1
|
Gallo N, Ahmed R, Palmer G, Foley B, Haughey BH. Management of infraclavicular squamous cell carcinoma exposing a pacemaker with a fasciocutaneous flap. JAAD Case Rep 2022; 26:38-40. [PMID: 35865724 PMCID: PMC9294472 DOI: 10.1016/j.jdcr.2022.05.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nina Gallo
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - George Palmer
- Advent Health Cardiovascular Surgery, Celebration, Florida
| | - Brandon Foley
- University of Central Florida College of Medicine, Orlando, Florida
| | - Bruce H Haughey
- Advent Health Otolaryngology-Head and Neck Surgery, Celebration, Orlando, Florida.,Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida
| |
Collapse
|
2
|
Britt CJ, Hwang MS, Day AT, Boahene K, Byrne P, Haughey BH, Desai SC. A Review of and Algorithmic Approach to Soft Palate Reconstruction. JAMA FACIAL PLAST SU 2020; 21:332-339. [PMID: 30920582 DOI: 10.1001/jamafacial.2019.0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The soft palate contributes to deglutition, articulation, and respiration. Current reconstructive techniques focus on restoration of both form and function. The unique challenges of soft palate reconstruction include maintenance of complex upper aerodigestive tract function, with minimal local or donor site morbidity. Objective To review the literature on soft palate reconstruction and present an algorithm on how to approach soft palate defects based on this review. Evidence Review A review of the literature for articles reporting studies on and that described concepts related to soft palate reconstruction was conducted in March 2017. In all, 1804 candidate titles and abstracts were independently reviewed. English-language articles that discussed acquired soft palate defect reconstruction were included. Non-English language studies without available translations, studies on primary soft palate defect reconstruction (ie, cleft palate repair) and primary cleft palate repair, studies in which the soft palate was not the focus of the article, and studies involving animals were excluded. Findings The following observations were made from the review of 92 included articles. Soft palate anatomy is a complex interplay of multiple structures working in a 3-dimensional area. Three of the authors created an initial algorithmic framework based on the selected studies. After this, a round table discussion among 3 authors considered experts was used to refine the algorithm based on their expert opinion. The 4 most important factors were determined to be defect size, defect extension to other subsites, defect thickness, and history of radiotherapy or planned radiotherapy. This algorithm includes both surgical and nonsurgical options. Defects in the soft palate not only affect the size and shape of the organ but, more critically, the function. The reconstructive ladder is used to help maximize the remaining soft palate functional tissue and minimize the effect of nonfunctional implanted tissue. Partial-thickness defects or defects less than one-fourth of the soft palate may not require locoregional tissue transfer. Patients with a history of radiotherapy or defects of up to 75% of the soft palate may require locoregional tissue transfer. Defects greater than 75% of the soft palate, defects that include exposure of the neck vasculature, or defects that include significant portions of the hard palate or adjacent oropharyngeal subsites may require free tissue transfer. Obturation should be considered a second-line option in most cases. Conclusions and Relevance Ideal reconstruction of the soft palate relies on a comprehensive understanding of soft palate anatomy, a full consideration of the armamentarium of surgical techniques, consideration for adjacent subsite deficits, and a detailed knowledge of various intrinsic and extrinsic patient factors to optimize speech, swallowing, and airway outcomes. The included algorithm may serve as a useful starting point for the surgeon when considering reconstruction.
Collapse
Affiliation(s)
- Christopher J Britt
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Michelle S Hwang
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Kofi Boahene
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick Byrne
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bruce H Haughey
- Department of Otolaryngology-Head and Neck Surgery, AdventHealth Celebration Hospital, Orlando, Florida
| | - Shaun C Desai
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
3
|
Gay HA, Oh JH, Apte AP, Daly MD, Adkins DR, Rich J, Oppelt PJ, Dyk PT, Mullen DF, Eschen L, Chin RI, Nussenbaum B, Haughey BH, Thorstad WL, Deasy JO. Predictors of acute throat or esophageal patient reported pain during radiation therapy for head and neck cancer. Clin Transl Radiat Oncol 2018; 13:1-6. [PMID: 30211324 PMCID: PMC6134163 DOI: 10.1016/j.ctro.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/20/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/29/2022] Open
Abstract
Background and purpose Acute pain during weekly radiotherapy (RT) to the head and neck is not well characterized. We studied dose-volume metrics and clinical variables that are plausibly associated with throat or esophageal pain as measured with a weekly questionnaire during RT. Materials and methods We prospectively collected weekly patient-reported outcomes from 122 head and neck cancer patients during RT. The pain score for each question consisted of a four-level scale: none (0), mild (1), moderate (2), and severe (3). Univariate and multivariate ordinal logistic regression analyses were performed to investigate associations between both esophageal and throat pain and clinical as well as dosimetric variables. Results In multivariate analysis, age was significantly associated with both types of pain, leading to odds ratio (OR) = 0.95 (p = 0.008) and OR = 0.95 (p = 0.007) for esophageal and throat pain, respectively. For throat pain, sex (OR = 4.12; p = 0.010), with females at higher risk, and fractional organ at risk (OAR) mean dose (OR = 3.30; p = 0.014) were significantly associated with throat pain. Conclusions A fractional OAR mean dose of 1.1 Gy seems a reasonable cutoff for separating no or mild pain from moderate to severe esophageal and throat pain. Younger patients who received RT experienced more esophageal and throat pain. Females experienced more throat pain, but not esophageal pain.
Collapse
Affiliation(s)
- Hiram A Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Aditya P Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Mackenzie D Daly
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Douglas R Adkins
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, United States.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States
| | - Jason Rich
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO, United States
| | - Peter J Oppelt
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Pawel T Dyk
- Department of Radiation Oncology, Missouri Baptist Cancer Center, St. Louis, MO, United States
| | - Daniel F Mullen
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Laura Eschen
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Re-I Chin
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | | | - Bruce H Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, United States
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| |
Collapse
|
4
|
Sinha P, Haughey BH, Kallogjeri D, Jackson RS. Long‐term analysis of transorally resected p16 + Oropharynx cancer: Outcomes and prognostic factors. Laryngoscope 2018; 129:1141-1149. [DOI: 10.1002/lary.27472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| | - Bruce H. Haughey
- Department of Head and Neck SurgeryFlorida Hospital Celebration Health, Celebration Florida U.S.A
- Department of SurgeryUniversity of Auckland Faculty of Medicine and Health Sciences Auckland New Zealand
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| |
Collapse
|
5
|
Zenga J, Pipkorn P, Graboyes EM, Martin EJ, Rich JT, Moore EJ, Haughey BH, Jackson RS. Oncologic outcomes of extended neck dissections in human papillomavirus-related oropharyngeal squamous cell carcinoma. Head Neck 2018; 40:955-962. [PMID: 29377416 DOI: 10.1002/hed.25060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/12/2017] [Accepted: 11/22/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Oncologic outcomes of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC) requiring resection of major muscular or neurovascular tissue during neck dissection for invasive nodal disease remain uncertain. METHODS Patients with HPV-related oropharyngeal SCC requiring resection of major muscular or neurovascular tissue during their neck dissections were retrospectively identified. RESULTS Seventy-two patients were included. Regional and distant recurrences occurred in 6% and 17% of patients. Advanced T classification, pathological node number of 5 or more, and omission of adjuvant therapy were associated with decreased disease-free survival (DFS). The addition of adjuvant chemotherapy was not associated with improved survival. CONCLUSION Patients with invasive nodal disease from HPV-related oropharyngeal SCC can be managed with up-front surgery and adjuvant therapy, as indicated with good regional control. Although distant recurrence was the primary site of failure, adjuvant chemotherapy was not associated with improved outcomes. The T classification, node number, and adjuvant radiotherapy are independent prognostic factors in this patient population.
Collapse
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology - Head and Neck Surgery, Washington University, Saint Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Washington University, Saint Louis, Missouri
| | - Evan M Graboyes
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Eliot J Martin
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jason T Rich
- Department of Otolaryngology - Head and Neck Surgery, Washington University, Saint Louis, Missouri
| | - Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Bruce H Haughey
- Department of Surgery, University of Auckland Faculty of Medicine, Auckland, New Zealand.,Head and Neck Surgery Center of Florida, Celebration Hospital, Celebration, Florida
| | - Ryan S Jackson
- Department of Otolaryngology - Head and Neck Surgery, Washington University, Saint Louis, Missouri
| |
Collapse
|
6
|
Jackson RS, Sinha P, Zenga J, Kallogjeri D, Suko J, Martin E, Moore EJ, Haughey BH. Transoral Resection of Human Papillomavirus (HPV)-Positive Squamous Cell Carcinoma of the Oropharynx: Outcomes with and Without Adjuvant Therapy. Ann Surg Oncol 2017; 24:3494-3501. [PMID: 28808988 PMCID: PMC9012985 DOI: 10.1245/s10434-017-6041-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 12/04/2023]
Abstract
BACKGROUND With the rise of oropharyngeal squamous cell carcinoma associated with human papillomavirus (HPV), appropriate treatment strategies continue to be tailored toward minimizing treatment while preserving oncologic outcomes. This study aimed to compare the outcomes for those undergoing transoral resection with or without adjuvant therapy for HPV-related oropharyngeal carcinoma. METHODS A case-match cohort analysis was performed at two institutions on patients with HPV-related oropharyngeal squamous cell carcinoma. All the subjects underwent transoral surgery and neck dissection. The patients treated with surgery alone were matched 1:1 to those treated with surgery and adjuvant therapy using two groups identified as confounders: T-stage (T1/2 or T3/4) and number of pathologically positive lymph nodes (≤4 or >4). RESULTS The study identified 105 matched pairs, with a median follow-up period of 42 months (range 3.1-102.3 months). The patients were staged as T1/T2 (86%) or T3/4 (14%). Each group had five patients with more than four positive lymph nodes. Adjuvant therapy significantly improved disease-free survival (hazard ratio [HR] 0.067; 95% confidence interval [CI] 0.01-0.62) and was associated with a lower risk of local and regional recurrence (risk ratio [RR] 0.096; 95% CI 0.02-0.47). No difference in disease-specific survival (HR 0.22; 95% CI 0.02-2.57) or overall survival (HR 0.18; 95% CI 0.01-2.4) was observed with the addition of adjuvant therapy. The risk of the gastrostomy tube was higher for those receiving adjuvant therapy (RR 7.3; 95% CI 2.6-20.6). CONCLUSIONS Transoral surgery is an effective approach for the treatment of HPV-related oropharyngeal carcinoma. The addition of adjuvant therapy appears to decrease the risk of recurrence and improve disease-free survival but may not significantly improve overall survival.
Collapse
Affiliation(s)
- Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA.
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
| | - Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
- Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA
| | - Jasmina Suko
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
- Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA
| | - Eliot Martin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bruce H Haughey
- Head and Neck Surgery Center of Florida, Florida Hospital Celebration Health and Florida Hospital Cancer Institute, Celebration, FL, USA
| |
Collapse
|
7
|
Chin RI, Rao YJ, Hwang MY, Spencer CR, Pierro M, DeWees T, Patel P, Sinha P, Gay HA, Daly M, Haughey BH, Nussenbaum B, Adkins DR, Lewis JS, Thorstad WL. Comparison of unilateral versus bilateral intensity-modulated radiotherapy for surgically treated squamous cell carcinoma of the palatine tonsil. Cancer 2017; 123:4594-4607. [DOI: 10.1002/cncr.30931] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Re-I Chin
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Yuan James Rao
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Michael Y. Hwang
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Christopher R. Spencer
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Michael Pierro
- Department of Internal Medicine; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Todd DeWees
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Pranav Patel
- Department of Internal Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Parul Sinha
- Division of Head and Neck Surgery; Department of Otolaryngology, Washington University School of Medicine; St. Louis Missouri
| | - Hiram A. Gay
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Mackenzie Daly
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Bruce H. Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration; Florida
| | - Brian Nussenbaum
- Division of Head and Neck Surgery; Department of Otolaryngology, Washington University School of Medicine; St. Louis Missouri
| | - Douglas R. Adkins
- Division of Hematology and Oncology; Department of Internal Medicine, Washington University School of Medicine; St. Louis Missouri
| | - James S. Lewis
- Department of Pathology; Microbiology, and Immunology, Vanderbilt University School of Medicine; Nashville Tennessee
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| |
Collapse
|
8
|
Kligerman MP, Song Y, Schoppy D, Divi V, Megwalu UC, Haughey BH, Sirjani D. Retrograde Parotidectomy and facial nerve outcomes: A case series of 44 patients. Am J Otolaryngol 2017. [PMID: 28647300 DOI: 10.1016/j.amjoto.2017.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The most common surgical method to remove benign parotid tumors remains the prograde approach. We examined if a retrograde surgical technique offers better outcomes than historical prograde controls. MATERIALS AND METHODS A retrospective chart review at Stanford Hospital was conducted to identify retrograde parotidectomies between February 2012 and October 2014 that were staffed by the senior author (DS) with resident involvement. Facial nerve (FN) outcomes and other post-surgical parameters were recorded. RESULTS We identified 44 consecutive cases and found that 18.2% (n=8) of patients experienced temporary paresis and 2.3% (n=1) experienced minor (HB 2) permanent paresis limited to one branch. The average hospital length of stay was 0.64 days and complication rate was 6.8%. CONCLUSION The retrograde technique has complication rates comparable to historical rates for the prograde technique and is amenable to minimally invasive outpatient superficial parotidectomy.
Collapse
|
9
|
Jackson RS, Sinha P, Zenga J, Kallogjeri D, Suko J, Martin E, Moore EJ, Haughey BH. Erratum to: Transoral Resection of Human Papillomavirus (HPV)-Positive Squamous Cell Carcinoma of the Oropharynx: Outcomes with and Without Adjuvant Therapy. Ann Surg Oncol 2017; 24:695. [PMID: 28849373 DOI: 10.1245/s10434-017-6068-z] [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: 11/18/2022]
Affiliation(s)
- Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, St. Louis, MO, USA.
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, St. Louis, MO, USA
| | - Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, St. Louis, MO, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, St. Louis, MO, USA.,Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA
| | - Jasmina Suko
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, St. Louis, MO, USA.,Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA
| | - Eliot Martin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bruce H Haughey
- Head and Neck Surgery Center of Florida, Florida Hospital Celebration Health and Florida Hospital Cancer Institute, Celebration, FL, USA
| |
Collapse
|
10
|
Sinha P, Yuen SN, Chernock RD, Haughey BH. Mandibular Lytic Lesion in Familial Paraganglioma Syndrome Type I: A Clinical Conundrum. Ann Otol Rhinol Laryngol 2017; 126:615-618. [DOI: 10.1177/0003489417717502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Parul Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sonia N. Yuen
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rebecca D. Chernock
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bruce H. Haughey
- Department of Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, Florida, USA
- Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand
| |
Collapse
|
11
|
Pipkorn P, Sinha P, Zenga J, Graboyes E, Haughey BH. Acellular dermal graft pharyngeal repair augmentation after laryngectomy. Am J Otolaryngol 2017; 38:329-332. [PMID: 28196713 DOI: 10.1016/j.amjoto.2017.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/29/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Pharyngocutaneous fistula (PCF) after laryngectomy continues to be a serious complication, especially after radiation. Recruitment of non-radiated tissue into the surgical defect may decrease the risk of fistula. These techniques however have significant morbidity and increases operative time. We hypothesized that using acellular dermal graft to reinforce the pharyngeal closure could decrease the risk of fistula, without the added morbidity of a vascularized flap. METHODS We performed a retrospective chart review of all patients that underwent a laryngectomy between 2005 and 2015 at an acedemic tertiary referral center. Patients who underwent primary pharyngeal closure with Alloderm® reinforcement without any other flap reconstruction were identified. Basic demographics, previous treatment, operative technique and fistula were extracted from the medical records. The primary outcome was PCF rate. The time to closure, margin status and disease recurrence was also evaluated. RESULTS Among 16 patients with AlloDerm® augmentation, eight had primary laryngectomy and eight had salvage laryngectomy. A total of three in the salvage laryngectomy with prior history of radiation developed PCF. The fistula closed in all three cases with conservative treatment. There was no PCF in the primary laryngectomy group without prior history of radiation. CONCLUSION The rate of PCF among the salvage laryngectomy group with previous radiation did not differ from historical data. AlloDerm® can however, provide a simple alternative for repair in radiation patients where flap cannot be performed for pharyngeal reconstruction. In non-radiated patients, AlloDerm® augmentation may have a protective effect on fistula formation.
Collapse
|
12
|
Day AT, Haughey BH, Rich JT. Prevertebral muscle flap for internal carotid artery coverage during oropharyngeal transoral surgery. Laryngoscope 2017; 127:2256-2259. [DOI: 10.1002/lary.26542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/28/2016] [Accepted: 01/25/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew T. Day
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - Bruce H. Haughey
- Department of Head and Neck Surgery; Florida Hospital Celebration Health; Celebration Florida U.S.A
- Department of Surgery; University of Auckland; Auckland New Zealand
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis School of Medicine; Saint Louis Missouri U.S.A
| |
Collapse
|
13
|
Sinha P, Pipkorn P, Zenga J, Haughey BH. The Hybrid Transoral-Pharyngotomy Approach to Oropharyngeal Carcinoma: Technique and Outcome. Ann Otol Rhinol Laryngol 2017; 126:357-364. [DOI: 10.1177/0003489417691297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The indications, techniques, and outcomes for a minimally invasive surgical approach in oropharyngeal squamous cell carcinoma (OPSCC) unsuitable for transoral resection are not well-described. Methods: A retrospective case series was performed using a prospectively assembled database of transoral surgery–treated OPSCC patients who also underwent a “hybrid” approach of combined transoral and limited pharyngotomy for tumor resection. Disease and functional outcomes were evaluated. Results: Twenty patients underwent complete tumor resection using the hybrid approach. Median follow-up was 48 months. No postoperative pharyngocutaneous fistula occurred. One patient (5%) had a local recurrence. Kaplan-Meier estimates for disease-specific survival at 2 and 5 years were 94.4% (95% CI, 84%-100%) and 87% (95% CI, 70%-100%). All but 1 patient (due to chemoradiotherapy-related chondroradionecrosis) were decannulated, and 2 required long-term gastrostomy. Conclusion: In the absence of a favorable transoral access, the “hybrid” approach of combined transoral and limited pharyngotomy can accomplish margin-negative primary tumor resection, with a high degree of disease control and functional recovery in selected OPSCC patients.
Collapse
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bruce H. Haughey
- Department of Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, Florida, USA
- Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand
| |
Collapse
|
14
|
Zenga J, Haughey BH, Jackson RS, Adkins DR, Aranake-Chrisinger J, Bhatt N, Gay HA, Kallogjeri D, Martin EJ, Moore EJ, Paniello RC, Rich JT, Thorstad WL, Nussenbaum B. Outcomes of surgically treated human papillomavirus-related oropharyngeal squamous cell carcinoma with N3 disease. Laryngoscope 2016; 127:2033-2037. [PMID: 28008626 DOI: 10.1002/lary.26455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/29/2016] [Accepted: 11/14/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Bruce H. Haughey
- Department of Surgery; University of Auckland Faculty of Medicine; Auckland New Zealand
- Head and Neck Surgery Center of Florida; Celebration Hospital, Celebration; Florida U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Douglas R. Adkins
- Department of Medical Oncology; Washington University; St. Louis Missouri U.S.A
| | | | - Neel Bhatt
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Hiram A. Gay
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Eliot J. Martin
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Randal C. Paniello
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| |
Collapse
|
15
|
Sinha P, Haughey BH, Kallogjeri D, Spitznagel EL, Piccirillo JF. The role of postoperative chemoradiation for oropharyngeal carcinoma: A critical appraisal revisited. Cancer 2016; 123:887-888. [DOI: 10.1002/cncr.30480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/11/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis School of Medicine; St. Louis Missouri
| | - Bruce H. Haughey
- Head and Neck Surgery; Florida Hospital Celebration Health; Celebration Florida
- Department of Surgery; University of Auckland Faculty of Medicine and Health Sciences; Auckland New Zealand
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis School of Medicine; St. Louis Missouri
| | - Edward L. Spitznagel
- Department of Mathematics; Washington University in St. Louis; St. Louis Missouri
| | - Jay F. Piccirillo
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis School of Medicine; St. Louis Missouri
| |
Collapse
|
16
|
Affiliation(s)
- Bruce H Haughey
- Saint Louis MO; Goettingen Germany; Barcelona Spain; Scottsdale AZ; Jacksonville FL; Boston MA
| | - Wolfgang Steiner
- Saint Louis MO; Goettingen Germany; Barcelona Spain; Scottsdale AZ; Jacksonville FL; Boston MA
| | | | - Michael L Hinni
- Saint Louis MO; Goettingen Germany; Barcelona Spain; Scottsdale AZ; Jacksonville FL; Boston MA
| | - John R Salassa
- Saint Louis MO; Goettingen Germany; Barcelona Spain; Scottsdale AZ; Jacksonville FL; Boston MA
| | - Steven M Zeitels
- Saint Louis MO; Goettingen Germany; Barcelona Spain; Scottsdale AZ; Jacksonville FL; Boston MA
| |
Collapse
|
17
|
Uppaluri R, Winkler AE, Lin T, Law JH, Haughey BH, Nussenbaum B, Paniello RC, Rich JT, Diaz JA, Michel LP, Wildes T, Dunn GP, Zolkind P, Kallogjeri D, Piccirillo JF, Dehdashti F, Siegel BA, Chernock RD, Lewis JS, Adkins DR. Biomarker and Tumor Responses of Oral Cavity Squamous Cell Carcinoma to Trametinib: A Phase II Neoadjuvant Window-of-Opportunity Clinical Trial. Clin Cancer Res 2016; 23:2186-2194. [PMID: 28151720 DOI: 10.1158/1078-0432.ccr-16-1469] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 01/30/2023]
Abstract
Purpose: Ras/MEK/ERK pathway activation is common in oral cavity squamous cell carcinoma (OCSCC). We performed a neoadjuvant (preoperative) trial to determine the biomarker and tumor response of OCSCC to MEK inhibition with trametinib.Experimental Design: Patients with stage II-IV OCSCC received trametinib (2 mg/day, minimum 7 days) prior to surgery. Primary tumor specimens were obtained before and after trametinib to evaluate immunohistochemical staining for p-ERK1/2 and CD44, the primary endpoint. Secondary endpoints included changes in clinical tumor measurements and metabolic activity [maximum standardized uptake values (SUVmax) by F-18 fluorodeoxyglucose positron emission tomography/CT), and in tumor downstaging. Drug-related adverse events (AE) and surgical/wound complications were evaluated.Results: Of 20 enrolled patients, 17 (85%) completed the study. Three patients withdrew because of either trametinib-related (n = 2: nausea, duodenal perforation) or unrelated (n = 1: constipation) AEs. The most common AE was rash (9/20 patients, 45%). Seventeen patients underwent surgery. No unexpected surgical/wound complications occurred. Evaluable matched pre- and posttrametinib specimens were available in 15 (88%) of these patients. Reduction in p-ERK1/2 and CD44 expression occurred in 5 (33%) and 2 (13%) patients, respectively. Clinical tumor response by modified World Health Organization criteria was observed in 11 of 17 (65%) evaluable patients (median 46% decrease, range 14%-74%). Partial metabolic response (≥25% reduction in SUVmax) was observed in 6 of 13 (46%) evaluable patients (median 25% decrease, range 6%-52%). Clinical-to-pathologic tumor downstaging occurred in 9 of 17 (53%) evaluable patients.Conclusions: Trametinib resulted in significant reduction in Ras/MEK/ERK pathway activation and in clinical and metabolic tumor responses in patients with OCSCC. Clin Cancer Res; 23(9); 2186-94. ©2016 AACR.
Collapse
Affiliation(s)
- Ravindra Uppaluri
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri. .,Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Ashley E Winkler
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Tianxiang Lin
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Jonathan H Law
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Bruce H Haughey
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Brian Nussenbaum
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Randal C Paniello
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Jason T Rich
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Jason A Diaz
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Loren P Michel
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Division of Medical Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Tanya Wildes
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Division of Medical Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Gavin P Dunn
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Paul Zolkind
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Jay F Piccirillo
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Otolaryngology, Washington University in St. Louis, St. Louis, Missouri
| | - Farrokh Dehdashti
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Barry A Siegel
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Rebecca D Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas R Adkins
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Division of Medical Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
18
|
Haughey BH, Sinha P, Kallogjeri D, Goldberg RL, Lewis JS, Piccirillo JF, Jackson RS, Moore EJ, Brandwein-Gensler M, Magnuson SJ, Carroll WR, Jones TM, Wilkie MD, Lau A, Upile NS, Sheard J, Lancaster J, Tandon S, Robinson M, Husband D, Ganly I, Shah JP, Brizel DM, O'Sullivan B, Ridge JA, Lydiatt WM. Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncol 2016; 62:11-19. [PMID: 27865363 PMCID: PMC5523818 DOI: 10.1016/j.oraloncology.2016.09.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/06/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC. METHODS Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, "HPVpath" staging system that combines features of the primary tumor and nodal metastases. RESULTS A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort. CONCLUSIONS Three loco-regional "HPVpath" stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC.
Collapse
Affiliation(s)
- B H Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA; Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand.
| | - P Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D Kallogjeri
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R L Goldberg
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J S Lewis
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J F Piccirillo
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R S Jackson
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - E J Moore
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Brandwein-Gensler
- Pathology and Anatomical Sciences, SUNY at the University at Buffalo, Buffalo, NY, USA
| | - S J Magnuson
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA
| | - W R Carroll
- Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA
| | - T M Jones
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M D Wilkie
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - A Lau
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N S Upile
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jon Sheard
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK; Pathology, University of Liverpool, UK
| | - J Lancaster
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Tandon
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Robinson
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK
| | - D Husband
- Clatterbridge Cancer Centre, Wirral, UK
| | - I Ganly
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D M Brizel
- Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - B O'Sullivan
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J A Ridge
- Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - W M Lydiatt
- Clinical Professor, Creighton Department of Surgery, Omaha, NE, USA
| |
Collapse
|
19
|
Zenga J, Jackson RS, Graboyes EM, Sinha P, Lindberg M, Martin EJ, Ma D, Thorstad WL, Rich JT, Moore EJ, Haughey BH. Oncologic outcomes of selective neck dissection in HPV-related oropharyngeal squamous cell carcinoma. Laryngoscope 2016; 127:623-630. [DOI: 10.1002/lary.26272] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/01/2016] [Accepted: 07/21/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Miranda Lindberg
- Washington University School of Medicine; Saint Louis Missouri U.S.A
| | - Eliot J. Martin
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Daniel Ma
- Department of Radiation Oncology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University; Saint Louis Missouri U.S.A
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Bruce H. Haughey
- Head and Neck Surgery Center of Florida; Celebration Hospital; Celebration Florida U.S.A
- Department of Surgery; University of Auckland Faculty of Medicine; Auckland New Zealand
| |
Collapse
|
20
|
Day AT, Sinha P, Nussenbaum B, Kallogjeri D, Haughey BH. Management of primary T1-T4 glottic squamous cell carcinoma by transoral laser microsurgery. Laryngoscope 2016; 127:597-604. [PMID: 27578610 DOI: 10.1002/lary.26207] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 03/15/2016] [Revised: 06/15/2016] [Accepted: 06/27/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate the oncologic outcomes of patients with early and select advanced primary glottic squamous cell carcinoma (SCCa) managed by transoral laser microsurgery (TLM). STUDY DESIGN Retrospective cohort study. METHODS Ninety cases of TLM-managed primary glottic SCCa were identified retrospectively using a prospectively collected database. RESULTS Outcomes of patients with pTis-pT2a disease (n = 65) and pT2b-pT4a disease (n = 25) were, respectively: 5-year local control, 86.2% and 67.5%; 5-year disease-free survival, 64.9% and 44.9%; 5-year disease-specific survival, 96.4% and 59.0%; laryngeal preservation, 96.9% and 80%. Five of nine patients (56%) with supraglottic-glottic-subglottic tumors were local recurrence-free compared to the 70 of 81 (86%) patients with glottic, supraglottic-glottic, and glottic-subglottic tumors. Seven of 13 patients (54%) with positive or indeterminate margins were local recurrence-free compared to 68 of 77 (88%) patients with negative margins. CONCLUSIONS Given sample size considerations, this study highlights the satisfactory oncologic outcomes of TLM-treated glottic cancer and the potential importance of margin management and disease extension within the larynx. LEVEL OF EVIDENCE 4 Laryngoscope, 127:597-604, 2017.
Collapse
Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Bruce H Haughey
- Department of Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, Florida, U.S.A.,Department of Surgery, University of Auckland, Auckland, New Zealand
| |
Collapse
|
21
|
Chin RI, Spencer CR, DeWees T, Hwang MY, Patel P, Sinha P, Gay HA, Haughey BH, Nussenbaum B, Adkins DR, Lewis JS, Thorstad WL. Reevaluation of postoperative radiation dose in the management of human papillomavirus-positive oropharyngeal cancer. Head Neck 2016; 38:1643-1649. [PMID: 27152851 DOI: 10.1002/hed.24486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 09/12/2015] [Revised: 02/29/2016] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare outcomes of patients with p16-positive oropharyngeal squamous cell carcinoma (SCC) treated with postoperative intensity-modulated radiotherapy (IMRT) before and after an institutional dose reduction policy effective on February 2009. METHODS Between 1998 and 2013, 175 consecutive patients with p16-positive oropharyngeal SCC with extracapsular extension (ECE) and/or close or positive margins were treated postoperatively to 66 Gy (n = 109) or 60 Gy (n = 66) in 2 Gy/fx. RESULTS Between the 66 and 60 Gy groups, there was no difference in tumor classification (pT4 vs pT1-T3; p = .181) and nodal classification (pN2c-N3 vs pN0-N2b; p = .704), and American Joint Committee on Cancer (AJCC) group stage (IV vs I-III; p = .473). Median follow-up was 5.9 years overall (66 Gy: 7.4 years; 60 Gy: 4.0 years). There was no difference in locoregional recurrence-free survival (2-year: 98.1% vs 98.5%; p = .421). CONCLUSION This study suggests that treating p16-positive oropharyngeal SCC with ECE and/or close or positive margins with postoperative IMRT to 60 Gy may not compromise locoregional recurrence-free survival compared to 66 Gy. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
Collapse
Affiliation(s)
- Re-I Chin
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Christopher R Spencer
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Pranav Patel
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Parul Sinha
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Bruce H Haughey
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri.,Department of Surgery, University of Auckland School of Medicine, Auckland, New Zealand
| | - Brian Nussenbaum
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Douglas R Adkins
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - James S Lewis
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
| |
Collapse
|
22
|
Zenga J, Wilson M, Adkins DR, Gay HA, Haughey BH, Kallogjeri D, Michel LS, Paniello RC, Rich JT, Thorstad WL, Nussenbaum B. Treatment Outcomes for T4 Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2016; 141:1118-27. [PMID: 25902372 DOI: 10.1001/jamaoto.2015.0764] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Little is known about treatment outcomes for T4 oropharyngeal squamous cell carcinoma (OPSCC), particularly in the era of human papillomavirus (HPV)-related disease. OBJECTIVE To evaluate oncologic outcomes for T4 OPSCC treated with primary surgical and nonsurgical therapies. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 131 patients from a single academic hospital, who were treated for T4a or T4b OPSCC (with any N stage and without distant metastatic disease at presentation) between 1998 and 2012 and had a minimum 2-year follow-up (the median follow-up time was 34.6 months). This study was conducted between January 1, 1998, and November 1, 2012. INTERVENTIONS Sixty-nine patients underwent nonsurgical therapy, 47 (68%) of whom had p16-positive tumors. Nonsurgical treatment paradigms included induction chemotherapy followed by chemoradiotherapy (n = 36 [54%]), concurrent chemoradiotherapy (n = 29 [43%]), and induction chemotherapy followed by radiation therapy alone (n = 2 [3%]). Sixty-two patients underwent surgical treatment, 50 (81%) of whom had p16-positive tumors. Fifty-seven surgical patients (92%) received adjuvant therapy. MAIN OUTCOMES AND MEASURES Overall survival (OS) was the primary outcome measure. Secondary outcome measures included disease-specific survival (DSS), disease-free survival (DFS), 2-year gastrostomy and tracheostomy tube rates, and major complication rates. RESULTS Significant baseline differences between the surgical vs nonsurgical groups included age (mean 59.8 vs 55.4 years [P = .005]), sex (male, 95% vs 84% [P = .04]), body mass index (<18.5 [calculated as weight in kilograms divided by height in meters squared], 3% vs 16% [P = .02]), and smoking history of 10 or more pack-years (48% vs 77% [P = .003]). For p16-positive patients, Kaplan-Meier estimates of OS, DSS, and DFS were significantly higher for surgically treated patients than for the nonsurgical group (χ(2)(1) = 7.335 for log-rank P = .007, χ(2)(1) = 8.607 for log-rank P = .003, and χ(2)(1) = 7.763 for log-rank P = .005, respectively). For p16-negative patients, Kaplan-Meier estimates of OS and DSS were higher for the surgical group but did not reach statistical significance (χ(2)(1) = 2.649 for log-rank P = .10 and χ(2)(1) = 2.077 for log-rank P = .15, respectively), while estimates of DFS were significantly higher for patients treated with primary surgery (χ(2)(1)= 3.869 for log-rank P = .049. In a multivariable Cox survival analysis, p16-positive immunohistochemical status had a significant positive association with OS (hazard ratio [HR], 0.55; 95% CI, 0.32-0.95 [P = .03]), DSS (HR, 0.45; 95% CI, 0.22-0.92 [P = .03]), and DFS (HR, 0.55; 95% CI, 0.32-0.95 [P = .03]), and nonsurgical treatment had a significant negative association with OS (HR, 2.79; 95% CI, 1.51-5.16 [P = .001]), DSS (HR, 3.38; 95% CI, 1.59-7.16 [P = .002]), and DFS (HR, 2.59; 95% CI, 1.51-4.45 [P = .001]). CONCLUSIONS AND RELEVANCE Primary surgical treatment may be associated with improved outcomes in patients with T4 OPSCC. p16 Immunohistochemical status remains a strong prognostic indicator even in patients with locally advanced disease.
Collapse
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, Missouri
| | - Michael Wilson
- medical student at Washington University, School of Medicine, St Louis, Missouri
| | - Douglas R Adkins
- Department of Medical Oncology, Washington University, St Louis, Missouri
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University, St Louis, Missouri
| | - Bruce H Haughey
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, Missouri
| | - Loren S Michel
- Department of Medical Oncology, Washington University, St Louis, Missouri
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, Missouri
| | - Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, Missouri
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University, St Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, Missouri
| |
Collapse
|
23
|
Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Dunphy F, Eisele DW, Foote RL, Gilbert J, Gillison ML, Haddad RI, Haughey BH, Hicks WL, Hitchcock YJ, Jimeno A, Kies MS, Lydiatt WM, Maghami E, McCaffrey T, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rodriguez CP, Samant S, Shah JP, Weber RS, Wolf GT, Worden F, Yom SS, McMillian N, Hughes M. Head and Neck Cancers, Version 1.2015. J Natl Compr Canc Netw 2016; 13:847-55; quiz 856. [PMID: 26150579 DOI: 10.6004/jnccn.2015.0102] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [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
These NCCN Guidelines Insights focus on recent updates to the 2015 NCCN Guidelines for Head and Neck (H&N) Cancers. These Insights describe the different types of particle therapy that may be used to treat H&N cancers, in contrast to traditional radiation therapy (RT) with photons (x-ray). Research is ongoing regarding the different types of particle therapy, including protons and carbon ions, with the goals of reducing the long-term side effects from RT and improving the therapeutic index. For the 2015 update, the NCCN H&N Cancers Panel agreed to delete recommendations for neutron therapy for salivary gland cancers, because of its limited availability, which has decreased over the past 2 decades; the small number of patients in the United States who currently receive this treatment; and concerns that the toxicity of neutron therapy may offset potential disease control advantages.
Collapse
|
24
|
Zenga J, Graboyes EM, Haughey BH, Paniello RC, Mehrad M, Lewis JS, Thorstad WL, Nussenbaum B, Rich JT. Definitive Surgical Therapy after Open Neck Biopsy for HPV-Related Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2016; 154:657-66. [PMID: 26861231 DOI: 10.1177/0194599815627642] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/29/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the impact of prior open neck biopsy on the prognosis of patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) who are subsequently treated with a definitive surgical paradigm, including adjuvant therapy when indicated. STUDY DESIGN Retrospective cohort. SETTING Tertiary care university hospital. SUBJECTS AND METHODS Patients with open neck biopsies who were treated with definitive surgery, with or without adjuvant therapy, for HPV-related OPSCC between 1998 and 2012 were compared with a matched control group who did not undergo open neck biopsy. Outcomes were disease-free survival, overall survival, disease-specific survival, incidence of tumor deposit in dermal scar, patterns of recurrence, and neck dissection complications. RESULTS Forty-five patients who underwent open neck biopsy were compared with 90 matched controls. Tumor deposits in dermal scars from the prior open neck biopsy were found in 3 patients (7%) during completion neck dissection. Overall complications of the neck dissection were not significantly increased in the open biopsy group over matched controls (20% vs 12%, respectively; P > .05). Five-year Kaplan-Meier estimates for disease-free survival, overall survival, and disease-specific survival were not significantly different between the open biopsy and control groups (93% vs 91%, 98% vs 97%, 98% vs 99%, respectively; all P > .05). Recurrence rates were also not significantly different between groups. CONCLUSIONS Patients with HPV-related OPSCC who have undergone a prior open neck biopsy can be successfully treated with a definitive surgical paradigm. Although needle biopsy is preferable to establish a diagnosis, previous open neck biopsy does not affect prognosis in these patients.
Collapse
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Bruce H Haughey
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Mitra Mehrad
- Department of Pathology, Washington University School of Medicine, St Louis, Missouri, USA
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| |
Collapse
|
25
|
Sylvester PT, Moran CJ, Derdeyn CP, Cross DT, Dacey RG, Zipfel GJ, Kim AH, Uppaluri R, Haughey BH, Tempelhoff R, Rich KM, Schneider J, Chole RA, Chicoine MR. Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature. J Neurosurg 2016; 125:1256-1276. [PMID: 26771847 DOI: 10.3171/2015.6.jns142483] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1-107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by coil placement, 2 underwent lesion embolization (coil or stent-assisted coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion embolization was primarily performed by coil embolization without stenting (16 cases) and stent-assisted coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was performed by covered stent (24 cases) and flow diverter (5 cases) placement. Covered stents showed a reasonably high rate of technical complications (10 [41.7%] of 24); however, 8 of these problems were resolved, leaving a small percentage with major technical complications (2 [8.3%] of 24). Flow diverter placement was also well tolerated, with only 1 minor technical complication. CONCLUSIONS Endovascular treatments including vessel sacrifice, coil embolization (with or without stent assistance), and endoluminal reconstruction offer a tailored approach to ICA injury management after endonasal surgery. Vessel sacrifice remains the definitive treatment for acute, uncontrolled bleeding; however, vessel preservation techniques should be considered carefully in select patients. Multiple factors including vascular anatomy, injury characteristics, and risk of dual antiplatelet therapy should guide best treatment, but more study is needed (particularly with flow diverters) to refine this decision-making process. Ideally, all endovascular treatment options should be available at institutions performing endonasal surgery.
Collapse
Affiliation(s)
| | - Christopher J Moran
- Division of Neuroradiology, Mallinckrodt Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Colin P Derdeyn
- Departments of 1 Neurosurgery.,Division of Neuroradiology, Mallinckrodt Institute, Washington University School of Medicine, St. Louis, Missouri
| | - DeWitte T Cross
- Division of Neuroradiology, Mallinckrodt Institute, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Zenga J, Graboyes EM, Sinha P, Haughey BH. The unplanned intraoperative pharyngotomy: Pull, plug, or patch. Laryngoscope 2015; 125:2736-40. [PMID: 26452178 DOI: 10.1002/lary.25526] [Citation(s) in RCA: 2] [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: 05/18/2015] [Accepted: 06/30/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, U.S.A
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, U.S.A
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, U.S.A
| | - Bruce H Haughey
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, U.S.A.,Department of Surgery, University of Auckland School of Medicine, Auckland, New Zealand
| |
Collapse
|
27
|
Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Dunphy F, Eisele DW, Gilbert J, Gillison ML, Haddad RI, Haughey BH, Hicks WL, Hitchcock YJ, Jimeno A, Kies MS, Lydiatt WM, Maghami E, Martins R, McCaffrey T, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rodriguez CP, Samant S, Schuller DE, Shah JP, Weber RS, Wolf GT, Worden F, Yom SS, McMillian NR, Hughes M. Head and neck cancers, Version 2.2014. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2015; 12:1454-87. [PMID: 25313184 DOI: 10.6004/jnccn.2014.0142] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers focuses on glottic laryngeal cancer, which is the most common type of laryngeal cancer and has an excellent cure rate. The lymphatic drainage of the glottis is sparse, and early stage primaries rarely spread to regional nodes. Because hoarseness is an early symptom, most glottic laryngeal cancer is early stage at diagnosis. Updates to these guidelines for 2014 include revisions to "Principles of Radiation Therapy" for each site and "Principles of Surgery," and the addition of a new section on "Principles of Dental Evaluation and Management."
Collapse
|
28
|
Zenga J, Sharon JD, Santiago P, Nussenbaum B, Haughey BH, Fox IK, Myckatyn TM, Diaz JA, Chicoine MR. Lower Trapezius Flap for Reconstruction of Posterior Scalp and Neck Defects after Complex Occipital-Cervical Surgeries. J Neurol Surg B Skull Base 2015; 76:397-408. [PMID: 26401483 DOI: 10.1055/s-0034-1544123] [Citation(s) in RCA: 9] [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: 08/30/2014] [Accepted: 12/08/2014] [Indexed: 10/23/2022] Open
Abstract
Objectives To review the indications, techniques, and outcomes for a series of patients in whom the lower trapezius flaps was used for repair of complex posterior scalp and neck defects after posterior occipital-cervical surgeries. Design Retrospective case series. Setting Tertiary academic hospital. Participants A retrospective review of cases that required complex occipital-cervical repair was performed to identify patients who underwent reconstruction using the lower trapezius flap. Data collected included demographics, clinical presentations, surgical anatomy, operative techniques, and outcomes with review of the pertinent literature. Outcomes Nine patients who underwent reconstruction using the lower trapezius flap were identified. Prior surgical interventions included five complex tumor resections, two patients with multiple instrumented cervical spine surgeries, one patient with a craniotomy for attempted extracranial to intracranial arterial bypass for a basilar aneurysm repair, and a posterior occipital-cervical decompression after trauma. During the median follow-up period of 7 months, all nine single-stage reconstructions resulted in successful healing without major surgical complications. Conclusion Lower trapezius island flaps provide a reliable option for the reconstruction of complex scalp and neck defects that develop after complex occipital-cervical surgeries.
Collapse
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Jeffrey D Sharon
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Paul Santiago
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, United States
| | - Brian Nussenbaum
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Bruce H Haughey
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Ida K Fox
- Department of Plastic Surgery, Washington University, St. Louis, Missouri, United States
| | - Terence M Myckatyn
- Department of Plastic Surgery, Washington University, St. Louis, Missouri, United States
| | - Jason A Diaz
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Michael R Chicoine
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, United States
| |
Collapse
|
29
|
Sinha P, Kallogjeri D, Gay H, Thorstad WL, Lewis JS, Chernock R, Nussenbaum B, Haughey BH. High metastatic node number, not extracapsular spread or N-classification is a node-related prognosticator in transorally-resected, neck-dissected p16-positive oropharynx cancer. Oral Oncol 2015; 51:514-20. [PMID: 25771076 DOI: 10.1016/j.oraloncology.2015.02.098] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [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: 01/19/2015] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Due to unique biology and prognosis, precise identification of predictive parameters is critical for p16+ oropharyngeal squamous cell carcinoma (OPSCC). Prior studies showing absence of prognostication from extracapsular spread (ECS) and/or high N-classification in surgically-treated p16+ OPSCC necessitate new, evidence-based prognosticators. METHODS A prospectively assembled cohort of 220, transoral surgery+neck dissection±adjuvant therapy-treated, p16+ OPSCC patients was analyzed. Disease recurrence and disease-specific survival (DSS) were primary endpoints. RESULTS Median follow-up was 59 (12-189) months. Distribution of metastatic node numbers was: 0 in 9.5% (n=21), 1 in 33.6% (n=74), 2 in 17% (n=38), 3 in 14.5% (n=32), 4 in 8.2% (n=18), and ⩾5 in 17% (n=37). ECS was recorded in 80% (n=159), and N2c-N3 in 17% (n=38). Adjuvant radiotherapy and chemoradiotherapy was administered in 44% and 34%. Recurrence developed in 22 patients (10%); 4 local, 5 regional, 2 regional and distant, and 11 distant. The 3- and 5-year DSS estimates were 94.6% and 93%. Multivariable logistic regression identified ⩾5 nodes and T3-T4 classification as predictors for recurrence. In multivariable Cox analyses, ⩾5 nodes, T3-T4 classification and margins were prognostic for DSS. ECS, N2c-N3 classification and smoking were not prognostic. CONCLUSIONS Metastatic node number, not ECS or high N-classification is an independent nodal predictor of outcomes in surgically-treated p16+ OPSCC patients. Despite high DSS (~80%), closer surveillance for recurrence is recommended for patients with ⩾5 metastatic nodes.
Collapse
Affiliation(s)
- Parul Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Dorina Kallogjeri
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States; Clinical Outcomes Research, Washington University School of Medicine, St. Louis, MO, United States
| | - Hiram Gay
- Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Wade L Thorstad
- Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - James S Lewis
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States; Pathology, Washington University School of Medicine, St. Louis, MO, United States
| | - Rebecca Chernock
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States; Pathology, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian Nussenbaum
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Bruce H Haughey
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States.
| |
Collapse
|
30
|
Henke LE, Pfeifer JD, Ma C, Perkins SM, DeWees T, El-Mofty S, Moley JF, Nussenbaum B, Haughey BH, Baranski TJ, Schwarz JK, Grigsby PW. BRAF mutation is not predictive of long-term outcome in papillary thyroid carcinoma. Cancer Med 2015; 4:791-9. [PMID: 25712893 PMCID: PMC4472201 DOI: 10.1002/cam4.417] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 10/17/2014] [Revised: 12/15/2014] [Accepted: 12/24/2014] [Indexed: 02/07/2023] Open
Abstract
The BRAF mutation occurs commonly in papillary thyroid carcinoma (PTC). Previous investigations of its utility to predict recurrence-free survival (RFS) and disease-specific survival (DSS) have reported conflicting results and its role remains unclear. The purpose of this retrospective study was to determine the incidence of the BRAF mutation and analyze its relationship to clinicopathologic risk factors and long-term outcomes in the largest, single-institution American cohort to date. BRAF mutational status was determined in 508 PTC patients using RFLP analysis. The relationships between BRAF mutation status, patient and tumor characteristics, RFS, and DSS were analyzed. The BRAF mutation was present in 67% of patients. On multivariate analysis, presence of the mutation predicted only for capsular invasion (HR, 1.7; 95% CI, 1.1–2.6), cervical lymph node involvement (HR, 1.7; 95% CI, 1.1–2.7), and classic papillary histology (HR, 1.8; 95% CI 1.1–2.9). There was no significant relationship between the BRAF mutation and RFS or DSS, an observation that was consistent across univariate, multivariate, and Kaplan–Meier analyses. This is the most extensive study to date in the United States to demonstrate that BRAF mutation is of no predictive value for recurrence or survival in PTC. We found correlations of BRAF status and several clinicopathologic characteristics of high-risk disease, but limited evidence that the mutation correlates with more extensive or aggressive disease. This analysis suggests that BRAF is minimally prognostic in PTC. However, prevalence of the BRAF mutation is 70% in the general population, providing the opportunity for targeted therapy.
Collapse
Affiliation(s)
- Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - John D Pfeifer
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri
| | - Changquing Ma
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Samir El-Mofty
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey F Moley
- Section of Endocrine and Oncologic Surgery, Department of General Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Bruce H Haughey
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Thomas J Baranski
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.,Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri
| |
Collapse
|
31
|
Sylvester PT, Evans JA, Zipfel GJ, Chole RA, Uppaluri R, Haughey BH, Getz AE, Silverstein J, Rich KM, Kim AH, Dacey RG, Chicoine MR. Combined high-field intraoperative magnetic resonance imaging and endoscopy increase extent of resection and progression-free survival for pituitary adenomas. Pituitary 2015; 18:72-85. [PMID: 24599833 PMCID: PMC4161669 DOI: 10.1007/s11102-014-0560-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The clinical benefit of combined intraoperative magnetic resonance imaging (iMRI) and endoscopy for transsphenoidal pituitary adenoma resection has not been completely characterized. This study assessed the impact of microscopy, endoscopy, and/or iMRI on progression-free survival, extent of resection status (gross-, near-, and sub-total resection), and operative complications. METHODS Retrospective analyses were performed on 446 transsphenoidal pituitary adenoma surgeries at a single institution between 1998 and 2012. Multivariate analyses were used to control for baseline characteristics, differences during extent of resection status, and progression-free survival analysis. RESULTS Additional surgery was performed after iMRI in 56/156 cases (35.9%), which led to increased extent of resection status in 15/156 cases (9.6%). Multivariate ordinal logistic regression revealed no increase in extent of resection status following iMRI or endoscopy alone; however, combining these modalities increased extent of resection status (odds ratio 2.05, 95% CI 1.21-3.46) compared to conventional transsphenoidal microsurgery. Multivariate Cox regression revealed that reduced extent of resection status shortened progression-free survival for near- versus gross-total resection [hazard ratio (HR) 2.87, 95% CI 1.24-6.65] and sub- versus near-total resection (HR 2.10; 95% CI 1.00-4.40). Complication comparisons between microscopy, endoscopy, and iMRI revealed increased perioperative deaths for endoscopy versus microscopy (4/209 and 0/237, respectively), but this difference was non-significant considering multiple post hoc comparisons (Fisher exact, p = 0.24). CONCLUSIONS Combined use of endoscopy and iMRI increased pituitary adenoma extent of resection status compared to conventional transsphenoidal microsurgery, and increased extent of resection status was associated with longer progression-free survival. Treatment modality combination did not significantly impact complication rate.
Collapse
Affiliation(s)
- Peter T. Sylvester
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8057, St. Louis, MO, USA
| | - John A. Evans
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8057, St. Louis, MO, USA
| | - Gregory J. Zipfel
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8057, St. Louis, MO, USA
| | - Richard A. Chole
- Getz Department of Otolaryngology, Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ravindra Uppaluri
- Getz Department of Otolaryngology, Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Bruce H. Haughey
- Getz Department of Otolaryngology, Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne E. Getz
- Getz Department of Otolaryngology, Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Silverstein
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8057, St. Louis, MO, USA
- Department of Internal Medicine/Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, USA
| | - Keith M. Rich
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8057, St. Louis, MO, USA
| | - Albert H. Kim
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8057, St. Louis, MO, USA
| | - Ralph G. Dacey
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8057, St. Louis, MO, USA
| | - Michael R. Chicoine
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8057, St. Louis, MO, USA
| |
Collapse
|
32
|
Sinha P, Piccirillo JF, Kallogjeri D, Spitznagel EL, Haughey BH. The role of postoperative chemoradiation for oropharynx carcinoma: A critical appraisal of the published literature and National Comprehensive Cancer Network guidelines. Cancer 2015; 121:1747-54. [DOI: 10.1002/cncr.29242] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/10/2014] [Accepted: 12/09/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
| | - Jay F. Piccirillo
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
- Clinical Outcomes Research Office; Washington University School of Medicine; St. Louis Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
- Clinical Outcomes Research Office; Washington University School of Medicine; St. Louis Missouri
| | | | - Bruce H. Haughey
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
| |
Collapse
|
33
|
Affiliation(s)
- Jordan P. Sand
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Bruce H. Haughey
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
34
|
Graboyes EM, Sinha P, Thorstad WL, Rich JT, Haughey BH. Management of human papillomavirus-related unknown primaries of the head and neck with a transoral surgical approach. Head Neck 2014; 37:1603-11. [DOI: 10.1002/hed.23800] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/21/2014] [Accepted: 06/11/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis; St. Louis Missouri
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis; St. Louis Missouri
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University in St. Louis; St. Louis Missouri
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis; St. Louis Missouri
| | - Bruce H. Haughey
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis; St. Louis Missouri
| |
Collapse
|
35
|
Spencer CR, Gay HA, Haughey BH, Nussenbaum B, Adkins DR, Wildes TM, DeWees TA, Lewis JS, Thorstad WL. Eliminating radiotherapy to the contralateral retropharyngeal and high level II lymph nodes in head and neck squamous cell carcinoma is safe and improves quality of life. Cancer 2014; 120:3994-4002. [PMID: 25143048 DOI: 10.1002/cncr.28938] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 01/09/2014] [Revised: 06/13/2014] [Accepted: 06/24/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Radiation treatment volumes in head and neck squamous cell carcinoma (HNSCC) are controversial. The authors report the outcomes, patterns of failure, and quality of life (QOL) of patients who received treatment for HNSCC using intensity-modulated radiation therapy (IMRT) that eliminated the treatment of contralateral retropharyngeal lymph nodes (RPLNs) in the clinically uninvolved neck. METHODS A prospective institutional database was used to identify patients who had primary oral cavity, oropharyngeal, hypopharyngeal, laryngeal, and unknown primary HNSCC for which they received IMRT. There were 3 temporal groups (generations 1-3). Generation 1 received comprehensive neck IMRT with parotid sparing, generation 2 eliminated the contralateral high level II (HLII) lymph nodes, and generation 3 further eliminated the contralateral RPLNs in the clinically uninvolved neck. Patterns of failure and survival analyses were completed, and QOL data measured using the MD Anderson Dysphagia Inventory were compared in a subset of patients from generations 1 and 3. RESULTS In total, 748 patients were identified. Of the 488 patients who received treatment in generation 2 or 3, 406 had a clinically uninvolved contralateral neck. There were no failures in the spared RPLNs (95% confidence interval, 0%-1.3%) or in the high contralateral neck (95% confidence interval, 0%-0.7%). QOL data were compared between 44 patients in generation 1 and 51 patients in generation 3. QOL improved both globally and in all domains assessed for generation 3, in which reduced radiotherapy volumes were used (P < .007). CONCLUSIONS For patients with locally advanced HNSCC, eliminating coverage to the contralateral HLII lymph nodes and contralateral RPLNs in the clinically uninvolved side of the neck is associated with minimal risk of failure in these regions and significantly improved patient-reported QOL.
Collapse
Affiliation(s)
- Christopher R Spencer
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Sinha P, Mehrad M, Chernock RD, Lewis JS, El-Mofty SK, Wu N, Nussenbaum B, Haughey BH. Histologic and systemic prognosticators for local control and survival in margin-negative transoral laser microsurgery treated oral cavity squamous cell carcinoma. Head Neck 2014; 37:52-63. [PMID: 24430914 DOI: 10.1002/hed.23553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/27/2013] [Accepted: 11/02/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Appreciable local recurrence rates observed in patients with margin-negative, transoral laser microsurgery (TLM)-treated oral cavity squamous cell carcinoma (SCC) necessitate identification of new prognosticators for local control and survival. A histopathologic index (Brandwein-Gensler score [BGS]) and intrinsic/iatrogenic/chronic conditions causing immune compromise are investigated. METHODS From a prospectively assembled database of TLM-treated oral cavity SCC, specimens for 60 patients with a minimum of 2-years follow-up could undergo BGS assignment. Local control, disease-specific survival (DSS), and overall survival (OS) were study endpoints. RESULTS "Low-BGS" was recorded in 28 patients (47%) and "high-BGS" in 32 patients (53%), whereas immune compromise was observed in 18%. In multivariate analyses, immune compromise was the only predictor for local control. T classification and immune compromise were prognostic for DSS and OS. "High-BGS" was prognostic only for OS. CONCLUSION "High-BGS" was associated with recurrences but immune compromise was the most significant predictor of local control and survival in margin-negative, TLM-treated oral cavity SCC. Strategies that maintain/restore tumor-specific immune responses in immune compromised oral cavity SCC hosts need to be developed.
Collapse
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Sinha P, Thorstad WT, Nussenbaum B, Haughey BH, Adkins DR, Kallogjeri D, Lewis JS. Distant metastasis in p16-positive oropharyngeal squamous cell carcinoma: a critical analysis of patterns and outcomes. Oral Oncol 2013; 50:45-51. [PMID: 24211084 DOI: 10.1016/j.oraloncology.2013.10.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE With good loco-regional control, disease failure in p16-positive oropharyngeal squamous cell carcinoma (OPSCC) mainly results from distant metastasis (DM). Our objective was to characterize the patterns and clinical outcomes of DM in p16-positive OPSCC and compare these to patients with p16-negative disease. METHODS Primary OPSCC patients who developed DM after completing surgical or non-surgical treatment were identified and p16 status was evaluated. Patterns of DM and post-DM progression-free (PFS) and disease-specific survival (DSS) were assessed. RESULTS Forty-one of the 66 (62%) patients with DM were p16-positive. DM patterns were not statistically different by p16 status. However, p16-positive patients developed DM later in their course and had longer survival. All p16-negative patients either had progression or died within 24 months of DM detection whereas the 2-year post-DM PFS in the p16-positive group was 20% (95% CI: 8-32.5%, p=0.003). The 3-year post-DM disease-specific survival (DSS) estimate in the p16-positive patients was 16% (95% CI: 7-18%) while all p16-negative patients died within 34 months (p<0.001). p16-negativity, loco-regional disease, and no/palliative versus curative intent treatment were all associated with reduced post-DM DSS in multivariate analysis. CONCLUSIONS The DM pattern did not differ remarkably between p16-positive and negative OPSCC patients in our practice. In p16-positive OPSCC with pulmonary oligometastatic disease, curative intent treatment and optimized locoregional control for the index primary prolonged survival.
Collapse
Affiliation(s)
- P Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - W T Thorstad
- Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - B Nussenbaum
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - B H Haughey
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D R Adkins
- Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - D Kallogjeri
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J S Lewis
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
38
|
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of MedicineSt. Louis Missouri U.S.A
| | - David J. Grindler
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of MedicineSt. Louis Missouri U.S.A
| | - Bruce H. Haughey
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of MedicineSt. Louis Missouri U.S.A
| |
Collapse
|
39
|
Stoddard TR, Haughey BH, Holsinger FC, Nussenbaum B, Stadler ME. Safety and Quality Considerations in Transoral Surgery for Neoplastic Disease. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813496044a155] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: 1) Review the importance of quality and patient safety initiatives in surgical care, identifying the specific role that these play in transoral surgical (TOS) procedures. 2) Describe the usefulness of a surgical safety checklist designed for TOS procedures. Methods: Expert opinion, clinical consensus, and a comprehensive literature search were conducted in this project. A systematic review of the literature between 1946 and January 2013 was performed using Pubmed and Medline. Search terms included: quality, patient safety, otolaryngology, head and neck surgery, Surgical checklist, clinical care pathway, transoral laser microsurgery, transoral robotic surgery. Altogether, 200 abstracts were initially reviewed, and 51 studies were selected based on their relevance to the objectives listed above. Results: A comprehensive review of quality and patient safety initiatives in surgical care revealed that clinical care pathways and surgical safety checklists are effective tools in reducing perioperative morbidity, mortality, and cost of care. In otolaryngology-head and neck surgery, checklists have only been described for endoscopic sinus surgery. A comprehensive, yet usable, surgical quality and safety checklist for TOS procedures was then developed by the authors based on previously successful models from the literature, as well as from expert opinion. Conclusions: Transoral surgery (TOS), including the use of lasers and/or robotics, is an increasingly used and important treatment option for the management of neoplastic diseases of the head and neck. We propose a comprehensive surgical safety checklist that addresses the unique risks and technical requirements of TOS procedures.
Collapse
|
40
|
Burns JA, Haughey BH, Weinstein GS. Surgical Innovations for Larynx and Pharynx Cancer. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813493390a44] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Program Description: Transoral treatment of larynx and pharynx cancer has been done for over a century. Despite substantial technical innovations such as enhanced imaging, innovative laser technologies, and robotic guidance systems, chemoradiation protocols dominate treatment strategies at many institutions. Outcomes data on transoral microsurgical management for advanced oropharynx and larynx cancer will be presented to illustrate the efficacy of surgical management of these diseases. Robotics and laser photoangiolysis of laryngeal cancer are two emerging technologies that can enhance endoscopic surgery. This miniseminar will highlight advantages and disadvantages of endoscopic techniques and innovative technology through presentations from experts in the field. Educational Objectives: 1) Evaluate outcomes data on transoral laser microsurgery for advanced oropharyngeal and laryngeal cancer. 2) Interpret the emerging role of robotics in the endoscopic surgical management of larynx and pharynx cancer. 3) Apply concepts of photoangiolysis in treatment of aerodigestive tract malignancy.
Collapse
|
41
|
Pfister DG, Ang KK, Brizel DM, Burtness BA, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Dunphy F, Eisele DW, Gilbert J, Gillison ML, Haddad RI, Haughey BH, Hicks WL, Hitchcock YJ, Kies MS, Lydiatt WM, Maghami E, Martins R, McCaffrey T, Mittal BB, Pinto HA, Ridge JA, Samant S, Schuller DE, Shah JP, Spencer S, Weber RS, Wolf GT, Worden F, Yom SS, McMillian NR, Hughes M. Head and neck cancers, version 2.2013. Featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2013; 11:917-23. [PMID: 23946171 DOI: 10.6004/jnccn.2013.0113] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [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: 11/17/2022]
Abstract
These NCCN Guidelines Insights focus on nutrition and supportive care for patients with head and neck cancers. This topic was a recent addition to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers. The NCCN Guidelines Insights focus on major updates to the NCCN Guidelines and discuss the new updates in greater detail. The complete version of the NCCN Guidelines for Head and Neck Cancers is available on the NCCN Web site (NCCN.org).
Collapse
Affiliation(s)
- David G Pfister
- From 1Memorial Sloan-Kettering Cancer Center; 2The University of Texas MD Anderson Cancer Center; 3Duke Cancer Institute; 4Fox Chase Cancer Center; 5Massachusetts General Hospital Cancer Center; 6Moffitt Cancer Center; 7Vanderbilt-Ingram Cancer Center; 8Stanford Cancer Institute; 9The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; 10The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; 11Dana-Farber/Brigham and Women's Cancer Center; 12Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; 13Roswell Park Cancer Institute; 14Huntsman Cancer Institute at the University of Utah; 15UNMC Eppley Cancer Center at The Nebraska Medical Center; 16City of Hope Comprehensive Cancer Center; 17University of Washington/Seattle Cancer Care Alliance; 18Robert H. Lurie Comprehensive Cancer Center of Northwestern University; 19St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; 20University of Alabama at Birmingham Comprehensive Cancer Center; 21University of Michigan Comprehensive Cancer Center; 22UCSF Helen Diller Family Comprehensive Cancer Center; and 23National Comprehensive Cancer Network
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Sinha P, Desai SC, Ha DH, Chicoine MR, Haughey BH. Extracranial radial forearm free flap closure of refractory cerebrospinal fluid leaks: a novel hybrid transantral-endoscopic approach. Neurosurgery 2013; 71:ons219-25; discussion ons225-6. [PMID: 22791035 DOI: 10.1227/neu.0b013e3182684ac8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although rare, recalcitrant cerebrospinal fluid (CSF) leak after skull base tumor resection or major head trauma is a difficult therapeutic challenge, often complicated by lack of local vascularized tissue in a scarred, radiated field. Craniotomy with a free tissue transfer has been described for CSF leak repair from these complicated skull base defects. OBJECTIVE : We present our experience with a novel extracranial approach to manage refractory CSF leaks with a radial forearm free flap set in through a transantral and ethmoid sinus approach. METHODS Five patients with recalcitrant CSF leaks in the anterior skull base underwent radial forearm free tissue transfer via a hybrid transantral-endoscopic approach. RESULTS There were 4 female patients and 1 male patient. Average age was 58 years (range, 30-72 years). Four patients had previous neurosurgical anterior skull base tumor resections, and 1 patient had significant head trauma leading to a recalcitrant CSF leak. All 5 patients had undergone multiple prior endoscopic and/or open repairs. All 5 patients had successful resolution of their leak after undergoing radial forearm free tissue transfer. Two of 5 patients required a second minor endoscopic procedure. No patients required a craniotomy. CONCLUSION An extracranial transantral-endoscopic approach for the inset of radial forearm free flap is a safe treatment technique that precludes the need for a craniotomy and promotes effective repair of CSF leaks refractory to traditional endoscopic procedures. ABBREVIATION RFFF, radial forearm free flap.
Collapse
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology - Head & Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | | |
Collapse
|
43
|
Sinha P, Hackman T, Nussenbaum B, Wu N, Lewis JS, Haughey BH. Transoral laser microsurgery for oral squamous cell carcinoma: oncologic outcomes and prognostic factors. Head Neck 2013; 36:340-51. [PMID: 23729304 DOI: 10.1002/hed.23293] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Modest survival rates are published for treatment of oral squamous cell carcinoma (OSCC) using conventional approaches. Few cohort studies are available for transoral resection of OSCC. METHODS Analysis for recurrence, survival, and prognosis of patients with OSCC treated with transoral laser microsurgery (TLM) ± neck dissection was obtained from a prospective database. RESULTS Ninety-five patients (71 patients had stages T1-T2 and 24 had stages T3-T4 disease) with minimum follow-up of 24 months met criteria and demonstrated negative margins in 95%. Five-year local control (LC) and disease-specific survival (DSS) were 78% and 76%, respectively. Surgical salvage achieved an absolute final locoregional control of 92%. Immune compromise and final margins were prognostic for LC, whereas T classification, N classification, TNM stage, comorbidity, and perineural invasion were also significant for DSS. CONCLUSION We document a large series of patients with OSCC treated with TLM, incorporating T1 to T4 primaries. A significant proportion of stage III/IV cases demonstrates feasibility of TLM in higher stages, with final margin positivity of 5%, LC greater than 90%, and comparable survival outcomes.
Collapse
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | |
Collapse
|
44
|
Haughey BH. Role of adjuvant therapy in postsurgical quality-of-life and functional impairment. JAMA Otolaryngol Head Neck Surg 2013; 139:1109-10. [PMID: 23575556 DOI: 10.1001/jamaoto.2013.2777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Bruce H Haughey
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
45
|
Adelstein DJ, Ridge JA, Brizel DM, Holsinger FC, Haughey BH, O'Sullivan B, Genden EM, Beitler JJ, Weinstein GS, Quon H, Chepeha DB, Ferris RL, Weber RS, Movsas B, Waldron J, Lowe V, Ramsey S, Manola J, Yueh B, Carey TE, Bekelman JE, Konski AA, Moore E, Forastiere A, Schuller DE, Lynn J, Ullmann CD. Transoral resection of pharyngeal cancer: summary of a National Cancer Institute Head and Neck Cancer Steering Committee Clinical Trials Planning Meeting, November 6-7, 2011, Arlington, Virginia. Head Neck 2012; 34:1681-703. [PMID: 23015475 PMCID: PMC7721598 DOI: 10.1002/hed.23136] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2012] [Indexed: 11/10/2022] Open
Abstract
Recent advances now permit resection of many pharyngeal tumors through the open mouth, an approach that can greatly reduce the morbidity of surgical exposure. These transoral techniques are being rapidly adopted by the surgical community and hold considerable promise. On November 6-7, 2011, the National Cancer Institute sponsored a Clinical Trials Planning Meeting to address how to further investigate the use of transoral surgery, both in the good prognosis human papillomavirus (HPV)-initiated oropharyngeal cancers, and in those with HPV-unrelated disease. The proceedings of this meeting are summarized.
Collapse
|
46
|
Haughey BH, Sinha P. Prognostic factors and survival unique to surgically treated p16+ oropharyngeal cancer. Laryngoscope 2012; 122 Suppl 2:S13-33. [DOI: 10.1002/lary.23493] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
47
|
Abstract
CONTEXT Parathyroid oxyphil cells, whose function is unknown, are thought to be derived from chief cells. Oxyphil cells increase in number in parathyroid glands of patients with chronic kidney disease (CKD) and are even more abundant in patients receiving treatment for hyperparathyroidism with calcitriol and/or the calcimimetic cinacalcet. OBJECTIVE We examined oxyphil and chief cells of parathyroid glands of CKD patients for differential expression of genes important to parathyroid function. DESIGN/SETTING/PARTICIPANTS Parathyroid tissue from CKD patients with refractory hyperparathyroidism was immunostained for gene expression studies. MAIN OUTCOME MEASURE Immunostaining for PTH, PTHrP, calcium-sensing receptor, glial cells missing 2, vitamin D receptor, 25-hydroxyvitamin D-1α-hydroxylase, and cytochrome c was quantified and expression reported for oxyphil and chief cells. RESULTS Expression of all proteins analyzed, except for the vitamin D receptor, was higher in oxyphil cells than in chief cells. CONCLUSION Human parathyroid oxyphil cells express parathyroid-relevant genes found in the chief cells and have the potential to produce additional autocrine/paracrine factors, such as PTHrP and calcitriol. Additional studies are warranted to define the secretory properties of these cells and clarify their role in parathyroid pathophysiology.
Collapse
Affiliation(s)
- Cynthia S Ritter
- Renal Division, Washington University School of Medicine, Barnes Jewish Hospital, St Louis, Missouri 63110, USA
| | | | | | | |
Collapse
|
48
|
Burns JA, Haughey BH, Weinstein GS, Zeitels SM. State-of-the-Art Management of Larynx and Pharynx Cancer. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812449008a47] [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]
|
49
|
Perkins SM, Spencer CR, Chernock RD, Haughey BH, Nussenbaum B, Adkins DR, Kuperman DI, Thorstad WL. Radiotherapeutic Management of Cervical Lymph Node Metastases From an Unknown Primary Site. ACTA ACUST UNITED AC 2012; 138:656-61. [DOI: 10.1001/archoto.2012.1110] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
50
|
Ritter CS, Haughey BH, Armbrecht HJ, Brown AJ. Distribution and regulation of the 25-hydroxyvitamin D3 1α-hydroxylase in human parathyroid glands. J Steroid Biochem Mol Biol 2012; 130:73-80. [PMID: 22326730 DOI: 10.1016/j.jsbmb.2012.01.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/12/2012] [Accepted: 01/20/2012] [Indexed: 01/22/2023]
Abstract
Parathyroid glands express the 25-hydroxyvitamin D(3) 1α-hydroxylase (1αOHase). 1,25-dihydroxyvitamin D(3) (calcitriol) synthesized by extrarenal tissues generally does not enter the circulation, but plays an autocrine/paracrine role specific to the cell type, and is regulated by the needs of that particular cell. While the role of calcitriol produced in the parathyroid glands presumably is to suppress PTH and cell growth, its regulation in this cell type has not been defined. In the present study, we found that regulation of the human parathyroid 1αOHase differs from the renal enzyme in that it is induced by FGF-23 and extracellular calcium. Hyperplastic parathyroid glands from patients with chronic kidney failure normally display a heterogeneous cellularity. We found that the 1αOHase is expressed at much higher levels in oxyphil cells than in chief cells in these patients. Recent findings indicate that oxyphil cell content is increased by treatment with calcium receptor activators (calcimimetics). Here, we demonstrate that the calcimimetic cinacalcet increases the expression of 1αOHase in human parathyroid cultures. Additionally, we found that the 1αOHase in human parathyroid cultures is functionally active, as evidenced by the ability of the enzyme to 1-hydroxylate 25(OH)D(3) in parathyroid monolayers. Calcium, as well as cinacalcet, also induced expression of the degradation enzyme 24-hydroxylase, indicating the presence of a negative feedback system in the parathyroid cells. Therefore, local production of 1αOHase suggests an autocrine/paracrine role in regulating parathyroid function and may mediate, in part, the suppression of PTH by calcium and FGF-23.
Collapse
Affiliation(s)
- Cynthia S Ritter
- Renal Division, Washington University School of Medicine, St. Louis, MO 63110, United States.
| | | | | | | |
Collapse
|