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Drake VE, Moyer JS. Decision Making in Nasal Reconstruction: When to Use the Forehead Flap? Facial Plast Surg Clin North Am 2024; 32:211-219. [PMID: 38575279 DOI: 10.1016/j.fsc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
In this review, the paramedian forehead flap indications and uses are reviewed, specifically examining clinical situations where patient selection is important. In these settings, a preoperative discussion with a patient regarding surgical expectations and goals in the setting of their defect is paramount. The authors review the literature regarding the psychosocial aspects of major nasal reconstruction and review preoperative discussion points that are key to a well-informed patient and improved patient satisfaction through the nasal reconstructive process.
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Affiliation(s)
- Virginia E Drake
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, 170 Manning Drive, CB #7070, Chapel Hill, NC 27599, USA
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive; TC1904, Ann Arbor, MI 48109, USA.
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Drake VE, Smith C, Watkins MO, Rudy SF, Joseph AW, Stucken CL, Brenner MJ, Kim JC, Moyer JS. Outcomes of Autologous Versus Irradiated Homologous Costal Cartilage Graft in Rhinoplasty. Facial Plast Surg Aesthet Med 2024. [PMID: 38502836 DOI: 10.1089/fpsam.2023.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Background: Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are commonly used in septorhinoplasty when there is insufficient septal cartilage for grafting. Objective: To assess the surgical outcomes of patients who underwent septorhinoplasty with either ACC or IHCC as measured by rates of infection, resorption, warping, and revision rate. Methods: A retrospective analysis of patients who underwent rhinoplasty with ACC or IHCC at a single academic institution was performed. Demographic data, surgical details, antibiotic use, and outcomes, including surgical duration, infection, resorption, warping, and revision rate, were analyzed using Fisher's exact test, chi-squared test, and logistic regression. Results: One hundred forty-three patients were identified. The median age was 48 years (interquartile range: 35-57.5) and 62.2% (n = 89) were female, 61 patients (42.7%) underwent ACC, and 82 (57.3%) IHCC. Revision rate in both groups was similar (ACC = 14.8%, IHCC = 14.6%; p = 0.98). There was no difference in infection rate (ACC = 4.9%, IHCC = 3.7%; p = 0.71). Postoperative deformity and nasal obstruction were the most common indications for revision surgery. Surgical time was shorter with IHCC (p < 0.01). Mean follow-up time was 26.5 months (±25) for ACC, and 16 months (±12) for IHCC. Conclusions: ACC and IHCC are similar in terms of effectiveness and safety in septorhinoplasty.
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Affiliation(s)
- Virginia E Drake
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Connor Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Mariel O Watkins
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Shannon F Rudy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Andrew W Joseph
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Jennifer C Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
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Justicz N, Ryder CY, Rudy SF, Bellile EL, Kim JC, Baker S, Moyer JS. A Comparison of Pulsed Dye Laser and Dermabrasion After Nasal Reconstruction. Facial Plast Surg Aesthet Med 2024; 26:197-199. [PMID: 37205866 DOI: 10.1089/fpsam.2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Affiliation(s)
- Natalie Justicz
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - C Yoonhee Ryder
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shannon F Rudy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Emily L Bellile
- Department of Biostatistics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jennifer C Kim
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shan Baker
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Yalamanchi P, Peddireddy NS, McMichael B, Keilin C, Casper KA, Malloy KM, Moyer JS, Prince MEP, Rosko AJ, Stucken CL, Spector ME, Chinn SB. Team-Based Surgical Approach to Head and Neck Microvascular Free Flap Reconstruction. JAMA Otolaryngol Head Neck Surg 2023; 149:1021-1026. [PMID: 37796525 PMCID: PMC10557027 DOI: 10.1001/jamaoto.2023.3028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/13/2023] [Indexed: 10/06/2023]
Abstract
Importance Because microvascular free flap reconstruction is increasingly used to restore function in patients with head and neck cancer, there is a growing need for evidence-based perioperative care. Objective To assess the association of different team-based surgical approaches with intraoperative and postoperative outcomes for patients undergoing head and neck free flap reconstruction. Design, Setting, and Participants This retrospective cohort study of 733 patients was conducted at an academic tertiary care medical center. Head and neck oncologic procedures involving microvascular free flap reconstruction with available intraoperative data collected from January 1, 2000, to December 31, 2021, were included. Main Outcomes and Measures Patient characteristics including demographic characteristics and comorbid conditions, operative variables, length of stay, and postoperative outcomes were measured. Descriptive statistics and effect size measures were performed to compare the 3 intraoperative surgical team approaches, specifically single surgeon, separate 2-team approach, and integrated 2-team approach; 1:1 nearest neighbor matching without caliper was performed to compare single- vs 2-team and separate and integrated 2-team approaches. Effect size measures including Cramer V for dichotomous variables, the Kendall W coefficient of concordance for ordinal variables, and η2 for continuous variables were reported with 95% CIs to describe precision. Results Among 733 cases, there were no clinically significant differences in patient demographic characteristics, clinicopathologic characteristics, and choice of free flap reconstruction based on intraoperative surgical team approach. The mean (SD) age was 58.7 (12.4) years, and 514 were male (70.1%). In terms of operative and postoperative variables, there was a difference in operative times and intraoperative fluid requirements among the 3 different techniques, with the integrated 2-team approach demonstrating a mean reduction in operative time of approximately 2 hours (η2 = 0.871; 95% CI, 0.852-0.887; mean [SD] operative time = 541 [191] minutes for the single-surgeon approach, 399 [175] minutes for the integrated 2-team approach, and 537 [200] minutes for the separate 2-team approach) and lower fluid requirements of greater than 1 L (η2 = 0.790; 95% CI, 0.762-0.817). In both unadjusted analyses and propensity score matching, there were no clinically significant differences in terms of ischemia time, use of pressors, postoperative complications (including free flap failure, number of return trips to the operating room, length of stay, or 30-day readmission) based on intraoperative team approach. Conclusions and Relevance Findings suggest that the integrated 2-team surgical approach for complex head and neck microvascular reconstruction can be used to safely decrease operative time, with no difference in postoperative outcomes.
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Affiliation(s)
- Pratyusha Yalamanchi
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nithin S. Peddireddy
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Brennan McMichael
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Charles Keilin
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Keith A. Casper
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Kelly M. Malloy
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Jeffrey S. Moyer
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Mark E. P. Prince
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Andrew J. Rosko
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Chaz L. Stucken
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Matthew E. Spector
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Steven B. Chinn
- Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
- Rogel Cancer Center, University of Michigan, Ann Arbor
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Drake VE, Moyer JS. The Measure of a Scar: Patient Perceptions and Scar Optimization after Skin Cancer Reconstruction. Facial Plast Surg 2023; 39:501-507. [PMID: 37290453 DOI: 10.1055/s-0043-1769807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
In facial reconstruction after skin cancer resection, management and optimization of postoperative scar is a complex paradigm. Every scar is unique and presents a different challenge-whether due to anatomic, aesthetic, or patient-specific factors. This necessitates a comprehensive evaluation and an understanding of the tools at hand to improve its appearance. How a scar looks is meaningful to patients, and the facial plastic and reconstructive surgeon is tasked with its optimization. Clear documentation of a scar is critical to assess and determine optimal care. Scar scales such as the Vancouver Scar Scale, the Manchester Scar Scale, the Patient and Observer Assessment Scale, the Scar Cosmesis Assessment and Rating "SCAR" Scale, and FACE-Q, among others, are reviewed here in the context of evaluating postoperative or traumatic scar. Measurement tools objectively describe a scar and may also incorporate the patient's assessment of their own scar. In addition to physical exam, these scales quantify scars that are symptomatic or visually unpleasant and would be best served by adjuvant treatment. The current literature regarding the role of postoperative laser treatment is also reviewed. While lasers are an excellent tool to assist in blending of scar and decreasing pigmentation, studies have failed to evaluate laser in a consistent, standardized way that allows for quantifiable and predictable improvement. Regardless, patients may derive benefit from laser treatment given the finding of subjective improvement in their own perception of scar, even when there is not a significant change to the clinician's eye. This article also discusses recent eye fixation studies which demonstrate the importance of careful repair of large and central defects of the face, and that patients value the quality of the reconstruction.
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Affiliation(s)
- Virginia E Drake
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Livonia, Michigan
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Livonia, Michigan
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Yamasaki A, Dermody SM, Moyer JS. Reducing Risks of Graft Failure for Composite Skin–Cartilage Grafts. Facial Plast Surg Clin North Am 2023; 31:289-296. [PMID: 37001931 DOI: 10.1016/j.fsc.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Facial skin defects pose unique challenges for the reconstructive surgeon. Aesthetically complex areas involving a free margin-such as the ear, eyelid, columella, columella-lobule interface, soft tissue triangle, alar rim, and internal nasal lining-are particularly demanding, as secondary soft tissue contracture in these locations can lead to a very poor cosmetic outcome. In these cases, composite grafts offer an ideal combination of soft tissue coverage and structural rigidity, all accomplished in a single-stage surgery. Composite grafts are often underused in facial reconstructive surgery due to the tenuous blood supply and high reported rates of graft failure.
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Affiliation(s)
- Alisa Yamasaki
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA.
| | - Sarah M Dermody
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
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Patel AU, Moyer JS. An Assessment of LGBTQ+ Cultural Competency and Attitudes of US Otolaryngologists. OTO Open 2022; 6:2473974X221126167. [PMID: 36160932 PMCID: PMC9490464 DOI: 10.1177/2473974x221126167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Otolaryngologists can play a significant role in the care of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) patients through gender-affirming care and routine care in everyday practice. To avoid stigmatizing LGBTQ+ patients, otolaryngologists should maintain high levels of LGBTQ+ cultural competency; however, US otolaryngology programs offer limited amounts of LGBTQ+ topics in didactic curricula, and the LGBTQ+ cultural competency of otolaryngologists remains unknown. A cross-sectional survey of demographics, attitude questions, and the 7-point Likert LGBT-Development of Clinical Skills Scale was distributed to otolaryngologists across the United States. Otolaryngologists (n = 176) had moderately high Overall LGBTQ+ cultural competency (mean, 5.82; range, 3.83-7.00), moderately high Basic Knowledge (mean, 5.43; range, 1.53-7.00), moderately high Clinical Preparedness (mean, 5.34; range, 2.00-7.00), and high Attitudinal Awareness (mean, 6.51; range, 2.42-7.00). Attending otolaryngologists had significantly lower LGBTQ+ Basic Knowledge than residents and fellows (P = .002). Further education at all levels of practice, including attendings, is necessary to improve LGBTQ+ cultural competency among otolaryngologists.
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Affiliation(s)
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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8
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Pleasant TK, Benvenuto A, Moyer JS. Nasal Ulceration in Trigeminal Trophic Syndrome. Facial Plast Surg Aesthet Med 2022; 24:506-508. [DOI: 10.1089/fpsam.2021.0417] [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: 11/12/2022] Open
Affiliation(s)
- Terrence K. Pleasant
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Jeffrey S. Moyer
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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9
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Moyer JS. Commentary on “Visual Attention to Facial Defects Predicts Willingness to Pay for Reconstructive Surgery” by Ryan et al. Facial Plast Surg Aesthet Med 2022; 24:443-444. [DOI: 10.1089/fpsam.2022.0057] [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: 11/13/2022] Open
Affiliation(s)
- Jeffrey S. Moyer
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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10
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Farlow JL, Marchiano EJ, Fischer IP, Moyer JS, Thorne MC, Bohm LA. Addressing the Impact of COVID-19 on the Residency Application Process Through a Virtual Subinternship. Otolaryngol Head Neck Surg 2020; 163:926-928. [PMID: 32513054 DOI: 10.1177/0194599820934775] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Senior medical students are facing an unparalleled experiential gap left by COVID-19 restrictions. Due to a shared commitment to safety, equity, and well-being, away rotations are actively being discouraged or even prohibited. As a result, students transitioning to residency encounter reduced clinical training experiences and decreased access to advising, mentorship, and research opportunities. In addition, limited exposure to residency life across subspecialties and institutions poses unique challenges during the current residency application cycle. The otolaryngology-head and neck surgery community has met these unprecedented challenges by producing diverse electronic resources for specialty-specific clinical education, as well as discussing ways to increase access to advising. In this commentary, we review these initiatives and propose an institutional virtual event as a platform for meeting goals previously achieved by visiting subinternships.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Emily J Marchiano
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Ilana P Fischer
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Marc C Thorne
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Lauren A Bohm
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Moyer JS. Management of Melanoma and Advanced Non-Melanoma Skin Cancers of the Face. Facial Plast Surg 2020; 36:131-132. [PMID: 32413919 DOI: 10.1055/s-0040-1709120] [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: 10/24/2022] Open
Affiliation(s)
- Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
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12
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Rudy SF, Moyer JS. Nasal Obstruction after Mohs Surgery: Prevention and Correction. Facial Plast Surg 2020; 36:84-90. [PMID: 32191964 DOI: 10.1055/s-0040-1701481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
As rates of Mohs micrographic surgery (MMS) have risen over recent decades in the setting of increased incidence of nonmelanoma skin cancer, so too has the need for post-Mohs reconstruction. The nose is one of the most common sites of post-MMS nasal reconstruction and presents unique challenges that often require expertise in facial plastic and reconstructive surgery. In addition to the aesthetic importance of the nose, preserving nasal function and preventing nasal obstruction are paramount to successful nasal reconstruction. This article will provide a brief review of nasal anatomy, with a focus on particular anatomic risk factors for post-MMS reconstruction nasal obstruction, strategies to prevent nasal obstruction, as well as techniques to correct the problem when it arises.
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Affiliation(s)
- Shannon F Rudy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
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13
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Farlow JL, Birkeland AC, Hardenbergh A, Lyden T, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Rosko AJ, Spector ME. Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx. Eur Arch Otorhinolaryngol 2020; 277:1459-1465. [PMID: 31989269 DOI: 10.1007/s00405-020-05809-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize outcomes of total laryngectomy for the dysfunctional larynx after radiation. METHODS Retrospective case series of all subjects who underwent total laryngectomy for the irradiated dysfunctional larynx between 2000 and 2018 at an NCI-designated comprehensive cancer center at a single tertiary care academic medical center. Main outcomes included enteral tube feeding dependency, functional tracheoesophageal speech, and number and timing of postoperative pharyngeal dilations. RESULTS Median time from radiation to laryngectomy was 2.8 years (range 0.5-27 years). Functional outcomes were analyzed for the 32 patients with 1-year follow-up. Preoperatively, 81% required at least partial enteral tube feeding, as compared to 34% 1-year postoperatively (p = 0.0003). At 1 year, 81% had achieved functional tracheoesophageal speech, which was associated with cricopharyngeal myotomy (p = 0.04, HR 0.04, 95% CI 0.002-0.949). There were 34% of subjects who required at least one pharyngeal dilation for stricture by 1 year postoperatively. Over half (60%) of the cohort were dilated over the study period. CONCLUSIONS Laryngectomy for the dysfunctional larynx improves speech and swallowing outcomes in many patients. Cricopharyngeal myotomy is associated with improved postoperative voice. While the need for enteral feeding is decreased, persistent postoperative swallowing dysfunction is common. Careful patient selection and education regarding functional expectations are paramount.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew C Birkeland
- Department of Otolaryngology, Head and Neck Surgery, University of California Davis, Sacramento, CA, 98517, USA
| | - Anna Hardenbergh
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Teresa Lyden
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - J Chad Brenner
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew G Shuman
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Steven B Chinn
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Chaz L Stucken
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Kelly M Malloy
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Keith A Casper
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Mark E P Prince
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Carol R Bradford
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Gregory T Wolf
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Andrew J Rosko
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
| | - Matthew E Spector
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
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14
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Heft Neal ME, Brennan J, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, McLean SA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Rosko AJ, Spector ME. Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy. Ann Surg Oncol 2019; 27:451-457. [PMID: 31538289 DOI: 10.1245/s10434-019-07841-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with recurrent oropharyngeal cancer often require extensive salvage surgery. For patients with clinically N0 necks, the indication for concurrent neck dissection remains unclear. This study aimed to determine predictors, prevalence, and distribution of nodal disease in patients treated with salvage oropharyngectomy. METHODS In a case series with data collection at a single tertiary academic National Cancer Institute (NCI)-designated comprehensive cancer center, this study analyzed patients treated with prior radiation or chemoradiation who had persistent, recurrent, or second primary squamous cell carcinoma of the oropharynx requiring oropharyngeal resection between 1998 and 2017 (n = 95). Clinical and oncologic characteristics and treatment outcomes were collected, and statistical analyses were performed. RESULTS The overall rate of nodal positivity was 21% (24/95), and the rate of occult nodal disease was 6% (4/65). Ipsilateral and contralateral level 2 were the most common areas harboring positive nodes. Bivariate analysis showed female sex (p = 0.01), initial overall stage (p = 0.02), and N status (p = 0.03), as well as recurrent overall and T stage (p = 0.05) to be predictors of nodal disease. In the multivariate analysis, recurrent T stage continued to be significantly predictive of pathologic nodal disease. Both computed tomography (CT) and positron emission tomography-CT were moderately accurate in predicting nodal disease in the salvage setting (area under the curve, 0.79 and 0.80, respectively). CONCLUSION Occult nodal disease is observed in few patients undergoing salvage oropharyngeal resection. This study identified factors predictive of nodal disease in patients undergoing salvage oropharyngectomy and appropriate diagnostic tests in this setting.
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Affiliation(s)
- M E Heft Neal
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J Brennan
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J C Brenner
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - A G Shuman
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - S B Chinn
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - C L Stucken
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - K M Malloy
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J S Moyer
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - K A Casper
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - S A McLean
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M E P Prince
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - C R Bradford
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - G T Wolf
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - D B Chepeha
- Head and Neck Surgical Oncology and Reconstructive Microsurgery, Department of Otolaryngology, Department of Surgical Oncology, University of Toronto, Toronto, ON, USA
| | - A J Rosko
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M E Spector
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
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Farlow JL, Birkeland AC, Rosko AJ, VanKoevering K, Haring CT, Smith JD, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, McLean SA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Spector ME. Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy. Ann Surg Oncol 2019; 26:2542-2548. [PMID: 30830535 DOI: 10.1245/s10434-019-07270-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Indications for and efficacy of paratracheal nodal dissection (PTND) in patients undergoing laryngectomy (salvage) for persistent or recurrent laryngeal squamous cell carcinoma are not well-defined. METHODS A retrospective cohort study was performed for patients undergoing salvage laryngectomy with clinically and radiographically negative neck disease between 1998 and 2015 (n = 210). Univariate and multivariate Cox regression analyses were performed. RESULTS PTND was performed on 77/210 patients (36%). The PTND cohort had a greater proportion of advanced T classification (rT3/rT4) tumors (78%) than subjects without PTND (55%; p = 0.001). There was a 14% rate of occult nodal metastases in the paratracheal basin; of these, 55% did not have pathologic lateral neck disease. Multivariate analysis controlling for tumor site, tumor stage, and pathologic lateral neck disease demonstrated that PTND was associated with improved overall survival [OS] (p = 0.03; hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.38-0.96), disease-free survival [DFS] (p = 0.03; HR 0.55, 95% CI 0.31-0.96), and distant DFS survival (p = 0.01; HR 0.29, 95% CI 0.11-0.77). The rate of hypocalcemia did not differ between subjects who underwent bilateral PTND, unilateral PTND, or no PTND (p = 0.19 at discharge, p = 0.17 at last follow-up). CONCLUSIONS PTND at the time of salvage laryngectomy was more common in patients with rT3/rT4 tumors and was associated with improved OS and DFS, with no effect on hypocalcemia. In patients undergoing PTND, the finding of occult paratracheal metastases was often independent of lateral neck metastases.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kyle VanKoevering
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Catherine T Haring
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
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16
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Affiliation(s)
- Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Michigan Medicine, Ann Arbor
| | - Shi Yang
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Michigan Medicine, Ann Arbor
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17
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Hoesli R, Brennan JR, Rosko AJ, Birkeland AC, Malloy KM, Moyer JS, Prince MEP, Shuman AG, Chinn SB, Stucken CL, Casper KA, Spector ME. Intraoperative Fluorescent Angiography Predicts Pharyngocutaneous Fistula After Salvage Laryngectomy. Ann Surg Oncol 2019; 26:1320-1325. [PMID: 30805812 DOI: 10.1245/s10434-019-07262-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Technology to assess tissue perfusion is exciting with translational potential, although data supporting its clinical applications have been lagging. Patients who have undergone radiation are at particular risk of poor tissue perfusion and would benefit from this expanding technology. We designed a prospective clinical trial using intraoperative indocyanine green angiography to evaluate for wound-healing complications in patients undergoing salvage laryngectomy after radiation failure. PATIENTS AND METHODS This prospective trial included patients undergoing salvage laryngectomy at a National Cancer Institute-designated tertiary cancer center between 2016 and 2018. After tumor extirpation and prior to reconstruction, 10 mg indocyanine green dye was infused and the fluorescence (FHYPO) and ingress rate of the pharyngeal mucosa recorded. The primary outcome measure was formation of a pharyngocutaneous fistula (PCF). RESULTS Patients who developed a PCF had significantly lower FHYPO (87 vs 172, p < 0.001) and ingress rates (6.7 vs 15.8, p = 0.043) compared with those who did not develop a fistula. There were no fistulas in patients with FHYPO > 150 (n = 21) or ingress > 15 (n = 15). There was a 50% fistula rate in patients with FHYPO ≤ 103 (n = 10) and ingress rate ≤ 6 (n = 6). CONCLUSIONS Intraoperative indocyanine green angiography can assess hypoperfusion in patients and predict risk of PCFs after salvage laryngectomy, and can thus intraoperatively risk-stratify patients for postoperative wound-healing complications.
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Affiliation(s)
- Rebecca Hoesli
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
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18
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Moyer JS. State-of-the-Art in Skin Cancer Surgery. Facial Plast Surg Clin North Am 2018; 27:xiii. [PMID: 30420077 DOI: 10.1016/j.fsc.2018.08.015] [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: 10/27/2022]
Affiliation(s)
- Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, TC 1904, Ann Arbor, MI 48109, USA.
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Wolf GT, Moyer JS, Kaplan MJ, Newman JG, Egan JE, Berinstein NL, Whiteside TL. IRX-2 natural cytokine biologic for immunotherapy in patients with head and neck cancers. Onco Targets Ther 2018; 11:3731-3746. [PMID: 29988729 PMCID: PMC6029613 DOI: 10.2147/ott.s165411] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is an immunosuppressive malignancy characterized by tumor-driven immune-system abnormalities that contribute to disease progression. For patients with surgically resectable HNSCC, treatment is often curative surgery followed by irradiation or chemoradiation in high-risk settings to reduce the risk of recurrence. Poor survival and considerable morbidity of current treatments suggest the need for new therapeutic modalities that can improve outcomes. Defects in antitumor immunity of HNSCC patients include suppressed dendritic cell (DC) maturation, deficient antigen-presenting cell function, compromised natural killer (NK)-cell cytotoxicity, increased apoptosis of activated T lymphocytes, and impaired immune-cell migration to tumor sites. Strategies for relieving immunosuppression and restoring antitumor immune functions could benefit HNSCC patients. IRX-2 is a primary cell-derived biologic consisting of physiologic levels of T-helper type 1 cytokines produced by stimulating peripheral blood mononuclear cells of normal donors with phytohemagglutinin. The primary active components in IRX-2 are IL2, IL1β, IFNγ, and TNFα. In vitro, IRX-2 acts on multiple immune-system cell types, including DCs, T cells, and NK cells, to overcome tumor-mediated immunosuppression. In clinical settings, IRX-2 is administered as part of a 21-day neoadjuvant regimen, which includes additional pharmacologic agents (low-dose cyclophosphamide, indomethacin, and zinc) to promote anticancer immunoresponses. In a Phase IIA trial in 27 patients with surgically resectable, previously untreated HNSCC, neoadjuvant IRX-2 increased infiltration of T cells, B cells, and DCs into tumors and was associated with radiological reductions in tumor size. Event-free survival was 64% at 2 years, and overall 5-year survival was 65%. Follow-up and data analysis are under way in the multicenter, randomized, Phase IIB INSPIRE trial evaluating the IRX-2 regimen as a stand-alone therapy for activating the immune system to recognize and attack tumors.
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Affiliation(s)
- Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI,
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI,
| | - Michael J Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA
| | - Jason G Newman
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Theresa L Whiteside
- Department of Immunology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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20
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Abstract
Dissatisfaction with the appearance of the nasal tip is a common compliant in patients seeking revision surgery after rhinoplasty. Revision rhinoplasty is more technically difficult and unpredictable given the frequent presence of scar contracture, impaired skin envelope quality, and missing alar cartilage. This article describes some of the more common causes for tip revision surgery and techniques to address these abnormalities.
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Affiliation(s)
- Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
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21
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Prince MEP, Zhou L, Moyer JS, Tao H, Lu L, Owen J, Etigen M, Zheng F, Chang AE, Xia J, Wolf G, Wicha MS, Huang S, Ren X, Li Q. Evaluation of the immunogenicity of ALDH(high) human head and neck squamous cell carcinoma cancer stem cells in vitro. Oral Oncol 2018; 59:30-42. [PMID: 27424180 DOI: 10.1016/j.oraloncology.2016.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 09/05/2014] [Revised: 05/04/2016] [Accepted: 05/20/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To establish the concept that the antigenicity/immunogenicity of ALDH(high) human head and neck squamous cell carcinoma (HNSCC) cancer stem cells (CSC) is distinct from that of ALDH(low) non-CSCs. METHODS We generated CSC-loaded dendritic cells (DCs) to sensitize autologous peripheral blood T, B lymphocytes to react with CSCs using human HNSCC samples in vitro. RESULTS From peripheral blood collected from patients with HNSCC, we obtained PBMCs. DCs generated from the PBMC and pulsed with the lysate of ALDH(high) cells isolated from cultured HNSCC cells (CSC-DC) could sensitize autologous T, B lymphocytes in vitro, which was evident by cytokine production, CTL activity, and antibody secretion of these primed T, B cells in response to ALDH(high) CSCs. In contrast, DCs pulsed with lysate of ALDH(low) cells (ALDH(low)-DC) resulted in limited sensitization/priming of autologous T, B lymphocytes to produce IFNγ, GM-CSF; lyse CSCs, and secrete IgM and IgG in response to ALDH(high) CSCs. These results demonstrated significant differences in the antigenicity/immunogenicity between ALDH(high) CSCs vs. ALDH(low) cells isolated from the tumor specimen of patients with HNSCC, which indicates the existence of unique CSC antigens in the ALDH(high) population. CONCLUSION It is feasible to generate DCs from the PBMCs and isolate ALDH(high) CSCs from cultured tumor cells of the patients with HNSCC to prepare CSC-DC vaccines that can induce anti-HNSCC CSC cellular and humoral immunity, indicating its potential clinical application to treat patients with HNSCC.
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Affiliation(s)
- Mark E P Prince
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Li Zhou
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA.,Department of Immunology, Biotherapy Center ,Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Tianjin, P. R. China
| | - Jeffrey S Moyer
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Huimin Tao
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA.,Hubei Province Stem Cell Research & Appling Center, Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Lu
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA.,State Key Laboratory of Oncology in Southern China and Department of Experimental Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - John Owen
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Martin Etigen
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Fang Zheng
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA.,Hubei Province Stem Cell Research & Appling Center, Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Alfred E Chang
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Jianchuan Xia
- State Key Laboratory of Oncology in Southern China and Department of Experimental Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Gregory Wolf
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Max S Wicha
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Shiang Huang
- Hubei Province Stem Cell Research & Appling Center, Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiubao Ren
- Department of Immunology, Biotherapy Center ,Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Tianjin, P. R. China
| | - Qiao Li
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
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Abstract
Successful reconstruction of the cheek following excision for cutaneous malignancy requires careful consideration of defect location, size, and depth in relation to the anatomic properties of the affected cheek unit. Various reconstructive options are available to the surgeon, ranging from simple excisions to complex cervicofacial advancements to meet the needs for functional and aesthetically pleasing reconstructive outcomes. The surgeon must prevent distortion of mobile structures, such as the eyelid, nose, and lips; respect aesthetic subunits; and avoid blunting natural creases. This discussion covers choice of flap, techniques, and technical considerations for medial/perinasal, perilabial, preauricular, lateral, and zygomatic cheek defects.
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Affiliation(s)
- John E Hanks
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
| | - Michael J Brenner
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA.
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23
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Rosko AJ, Birkeland AC, Bellile E, Kovatch KJ, Miller AL, Jaffe CC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Spector ME. Hypothyroidism and Wound Healing After Salvage Laryngectomy. Ann Surg Oncol 2017; 25:1288-1295. [PMID: 29264671 DOI: 10.1245/s10434-017-6278-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients undergoing salvage laryngectomy are predisposed to radiation-induced hypothyroidism and impaired wound healing secondary to the tissue effects of prior treatment. The impact of hypothyroidism on postoperative wound healing is not established. METHODS A single-institution retrospective case series was performed. The inclusion criteria specified preoperatively euthyroid adults who underwent salvage laryngectomy with concurrent neck dissection between 1997 and 2015 for persistent or recurrent laryngeal squamous cell carcinoma after radiation or chemoradiation therapy (n = 182). The principal explanatory variable was postoperative hypothyroidism, defined as thyroid-stimulating hormone (TSH) higher than 5.5 mIU/L. The primary end points of the study were pharyngocutaneous fistulas and wounds requiring reoperation. Multivariate analysis was performed. RESULTS The fistula rate was 47% among hypothyroid patients versus 23% among euthyroid patients. In the multivariate analysis, the patients who experienced hypothyroidism in the postoperative period had a 3.6-fold greater risk of fistula [95% confidence interval (CI) 1.8-7.1; p = 0.0002]. The hypothyroid patients had an 11.4-fold greater risk for a required reoperation (24.4 vs 5.4%) than the euthyroid patients (95% CI 2.6-49.9; p = 0.001). The risk for fistula (p = 0.003) and reoperation (p = 0.001) increased with increasing TSH. This corresponds to an approximate 12.5% incremental increase in the absolute risk for fistula and a 10% increase in the absolute risk for reoperation with each doubling of the TSH. CONCLUSION Postoperative hypothyroidism independently predicts postoperative wound-healing complications. The association of hypothyroidism with fistula formation may yield opportunities to modulate wound healing with thyroid supplementation or to provide a biomarker of wound progression.
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Affiliation(s)
- Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Ashley L Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Craig C Jaffe
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto Health System, Toronto, ON, Canada
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
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25
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Liao F, Hu YY, Chen X, Chang AE, Hollingsworth RE, Hurt E, Owen J, Moyer JS, Prince ME, Whitfield J, Chu Y, Song Q, Wicha MS, Li Q. Abstract 1903: Cancer stem cell vaccine significantly reduces local tumor relapse and prolongs survival in the adjuvant setting. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Although surgical resection has been a standard treatment for solid malignancies, therapeutic efficacy is limited by both local and distant recurrence. Effectively preventing local tumor recurrence remains a significant challenge. The existence of micro metastasis at the time of tumor resection represents an even greater therapeutic challenge, since 90% of tumor deaths are due to tumor metastasis. There is increasing evidence that many cancers are driven and maintained by a subpopulation of cells that display stem cell properties. Cancer stem cells (CSCs) can self-renew, mediate tumor growth and contribute to tumor recurrence and metastasis. Targeting CSCs may thus increase the therapeutic efficacy of current cancer treatment. We previously described a strategy to target CSCs using CSC-dendritic cell (DC) vaccination. However, the efficacy of CSC targeted therapeutics may be greatest when they are deployed in the adjuvant setting. In this study, two mouse models were utilized: SCC7 subcutaneous (s.c.) tumors, and a D5 melanoma model. Established s.c. SCC7 tumors were surgically removed from mice followed by treatment using ALDHhigh SCC7 CSC-DC vaccine, which significantly reduced local tumor relapse and prolonged animal survival. This effect was significantly augmented by simultaneous administration of anti-PD-L1 mAb. In the minimal disease setting of D5, ALDHhigh CSC-DC vaccination significantly inhibited tumor growth, reduced spontaneous lung metastases resulting in increased survival. CCR10 and its ligands were down-regulated on ALDHhigh D5 CSCs and in lung tissues respectively in animals subjected to ALDHhigh D5 CSC-DC vaccination. Down-regulation of CCR10 by siRNA significantly blocked tumor cell migration in vitro and metastasis in vivo. T cells harvested from ALDHhigh D5 CSC-DC vaccinated animals selectively killed the ALDHhigh D5 CSCs. There was also evidence of humoral immunological targeting of CSCs. As a result, CSC-DC vaccination significantly decreased the percentage of ALDHhigh cells in residual tumors. These data indicate that, when used in an adjuvant setting, ALDHhigh CSC-DC vaccines effectively inhibit local tumor recurrence, reduce spontaneous lung metastasis, and prolong animal survival; compared with traditional DC vaccines and that simultaneous PD-L1 blockade can significantly enhance this effect.
Citation Format: Fei Liao, Yang yang Hu, Xin Chen, Alfed E Chang, Robert E Hollingsworth, Elaine Hurt, John Owen, Jeffrey S Moyer, Mark E.P Prince, Joel Whitfield, Yuxin Chu, Qibin Song, Max S Wicha, Qiao Li. Cancer stem cell vaccine significantly reduces local tumor relapse and prolongs survival in the adjuvant setting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1903. doi:10.1158/1538-7445.AM2017-1903
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Affiliation(s)
- Fei Liao
- 1Univ. of Michigan, Ann Arbor, MI
| | | | - Xin Chen
- 1Univ. of Michigan, Ann Arbor, MI
| | | | | | | | | | | | | | | | - Yuxin Chu
- 3Renmin Hospital of Wuhan University, Wuhan, China
| | - Qibin Song
- 3Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Qiao Li
- 1Univ. of Michigan, Ann Arbor, MI
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Moyer JS, Rudy S, Boonstra PS, Kraft C, Chinn SB, Baker SR, Schwartz JL, Bichakjian CK, Fullen D, Durham AB, Lowe L, Johnson TM. Efficacy of Staged Excision With Permanent Section Margin Control for Cutaneous Head and Neck Melanoma. JAMA Dermatol 2017; 153:282-288. [PMID: 28002553 DOI: 10.1001/jamadermatol.2016.4603] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [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 Melanoma arising in chronically photodamaged skin, especially on the head and neck, is often characterized by poorly defined clinical margins and unpredictable occult extension. Staged excision techniques have been described to treat these challenging melanomas. Objective To investigate the local recurrence rates and margin to clearance end points using staged excision with comprehensive hematoxylin-eosin-stained permanent section margin control. Design, Setting, and Participants In this observational cohort study performed from October 8, 1997, to December 31, 2006, with a median follow-up of 9.3 years, 806 patients with melanoma on the head and neck, where clinical occult extension is common, were studied at an academic medical center. Interventions Staged excision with comprehensive hematoxylin-eosin-stained permanent section margin control commonly known as the square technique. Main Outcomes and Measures Local recurrence rates and margin to clearance end points. Results A total of 806 patients (276 women [34.2%]; 805 white [99.9%]) with a median age at the time of first staged excision procedure of 65 years (range, 20-94 years) participated in the study. The estimated local recurrence rates were 1.4% at 5 years, 1.8% at 7.5 years, and 2.2% at 10 years. For each 50-mm2 increase in the size of the clinical lesion, there was a 9% increase in the rate of local recurrence (hazard ratio, 1.09; 95% CI, 1.02-1.15; P = .02). The mean (SD) margin from lesion to clearance for melanoma in situ was 9.3 (5.1) mm compared with 13.7 (5.9) mm for invasive melanoma. For melanoma in situ, margins were clear after 5 mm or less in 232 excisions (41.1%) and after 10 mm or less in 420 excisions (74.5%). For invasive melanoma, margins were clear after 5 mm or less in 8 excisions (3.0%) and after 10 mm or less in 141 excisions (52.2%). Conclusions and Relevance Staged excision with comprehensive permanent section margin control of melanomas arising in chronically sun-damaged skin on the head and neck has favorable recurrence rates when melanoma margins are difficult to assess, and recurrence rates are high with traditional techniques.
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Affiliation(s)
- Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
| | - Shannon Rudy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
| | - Philip S Boonstra
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | - Casey Kraft
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
| | - Shan R Baker
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
| | | | | | - Douglas Fullen
- Department of Dermatology, University of Michigan Medical School, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Alison B Durham
- Department of Dermatology, University of Michigan Medical School, Ann Arbor
| | - Lori Lowe
- Department of Dermatology, University of Michigan Medical School, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Timothy M Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor3Department of Dermatology, University of Michigan Medical School, Ann Arbor5Division of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
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Affiliation(s)
- Andrew J. Rosko
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Kyle K. Vankoevering
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Scott A. McLean
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | | | - Jeffrey S. Moyer
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
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Abstract
Osteotomies are critical techniques in rhinoplasty. There are a variety of approaches, trajectories, and tools used with no widely standardized classification or nomenclature. Percutaneous osteotomies are gaining in popularity, and picture framing the nasomaxillary bone is crucial for predictable fracture and reproducible results. This is best accomplished with medial, lateral, and transverse osteotomies. Intermediate osteotomies are used less frequently, but provide more mobility. With a detailed understanding of anatomy and a thorough approach to nasal osteotomies, the contour and function of the bony vault can be reshaped with a successful outcome for both the surgeon and patient.
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Affiliation(s)
- Kyle K VanKoevering
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
| | - Andrew J Rosko
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA; Center for Facial Cosmetic Surgery, 19900 Haggerty Road, Suite 103, Livonia, MI 48152, USA.
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Affiliation(s)
- Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Michigan, Ann Arbor
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Spector ME, Sacco AG, Bellile E, Taylor JMG, Jones T, Sun K, Brown WC, Birkeland AC, Bradford CR, Wolf GT, Prince ME, Moyer JS, Malloy K, Swiecicki P, Eisbruch A, McHugh JB, Chepeha DB, Rozek L, Worden FP. E6 and E7 Antibody Levels Are Potential Biomarkers of Recurrence in Patients with Advanced-Stage Human Papillomavirus-Positive Oropharyngeal Squamous Cell Carcinoma. Clin Cancer Res 2016; 23:2723-2729. [PMID: 27872102 DOI: 10.1158/1078-0432.ccr-16-1617] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 06/26/2016] [Revised: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 11/16/2022]
Abstract
Purpose: There is a paucity of biomarkers to predict failure in human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) following curative therapy. E6/E7 viral oncoproteins are constitutively expressed in HPV+ tumors and highly immunogenic, resulting in readily detected serum antibodies. The purpose of this study is to determine whether serum E6 and E7 antibody levels can potentially serve as a biomarker of recurrence in patients with HPV+OPSCC.Experimental Design: We evaluated E6/E7 antibody levels in patients with previously untreated, advanced stage (III, IVa-b), HPV+OPSCC receiving definitive chemoradiation under a uniform protocol from 2003 to 2010. Baseline and longitudinal serum samples were obtained from our archived repository. E6/E7 serum levels were measured using a glutathione-S-transferase capture ELISA and quantified by approximating the area under the dilution curve, and were analyzed using ANOVA and linear mixed model for longitudinal analysis.Results: We compared 22 HPV+OPSCC patients who developed recurrence with 30 patients who remained disease-free. There were no differences in T classification, N classification, disease subsite, or smoking status between the groups. In a longitudinal analysis, recurrent patients had significantly higher E6 and E7 serum antibody levels than the nonrecurrent patients over the follow-up period (P = 0.02 and P = 0.002, respectively). Patients who recurred had a lower clearance of E7 antibody than patients who remained disease-free (P = 0.0016).Conclusions: Patients with HPV+OPSCC whose disease recurs have a lower clearance of E6 and E7 antibodies than patients who do not have recurrence. The ratio of E7 antibody at disease recurrence compared with baseline is potentially a clinically significant measurement of disease status in HPV+OPSCC. Clin Cancer Res; 23(11); 2723-9. ©2016 AACR.
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MESH Headings
- Adult
- Aged
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/immunology
- Carcinoma, Squamous Cell/blood
- Carcinoma, Squamous Cell/immunology
- Carcinoma, Squamous Cell/pathology
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/immunology
- Oncogene Proteins, Viral/blood
- Oncogene Proteins, Viral/immunology
- Oropharyngeal Neoplasms/blood
- Oropharyngeal Neoplasms/immunology
- Oropharyngeal Neoplasms/pathology
- Papillomaviridae/immunology
- Papillomavirus E7 Proteins/blood
- Papillomavirus E7 Proteins/immunology
- Papillomavirus Infections/blood
- Papillomavirus Infections/immunology
- Repressor Proteins/blood
- Repressor Proteins/immunology
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Affiliation(s)
- Matthew E Spector
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan.
| | - Assuntina G Sacco
- Moores Cancer Center, University of California at San Diego, La Jolla, California
| | - Emily Bellile
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Jeremy M G Taylor
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Tamara Jones
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Kan Sun
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - William C Brown
- University of Michigan High-throughput Protein Laboratory, Center for Structural Biology, Life Sciences Institute, Ann Arbor, Michigan
| | | | - Carol R Bradford
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Gregory T Wolf
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Mark E Prince
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Jeffrey S Moyer
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Kelly Malloy
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Paul Swiecicki
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Avraham Eisbruch
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Jonathan B McHugh
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Douglas B Chepeha
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
- University of Toronto, Toronto, Ontario, Canada
| | - Laura Rozek
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Francis P Worden
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
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Spector ME, Chinn SB, Bellile E, Gallagher KK, Kang SY, Moyer JS, Prince ME, Wolf GT, Bradford CR, McHugh JB, Carey TE, Worden FP, Eisbruch A, Ibrahim M, Chepeha DB. Exploration for an Algorithm for Deintensification to Exclude the Retropharyngeal Site From Advanced Oropharyngeal Squamous Cell Carcinoma Treatment. JAMA Otolaryngol Head Neck Surg 2016; 142:313-8. [PMID: 26892642 DOI: 10.1001/jamaoto.2015.3602] [Citation(s) in RCA: 8] [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: 01/06/2023]
Abstract
IMPORTANCE Understanding the drainage patterns to the retropharyngeal lymph nodes is an important consideration in oropharyngeal squamous cell carcinoma (OPSCC) because treatment of these nodes is related to increased morbidity. Prediction of these drainage patterns could not only help minimize treatment morbidity but also prevent failures in at-risk patients as deintensification trials are under way for this disease. OBJECTIVE To evaluate the prevalence of pathologic retropharyngeal adenopathy (RPA) in OPSCC relative to involvement of the oropharyngeal subsite, number of metastatic neck nodes, T classification, and N classification. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective review from January 1, 2003, through December 31, 2010, at an academic referral center of 205 previously untreated patients with pathologically confirmed, advanced-stage (III, IV) OPSCC. Data analysis was performed from January 1, 2013, through June 30, 2015. EXPOSURE Concurrent chemoradiotherapy. MAIN OUTCOMES AND MEASURES Radiologic evidence of pathologic RPA was tabulated and related to involvement of the oropharyngeal subsite, number of metastatic neck nodes, T classification, and N classification. RESULTS Of the 205 previously untreated patients (183 men; mean age, 56.1 years), pathologic RPA was identified in 37 (18.0%) of the 205 patients. Pathologic retropharyngeal lymph nodes were found in 12 (13.5%) of 89 patients with base of tongue cancers, 24 (22.0%) of 109 patients with tonsil cancers, and 1 (14.3%) of 7 patients with other oropharyngeal subsite cancers. Increasing prevalence of RPA was positively correlated with closer proximity to the posterior tonsillar pillar. A multivariable logistic regression model using the oropharyngeal subsite, involvement of the posterior tonsillar pillar, number of metastatic neck nodes, T classification, and N classification revealed that the number of metastatic neck nodes was statistically significant (odds ratio, 1.44; 95% CI, 1.20-1.71; P < .001). CONCLUSIONS AND RELEVANCE The prevalence of pathologic RPA in this cohort was 18.0%, and patients with multiple nodes had the highest risk of pathologic RPA, followed by involvement of the posterior tonsillar pillar. However, these data suggest that there is no clear algorithm that can be used for deintensification to exclude the retropharyngeal site from the treatment volume using extent of disease gathered from pretreatment imaging for patients with advanced-stage OPSCC.
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Affiliation(s)
| | - Steven B Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - K Kelly Gallagher
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas
| | - Stephen Y Kang
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Jeffrey S Moyer
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Mark E Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Gregory T Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | | | | | - Thomas E Carey
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Francis P Worden
- Department of Medical Oncology, University of Michigan, Ann Arbor
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | | | - Douglas B Chepeha
- Department of Otolaryngology, University of Michigan, Ann Arbor8Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
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Lei Y, Xie Y, Tan YS, Prince ME, Moyer JS, Nör J, Wolf GT. Telltale tumor infiltrating lymphocytes (TIL) in oral, head & neck cancer. Oral Oncol 2016; 61:159-65. [PMID: 27553942 DOI: 10.1016/j.oraloncology.2016.08.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 02/29/2016] [Revised: 07/11/2016] [Accepted: 08/15/2016] [Indexed: 12/13/2022]
Abstract
Evidence gleaned from recent studies on the role of tumor-infiltrating lymphocytes (TILs) suggests that cancer is not only a genetic disease but also an immunologic disease. Head and Neck Squamous Cell Carcinoma (HNSCC) has been a significant model to study cancer cell-immune cell interactions. First, immune cell infiltration is an important feature of these tumors. Second, HNSCC frequently develops resistance to immunogenic cytotoxicity, which provides a window to decipher how tumors engage the immune system to establish immune tolerance. Finally, chemoradiation therapy, as a central modality for HNSCC treatment, has been shown to elicit immune activation. The presence of effector immune cells in the tumor microenvironment is often associated with superior clinical response to adjuvant therapy. On the other hand, an activated immune system, in addition to limiting tumor initiation and progression, could also exert selective pressure to promote the growth of less immunogenic tumors, as a pivotal immunoediting process. But it remains unclear how cancer cell signaling regulates tumor immunogenicity and how to mitigate HNSCC-potentiated TIL suppression. In this review, we will revisit the prognostic role of TILs in HNSCC, and collectively discuss how cancer cell machinery impacts upon the plasticity of TILs.
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Affiliation(s)
- Yu Lei
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI 48109, United States; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, School of Medicine, Ann Arbor, MI 48109, United States; Translational Oncology Program, U-M Comprehensive Cancer Center, Ann Arbor, MI 48109, United States; Graduate Program in Immunology, University of Michigan, School of Medicine, Ann Arbor, MI 48109, United States.
| | - Yuying Xie
- Department of Computational Mathematics, Science, and Engineering, Michigan State University, East Lansing 48824, United States
| | - Yee Sun Tan
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI 48109, United States; Translational Oncology Program, U-M Comprehensive Cancer Center, Ann Arbor, MI 48109, United States
| | - Mark E Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, School of Medicine, Ann Arbor, MI 48109, United States
| | - Jeffrey S Moyer
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, School of Medicine, Ann Arbor, MI 48109, United States
| | - Jacques Nör
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, School of Medicine, Ann Arbor, MI 48109, United States; Translational Oncology Program, U-M Comprehensive Cancer Center, Ann Arbor, MI 48109, United States; Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI 48109, United States
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, School of Medicine, Ann Arbor, MI 48109, United States; Translational Oncology Program, U-M Comprehensive Cancer Center, Ann Arbor, MI 48109, United States.
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Hu Y, Lu L, Xia Y, Chen X, Chang AE, Hollingsworth RE, Hurt E, Owen J, Moyer JS, Prince MEP, Dai F, Bao Y, Wang Y, Whitfield J, Xia JC, Huang S, Wicha MS, Li Q. Therapeutic Efficacy of Cancer Stem Cell Vaccines in the Adjuvant Setting. Cancer Res 2016; 76:4661-72. [PMID: 27325649 DOI: 10.1158/0008-5472.can-15-2664] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 05/22/2016] [Indexed: 12/31/2022]
Abstract
Dendritic cell (DC)-based vaccine strategies aimed at targeting cancer stem-like cells (CSC) may be most efficacious if deployed in the adjuvant setting. In this study, we offer preclinical evidence that this is the case for a CSC-DC vaccine as tested in murine models of SCC7 squamous cell cancer and D5 melanoma. Vaccination of mice with an ALDH(high) SCC7 CSC-DC vaccine after surgical excision of established SCC7 tumors reduced local tumor relapse and prolonged host survival. This effect was augmented significantly by simultaneous administration of anti-PD-L1, an immune checkpoint inhibitor. In the minimal disease setting of D5 melanoma, treatment of mice with ALDH(high) CSC-DC vaccination inhibited primary tumor growth, reduced spontaneous lung metastases, and increased host survival. In this setting, CCR10 and its ligands were downregulated on ALDH(high) D5 CSCs and in lung tissues, respectively, after vaccination with ALDH(high) D5 CSC-DC. RNAi-mediated attenuation of CCR10 blocked tumor cell migration in vitro and metastasis in vivo T cells harvested from mice vaccinated with ALDH(high) D5 CSC-DC selectively killed ALDH(high) D5 CSCs, with additional evidence of humoral immunologic engagement and a reduction in ALDH(high) cells in residual tumors. Overall, our results offered a preclinical proof of concept for the use of ALDH(high) CSC-DC vaccines in the adjuvant setting to more effectively limit local tumor recurrence and spontaneous pulmonary metastasis, as compared with traditional DC vaccines, with increased host survival further accentuated by simultaneous PD-L1 blockade. Cancer Res; 76(16); 4661-72. ©2016 AACR.
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Affiliation(s)
- Yangyang Hu
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan. Center for Stem Cell Research and Application, Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Lu
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan. State Key Laboratory of Oncology in Southern China and Department of Experimental Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yang Xia
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan. The Third Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin Chen
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan. Department of Oncology, Wuhan University, Renmin Hospital, Wuhan, China
| | - Alfred E Chang
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | | | | | - John Owen
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Jeffrey S Moyer
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Mark E P Prince
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Fu Dai
- The Third Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yangyi Bao
- The Third Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yi Wang
- The Third Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Joel Whitfield
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Jian-Chuan Xia
- State Key Laboratory of Oncology in Southern China and Department of Experimental Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shiang Huang
- Center for Stem Cell Research and Application, Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Max S Wicha
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan.
| | - Qiao Li
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan.
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Abstract
Head and neck squamous cell carcinoma has been found to be an immunosuppressive malignancy, with many defects in the host immune system contributing to the progression of disease. A greater understanding of these defects has lead to the identification and investigation of new therapeutic strategies, targeting immune system dysfunction in an effort to improve the outcomes of this disease. This article provides a brief review of the knowledge regarding the immune defects present in head and neck cancer, as well as a review of the current therapeutic strategies being investigated for use.
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Affiliation(s)
- Rebecca C Hoesli
- University of Michigan, 1500 East Medical Center Drive - SPC 5312, Ann Arbor, MI 48109
| | - Jeffrey S Moyer
- University of Michigan, 1500 East Medical Center Drive - SPC 5312, Ann Arbor, MI 48109
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Moyer JS. Healing by Secondary Intention-Reply. JAMA FACIAL PLAST SU 2016; 18:233. [PMID: 27031329 DOI: 10.1001/jamafacial.2016.0061] [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)
- Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
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36
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Rosko AJ, Spector ME, Griffin GR, Vainshtein JM, Lee J, Bradford CR, Prince MEP, Moyer JS, Worden FP, Eisbruch A, Chepeha DB. Neurologic late effects associated with radiologic evidence of vertebral osteoradionecrosis after salvage laryngectomy: A syndrome associated with survivors of laryngeal and hypopharyngeal cancer. Head Neck 2016; 38:1187-93. [PMID: 27080049 DOI: 10.1002/hed.24348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Delayed nonspecific posterior neck pain after pharyngeal instrumentation can be associated with a syndrome of rapidly progressive neurologic embarrassment. We present this cohort to help define the syndrome and aid in early detection. METHODS We conducted a retrospective case series of 6 patients presenting from 2003 to 2012 with a history of laryngeal or hypopharyngeal squamous cell carcinoma (SCC) who underwent radiotherapy (RT) or chemoradiotherapy (CRT) followed by salvage laryngectomy. RESULTS Posterior neck and upper back pain developed a mean of 27.5 days after instrumentation of the pharynx (reconstruction after laryngectomy or pharyngeal dilation). Myelopathy developed an average of 21.5 days after the onset of posterior neck pain. Five patients required urgent decompression. Three patients developed quadriplegia. The disease-specific mortality was 50%. CONCLUSION There is a syndrome of late neurological effects after RT, salvage surgery, and pharyngeal instrumentation that is associated with high morbidity and mortality. © 2016 Wiley Periodicals, Inc. Head Neck 38:1187-1193, 2016.
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Affiliation(s)
- Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Garrett R Griffin
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.,Midwest ENT Specialists, Woodbury, Minnesota
| | - Jeffrey M Vainshtein
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.,Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Jae Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Francis P Worden
- Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Gallagher KK, Sacco AG, Lee JSJ, Taylor R, Chanowski EJP, Bradford CR, Prince ME, Moyer JS, Wolf GT, Worden FP, Eisbruch A, Chepeha DB. Association Between Multimodality Neck Treatment and Work and Leisure Impairment: A Disease-Specific Measure to Assess Both Impairment and Rehabilitation After Neck Dissection. JAMA Otolaryngol Head Neck Surg 2016; 141:888-93. [PMID: 26426565 DOI: 10.1001/jamaoto.2015.2049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE This study describes the effect of adjuvant treatment on shoulder-related quality of life, leisure activities, and employment for patients undergoing neck dissection for head and neck cancer. OBJECTIVE To explore the association between treatment outcome and shoulder-related on critical daily life functions such as employment and recreation. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of patients with head and neck cancer at a tertiary care hospital. EXPOSURES Level V–sparing selective neck dissection or modified radical neck dissection sparing the accessory nerve, with or without radiation therapy and/or chemotherapy. MAIN OUTCOMES AND MEASURES Patients completed the Neck Dissection Impairment Index (NDII), with scores ranging from 0 to 100 and higher scores indicating better shoulder functioning and shoulder-related quality of life, and underwent objective testing with the Constant-Murley Shoulder Function Test (Constant test) at least 12 months after the completion of all adjuvant treatment. Additional outcome measures related to physical therapy, pain medication use, leisure activity, and employment status. RESULTS We evaluated 167 patients who underwent 121 selective neck dissections and 46 modified radical neck dissections. The median (range) NDII score was 90 (10-100). Patients with modified radical neck dissection reported lower scores than those with selective neck dissection (85 [10-100] vs. 92 [30-100]; P = .01). Multivariable analysis showed that advanced-stage disease (mean, 77 [range, 25-100] vs. 87 [18-100]; P = .006), radiation therapy (80 [10-100] vs. 88 [50-100]; P = .03), and chemotherapy (77 [30-100] vs. 83 [18-100]; P = .002) were associated with greater shoulder impairment. The NDII and Constant test were well correlated (0.64; P < .001). Change in leisure activity was correlated with greater impairment (median [range] NDII score, 90 [18-100] for patients with no change vs. 53 [10-100] for patients with change, P = .005; Constant score, 85 [12-100] vs. 68 [10-88], P = .004). Patients who remained employed or resumed working had higher median (range) NDII scores (94 [10-100] and 88 [75-100], respectively) than those who limited or stopped working (70 [10-100]), which also correlates with greater shoulder impairment (P < .001). CONCLUSIONS AND RELEVANCE More aggressive treatment, either in the form of increased surgical dissection, radiation therapy, or chemotherapy, was associated with worse shoulder function and quality of life. The degree of impairment perceived by the patient and measured in objective testing was correlated with leisure activity and employment status. These findings may stimulate further investigation related to optimizing quality of life following neck dissection.
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Abstract
IMPORTANCE The decision whether to discontinue antiplatelet and/or anticoagulant medications before a facial plastic surgical procedure is a complicated and multifactorial process that involves weighing the risk of perioperative thromboembolic complications with bleeding-related complications. OBJECTIVE To determine the complication rates in patients who undergo a range of facial plastic surgical procedures while receiving antiplatelet and/or anticoagulation therapy. DESIGN, SETTING, AND PARTICIPANTS A total of 9204 surgical procedures from January 1, 2007, through December 31, 2012, at an academic medical center and its affiliated surgical sites were analyzed, with patients who continued receiving antiplatelet and/or anticoagulation (aspirin, clopidogrel bisulphate, and warfarin sodium) therapy during the perioperative period identified and compared with a matched case-control group of patients who did not receive antiplatelet and/or anticoagulation therapy during this period. INTERVENTIONS Facial plastic surgery procedures and perioperative management. MAIN OUTCOME AND MEASURES Complication rates of wound healing (dehiscence or necrosis), infection, bleeding (hematoma or ecchymosis), and return to the operating room. RESULTS Patients who received aspirin therapy at the time of surgery were not more likely to have a complication compared with control patients (odds ratio [95% CI], 0.73 [0.45-1.17]). Patients who received warfarin had increased perioperative bleeding (odds ratio [95% CI], 3.80 [1.15-12.60]) and postoperative infections (odds ratio [95% CI], 7.29 [1.17-45.40]) compared with control patients. Serious complications (flap necrosis, dehiscence, or return to the operating room) were not increased with warfarin use. CONCLUSIONS AND RELEVANCE This study demonstrates that patients who undergo facial plastic surgery may continue taking antiplatelet and/or anticoagulation therapy during the perioperative period safely with minimal serious complications. LEVEL OF EVIDENCE 3.
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Chepeha DB, Spector ME, Chinn SB, Casper KA, Chanowski EJP, Moyer JS, Morrison R, Carvill E, Lyden TH. Hemiglossectomy tongue reconstruction: Modeling of elevation, protrusion, and functional outcome using receiver operator characteristic curve. Head Neck 2016; 38:1066-73. [PMID: 26900144 DOI: 10.1002/hed.24417] [Citation(s) in RCA: 10] [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] [Accepted: 12/29/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to model >12 month speech and the oral phase of swallowing outcomes with the reconstructive metrics of tongue elevation and protrusion in patients reconstructed with the rectangle tongue template for a hemiglossectomy defect. METHODS We conducted a study using 40 surviving patients (23 men, 17 women) treated between 2000 and 2012. Statistically significant correlations of elevation and protrusion with functional outcomes were modeled with receiver operator characteristic (ROC) curves to understand the performance and reliability of the rectangle tongue reconstruction. RESULTS Tongue elevation (1.8-1.9 cm) reliably produces best outcomes in nutritional mode, range of liquids, and ≥4/6 for range of solids. Greater tongue elevation (2.1-2.2 cm) reliably produces best outcomes for eating and speaking in public and understandability of speech. Tongue protrusion (0.8-1.0 cm) reliably produces best scores across all assessed outcomes except ≥4/6 for range of solids and ≥4/5 understandability of speech. CONCLUSION ROC curves are useful for assessing reliability and relating reconstructive objectives to functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1066-1073, 2016.
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Affiliation(s)
- Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven B Chinn
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Eric J P Chanowski
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Robert Morrison
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Emily Carvill
- Department of Speech-Language Pathology, McLaren Flint Health Care System, Flint, Michigan
| | - Teresa H Lyden
- Department of Speech-Language Pathology, University of Michigan, Ann Arbor, Michigan
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Spector ME, Chinn SB, Bellile E, Gallagher KK, Ibrahim M, Vainshtein J, Chanowski EJ, Walline HM, Moyer JS, Prince ME, Wolf GT, Bradford CR, McHugh JB, Carey T, Worden FP, Eisbruch A, Chepeha DB. Matted nodes as a predictor of distant metastasis in advanced-stage III/IV oropharyngeal squamous cell carcinoma. Head Neck 2016; 38:184-90. [PMID: 25251643 PMCID: PMC4370799 DOI: 10.1002/hed.23882] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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] [Accepted: 09/19/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We recently described the imaging characteristics of multiple confluent regional metastases (matted nodes) and found that this characteristic was associated with distant metastasis in patients with oropharyngeal squamous cell carcinoma (SCC). The purpose of this study was to determine if matted nodes are a predictive marker for distant metastasis. METHODS Radiologic lymph node characteristics on 205 patients with untreated stage III/IV with oropharyngeal SCC of whom 192 had known human papillomavirus (HPV) status underwent weekly carboplatin and paclitaxel with concomitant intensity-modulated radiation therapy (IMRT) between 2003 and 2010 with a minimum of 2-year of follow-up. RESULTS The 3-year disease-specific survival (DSS) for patients with matted nodes was 58% versus 97% with nonmatted nodes (p = .0001). The prevalence of matted nodes in the population was 20%. The positive predictive value of matted nodes for distant metastasis was 66%, and the negative predictive value was 99%. CONCLUSION Matted nodes are a predictive marker for distant disease and can be used for planning new clinical interventions.
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Affiliation(s)
- Matthew E Spector
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan Health System, Ann Arbor, MI, USA
| | - K Kelly Gallagher
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Mohannad Ibrahim
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jeffrey Vainshtein
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Eric J Chanowski
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Heather M Walline
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Mark E Prince
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Thomas Carey
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Francis P Worden
- Department of Medical Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Douglas B Chepeha
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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Affiliation(s)
- James A. Owusu
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
- Department of Otorhinolaryngology, University of Texas Health Sciences Center at Houston
| | - Emily Bellile
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Jeffrey S. Moyer
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - James D. Sidman
- Department of Pediatric Otolaryngology and Facial Plastic Surgery, Children’s Hospitals and Clinics of Minnesota, Minneapolis
- Department of Otolaryngology, University of Minnesota, Minneapolis
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Abstract
IMPORTANCE Whether undergoing cervicofacial rhytidectomy after radiotherapy for tumors of the head and neck is associated with increased complication rates and therefore should be avoided remains unknown. OBJECTIVE To evaluate complication rates in patients who have undergone cervicofacial rhytidectomy after radiotherapy for head and neck tumors and compare these rates with those of patients who have not undergone radiotherapy. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of the medical records of 16 patients who underwent cervicofacial rhytidectomy after completing radiotherapy for head and neck tumors and those of 16 age-matched control participants who did not undergo radiotherapy. Patients underwent treatment from July 1, 2006, through February 28, 2014, with final follow-up on February 28, 2014. Complications after surgery were reviewed and data for surgery type, technique, radiation dose and delivery method, and time to surgery after radiotherapy were analyzed. Data were collected from June 1 through December 31, 2013, and analyzed from January 1, 2014, through June 1, 2015. MAIN OUTCOMES AND MEASURES Rate of complications after surgery. RESULTS The radiotherapy and control group patients were a mean of 62 years old. In the radiotherapy group, 8 of 16 were women; 14 of 16 were women in the control group. Two major complications, 1 hematoma and 1 perioperative stroke, occurred in the 16 patients who composed the study cohort. In the control group, there was 1 case of transient facial nerve weakness and 1 case of cellulitis that was successfully treated with antibiotics. Two patients experienced wound dehiscence, and no incidents of motor or sensory nerve injury occurred. Subcutaneous face-lift (3 of 3 patients [100%] vs 1 of 13 patients [8%] who underwent superficial musculoaponeurotic system and deep-plane face-lifts; P = .02) and the addition of chemotherapy (4 of 9 patients [44%] vs 0 of 7 patients who did not receive chemotherapy; P = .04) were associated with increased complications. Being older and the time from completion of radiotherapy and surgery did not show any correlation to complications. CONCLUSIONS AND RELEVANCE Aesthetic facial surgery after radiotherapy has an increased risk for complication compared with facial surgery without radiotherapy. The incidence of wound dehiscence is elevated in the population undergoing radiotherapy but can be managed conservatively in most cases. Patients who undergo radiotherapy must be counseled on the increased risk for complications before proceeding with cervicofacial rhytidectomy. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Sarah Novis
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Shan R Baker
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Jennifer C Kim
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
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Affiliation(s)
- Andrew Rosko
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Nicholas Herrman
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
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Hu Y, Lu L, Chang AE, Egenti M, Owen J, Moyer JS, Prince ME, Xia J, Huang S, Wicha MS, Li Q. Abstract 1530: Therapeutic efficacy of cancer stem cell vaccine in an adjuvant setting. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The inability to target cancer stem cells (CSC) may be a significant factor contributing to treatment failure. Novel therapeutic strategies are needed to immunologically target CSCs. We have developed a strategy to target the CSC populations in melanoma and squamous cell carcinoma using CSC lysate-pulsed dendritic cells (DC). Using mouse models we demonstrate that DC pulsed with CSCs enriched by virtue of their expression of the CSC marker ALDH (CSC-DC) significantly inhibited local tumor growth, reduced development of pulmonary metastases and prolonged survival in the minimal tumor models. The effect was associated with down regulation of CCR7 and CCR10 in tumor cells and decreased CCL27 and CCL28 expression in lung tissue. CSC-DC vaccine significantly reduced ALDHhigh CSCs. Direct targeting of CSCs was demonstrated by specific binding of IgG produced by ALDHhigh CSC-DC vaccine-primed B cells to ALDHhigh CSCs, resulting in lysis of these target cells in the presence of complement. When administered in the adjuvant setting after surgical excision of the bulk tumor mass, administration of CSC-DC vaccine reduced development of local tumor growth as well as systemic disease and prolonged survival demonstrating the efficacy of this approach. These data suggest that the CSC-DC vaccine approach may be useful in the adjuvant setting where local and systemic relapse are high after surgery.
Note: This abstract was not presented at the meeting.
Citation Format: Yangyang Hu, Lin Lu, Alfred E. Chang, Martin Egenti, John Owen, Jeffrey S. Moyer, Mark E.P. Prince, Jianchuan Xia, Shiang Huang, Max S. Wicha, Qiao Li. Therapeutic efficacy of cancer stem cell vaccine in an adjuvant setting. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1530. doi:10.1158/1538-7445.AM2015-1530
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Affiliation(s)
| | - Lin Lu
- University of Michigan, Ann Arbor, MI
| | | | | | - John Owen
- University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | - Qiao Li
- University of Michigan, Ann Arbor, MI
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Prince ME, Zhou L, Xia Y, Tao H, Moyer JS, Lu L, Owen J, Chang AE, Xia J, Wolf G, Wicha MS, Ren X, Bao Y, Huang S, Li Q. Abstract 1410: Evaluation of the immunogenicity of ALDHhigh human head and neck squamous cell carcinoma cancer stem cells in vitro. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Using mouse models we reported that dendritic cells (DC) pulsed with cancer stem cells (CSC) enriched by virtue of their expression of the CSC marker aldehyde dehydrogenase (ALDH) significantly reduced development of pulmonary metastases and prolonged survival. In this recent study, we established the concept that the antigenicity/immunogenicity of ALDHhigh human head and neck squamous cell carcinoma (HNSCC) cancer stem cells is distinct from that of ALDHlow non-CSCs. To this end, we generated CSC-loaded DCs to sensitize autologous peripheral blood lymphocytes to react with CSCs using human HNSCC samples in vitro. From peripheral blood and paired tumor tissues collected from 9 patients with HNSCC, we obtained PBMCs and established 4 HNSCC tumor cell lines. DCs generated from the PBMC and pulsed with the lysate of ALDHhigh cells isolated from cultured HNSCC cells (CSC-DC) could sensitize autologous T, B lymphocytes in vitro, which was evident by cytokine production, CTL activity, and antibody secretion of these primed T, B cells in response to ALDHhigh CSCs. In contrast, DCs pulsed with lysate of ALDHlow cells from the same HNSCC patient (ALDHlow-DC) resulted in limited sensitization/priming of autologous T, B lymphocytes to produce IFNγ, lyse CSCs, and secrete IgM and IgG in response to ALDHhigh CSCs. These results demonstrated significant differences in the antigenicity/immunogenicity between ALDHhigh CSCs vs. ALDHlow cells isolated from the tumor specimen of patients with HNSCC, which indicates the existence of unique CSC antigens in the ALDHhigh population. In addition, this study demonstrates that it is feasible to generate DCs from the PBMCs and isolate ALDHhigh CSCs from cultured tumor cells of the patients with HNSCC to prepare CSC-DC vaccines for clinical application.
Citation Format: Mark E.P. Prince, Li Zhou, Yang Xia, Huimin Tao, Jeffrey S. Moyer, Lin Lu, John Owen, Alfred E. Chang, Jianchuan Xia, Gregory Wolf, Max S. Wicha, Xiubao Ren, Yangyi Bao, Shiang Huang, Qiao Li. Evaluation of the immunogenicity of ALDHhigh human head and neck squamous cell carcinoma cancer stem cells in vitro. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1410. doi:10.1158/1538-7445.AM2015-1410
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Affiliation(s)
| | - Li Zhou
- University of Michigan, Ann Arbor, MI
| | - Yang Xia
- University of Michigan, Ann Arbor, MI
| | | | | | - Lin Lu
- University of Michigan, Ann Arbor, MI
| | - John Owen
- University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | | | | | - Qiao Li
- University of Michigan, Ann Arbor, MI
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Abstract
OBJECTIVES To review the current state of immunotherapy of head and neck squamous cell carcinoma. MATERIALS AND METHODS Review of the literature with emphasis on clinical trial data. RESULTS Patients with head and neck squamous cell carcinoma (HNSCC) have long been known to be immunosuppressed. This impairment of the immune system is believed, at least in part, to underlie the poor outcomes in this patient population. Modulating the immune system to improve cancer outcomes is an attractive concept in this difficult to treat population. CONCLUSION New studies have started to unravel the mechanisms of immunosuppression and new therapies are being developed to exploit this new information.
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Affiliation(s)
- Qiao Li
- University of Michigan Comprehensive Cancer Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Mark E P Prince
- University of Michigan Comprehensive Cancer Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Jeffrey S Moyer
- University of Michigan Comprehensive Cancer Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109, United States.
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Lu L, Tao H, Chang AE, Hu Y, Shu G, Chen Q, Egenti M, Owen J, Moyer JS, Prince ME, Huang S, Wicha MS, Xia JC, Li Q. Cancer stem cell vaccine inhibits metastases of primary tumors and induces humoral immune responses against cancer stem cells. Oncoimmunology 2015; 4:e990767. [PMID: 25949905 PMCID: PMC4404925 DOI: 10.4161/2162402x.2014.990767] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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: 09/26/2014] [Accepted: 11/18/2014] [Indexed: 02/08/2023] Open
Abstract
The inability to target cancer stem cells (CSC) may be a significant factor contributing to treatment failure. We have developed a strategy to target the CSC populations in melanoma and squamous cell carcinoma using CSC lysate-pulsed dendritic cells (DCs). The CSC-DC vaccine was administered in the adjuvant setting after localized radiation therapy of established tumors. Using mouse models we demonstrated that DCs pulsed with CSCs enriched by virtue of their expression of the CSC marker ALDH (termed CSC-DC) significantly inhibited tumor growth, reduced development of pulmonary metastases and prolonged survival. The effect was associated with downregulation of chemokine (C-C motif) receptors CCR7 and CCR10 in tumor cells and decreased expression of the chemokine (C-C motif) ligands CCL21, CCL27 and CCL28 in lung tissue. The CSC-DC vaccine significantly reduced ALDHhigh CSC frequency in primary tumors. Direct targeting of CSCs was demonstrated by the specific binding of IgG produced by ALDHhigh CSC-DC vaccine-primed B cells to ALDHhigh CSCs, resulting in lysis of these target CSCs in the presence of complement. These data suggest that the CSC-DC vaccine approach may be useful in the adjuvant setting where local and systemic relapse are high after conventional treatment of cancers.
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Affiliation(s)
- Lin Lu
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA ; State Key Laboratory of Oncology in Southern China and Department of Experimental Research; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Huimin Tao
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA ; Center for Stem Cell Research and Application; Institute of Hematology; Union Hospital, Tongji Medical College ; Huazhong University of Science and Technology ; Wuhan, China
| | - Alfred E Chang
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA
| | - Yangyang Hu
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA ; Center for Stem Cell Research and Application; Institute of Hematology; Union Hospital, Tongji Medical College ; Huazhong University of Science and Technology ; Wuhan, China
| | - Guoshun Shu
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA ; Second Xiangya Hospital; Central South University ; Changsha, Hunan, China
| | - Quanning Chen
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA ; Department of General Surgery; Tongji Hospital of Tongji University ; Shanghai, China
| | - Martin Egenti
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA
| | - John Owen
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA
| | - Jeffrey S Moyer
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA
| | - Mark Ep Prince
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA
| | - Shiang Huang
- Center for Stem Cell Research and Application; Institute of Hematology; Union Hospital, Tongji Medical College ; Huazhong University of Science and Technology ; Wuhan, China
| | - Max S Wicha
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA
| | - Jian-Chuan Xia
- State Key Laboratory of Oncology in Southern China and Department of Experimental Research; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Qiao Li
- University of Michigan Comprehensive Cancer Cente; Ann Arbor , MI USA
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Spector ME, Gallagher KK, Bellile E, Chinn SB, Ibrahim M, Byrd S, Chanowski EJ, Walline HM, Moyer JS, Prince ME, Wolf GT, Bradford CR, McHugh JB, Cordell K, Carey T, Worden FP, Eisbruch A, Chepeha DB. Patterns of nodal metastasis and prognosis in human papillomavirus-positive oropharyngeal squamous cell carcinoma. Head Neck 2014; 36:1233-40. [PMID: 23913653 PMCID: PMC4112024 DOI: 10.1002/hed.23438] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 04/25/2013] [Accepted: 07/24/2013] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The current American Joint Committee on Cancer (AJCC) staging system may not accurately reflect survival in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC). The purpose of this study was to develop a system that more precisely predicts survival. METHODS CT scans from 156 patients who underwent chemoradiation for advanced-stage oropharyngeal SCC with >2 years follow-up were reviewed. We modeled patterns of nodal metastasis associated with different survival rates. We defined HPV+ N1 as a single node <6 cm, ipsilaterally, contralaterally, or bilaterally. HPV+ N2 was defined as a single node ≥6 cm or ≥2 nodes ipsilaterally/contralaterally or ≥3 nodes bilaterally. HPV+ N3 was defined as matted nodes. RESULTS There was no significant difference in disease-specific survival (DSS; p = .14) or overall survival (OS; p = .16) by AJCC classification. In patients grouped by HPV+ N1, HPV+ N2, and HPV+ N3 nodal classification, significant differences in DSS (100%, 92%, and 55%, respectively; p = .0001) and OS (100%, 96%, and 55%, respectively; p = .0001) were found. CONCLUSION A staging system with reclassification of size, bilaterality, and matted nodes more accurately reflects survival differences in this cohort of patients. Review of the AJCC staging system with these criteria should be considered for HPV-positive oropharyngeal SCC.
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Affiliation(s)
- Matthew E Spector
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - K Kelly Gallagher
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Mohannad Ibrahim
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Serena Byrd
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Eric J Chanowski
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Heather M Walline
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Mark E Prince
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Kitrina Cordell
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Thomas Carey
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Francis P Worden
- Department of Medical Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA University of Michigan Health System, Ann Arbor, MI, USA
| | - Douglas B Chepeha
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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Darr OA, Colacino JA, Tang AL, McHugh JB, Bellile EL, Bradford CR, Prince MP, Chepeha DB, Rozek LS, Moyer JS. Epigenetic alterations in metastatic cutaneous carcinoma. Head Neck 2014; 37:994-1001. [PMID: 24700717 DOI: 10.1002/hed.23701] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 10/20/2013] [Revised: 03/11/2014] [Accepted: 03/28/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the 2 most common cutaneous carcinomas. Molecular profiles predicting metastasis of these cancers have not been identified. METHODS Epigenetic profiles of 37 primary cases of cutaneous SCC and BCC were quantified via the Illumina Goldengate Cancer Panel. Differential protein expression by metastatic potential was analyzed in 110 total cases by immunohistochemical (IHC) staining. RESULTS Unsupervised hierarchical clustering analysis revealed that metastatic BCCs had a methylation profile resembling cutaneous SCCs. Metastatic cutaneous SCCs were found to be hypermethylated at FRZB (median methylation: 46.7% vs 4.7%; p = 4 × 10(-5) ). Metastatic BCCs were found to be hypomethylated at MYCL2 (median methylation: 3.8% vs 83.4%; p = 1.9 × 10(-6) ). Immunohistochemical staining revealed few differences between metastatic and nonmetastatic cancers. CONCLUSION Metastatic primary BCCs and cutaneous SCCs had distinct epigenetic profiles when compared to their nonmetastatic counterparts. Epigenetic profiling may prove useful in future diagnosis and prevention of advanced nonmelanoma skin cancers.
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Affiliation(s)
- Owen A Darr
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Justin A Colacino
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Alice L Tang
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emily L Bellile
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Carol R Bradford
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark P Prince
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Laura S Rozek
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jeffrey S Moyer
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan
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Abstract
IMPORTANCE Understanding age-related changes is important when considering cartilage-based implants or grafts during rhinoplasty and nasal reconstructive surgery. OBJECTIVE To characterize the cellular and architectural changes in human nasal cartilage with aging. DESIGN Laboratory study. PARTICIPANTS Nasal septal cartilage was harvested from 50 consecutive patients undergoing septoplasty, rhinoplasty, or septorhinoplasty. INTERVENTION Cartilage specimens were stained with hematoxylin-eosin (H&E) and safranin O for cartilage. MAIN OUTCOME MEASURES A modified Mankin histologic grading scale was used to analyze each cartilage sample for H&E findings and safranin O staining. Higher H&E scores indicated more degenerative changes, while higher safranin O scores indicated reductions in proteoglycan content within the cartilage matrix, representing decreased active chondrocyte activity. Correlation between H&E and safranin O scores and patient age was determined. RESULTS There was positive correlation between safranin O staining scores and age, with higher scores seen with advancing age (P = .01). A linear regression best-fit equation was determined to calculate a potential safranin O staining score for a given age. CONCLUSIONS AND RELEVANCE We have quantitatively determined that advancing age is positively correlated with reductions in cartilage proteoglycan content and active cartilage growth. This finding not only enhances our current understanding of the natural changes that occur in cartilage with aging but may also affect surgical decision making when cartilage grafting is considered during functional, reconstructive, and aesthetic rhinoplasty. LEVEL OF EVIDENCE NR.
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Affiliation(s)
- Judy W Lee
- Center for Facial Cosmetic Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, USA.
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