
- Stefano Taboni
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, Toronto, ON, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, Toronto, ON, Canada.,Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Donovan Eu
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Tommaso Gualtieri
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Head & Neck Surgery, University College London Hospital, London, United Kingdom
| | - Andrew Sewell
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wael Hasan
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Ilyes Berania
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
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11
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Sahovaler A, Lee JJW, Xu W, Su S, Hosni A, Bayley A, Goldstein DP, de Almeida JR. Contralateral nodal failures in oropharyngeal cancers after TORS and unilateral neck management: a retrospective study. J Otolaryngol Head Neck Surg 2021; 50:71. [PMID: 34949220 PMCID: PMC8697460 DOI: 10.1186/s40463-021-00551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Report the incidence of contralateral nodal failure rates in well-lateralized oropharyngeal carcinoma treated with upfront surgery and unilateral neck management. Methods Lateralized oropharyngeal carcinomas treated with upfront surgery using transoral robotic surgery (TORS) and unilateral neck management (unilateral neck dissection ± unilateral radiation treatment) were identified. Primary endpoint was contralateral regional control (CRC). Secondary endpoints were local control (LC), and overall survival (OS). Results Thirty-two patients were included. Pathologic T categories included 66% pT1, 31% pT2 and 3% pT3. Nodal diseases comprised 41% N0 and 47% N1 (AJCC 8th). Twenty-three (72%) patients had HPV related tumors. 3-years CRC, LC and OS were 100%, 96% (89–100) and 96% (CI 89–100). One patient developed a second primary with contralateral nodal disease. Only one patient died from another primary cancer. Conclusion In selected patients with lateralized oropharyngeal cancer, treatment with TORS and ipsilateral management of the neck may be oncologically safe without significant risk of contralateral failure. Level of evidence: Level 2. Graphical abstract ![]()
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12
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Sahovaler A, Chan HHL, Gualtieri T, Daly M, Ferrari M, Vannelli C, Eu D, Manojlovic-Kolarski M, Orzell S, Taboni S, de Almeida JR, Goldstein DP, Deganello A, Nicolai P, Gilbert RW, Irish JC. Augmented Reality and Intraoperative Navigation in Sinonasal Malignancies: A Preclinical Study. Front Oncol 2021; 11:723509. [PMID: 34790568 PMCID: PMC8591179 DOI: 10.3389/fonc.2021.723509] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To report the first use of a novel projected augmented reality (AR) system in open sinonasal tumor resections in preclinical models and to compare the AR approach with an advanced intraoperative navigation (IN) system. Methods Four tumor models were created. Five head and neck surgeons participated in the study performing virtual osteotomies. Unguided, AR, IN, and AR + IN simulations were performed. Statistical comparisons between approaches were obtained. Intratumoral cut rate was the main outcome. The groups were also compared in terms of percentage of intratumoral, close, adequate, and excessive distances from the tumor. Information on a wearable gaze tracker headset and NASA Task Load Index questionnaire results were analyzed as well. Results A total of 335 cuts were simulated. Intratumoral cuts were observed in 20.7%, 9.4%, 1.2,% and 0% of the unguided, AR, IN, and AR + IN simulations, respectively (p < 0.0001). The AR was superior than the unguided approach in univariate and multivariate models. The percentage of time looking at the screen during the procedures was 55.5% for the unguided approaches and 0%, 78.5%, and 61.8% in AR, IN, and AR + IN, respectively (p < 0.001). The combined approach significantly reduced the screen time compared with the IN procedure alone. Conclusion We reported the use of a novel AR system for oncological resections in open sinonasal approaches, with improved margin delineation compared with unguided techniques. AR improved the gaze-toggling drawback of IN. Further refinements of the AR system are needed before translating our experience to clinical practice.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Tommaso Gualtieri
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy
| | - Michael Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Marco Ferrari
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy.,Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - Claire Vannelli
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Donovan Eu
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Mirko Manojlovic-Kolarski
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Susannah Orzell
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Stefano Taboni
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy.,Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
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13
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Hamour AF, Yang W, Lee JJW, Wu V, Ziai H, Singh P, Eskander A, Sahovaler A, Higgins K, Witterick IJ, Vescan A, Freeman J, de Almeida JR, Goldstein D, Gilbert R, Chepeha D, Irish J, Enepekides D, Monteiro E. Association of the Implementation of a Standardized Thyroid Ultrasonography Reporting Program With Documentation of Nodule Characteristics. JAMA Otolaryngol Head Neck Surg 2021; 147:343-349. [PMID: 33570552 DOI: 10.1001/jamaoto.2020.5233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Although most thyroid nodules are benign, the potential for malignant neoplasms is associated with unnecessary workup in the form of imaging, fine-needle aspiration, and diagnostic surgery. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is commonly used to assess the malignant neoplasm risk potential of thyroid nodules imaged by ultrasonography. However, standardized reporting of ACR TI-RADS descriptors is inconsistent. Objective To increase the documentation rate of ACR TI-RADS thyroid nodule characteristics to 80% in 18 months. Design, Setting, and Participants This prospective interrupted time series quality improvement study was conducted from December 1, 2018, to March 31, 2020, at a tertiary outpatient head and neck clinic among 229 patients who had at least 1 documented thyroid nodule identified on bedside clinic ultrasonography. Data analysis was performed throughout the entire study period because this was a quality improvement study with iterative small cycle changes; final analysis of the data was performed in April 2020. Main Outcomes and Measures The primary outcome was the documentation rates of 6 ACR TI-RADS ultrasonographic descriptors. Secondary outcomes included nodule fine-needle aspiration biopsy rate and physician-reported clinic flow efficiency. Results A total of 229 patients had at least 1 documented thyroid nodule and were included in the analysis. Size was the most frequently documented nodule characteristic (72 of 74 [97.3%]) at baseline, followed by echogenic foci (31 of 74 [41.9%]), composition (23 of 74 [31.1%]), echogenicity (17 of 74 [23.0%]), margin (6 of 74 [8.1%]), and shape (1 of 74 [1.4%]). After 3 Plan, Do, Study, Act (PDSA) cycles, the final intervention consisted of a standardized ultrasonography reporting form and educational initiatives for surgical trainees. After the third PDSA cycle (n = 36), reporting of nodule size, echogenic foci, and composition increased to 100%. Similarly, reporting of echogenicity (34 of 36 [94.4%]), shape (28 of 36 [77.8%]), and margin (25 of 36 [69.4%]) all increased. This represented a cumulative 90.3% documentation rate (195 of 216), a 56.5% increase from baseline (95% CI, 50.0%-61.9%). The standardized reporting form was used in 83.3% of eligible thyroid ultrasonography cases (30 of 36) after PDSA cycle 3, demonstrating good fidelity of implementation. There were no unintended consequences associated with clinic workflow, as a balancing measure, reported by staff surgeons. Conclusions and Relevance This study suggests that implementation of an ACR TI-RADS-based reporting form in conjunction with educational initiatives improved documentation of ultrasonographic thyroid nodule characteristics, potentially allowing for improved bedside risk stratification and communication among clinicians.
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Affiliation(s)
- Amr F Hamour
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John J W Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Praby Singh
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Scarborough Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Douglas Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
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14
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Sahovaler A, Gualtieri T, Lee JJW, Eskander A, Deutsch K, Rashid S, Orsini M, Deganello A, Davies J, Enepekides D, Higgins K. Applications of intraoperative angiography in head and neck reconstruction. ACTA ACUST UNITED AC 2021; 41:215-220. [PMID: 34264914 PMCID: PMC8283404 DOI: 10.14639/0392-100x-n1161] [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: 10/05/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022]
Abstract
Objective Laser-assisted angiography with indocyanine green (LAIG) allows objective intraoperative evaluation of tissue vascularity. We endeavored to describe our experience with this technique in the head and neck region. Methods A retrospective review from February 2016 till October 2018 was conducted. We included patients who underwent head and neck procedures in which LAIG was employed. The main outcome was postoperative wound complications. We analysed the influence of LAIG results in intraoperative decision-making process. Results Nineteen patients were included, and follow-up was for at least 6 months. LAIG was employed in 11 local flaps, 9 free flaps and 6 cases of pharyngeal closure during total laryngectomies. Wound complications occurred in two cases with distal tip flap necrosis. LAIG findings resulted in changes in decision making intraoperatively in 84% of procedures, which consisted in trimming poorly perfused tissues. There were no pharyngocutaneous fistulas. Conclusions This represents a descriptive report on the use of LAIG on diverse head and neck reconstruction cases, with important impact on the decision-making process. A low number of postoperative wound complications were observed.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Tommaso Gualtieri
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.,Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - John J W Lee
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Konrado Deutsch
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Rashid
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mario Orsini
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Joel Davies
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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15
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Sahovaler A, Gualtieri T, Palma D, Fung K, MacNeil SD, Yoo J, Nichols A. Head and neck cancer patients declining curative treatment: a case series and literature review. ACTA ACUST UNITED AC 2021; 41:18-23. [PMID: 33746218 PMCID: PMC7982756 DOI: 10.14639/0392-100x-n1099] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022]
Abstract
There is a scarcity of data assessing outcomes of head and neck cancer patients who refuse treatment for potentially curable disease. We report the data of patients who refused curative treatment at a tertiary referral centre and perform a review of the literature. Patients with a potentially curable mucosal head and neck cancers that were discussed at the multidisciplinary tumour board of a referral centre in a two-year period were included. Two cohorts were obtained: patients who accepted the proposed treatment and those who declined it. Statistical analysis was performed using a univariate analysis with parametric and non-parametric tests. Of a total of 803 patients, 14 (1.74%) refused treatment despite being potentially curable. Their median survival was 6.92 months (range 3-12). Patients who refused treatment were older (73.07 years [95% CI, 66.86-79.28] vs 65.56 years [95% CI, 64.70-66.43], p = 0.030) and more likely to have T4 disease (50% vs 26.04%, p = 0.044). Most patients with curable disease accept conventional treatment and those who refuse it experience dismal outcomes. This report provides objective evidence and can be employed to better counsel patients who refuse curative treatment.
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Affiliation(s)
- Axel Sahovaler
- Otolaryngology-Head and Neck Surgery Department, Western University, London Ontario, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Tommaso Gualtieri
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.,Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - David Palma
- Radiation Oncology Department, Western University, London Ontario, Canada
| | - Kevin Fung
- Otolaryngology-Head and Neck Surgery Department, Western University, London Ontario, Canada
| | - S Danielle MacNeil
- Otolaryngology-Head and Neck Surgery Department, Western University, London Ontario, Canada
| | - John Yoo
- Otolaryngology-Head and Neck Surgery Department, Western University, London Ontario, Canada
| | - Anthony Nichols
- Otolaryngology-Head and Neck Surgery Department, Western University, London Ontario, Canada
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16
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Ernst H, Sowerby L, Sahovaler A, Macneil D, Nichols A, Yoo J, Hilsden R, Strychowsky J, Fung K. Rapid standardized operating rooms (RAPSTOR) in thyroid and parathyroid surgery. J Otolaryngol Head Neck Surg 2021; 50:44. [PMID: 34238389 PMCID: PMC8265141 DOI: 10.1186/s40463-021-00525-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/13/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a high efficiency rapid standardized OR (RAPSTOR) for hemithyroid/parathyroid surgery using standardized equipment sets (SES) and consecutive case scheduling (CCS) on turnover times (TOT), average case volumes, patient outcomes, hospital costs and OR efficiency/stress. METHODS Patients requiring hemithyroidectomy (primary or completion) or unilateral parathyroidectomy in a single surgeon's practice were scheduled consecutively with SES. Retrospective control groups were classified as sequential (CS) or non-sequential (CNS). A survey regarding OR efficiency/stress was administered. Phenomenography and descriptive statistics were conducted for time points, cost and patient outcome variables. Hospital cost minimization analysis was performed. RESULTS The mean TOT of RAPSTOR procedures (16 min; n = 27) was not significantly different than CS (14 min, n = 14) or CNS (17 min, n = 6). Mean case number per hour was significantly increased in RAPSTOR (1.2) compared to both CS (0.9; p < 0.05) and CNS (0.7; p < 0.05). Average operative time was significantly reduced in RAPSTOR (32 min; n = 28) compared to CNS (48 min; p < 0.05) but not CS (33 min; p = 0.06). Time to discharge was reduced in RAPSTOR (595 min) compared to CNS (1210 min, p < 0.05). There was no difference in complication rate between all groups (p = 0.27). Survey responses suggested improved efficiency, teamwork and workflow. Furthermore, there is associated decrease in direct operative costs for RAPSTOR vs. CS. CONCLUSION A high efficiency standardized OR for hemithyroid and parathyroid surgery using SES and CCS is associated with improved efficiency and, in this study, led to increased capacity at reduced cost without compromising patient safety. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Hannah Ernst
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Leigh Sowerby
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Axel Sahovaler
- Department of Head and Neck Surgery Unit, General Surgery Department, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Department of Otolaryngology- Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Macneil
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Richard Hilsden
- Department of Surgery, Division of General Surgery, Western University, London, Ontario, Canada
| | - Julie Strychowsky
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada.
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17
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Eskander A, Sahovaler A, Shin J, Deutsch K, Crowson M, Goyal N, Witsell DL, Schulz K, Gross ND, Weber R, Khariwala SS, Cohen S, CyrLee DW, Mehta V. A preliminary assessment of guideline adherence and clinical variation in oral cancer treatment: a MarketScan database study. BMC Oral Health 2021; 21:270. [PMID: 34001080 PMCID: PMC8130137 DOI: 10.1186/s12903-021-01616-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients. METHODS Retrospective study using a U.S. healthcare research database (MarketScan). Index diagnoses were considered from 2010 to 2012 with follow-up from 2013 to 2014. Diagnostic and procedure codes were utilized to identify oral cavity patients with a defined treatment modality. Compliance with guideline-recommended processes of care, which included pre-treatment imaging, thyroid-function testing (TFTs), multidisciplinary consultation and gastrostomy-tube insertion rates, were assessed. RESULTS A total of 2752 patients were identified. Surgery alone was the most common treatment (60.8%), followed by surgery with adjuvant chemoradiotherapy (20.4%) and surgery with adjuvant radiotherapy (18.8%). Head/neck and chest imaging were obtained in 60% and 62.5% of patients respectively. Significant geographical differences in head and neck imaging were observed between North-central (64%), South (58.4%) and West (56.1%) regions (p = 0.026). Differences in chest imaging were also present between North-east (65%) and West (56.8%; p = 0.007). TFTs were obtained in 54.4% of the patients after radiation treatment, and 18.6% of patients had multidisciplinary consultation during the 6 months before and 3 months after initiation of treatment. During the year after treatment initiation, 21.2% of patients underwent G-tube placement, with significantly higher rates in patients receiving triple modality treatment (58%) when compared to surgery plus radiation (27%) and surgery alone (15%; p < 0.01). CONCLUSION Adherence to evidence-based practices was low based on the database coding. These data suggest a potential to improve adherence and increase the routine use of practices delineated in national clinical practice guidelines. CLINICAL RELEVANCE This study reflects a suboptimal adherence to guidelines based on the database employed. This study should be considered by healthcare providers and efforts should be maximized to follow the processes of care which have proven to impact on patient's outcomes.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada.
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada
| | - Jennifer Shin
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Konrado Deutsch
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada
| | - Matthew Crowson
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - David L Witsell
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Kristine Schulz
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Randal Weber
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Seth Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Derek Walter CyrLee
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA.,Clinical Research Unit, Duke University, Durham, NC, USA
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, NY, USA
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18
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Gualtieri T, Ferrari M, Taboni S, Chan H, Townson J, Mattavelli D, Sahovaler A, Eu D, Dey K, Mathews S, Re F, Bernardi S, Borsani E, Viswanathan S, Nicolai P, Sartore L, Russo D, Gilbert R, Irish J. 3D-mapping of mesenchymal stem cells growth on bioengineered scaffolds for maxillofacial skeleton regeneration: a preclinical, in vitro study. Cytotherapy 2021. [DOI: 10.1016/s146532492100517x] [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: 11/15/2022]
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19
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Sahovaler A, Ziai H, Cardemil F, Huang SH, Su J, Goldstein DP, Gilbert R, Hosni A, Hope A, Waldron J, Spreafico A, Monteiro E, Witterick I, Irish J, Gullane P, Xu W, O'Sullivan B, de Almeida JR. Importance of Margins, Radiotherapy, and Systemic Therapy in Mucosal Melanoma of the Head and Neck. Laryngoscope 2021; 131:2269-2276. [PMID: 33856051 DOI: 10.1002/lary.29555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS The ideal strategy in the treatment of mucosal melanoma of the head and neck (MMHN) remains unclear. Our objective was to evaluate the importance of surgical margins, radiotherapy, and systemic therapy in MMHN. STUDY DESIGN Retrospective Single Institutional Review. METHODS Retrospective review of patients with MMHN treated at a tertiary care oncology center between 1999 and 2016. RESULTS Seventy-six patients were included, 60 of whom were treated with curative intent. Negative or close margins compared with positive margins were associated with higher 3-year overall survival (OS) (62% vs. 29% vs. 13% P = .012), disease-free survival (33% vs. 29% vs. 4% P = .003), and distant control (48% vs. 29% vs. 22% P = .039). Cases with pre-/postoperative radiotherapy had a marginally higher locoregional control versus without (69% vs. 59%, P = .117). Immunotherapy for recurrent and/or metastatic disease was associated with an increase in 3-year OS (15% vs. 3% P = .01). CONCLUSION Achieving negative surgical margins is relevant in disease control. Despite small sample size, our data suggest that radiotherapy may enhance surgical outcomes. Immunotherapy has therapeutic benefit. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Felipe Cardemil
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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20
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Sahovaler A, Chan HHL, Ferrari M, Gualtieri T, Zhang C, Taboni S, Irish JC, Gilbert RW. Objective evaluation of orbito-zygomatic reconstruction with scapular tip free flaps to restore facial projection and orbital volume. Oral Oncol 2021; 117:105268. [PMID: 33848724 DOI: 10.1016/j.oraloncology.2021.105268] [Citation(s) in RCA: 3] [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: 01/26/2021] [Revised: 03/13/2021] [Accepted: 03/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Restoring anatomical contour and position of the malar eminence and orbital rim following ablative mid-face procedures is critical in maintaining facial contour and orbit position. OBJECTIVE To report our reconstructive approach using the scapular tip free-flap (STFF) for orbito-zygomatic defects, evaluating contour and overall shape restoration. METHODS The study included 2 series: a clinical cohort of 15 consecutive patients who underwent an orbito-zygomatic reconstruction with a STFF and a cohort of 10 patients who had CT scan imaging but did not have orbito-zygomatic surgical resection or reconstruction. Using a 3D software, overall conformance (OC) and contour conformance (CC) with respect to the mirrored contralateral (clinical cohort) or native zygoma (preclinical cohort) were analyzed. Postoperative orbital volumes were also measured in the clinical cohort. Mean, median, root-mean-square (RMS), minimum and maximum measurements were obtained both for OC and CC. Conformance values of clinical and preclinical cohort were compared to objectively evaluate the quality of reconstruction in terms of orbito-zygomatic framework restoration (Mann-Whitney test). RESULTS All measurements for OC and CC between scapular tip and the zygoma showed no differences, both on the clinical (RMS: OC 3.29 mm vs CC 3.32 mm -p = NS-) and preclinical (RMS: OC 2.03 mm and CC 2.31 mm -p = NS-) cohorts. Moreover, there were no differences in post-operative orbital volumes in the clinical cohort. Clinical outcomes of the case-series are also reported. CONCLUSION The STFF is highly effective in restoring facial projection and orbital volume in orbito-zygomatic reconstruction.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Marco Ferrari
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - ASST "Spedali Civili di Brescia", Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, University of Padua - Azienda Ospedaliera di Padova, Padua, Italy
| | - Tommaso Gualtieri
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - ASST "Spedali Civili di Brescia", Brescia, Italy
| | - Charlotte Zhang
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Stefano Taboni
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - ASST "Spedali Civili di Brescia", Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, University of Padua - Azienda Ospedaliera di Padova, Padua, Italy
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada.
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21
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Sahovaler A, Ferrari M, Athayde J, Mendez A, Fung K, Yoo J, Nichols AC, MacNeil SD. Investigating the Sources of Heterogeneity in Systematic Review of Recurrence Rate after Hemithyroidectomy for Low-Risk Well-Differentiated Thyroid Cancer. Eur Thyroid J 2021; 10:179-182. [PMID: 33981623 PMCID: PMC8077353 DOI: 10.1159/000511870] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
- *Axel Sahovaler, Department of Otolaryngology − Head and Neck Surgery, London Health Science Centre, Victoria Hospital, Room B3-432A, 437.217.3481, 800 Commissioners Rd. E, London ON N6A 5W9 (Canada),
| | - Marco Ferrari
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
- Unit of Otorhinolaryngology − Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
- Section of Otorhinolaryngology − Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Jonathan Athayde
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony C. Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S. Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Sahovaler A, Kim MH, Mendez A, Palma D, Fung K, Yoo J, Nichols AC, MacNeil SD. Survival Outcomes in Human Papillomavirus-Associated Nonoropharyngeal Squamous Cell Carcinomas: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 146:1158-1166. [PMID: 33057610 DOI: 10.1001/jamaoto.2020.3382] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Although the survival impact of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OPSCC) is well known, there has been conflicting and scarce evidence on the role of HPV in non-OPSCC. Objective To undertake a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review and meta-analysis of all published studies on the association between HPV status and survival outcomes in patients with non-OPSCC, analyzing each site separately. Data Sources PubMed, CINAHL, and Embase were searched from 1946 to December 16, 2019, for English-language articles. Study Selection Analysis comprised randomized clinical trials or observational studies that each included at least 10 patients with non-OPSCC in which the presence of HPV was analyzed, survival outcomes were reported, and a clinical follow-up of 1 year or more was performed. Studies excluded were those in which data on OPSCC and non-OPSCC were not distinguished between both cohorts and studies on patients with distant metastatic tumors at diagnosis. Final analysis included outcomes that were analyzed in at least 3 studies. Data Extraction and Synthesis Two reviewers independently abstracted the data. Risk of bias was estimated with the Newcastle-Ottawa Scale. Meta-analysis was performed using the random-effects model. Main Outcomes and Measures The primary end point was overall survival (OS); secondary end points were disease-specific survival (DSS) and disease-free survival (DFS). Results Of the 3947 articles screened, a total of 22 observational and 2 randomized clinical trials were included in the analysis, representing 24 854 patients. In oral cavity locations, OS was not significantly associated with HPV positivity (hazard ratio [HR], 1.16; 95% CI, 0.83-1.61; I2 = 71%); however, HPV-positive tumors showed worse DFS (HR, 1.81; 95% CI, 1.12-2.91; I2 = 47%). Laryngeal and hypopharyngeal HPV-positive tumors were associated with improved OS (HR, 0.71; 95% CI, 0.54-0.92; I2 = 38% and HR, 0.60; 95% CI, 0.47-0.76; I2 = 0%), respectively, whereas, in nasopharyngeal locations HPV was not associated with OS (HR, 0.82; 95% CI, 0.49-1.38; I2 = 46%) or DSS (HR, 0.55; 95% CI, 0.22-1.42; I2 = 65%). Conclusions and Relevance In this meta-analysis of 24 studies, HPV was associated with improved OS in laryngeal and hypopharyngeal locations but not in the oral cavity and the nasopharynx. This information may be useful for future clinical studies of laryngeal and hypopharyngeal tumors and whether HPV status should be incorporated in prognostication of patients with these cancers.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Guided Therapeutics Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Min Hui Kim
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - David Palma
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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23
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Sahovaler A, Ferrari M, Chan H, Ziai H, Gilbert R, Irish J. Comparing Contour Restoration of Mandibular Body Defects With Fibula, Iliac Crest, and Scapular Tip Flaps: A Conformance Virtual Study. J Oral Maxillofac Surg 2020; 79:1345-1354. [PMID: 33508237 DOI: 10.1016/j.joms.2020.12.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/30/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to determine which of the most commonly used flaps restore contour more accurately in mandibular body reconstructions using conformance analyses and virtual measurements. METHODS Using normal computed tomography (CT) scans and a 3D software, mandibular body defects were virtually created. "Single shot" and osteotomized fibula flaps (SS-FF and O-FF), iliac crest flaps (ICF) and scapular tip flaps (STF) were digitally harvested and coregistered to reconstruct those defects. Conformance analyses were performed by calculating the root mean square (RMS) for overall and contour conformance. RESULTS Ten patients normal CT scans were included. The STF demonstrated improved overall conformance compared with the ICF, the SS-FF and the O-FF (RMS = 2.03 mm vs 4.53 mm vs 2.76 vs 2.37 mm, respectively; p<.001). Similar trends were seen for contour conformance in STF compared with the ICF and the SS-FF (RMS = 2.48 mm vs 4.50 mm vs 3.28 mm, respectively), whereas the O-FF performed better than STF (RMS = 1.85 mm vs 2.48 mm; p<.001). CONCLUSIONS The osseous component of the STF resembles the mandibular body more accurately than the one in the ICF and FF without the need for an osteotomy. Future clinical studies can help to elucidate the clinical impact of these virtual findings.
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Affiliation(s)
- Axel Sahovaler
- Fellow, Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Fellow, Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
| | - Marco Ferrari
- Fellow, Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Resident, Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy; and International Scholar, Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley Chan
- Research Associate, Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Resident, Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Professor, Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Irish
- Professor, Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
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24
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Sahovaler A, Berania I, Ferrari M, Ziai H, Jethwa A, Goldstein DP, de Almeida JR, Gilbert R. Temporal Artery Posterior Auricular Skin Free Flap for Secondary Oral Cavity Reconstruction. Laryngoscope 2020; 131:1297-1300. [PMID: 33320348 DOI: 10.1002/lary.29250] [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: 09/19/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Ilyes Berania
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Marco Ferrari
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.,Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Hedyeh Ziai
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ashok Jethwa
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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25
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Kassirian S, Dzioba A, Hamel S, Patel K, Sahovaler A, Palma DA, Read N, Venkatesan V, Nichols AC, Yoo J, Fung K, Mendez A, MacNeil SD. Delay in diagnosis of patients with head-and-neck cancer in Canada: impact of patient and provider delay. Curr Oncol 2020; 27:e467-e477. [PMID: 33173386 PMCID: PMC7606041 DOI: 10.3747/co.27.6547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/15/2022] Open
Abstract
Background Head-and-neck cancers (hncs) often present at an advanced stage, leading to poor outcomes. Late presentation might be attributable to patient delays (reluctance to seek treatment, for instance) or provider delays (misdiagnosis, prolonged wait time for consultation, for example). The objective of the present study was to examine the length and cause of such delays in a Canadian universal health care setting. Methods Patients presenting for the first time to the hnc multidisciplinary team (mdt) with a biopsy-proven hnc were recruited to this study. Patients completed a survey querying initial symptom presentation, their previous medical appointments, and length of time between appointments. Clinical and demographic data were collected for all patients. Results The average time for patients to have their first appointment at the mdt clinic was 15.1 months, consisting of 3.9 months for patients to see a health care provider (hcp) for the first time since symptom onset and 10.7 months from first hcp appointment to the mdt clinic. Patients saw an average of 3 hcps before the mdt clinic visit (range: 1-7). No significant differences in time to presentation were found based on stage at presentation or anatomic site. Conclusions At our tertiary care cancer centre, a patient's clinical pathway to being seen at the mdt clinic shows significant delays, particularly in the time from the first hcp visit to mdt referral. Possible methods to mitigate delay include education about hnc for patients and providers alike, and a more streamlined referral system.
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Affiliation(s)
- S Kassirian
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - A Dzioba
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - S Hamel
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - K Patel
- Department of Otolaryngology, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, U.S.A
| | - A Sahovaler
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - D A Palma
- Department of Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - N Read
- Department of Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - V Venkatesan
- Department of Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - A C Nichols
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - J Yoo
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - K Fung
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - A Mendez
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - S D MacNeil
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
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Ferrari M, Sahovaler A, Chan HH, Nicolai P, Irish JC, Gilbert RW. Scapular tip-thoracodorsal artery perforator free flap for total/subtotal glossectomy defects: Case series and conformance study. Oral Oncol 2020; 105:104660. [DOI: 10.1016/j.oraloncology.2020.104660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 12/09/2022]
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27
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Sahovaler A, Krishnan RJ, Yeh DH, Zhou Q, Palma D, Fung K, Yoo J, Nichols A, MacNeil SD. Outcomes of Cutaneous Squamous Cell Carcinoma in the Head and Neck Region With Regional Lymph Node Metastasis: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2020; 145:352-360. [PMID: 30844021 DOI: 10.1001/jamaoto.2018.4515] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance There is a need to summarize the available evidence and provide quantitative data of the most important prognostic factors for patients with metastatic cutaneous squamous cell carcinoma of the head and neck region with regional lymph node metastasis (McSCCHN). Objective To undertake a PRISMA-compliant systematic review and meta-analysis of all published studies on the risk factors for overall survival (OS), locoregional control (LRC), locoregional recurrence (LRR), and disease-specific survival (DSS) for patients with McSCCHN. Data Sources PubMed, CINAHL, and Embase were searched from 1946 to August 2018 for English-language articles. Study Selection Inclusion criteria were randomized clinical trials or observational studies reporting on at least 10 patients with McSCCHN; studies analyzing 1 defined risk factor; reporting OS, LRC, LRR, or DSS; and clinical follow-up of 1 year of more. For the final analysis we included risk factors that were analyzed for the same outcome in at least 3 studies. Of the 2923 articles screened, 21 articles met the inclusion criteria. Data Extraction and Synthesis PRISMA guidelines were used for abstracting the data. Two reviewers independently abstracted the data. Risk of bias was estimated with the Newcastle-Ottawa Scale. Meta-analysis was performed using the random-effects model. All analysis took place between January and October 2018. Main Outcomes and Measures The primary end point was OS. Secondary end points included LRC, LRR, and DSS. Results A total of 20 observational studies and 1 randomized clinical trial were identified, representing 3534 patients (some reviewed articles reported no demographic characteristics), and were included in the analysis. Significant risk factors associated with OS were immunosuppression (hazard ratio [HR] of death, 2.66; 95% CI, 2.26-3.13), extracapsular spread (HR, 1.90; 95% CI, 1.12-3.23), adjuvant radiotherapy (HR, 0.45; 95% CI, 0.27-0.78), lymph node ratio (HR, 1.91; 95% CI, 1.09-3.35), and advanced age (HR, 1.03; 95% CI, 1.00-1.07). Immunosuppression (HR, 3.82; 95% CI, 2.47-5.92) and adjuvant radiotherapy (HR, 0.52; 95% CI, 0.33-0.84) were also significant risk factors for DSS. Conclusions and Relevance Immunosuppressed patients and those with extracapsular extension have poor prognosis. Adjuvant radiotherapy is associated with an improvement in OS. These risk factors will assist with better risk stratification and may also help to inform future clinical trials.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Head and Neck Surgery Unit, General Surgery Department, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Rohin J Krishnan
- Epidemiology and Biostatistics Department, Western University, London, Ontario, Canada
| | - David H Yeh
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Qi Zhou
- Research Methods and Clinical Impact Department, McMaster University, Hamilton, Ontario, Canada
| | - David Palma
- Department of Oncology, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Mundi N, Prokopec SD, Ghasemi F, Warner A, Patel K, MacNeil D, Howlett C, Stecho W, Plantinga P, Pinto N, Ruicci KM, Khan MI, Han MW, Yoo J, Fung K, Sahovaler A, Palma DA, Winquist E, Mymryk JS, Barrett JW, Boutros PC, Nichols AC. Genomic and human papillomavirus profiling of an oral cancer cohort identifies TP53 as a predictor of overall survival. Cancers Head Neck 2019; 4:5. [PMID: 31844556 PMCID: PMC6894507 DOI: 10.1186/s41199-019-0045-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Abstract
Background The genomic landscape of head and neck cancer has been reported through The Cancer Genome Atlas project. We attempt to determine if high-risk human papillomavirus (HPV) or frequently mutated genes are correlated with survival in an oral cancer cohort. Methods Patient demographic data along with data from final pathology was collected. Tumor DNA was analyzed using a custom Illumina targeted sequencing panel. Five high-risk HPV types were tested by qPCR. Statistical analyses were used to identify associations between patient outcome and mutational status. Results High-risk HPV types were identified in 7% of cases; HPV status was not associated with survival. Mutations were identified in TP53, TERT promoter, & PIK3CA. Mutations in TP53 were significantly associated with poorer overall survival on multi-variate analysis (p = 0.03). Conclusions Mutations in TP53 were associated with poor patient survival. Expanding our sample size may identify further predictors of outcome to direct customized cancer care.
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Affiliation(s)
- Neil Mundi
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada.,2Victoria Hospital, London Health Science Centre, Room B3-431A, 800 Commissioners Road East, London, ON N6A 5W9 Canada
| | | | - Farhad Ghasemi
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada
| | - Andrew Warner
- 4Department of Oncology, Western University, London, ON Canada
| | - Krupal Patel
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada
| | - Danielle MacNeil
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada.,4Department of Oncology, Western University, London, ON Canada
| | | | - William Stecho
- 5Department of Pathology, Western University, London, ON Canada
| | - Paul Plantinga
- 5Department of Pathology, Western University, London, ON Canada
| | - Nicole Pinto
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada.,4Department of Oncology, Western University, London, ON Canada
| | - Kara M Ruicci
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada.,4Department of Oncology, Western University, London, ON Canada
| | - Mohammed Imran Khan
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada
| | - Myung Woul Han
- 6Department of Otolaryngology, College of Medicine, Ulsan University Hospital, University of Ulsan, Ulsan, South Korea
| | - John Yoo
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada.,4Department of Oncology, Western University, London, ON Canada
| | - Kevin Fung
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada.,4Department of Oncology, Western University, London, ON Canada
| | - Axel Sahovaler
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada
| | - David A Palma
- 4Department of Oncology, Western University, London, ON Canada
| | - Eric Winquist
- 4Department of Oncology, Western University, London, ON Canada
| | - Joe S Mymryk
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada.,4Department of Oncology, Western University, London, ON Canada.,7Department of Microbiology & Immunology, Western University, London, ON Canada
| | - John W Barrett
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada.,4Department of Oncology, Western University, London, ON Canada
| | - Paul C Boutros
- 3Ontario Institute for Cancer Research, Toronto, ON Canada.,8Department of Medical Biophysics, University of Toronto, Toronto, ON Canada.,9Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada
| | - Anthony C Nichols
- 1Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON Canada.,4Department of Oncology, Western University, London, ON Canada
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Ferrari M, Daly MJ, Douglas CM, Chan HHL, Qiu J, Deganello A, Taboni S, Thomas CM, Sahovaler A, Jethwa AR, Hasan W, Nicolai P, Gilbert RW, Irish JC. Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study. Oral Oncol 2019; 99:104463. [PMID: 31683173 DOI: 10.1016/j.oraloncology.2019.104463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 07/23/2019] [Revised: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. MATERIALS AND METHODS Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. RESULTS The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). CONCLUSION This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting - with rigorous assessment of oncological outcomes - would be the proposed next step.
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Affiliation(s)
- Marco Ferrari
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Catriona M Douglas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Carissa M Thomas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Ashok R Jethwa
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Wael Hasan
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
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So T, Sahovaler A, Nichols A, Fung K, Yoo J, Weir MM, MacNeil SD. Utility of clinical features with fine needle aspiration biopsy for diagnosis of Warthin tumor. J Otolaryngol Head Neck Surg 2019; 48:41. [PMID: 31464652 PMCID: PMC6716907 DOI: 10.1186/s40463-019-0366-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/17/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022] Open
Abstract
Background Conservative management of Warthin tumor (WT) may be a viable alternative to surgery, but there are concerns of missed malignancies on fine needle aspiration biopsy (FNAB). The purpose of this study is to measure the sensitivity and positive predictive value of FNAB for WT, and to identify clinical features associated with WT that can aid in this diagnosis. Methods Retrospective analysis of patients from January 1, 2006 to April 30, 2017 at a tertiary care center in London, Ontario, Canada. All patients with a diagnosis of WT on FNAB or resection were included. Electronic medical records were identified for 177 patients that fit the criteria. Study outcomes included the sensitivity and positive predictive value of FNAB alone for WT, and, when including clinical features associated with WT. Results The mean age of patients in this study was 63.2 years (SD 10.4); 115 (65%) were male, and 157 (89%) were past or present smokers. The measured sensitivity and positive predictive value of FNAB for WT were 95.8 and 97.2% respectively. Two cases were classified as WT on FNAB but confirmed at resection as mucoepidermoid carcinoma and acinic cell carcinoma. When only patients with multifocal, bilateral or incidental tumors were assessed, sensitivities and positive predictive values for each were 100%. Isolating for inferior pole location also resulted in a positive predictive value of 100%. Conclusions The sensitivity and positive predictive value of FNAB for WT in this study are high, with two false negatives on FNAB. Multifocal, bilateral, incidentaloma and inferior pole location were identified as potential clinical features that may increase the diagnostic confidence for WT, strengthening the argument for conservative management in these patients. Overall, this study serves as an initial exploration into whether clinical features may be included with FNAB results to improve the sensitivity and positive predictive value of diagnosing WT. Further research is necessary before these findings can be translated into clinical practice.
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Affiliation(s)
- Thomas So
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada
| | - Michele M Weir
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada. .,Victoria Hospital, Suite B3-429, 800 Commissioners Rd E, 31, London, ON, N6A 5W9, Canada.
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Sahovaler A, Higgins K, Deutsch K, Eskander A, Enepekides D. Innovative insertion of the palmaris major tendon after lower lip reconstruction. Laryngoscope 2019; 129:2479-2481. [PMID: 30724365 DOI: 10.1002/lary.27825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/26/2018] [Accepted: 12/31/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Head and Neck Surgery Unit, General Surgery Department, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Konrado Deutsch
- Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Ghasemi F, Prokopec SD, MacNeil D, Mundi N, Gameiro SF, Howlett C, Stecho W, Plantinga P, Pinto N, Ruicci KM, Khan MI, Yoo J, Fung K, Sahovaler A, Palma DA, Winquist E, Mymryk JS, Barrett JW, Boutros PC, Nichols AC. Mutational analysis of head and neck squamous cell carcinoma stratified by smoking status. JCI Insight 2019; 4:123443. [PMID: 30626742 DOI: 10.1172/jci.insight.123443] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/20/2018] [Indexed: 12/14/2022] Open
Abstract
Smoking has historically been recognized as a negative prognostic factor in head and neck squamous cell carcinoma (HNSCC). This study aimed to assess the mutational differences between heavy smokers (>20 pack years) and never smokers among the HNSCC patients within The Cancer Genome Atlas (TCGA). Single nucleotide variation and copy number aberration differences between heavy smokers and never smokers were compared within human papillomavirus-positive (HPV-positive) (n = 67) and HPV-negative (n = 431) TCGA cohorts with HNSCC, and the impact of these mutations on survival were assessed. No genes were differentially mutated between smoking and never-smoking patients with HPV-positive tumors. By contrast, in HPV-negative tumors, NSD1 and COL1A11 were found to be more frequently mutated in heavy smokers, while CASP8 was more frequently altered in never smokers. HPV-negative patients with NSD1 mutations experienced significantly improved overall survival compared with NSD1 WT patients. This improved prognosis was validated in an independent cohort of 77 oral cavity cancer patients and a meta-analysis that included 2 additional data sets (688 total patients, hazard ratio for death 0.44, 95% CI, 0.30-0.65). NSD1 mutations are more common in HPV-negative heavy smokers, define a cohort with favorable prognosis, and may represent a clinically useful biomarker to guide treatment deintensification for HPV-negative patients.
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Affiliation(s)
- Farhad Ghasemi
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | | | - Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology
| | - Neil Mundi
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | | | - Christopher Howlett
- Department of Pathology University of Western Ontario, London, Ontario, Canada
| | - William Stecho
- Department of Pathology University of Western Ontario, London, Ontario, Canada
| | - Paul Plantinga
- Department of Pathology University of Western Ontario, London, Ontario, Canada
| | - Nicole Pinto
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology
| | - Kara M Ruicci
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology
| | - Mohammed Imran Khan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology
| | - Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | | | | | - Joe S Mymryk
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology.,Department of Microbiology & Immunology, and
| | - John W Barrett
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology
| | - Paul C Boutros
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Department of Medical Biophysics and.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology
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Prasad J, Sahovaler A, Theurer J, Yeh DH, Fung K, MacNeil SD, Yoo J, Nichols AC. Predictors of plate extrusion in oromandibular free flap reconstruction. Microsurgery 2018; 38:682-689. [DOI: 10.1002/micr.30349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 05/03/2018] [Accepted: 06/08/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica Prasad
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry; Western University; London Ontario Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry; Western University; London Ontario Canada
- General Surgery Department, Head and Neck Surgery Unit; Italian Hospital of Buenos Aires; Buenos Aires Argentina
| | - Julie Theurer
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry; Western University; London Ontario Canada
| | - David H. Yeh
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry; Western University; London Ontario Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry; Western University; London Ontario Canada
| | - S. Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry; Western University; London Ontario Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry; Western University; London Ontario Canada
| | - Anthony C. Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry; Western University; London Ontario Canada
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Sahovaler A, Yeh D, Yoo J. Primary facial reanimation in head and neck cancer. Oral Oncol 2017; 74:171-180. [DOI: 10.1016/j.oraloncology.2017.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/15/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
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Sahovaler A, Yeh DH, Morrison D, de Ribaupierre S, Izawa J, Power A, Inculet R, Parry N, Palma DA, Landis M, Leung A, Fung K, MacNeil SD, Yoo J, Nichols AC. The incidence and management of non-head and neck incidentalomas for the head and neck surgeon. Oral Oncol 2017; 74:98-104. [PMID: 29103759 DOI: 10.1016/j.oraloncology.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/16/2017] [Accepted: 09/02/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - David H Yeh
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Deric Morrison
- Department of Medicine, Division of Endocrinology, Western University, London Ontario, Canada
| | - Sandrine de Ribaupierre
- Department of Clinical Neurological Science, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jonathan Izawa
- Department of Surgery, Divisions of Urology and Surgical Oncology, Schulich School of Medicine & Dentistry Western University, Canada
| | - Adam Power
- Department of Surgery, Division of Vascular Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Richard Inculet
- Division of Thoracic Surgery, Department of Surgery, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Neil Parry
- Divisions of General Surgery and Critical Care, Departments of Surgery and Medicine, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - David A Palma
- Department of Radiation Oncology, London Regional Cancer Program, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Mark Landis
- Department of Radiology, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Andrew Leung
- Department of Radiology, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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Vaccarezza H, Sahovaler A, Im V, Rossi G, Vaccaro C. Hand-assisted laparoscopic colorectal surgery with double-glove technique. Surg Pract 2016. [DOI: 10.1111/1744-1633.12190] [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: 11/29/2022]
Affiliation(s)
- Hernán Vaccarezza
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Axel Sahovaler
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Víctor Im
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Gustavo Rossi
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Carlos Vaccaro
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
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37
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Larrañaga JJ, Sahovaler A, Picco PI, Mazzaro EL, Figari MF. Management Issues in the Treatment of an Ameloblastoma with an Atypical Presentation. Craniomaxillofac Trauma Reconstr 2015; 8:257-61. [PMID: 26269737 DOI: 10.1055/s-0035-1549012] [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: 08/21/2014] [Accepted: 11/01/2014] [Indexed: 10/23/2022] Open
Abstract
Benign ameloblastoma (BA) is the most common tumor arising from the odontogenic epithelium. Surgical resection with adequate margins is the mainstay of treatment due to the high index of tumor recurrence when not completely excised. Although locoregional spread has been described in the literature, it is very uncommon. We describe the treatment and follow-up of a 22-year-old woman with multiple recurrences and locoregional spread of a mandibular ameloblastoma who was referred to our center after several tumor resections with subsequent reconstructions. After a complete macroscopical removal of a new recurrence, the mandible was primarily reconstructed. A local homolateral recurrence and a second lesion in the contralateral maxilla were detected after 1-year follow-up and accordingly treated. After 4 years the patient showed a new tumor in the temporal fossa and was reoperated. The histopathology was consistent with a BA in all cases. Even though it is rare, locoregional spread of BA has been reported previously. Recurrences discovered during follow-up may require further resections. A close follow-up is mandatory, and treatment of these cases may result demanding requiring a multiple team approach, including oncologists and radiotherapists.
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Affiliation(s)
- Juan José Larrañaga
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Axel Sahovaler
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pedro Ignacio Picco
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo Luis Mazzaro
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Fernando Figari
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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