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Stanisce L, McGlone M, Koshkareva Y, Swendseid B, Lawrence I, Kubicek GJ, Gaughan JP, Solomon DH, Ahmad N. Socioeconomic Influence on Speech Rehabilitation After Total Laryngectomy. Otolaryngol Head Neck Surg 2023; 169:1499-1505. [PMID: 37422889 DOI: 10.1002/ohn.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Speech rehabilitation following a total laryngectomy significantly impacts the quality of life. Indwelling prosthetic voice restoration provides optimal outcomes; however, the long-term maintenance of these devices carries considerable financial costs, which are not universally covered by insurance. This investigation aimed to analyze associations between socioeconomic factors and outcomes in postlaryngectomy speech rehabilitation. STUDY DESIGN Retrospective cohort analysis. SETTING Academic tertiary-care center from May 2014 to September 2021. METHODS In patients undergoing total laryngectomy, the incidence of tracheoesophageal puncture with indwelling vocal prostheses (TEP-VP) placement within the first postoperative year was compared among household income, demographic factors, and disease characteristics. Functional and maintenance outcomes served as secondary endpoints. RESULTS Seventy-seven patients were included. Forty-five (58%) underwent indwelling TEP-VP (41 primaries). Eighty-nine percent of patients with annual incomes greater than $50k underwent TEP-VP compared to only 35% with incomes less than $50k/year. TEP-VP was performed in 85% of patients with commercial insurance, 70% with Medicare, 42% with Medicaid, and 0% with no insurance. On multivariate analysis, annual household incomes greater than $50k were predicted for TEP-VP placement (odds ratio: 12.7 [2.45-65.8], p = .002). The utilization of postoperative speech therapy and functional communication outcomes were similar among socioeconomic groups. Twelve patients were unable to afford supplies within the first year, with differences noted among insurance (p = .015) and income status (p = .003). CONCLUSION Disparities in vocal and speech rehabilitation following laryngectomy may disproportionally affect underserved patients.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Mick McGlone
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Brian Swendseid
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Ian Lawrence
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
- Division of Speech and Language Pathology, Cooper University Health Care, Camden, New Jersey, USA
| | - Gregory J Kubicek
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
- Department of Radiation Oncology, Cooper University Health Care, Camden, New Jersey, USA
| | - John P Gaughan
- Cooper Research Institute, Cooper University Health Care, Camden, New Jersey, USA
| | - Donald H Solomon
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
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2
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Stanisce L, Ahmad N, Solomon DH, Kolia N, Garcia LD, Spalla TC, Gaughan JP, Koshkareva Y. Improving Outpatient Follow-Up Rates for New In-Hospital Consults. Laryngoscope 2023; 133:2540-2545. [PMID: 36511340 DOI: 10.1002/lary.30519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE(S) This investigation aimed to define the rate of outpatient follow-up after in-hospital consultation, identify factors associated with establishing care, and evaluate an alternative scheduling process to improve outpatient adherence. METHODS Two-phase, prospective study at an academic, tertiary-care institution from March 2020 to August 2022. First, all patients not previously known to our practice encountered via inpatient consult who warranted outpatient follow-up were prospectively captured. Logistic regression analysis was used to identify demographic, disease, and practice factors predictive of follow-up. Second, a randomized control trial was performed to validate the effects of pre-assigning appointments prior to discharge. RESULTS Six hundred subjects were included in the final study cohort; 500 in phase-one, and 100 randomized during phase-two. In the phase-one cohort, 54% (n = 272) were lost to follow-up. Multivariate analysis showed increased odds of outpatient follow-up when appointments were pre-assigned before discharge (odds ratio [OR]: 3.69 [95% confidence interval [CI]: 2.29-5.96], p < 0.001), the primary reason for hospitalization was ENT and consult-related (OR: 3.29 [1.92-5.64], p < 0.001), and the diagnosis was one of Oncology (OR: 1.93 [1.02-3.69], p = 0.045) or Pediatrics (OR: 3.36 [1.41-7.98], p = 0.006) subspecialties. During phase-two, subjects randomized for pre-assigned appointments had higher outpatient follow-up (82%) compared to the control group (20%) (p < 0.001). CONCLUSION Hospital-based consultations represent an important referral pathway for new patients. Disease characteristics may identify patients less likely to follow-up upon discharge. Appointment scheduling protocols, including pre-assigning appointments, are modifiable targets for improving adherence to care. Laryngoscope, 133:2540-2545, 2023.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Donald H Solomon
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Nadeem Kolia
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Lucia D Garcia
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Thomas C Spalla
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - John P Gaughan
- Cooper Research Institute, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
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Fisher AH, Stanisce L, Nelson ZJ, Cohen MA, Matthews MS. Risk Assessment of Sleep Disordered Breathing in Cleft Lip and/or Palate. Cleft Palate Craniofac J 2023:10556656231193552. [PMID: 37545192 DOI: 10.1177/10556656231193552] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Children with cleft lip and/or palate (CL/P) are at increased risk for Sleep Disordered Breathing (SDB), particularly Obstructive Sleep Apnea (OSA). At our institution, routine screening for SDB is performed using the Chevrin Pediatric Sleep Questionnaire (PSQ). This analysis is a practice audit looking at the outcomes of screening children with CL/P. DESIGN/SETTING/PATIENTS/PARTICIPANTS A single-center, retrospective analysis was done of all non-syndromic patients with CL/P over the age of 36 months over a 4-year period. Children with known OSA were eliminated from analysis. MAIN OUTCOME MEASURES Univariate logistic regression was used to assess predictors for SDB (PSQ score > 8) amongst various patient, disease, and treatment characteristics. Outcomes of those screened were tracked. RESULTS Of the 239 patients in the study cohort, 43 (18%) had positive PSQs. These subjects were more likely to have class III dental occlusion with maxillary retrusion (OR = 2.65, 95% CI: 1.2-5.8, p = 0.02). There were no differences amongst age, type of cleft, Veau classification, BMI, or history of pharyngeal surgery. One third of the group did not complete recommended testing. Twenty-five subjects with positive sleep screening underwent subsequent polysomnography and 21 (84%) had OSA. CONCLUSION Routine screening reveals a significant proportion of patients with CL/P with symptoms suggestive of OSA. While several patients did not complete confirmatory testing, those who completed a PSG had a high rate of identification of OSA. After excluding children with known OSA, patients with SDB are also likely to have class III dental occlusion and maxillary retrusion.
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Affiliation(s)
- Alec H Fisher
- Division of Plastic Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Luke Stanisce
- Division of Otolaryngology - Head & Neck Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Zach J Nelson
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Marilyn A Cohen
- Division of Plastic Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Martha S Matthews
- Division of Plastic Surgery, Cooper University Health Care, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
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4
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Stanisce L. Starting a New Residency-The Early Years. Otolaryngol Head Neck Surg 2023; 168:544-545. [PMID: 35727634 DOI: 10.1177/01945998221108046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022]
Abstract
The social dimensions of residency are as essential as the scientific ones, particularly when starting a new program. Privileged to be the first-ever trainee in a newly accredited residency program, this reflection details the particulars defining my experience. In an attempt to balance humility with accomplishment, the following offers unique observation and insight on the many aspects we all share in training, in the aim of contributing something meaningful to them.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head & Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
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5
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Stanisce L, Swendseid B, Ahmad N, Koshkareva Y. Arteriosalivary Fistula From Locoregionally Recurrent Oral Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2023. [PMID: 36939518 DOI: 10.1002/ohn.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 01/30/2023]
Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Brian Swendseid
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA.,MD Anderson Cancer Center at Cooper-Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA.,MD Anderson Cancer Center at Cooper-Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA.,MD Anderson Cancer Center at Cooper-Head and Neck Cancer Center, Camden, New Jersey, USA
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6
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Stanisce L, Fisher AH, Choi BY, Newman A, Wang JL, Koshkareva Y. How Did the COVID-19 Pandemic Affect Trends in Facial Trauma? Craniomaxillofac Trauma Reconstr 2022; 15:132-138. [PMID: 35633770 PMCID: PMC8941287 DOI: 10.1177/19433875211022574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Study Design: Retrospective cohort analysis. Objective: To examine the impact the COVID-19 pandemic and its accompanying societal measures had on the incidence, characteristics, and management of maxillofacial traumatic injuries. Methods: This cohort analysis compared facial trauma injuries presenting to the highest-volume Level I Trauma Center in New Jersey, USA from January 1 to July 31 in 2020 and 2019. Differences in demographics, mechanisms, and interventions were compared between the pandemic period (March 16–July 31, 2020) and the equivalent pre-pandemic date period in 2019 using X2, Fishers Exact, and Mann–Whitney U testing. Results: In total, 616 subjects were included. The daily incidence of facial trauma consults during the 2020 pandemic (1.81 ± 1.1) decreased compared to 2019 (2.15 ± 1.3) (p = 0.042). During the outbreak, there was an increase in the proportion of subjects with positive urine drug screens (21.5% vs. 12.2%; p = 0.011) and injuries related to domestic violence (10.2% vs. 4.5%; p = 0.023). Patients were 30% less likely to be transferred from local hospitals (RR, 0.70 [0.53–0.93]; p = 0.014). Although subjects had a 25% increased risk of presenting with injuries deemed procedural (RR, 1.25 [95% CI, 1.05–1.56]; p = 0.048), a greater proportion were discharged with operative procedures scheduled as outpatients (16.0% vs. 4.9%; p = 0.005). Conclusions: The COVID-19 pandemic has impacted both the epidemiology and management of maxillofacial traumatic injuries, perhaps secondary to modifications in personal and community behaviors or the effects on healthcare systems in our region.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology—Head and Neck Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Alec H. Fisher
- Division of Plastic and Reconstructive Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Bo Young Choi
- Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Andrew Newman
- Division of Plastic and Reconstructive Surgery, Cooper University Health Care, Camden, NJ, USA
- Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Ju Lin Wang
- Cooper Medical School at Rowan University, Camden, NJ, USA
- Division of Trauma Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology—Head and Neck Surgery, Cooper University Health Care, Camden, NJ, USA
- Cooper Medical School at Rowan University, Camden, NJ, USA
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7
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Stanisce L, Solomon DH, Koshkareva Y. When "Stay" Sutures Stay. Ear Nose Throat J 2022:1455613221104428. [PMID: 35609264 DOI: 10.1177/01455613221104428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic airway foreign bodies represent a rare and challenging entity faced by otolaryngologists. Herein, we describe the case of an adult woman found to have a 17 cm-long internalized tracheostomy stay suture retained 2 years after decannulation. Thorough evaluation and contingency planning allowed for safe and successful removal of this novel airway foreign body. The selective use of stay sutures in adult tracheostomies and proper peri-operative care may have prevented its incidence.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology - Head and Neck Surgery, 2202Cooper University Health Care, Camden, NJ, USA
| | - Donald H Solomon
- Division of Otolaryngology - Head and Neck Surgery, 2202Cooper University Health Care, Camden, NJ, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology - Head and Neck Surgery, 2202Cooper University Health Care, Camden, NJ, USA
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8
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Wilson T, Wang S, Bolshom B, Stanisce L, Vimawala S, Ahmad N, Solomon D. Pediatric Soft Tissue Perineurioma in the Head and Neck. Ear Nose Throat J 2022:1455613221079493. [PMID: 35229665 DOI: 10.1177/01455613221079493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Soft tissue type perineuriomas (STP), or Extraneural perineuriomas, are typically found in the superficial extremities or trunk of adult patients. Their incidence in the head and neck is exceptionally rare, particularly amongst the pediatric population. Since 1978, only 19 cases of pediatric STP have been reported, with only one in the neck. This case report describes the second case of STP in the neck of a child as well as reviews the current literature on pediatric STP. The pattern of patient genetic anomalies associated with the few pediatric STP cases encountered suggests an association between genetic aberrations and STP. Clinicians should be aware of STP when formulating a differential diagnosis of pediatric soft tissue masses in the head and neck despite the rarity of this tumor.
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Affiliation(s)
- Traeden Wilson
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Sherrie Wang
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Luke Stanisce
- Division of Otolaryngology - Head & Neck Surgery, 2202Cooper University Health Care, Camden, NJ, USA
| | - Swar Vimawala
- Division of Otolaryngology - Head & Neck Surgery, 2202Cooper University Health Care, Camden, NJ, USA
| | - Nadir Ahmad
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
- Division of Otolaryngology - Head & Neck Surgery, 2202Cooper University Health Care, Camden, NJ, USA
| | - Donald Solomon
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
- Division of Otolaryngology - Head & Neck Surgery, 2202Cooper University Health Care, Camden, NJ, USA
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9
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O'Neill L, Nelson Z, Ahmad N, Fisher AH, Denton A, Renzi M, Fraimow HS, Stanisce L. Malignant Fungating Wounds of the Head and Neck: Management and Antibiotic Stewardship. OTO Open 2022; 6:2473974X211073306. [PMID: 35155974 PMCID: PMC8832587 DOI: 10.1177/2473974x211073306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Malignant fungating wounds (MFWs) are unfortunate and underreported manifestations of some advanced head and neck cancers. The management of MFWs is complex and challenging. MFWs are often mistaken for infectious processes/abscesses and treated indiscriminately with oral or intravenous antibiotics. Our aim is to promote awareness of MFWs and provide education on their management. We summarize their cost-effective and evidence-based therapies and highlight antibiotic stewardship with respect to their management. Data Sources A literature review was performed of PubMed, Cochrane Review, SCOPUS, Embase, and Google Scholar databases regarding topical and systemic treatments for MFWs. Review Methods Full-text articles were identified with the following terms: fungating, ulcerative, wound, tumor, malignancy, antibiotics, topical, dressings, radiotherapy, head, neck, scalp, face, lip, and ear. Treatment recommendations were extrapolated, categorically summarized, and retrospectively assigned with an evidence level based on the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation). Conclusions In the absence of systemic signs and symptoms of infections, MFWs should not be treated as conventional infections or abscesses, with prophylactic oral or intravenous antibiotics. Topical treatments such as ointments and wound dressings are the mainstay in terms of managing the unsightly appearance and fetid odor from these entities. Implications for Practice MFWs are most often not amenable to definitive/curative surgical or nonsurgical therapy, but consultation with a head and neck oncologic specialist will help to determine if the underlying malignancy requires surgery, radiation therapy, or palliative treatment.
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Affiliation(s)
- Liam O'Neill
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Zach Nelson
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Cooper Medical School of Rowan University, Camden, New Jersey, USA.,Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Alec H Fisher
- Division of Plastic and Reconstructive Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Ana Denton
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Michael Renzi
- Department of Dermatology, Cooper University Hospital, Camden, New Jersey, USA
| | - Henry S Fraimow
- Cooper Medical School of Rowan University, Camden, New Jersey, USA.,Division of Infectious Disease, Cooper University Hospital, Camden, New Jersey, USA
| | - Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
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10
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Wang S, Stanisce L, Begun Z, Wilson T, Ahmad N, Kubicek GJ, Koshkareva Y. Osteoradionecrosis of the hyoid presenting as acute airway compromise. Head Neck 2021; 43:E41-E44. [PMID: 34227172 DOI: 10.1002/hed.26790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Osteoradionecrosis (ORN) of the mandible is a well-known complication of radiation therapy for head and neck cancer. However, few reports have described hyoid bone ORN and its clinical implications. METHODS We describe a retrospective case series of previously irradiated patients who were seen with sudden airway compromise, found to have underlying pathological hyoid fractures secondary to osteoradionecrosis. RESULTS Six patients within postchemoradiation period (3-9 months) for oropharyngeal squamous cell carcinoma were seen with acute-onset dyspnea. Computed topography (CT) imaging was remarkable for severe airway luminal narrowing and pathological hyoid fractures. All six patients required urgent intervention with direct laryngoscopy and tracheostomy. Intraoperatively, five patients were seen with exposed necrotic hyoid bones. CONCLUSION The hyoid and its associated musculature strongly influence upper airway patency. ORN may compromise its physiological function and leads to acute airway compromise. Hyoid ORN may hold significant and imperative clinical implications in head and neck cancer post-treatment surveillance.
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Affiliation(s)
- Sherrie Wang
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Luke Stanisce
- Division of Otolaryngology - Head & Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Zoe Begun
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Traeden Wilson
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Cooper Medical School of Rowan University, Camden, New Jersey, USA.,Division of Otolaryngology - Head & Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA.,M. D. Anderson Cancer Center at Cooper - Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Gregory J Kubicek
- Cooper Medical School of Rowan University, Camden, New Jersey, USA.,M. D. Anderson Cancer Center at Cooper - Head and Neck Cancer Center, Camden, New Jersey, USA.,Department of Radiation Oncology, Cooper University Health Care, Camden, New Jersey, USA
| | - Yekaterina Koshkareva
- Cooper Medical School of Rowan University, Camden, New Jersey, USA.,Division of Otolaryngology - Head & Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA.,M. D. Anderson Cancer Center at Cooper - Head and Neck Cancer Center, Camden, New Jersey, USA
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11
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Stanisce L, Lai M, Ahmad N, Spalla TC, Reid LM, Gaughan JP, Koshkareva Y. Outcomes Associated With Fibrin Sealant Use in Lateral Neck Dissections. OTO Open 2020; 4:2473974X20981021. [PMID: 33709048 PMCID: PMC7907709 DOI: 10.1177/2473974x20981021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To determine whether the use of fibrin sealant tissue adhesives during
lateral neck dissections is associated with a change in postoperative
outcomes. Study Design Retrospective cohort. Setting Institutionally affiliated tertiary care center. Methods Various demographic, disease, and surgical data were collected for patients
who underwent lateral neck dissections. Univariate regression analysis was
performed with the following outcomes: total drain output and duration of
drain placement, as well as incidence of postoperative infection, hematoma,
seroma, chyle leak, and salivary leak. Results A total of 133 patients underwent lateral neck dissections. Fibrin sealant
was used in 35% of cases (n = 46). Its use was not associated with
differences in total drain output (P = .77) or the number
of days that the drains were in place (P = .83). On
secondary analysis, the use of fibrin sealant was not associated with a
difference in postoperative incidence of hematoma (P =
.65), seroma (P = .68), chyle leak (P =
.42), or salivary leak (P = .73). These results were
consistent when stratified by the presence of intraoperative complications.
Its use accompanied an average cost of $674 per case. Conclusions Fibrin sealant use during lateral neck dissections was not associated with a
reduction in drain output or days that the drains remained in situ. Although
the current study was limited by sample size, fibrin sealant use was not
associated with a decreased risk of postoperative adverse events. The
evidence in this report suggests that the routine use of these products adds
cost without clear benefit.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Michael Lai
- Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.,Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | - Thomas C Spalla
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.,Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | - Lisa M Reid
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.,Division of Surgical Oncology, Department of Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - John P Gaughan
- Cooper Research Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.,Cooper Medical School, Rowan University, Camden, New Jersey, USA
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12
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Stanisce L, Renzi T, Paripati N, Ahmad N, Spalla TC, Roth HL, Koshkareva Y. Incidence and Significance of Hypermetabolic PET-CT Findings in Unilateral TVF Motion Impairment. Otolaryngol Head Neck Surg 2019; 161:823-828. [PMID: 31335258 DOI: 10.1177/0194599819866403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the incidence and significance of asymmetric hypermetabolic laryngeal findings on positron emission tomography-computed tomography (PET-CT) in patients with unilateral true vocal fold (TVF) motion abnormalities. STUDY DESIGN Retrospective cohort. SETTING Single-center tertiary care institution. SUBJECTS AND METHODS The medical records of patients with unilateral TVF motion abnormalities were reviewed. The incidence of normal and asymmetric hypermetabolic laryngeal findings was calculated in patients who underwent PET-CT and laryngeal examination, operative laryngoscopy with biopsy, or injection medialization laryngoplasty. RESULTS A total of 135 patients with unilateral TVF motion abnormalities underwent PET-CT. After exclusion of patients who completed new or surveillance imaging for a laryngeal neoplasm (n = 27), asymmetric hypermetabolic findings in the larynx were noted in 21 (19%) cases: 13 (12%) on the contralateral side of the impaired TVF, 8 (7%) on the ipsilateral side. Two (25%) patients with ipsilateral hypermetabolism had concerning subsequent fiberoptic laryngeal examinations prompting operative biopsy. There was no evidence of inflammatory or neoplastic disease in all patients with contralateral hypermetabolic findings. Fifteen patients completed PET-CT scans after injection medialization procedures; 6 (40%) displayed avidity ipsilateral to the side of the injection. The median time from injection to scan was 27 days, as opposed to 193 days in the unremarkable scans (P = .011). CONCLUSION Contralateral hypermetabolism in patients with unilateral TVF motion abnormalities may represent a false-positive finding. Ipsilateral hypermetabolic uptake without recent fold instrumentation warrants prompt diagnostic evaluation.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.,Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Timothy Renzi
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Nikita Paripati
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.,Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Thomas C Spalla
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.,Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Howard L Roth
- Cooper Medical School at Rowan University, Camden, New Jersey, USA.,Department of Radiology, Cooper University Hospital, Camden, New Jersey, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA.,Cooper Medical School at Rowan University, Camden, New Jersey, USA
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Stanisce L, Ahmad N, Levin K, Deckard N, Enriquez M, Brody J, Koshkareva Y. Solitary Fibrous Tumors in the Head and Neck: Comprehensive Review and Analysis. Head Neck Pathol 2019; 14:516-524. [PMID: 31338745 PMCID: PMC7235103 DOI: 10.1007/s12105-019-01058-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
Abstract
Solitary fibrous tumors (SFT) arising in the head and neck region are uncommon yet well-recognized entities. Their biologic behavior and management still need to be elucidated. Systematically reviewing all published cases of SFT involving the head and neck region since 1991, a pooled meta-analysis was conducted to evaluate various demographic and tumor characteristics. 587 SFT in the head and neck have been reported; 343 met pooled analysis inclusion criteria. 61% of cases presented as a new mass; 89% were painless. Median onset of symptoms prior to evaluation was 8 months. Pre-operative local invasion and malignant histological features (hemorrhage, necrosis, mitoses > 4/10 hpf) were not statistically associated with decreased recurrence-free survival. Positive surgical margins was the only factor associated with shorter recurrence-free survival (p < 0.001). The evidence presented herein reveals novel associations between clinical presentation and tumor characteristics that provide otolaryngologists with new insight into SFT tumor behavior, thus prompting further investigations.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology – Head and Neck Surgery, Cooper University Health Care, Camden, NJ USA ,Cooper Medical School of Rowan University, Camden, NJ USA ,Division of Otolaryngology – Head and Neck Surgery, Cooper University Health Care, Three Cooper Plaza, Suite 411, Camden, NJ 08103 USA
| | - Nadir Ahmad
- Division of Otolaryngology – Head and Neck Surgery, Cooper University Health Care, Camden, NJ USA ,Cooper Medical School of Rowan University, Camden, NJ USA ,MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, NJ USA
| | - Kristin Levin
- Department of Otolaryngology – Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, KY USA
| | - Nathan Deckard
- Division of Otolaryngology – Head and Neck Surgery, Cooper University Health Care, Camden, NJ USA ,Cooper Medical School of Rowan University, Camden, NJ USA
| | - Miriam Enriquez
- Cooper Medical School of Rowan University, Camden, NJ USA ,Department of Pathology, Cooper University Health Care, Camden, NJ USA
| | - Joshua Brody
- Cooper Medical School of Rowan University, Camden, NJ USA ,Department of Radiology, Cooper University Health Care, Camden, NJ USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology – Head and Neck Surgery, Cooper University Health Care, Camden, NJ USA ,Cooper Medical School of Rowan University, Camden, NJ USA ,MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, NJ USA
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14
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Affiliation(s)
- Luke Stanisce
- Dr Luke Stanisce, Cooper Medical School of Rowan University, 401 S Broadway Camden, NJ 08103. 732-770-8484
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15
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Stanisce L, Ahmad N, Deckard N, Solomon D, Spalla TC, Gaughan JP, Koshkareva Y. The Impact of RVU-Based Compensation on Patient Safety Outcomes in Outpatient Otolaryngology Procedures. Otolaryngol Head Neck Surg 2019; 160:1003-1008. [DOI: 10.1177/0194599819827881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
Objective To determine the effects an incentive-based physician compensation model has on safety outcomes related to outpatient otolaryngology surgical procedures. Study Design A retrospective analysis of a prospectively maintained database assessing the difference in outpatient surgical volume and postoperative adverse outcomes before and after the implementation of a relative value unit (RVU)–based payment structure. Setting Single-center academic otolaryngology practice operating at a hospital-owned ambulatory surgery center. Subjects and Methods Data prospectively collected from outpatient otolaryngology surgical cases performed at the surgery center from April 2013 to April 2018 were retrospectively reviewed. Equal pre-RVU and post-RVU study periods were calculated for 4 surgeons based on their chronological transition in payment structure (range, 46-56 months). Case volume and incidence rates of adverse outcomes, including postoperative infections, emergency department visits, unplanned hospital admissions, and returns to the operating room, were compared between the pre-RVU and post-RVU study periods at both the surgeon and group levels. Results At the group level, the post-RVU period was associated with a higher volume of surgical cases ( P = .001). No significant differences were observed in the overall incidence of adverse outcomes ( P = .21) or among the specific rates of postoperative hospitalizations ( P = .39), infections ( P = .45), unplanned returns to the operating room ( P = 1.00), or emergency department visits ( P = .39). Comparable results were observed at the individual surgeon level. Conclusion The implementation of an incentive-based salary was not associated with a change in the incidence of adverse safety outcomes in the setting of increased outpatient otolaryngology procedures.
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Affiliation(s)
- Luke Stanisce
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- Department of Otolaryngology–Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Nathan Deckard
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- Department of Otolaryngology–Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Donald Solomon
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- Department of Otolaryngology–Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Thomas C. Spalla
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- Department of Otolaryngology–Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - John P. Gaughan
- Cooper Research Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Yekaterina Koshkareva
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- Department of Otolaryngology–Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
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16
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Stanisce L, Sims E, Hou C, Koshkareva Y, Gaughan JP, Kuzin I, Bottaro A. Differential cellular composition of human palatine and pharyngeal tonsils. Arch Oral Biol 2018; 96:80-86. [PMID: 30195143 DOI: 10.1016/j.archoralbio.2018.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The goal of this study was to gain a better understanding of the potential functional specialization of palatine and pharyngeal tonsils, by comparing their cellular composition in paired specimens from a large cohort of adenotonsillectomy patients. DESIGN Resident B cell, T cell, dendritic cell, and stromal cell subsets were characterized using multicolor flow cytometry in palatine and pharyngeal tonsil specimens from 27 patients, age 2-34 years. RESULTS Paired comparisons showed highly significant intra-individual differences in resident cell subsets of palatine and pharyngeal tonsils. Palatine tonsils harbored higher fractions of germinal center B cells/plasmablasts and IgD- CD27- double-negative B cells, and conversely lower fractions of IgD + CD38- resting naïve B cells compared to pharyngeal tonsils. Palatine tonsils also showed lower fractions of plasmacytoid dendritic cells, and higher percentages of two subsets of stromal cells - fibroblastic reticular cells and lymphatic endothelial cells - compared to pharyngeal tonsils from the same individual. CONCLUSIONS Despite their physical proximity and histological similarities, palatine and pharyngeal tonsils display marked intra-individual differences in their cellular composition with regard to functionally important immune and stromal subsets. These differences are likely to have immunologic, pathologic, and physiologic significance.
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Affiliation(s)
- Luke Stanisce
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Etty Sims
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States; Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Cheryl Hou
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | | | - John P Gaughan
- Biostatistics Service, Cooper Research Institute, Camden, NJ, United States
| | - Igor Kuzin
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States; Department of Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Andrea Bottaro
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States.
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Stanisce L, Levin K, Ahmad N, Koshkareva Y. Reviewing smokeless tobacco epidemiology, carcinogenesis, and cessation strategy for otolaryngologists. Laryngoscope 2018; 128:2067-2071. [PMID: 29427388 DOI: 10.1002/lary.27104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/OBJECTIVES We aimed to provide an otolaryngologist-targeted summary regarding the epidemiology, carcinogenesis, and cessation strategies for smokeless tobacco usage. STUDY DESIGN Evidence-based literature review. METHODS We reviewed the current evidence-based literature concerning trends in smokeless tobacco use, associations with neoplastic change, and therapeutic interventions to assist with sustained abstinence. In complement, we present an actual case of laryngeal squamous cell carcinoma in the setting of chronic tobacco-dentifrice usage in a lifelong nonsmoker. RESULTS This report provides a synopsis of epidemiological data and evidence-based recommendations for general, pharmaceutical, and behavioral cessation strategies. CONCLUSIONS Smokeless tobacco use continues to be prevalent among patients seen by otolaryngologists, particularly of various Indian and Southeast Asian descent. The data presented in this article will aid in the identification of at risk patients. The provided recommended cessation strategies will tool otolaryngologists for patient counseling and management, ultimately aimed at improving health outcomes. Laryngoscope, 128:2067-2071, 2018.
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Affiliation(s)
- Luke Stanisce
- Department of Biomedical Sciences, Cooper Medical School at Rowan University, Camden, New Jersey
| | - Kristin Levin
- Department of Biomedical Sciences, Cooper Medical School at Rowan University, Camden, New Jersey
| | - Nadir Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, U.S.A
| | - Yekaterina Koshkareva
- Department of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, U.S.A
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Stanisce L, Koshkareva Y, Xu Q, Patel A, Squillante C, Ahmad N, Rajagopalan K, Kubicek GJ. Stereotactic Body Radiotherapy Treatment for Recurrent, Previously Irradiated Head and Neck Cancer. Technol Cancer Res Treat 2018; 17:1533033818780086. [PMID: 29890894 PMCID: PMC6024262 DOI: 10.1177/1533033818780086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/16/2022] Open
Abstract
Purpose: Locally recurrent, previously irradiated primary head and neck tumors have historically been associated with poor outcomes. Stereotactic body radiation therapy has emerged as a feasible and promising treatment option for tumor recurrence, particularly in nonsurgical candidates. This study aimed to assess the associated outcomes of stereotactic body radiation therapy used in this setting. Methods: Retrospective analysis of a prospectively collected database of 25 patients treated with CyberKnife for unresectable, recurrent head and neck cancer in a previously irradiated field. The primary end points evaluated were rates of survival, tumor control, and treatment-related toxicities. Results: Median survival of the study population was 7.5 months (range, 1.5-47.0 months). Median survival of the 20 (80%) patients who were treated with curative purpose was 8.3 months. One-year overall survival rate for the entire population was 32%. The respective 1-year and 2-year survival rates for the curative subcohort were 40% and 20%, respectively. Local and locoregional failure occurred in 8 (32%) and 7 (28%) patients, respectively. Low severe acute (4%) and late (6%) treatment-related toxicity rates were observed. No grade 4 or 5 toxicities were observed. Conclusion: Stereotactic body radiation therapy is a viable treatment option for patients with unresectable, recurrent head and neck cancer. Significant tumor control rates are achievable with minimal severe toxicity. Although perhaps associated with patient selection and a heterogeneous sample, overall survival of stereotactic body radiation therapy outcomes appears unfavorable.
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Affiliation(s)
- Luke Stanisce
- 1 Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Yekaterina Koshkareva
- 2 Department of Otolaryngology-Head and Neck Surgery, MD Anderson Cancer Center at Cooper University, Camden, NJ, USA
| | - Qianyi Xu
- 3 Department of Radiation Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Ashish Patel
- 3 Department of Radiation Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Christian Squillante
- 4 Department of Medical Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Nadir Ahmad
- 2 Department of Otolaryngology-Head and Neck Surgery, MD Anderson Cancer Center at Cooper University, Camden, NJ, USA
| | - Kumar Rajagopalan
- 4 Department of Medical Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Gregory J Kubicek
- 3 Department of Radiation Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
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