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Barlow J, Sragi Z, Rodriguez N, Alsen M, Kappauf C, Ferrandino R, Chennareddy S, Kotz T, Kirke DN, Teng MS, Genden EM, Khan MN, Roof SA. Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta-analysis. Head Neck 2024; 46:1224-1233. [PMID: 38414175 DOI: 10.1002/hed.27684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/28/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Traditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6-14 days post-operatively due to concern for orocutaneous fistula development. METHODS Multiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed- and random-effects meta-analyses were used. RESULTS One randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = -0.02, p = 0.06) or free flap failure (RD = -0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference [days] = -2.43, p < 0.01). CONCLUSIONS While further prospective trials are necessary, initiation of oral intake before post-operative day 5 may be appropriate in properly selected patients following oral reconstruction.
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Affiliation(s)
- Joshua Barlow
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zara Sragi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nina Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mathilda Alsen
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catharine Kappauf
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rocco Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susmita Chennareddy
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tamar Kotz
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marita S Teng
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Gilja S, Kumar A, Kapustin D, Su V, Rubin SJ, Chai R, Roof SA, Khan MN. The Impact of Hospital Safety-Net Burden Status on Patients with HPV-Positive Oropharyngeal Cancer. Laryngoscope 2024; 134:1733-1740. [PMID: 37933810 DOI: 10.1002/lary.31131] [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: 06/26/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The objective of this study was to compare treatment characteristics and outcomes between patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) treated at hospitals of varying safety-net burden status. METHODS Patients with cT1-4, N0-3, M0 HPV-positive OPSCC who underwent definitive surgery or radiation were included. Patients were grouped based on their treating hospital safety-net burden status, defined as the percentage of uninsured and Medicaid-insured patients with OPSCC treated at the facility and stratified as low burden (LBH: 0-25th percentile), medium burden (MBH: 25th-75th percentile), or high burden (HBH: 75th-100th percentile). The primary outcome was primary treatment with surgery versus radiation, evaluated with multivariable-adjusted logistic regression. Secondary outcomes included TORS versus open surgical approach, and overall survival evaluated with Cox proportional hazards analysis. RESULTS Of the 19,810 patients with cT1-4, N0-3, M0 HPV-positive OPSCC included in this study, 4921 (24.8%) were treated at LBH, 12,201 (61.6%) were treated at MBH, and 2688 (13.6%) were treated at HBH. In multivariable-adjusted analysis, compared with treatment at LBH, treatment at HBH was associated with more frequent radiation over surgical treatment (OR: 1.26, 95% CI: 1.12-1.40, p < 0.001). For patients undergoing surgery, patients at HBH had less frequent transoral robotic surgery (OR: 0.30, 95% CI 0.24-0.38, p < 0.001) compared with patients treated at LBH. Overall survival of patients treated at HBH was worse than that of patients treated at LBH (HR: 1.27, 95% CI 1.13-1.43, p < 0.001). CONCLUSION These findings highlight underlying disparities at higher safety-net burden facilities that impact patterns of care and outcomes for patients with OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1733-1740, 2024.
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Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Danielle Kapustin
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Vivian Su
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Samuel J Rubin
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Raymond Chai
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
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Posner M, Roof SA. Endpoints in human papillomavirus-related oropharyngeal cancer trials. Lancet Oncol 2024; 25:270-272. [PMID: 38423041 DOI: 10.1016/s1470-2045(24)00065-2] [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] [Received: 01/23/2024] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Marshall Posner
- Head and Neck Oncology Program, Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mt Sinai, New York, NY 10029, USA.
| | - Scott A Roof
- Division of Head and Neck Oncology and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mt Sinai, New York, NY 10029, USA
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Barlow J, Gilja S, Ferrandino RM, Berger MH, Posner MR, Bakst RL, Khan MN, Teng MS, Genden EM, Chai RL, Roof SA. Evaluating human papillomavirus testing, prevalence, and association with prognosis in head and neck squamous cell carcinoma by subsite: A national cancer database study. Am J Otolaryngol 2024; 45:104243. [PMID: 38442460 DOI: 10.1016/j.amjoto.2024.104243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To compare human papillomavirus (HPV) testing, prevalence, and association with prognosis between head and neck squamous cell carcinoma (HNSCC) subsites. MATERIALS AND METHODS This study utilized the National Cancer Database (NCDB) to identify patients diagnosed with HNSCC between 2010 and 2017. Rates of HPV testing, HPV-positivity, and changes in these rates over time were measured by subsite. The impact of HPV-positivity on overall survival across six head and neck subsites was assessed using multivariable-adjusted Cox proportional hazards analysis. RESULTS A total of 121,550 patients were included. Of this cohort, 87,575 (72.1%) were tested for HPV, with the oropharynx (55,049/64,158; 85.8%) displaying the highest rates of testing and the sinonasal tract (1519/2853; 53.2%) displaying the lowest testing rates. Of the 86,136 with a definitive result, 46,878 (54.4%) were HPV-positive, with the oropharynx (40,313/54,205; 74.4%) displaying the highest rates of HPV-positivity and the oral cavity (1818/11,505; 15.8%) displaying the lowest. HPV-positive malignancy was associated with significantly improved adjusted overall survival in the oropharynx (HR = 0.42 [95% CI: 0.43-0.47]), oral cavity (HR = 0.86 [95% CI: 0.79-0.95]), sinonasal tract (HR = 0.63 [95% CI: 0.48-0.83]), larynx (HR = 0.78 [95% CI: 0.71-0.87]), and hypopharynx (HR = 0.56 [95% CI: 0.48-0.66]), but not the nasopharynx (HR = 0.93 [95% CI: 0.77-1.14]). CONCLUSION HPV testing rates were significantly lower in non-oropharyngeal subsites. This is relevant as HPV-associated disease displayed significantly improved overall survival in both the oropharynx and four of five non-oropharyngeal subsites. While validation with prospective studies is necessary, these findings may warrant HPV testing in all HNSCC subsites.
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Affiliation(s)
- Joshua Barlow
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
| | - Shivee Gilja
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Rocco M Ferrandino
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Michael H Berger
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Marshall R Posner
- Department of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Mohemmed N Khan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Marita S Teng
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Raymond L Chai
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Scott A Roof
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
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Ferrandino RM, Posner MR, Roof SA. Liquid Biopsies for Head and Neck Cancers-Any Hope for Human Papillomavirus-Negative Disease?-Reply. JAMA Otolaryngol Head Neck Surg 2024; 150:83-84. [PMID: 37971738 DOI: 10.1001/jamaoto.2023.3633] [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: 11/19/2023]
Affiliation(s)
- Rocco M Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall R Posner
- Department of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott A Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Gilja S, Barlow J, Kumar A, Berger MH, Khan MN, Kirke DN, Roof SA. Evaluating depth of invasion across oral cavity subsites as part of the AJCC 8th edition T staging criteria for oral cavity squamous cell carcinoma. Head Neck 2023; 45:2780-2788. [PMID: 37698539 DOI: 10.1002/hed.27497] [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: 04/27/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The prognostic impact of depth of invasion (DOI) in American Joint Committee on Cancer 8th edition TNM staging for oral cavity squamous cell carcinoma (OCSCCa) across oral cavity subsites is unknown. METHODS Overall survival of patients with pT1-4a OCSCCa in the National Cancer Database (2010-2017), stratified by tumor size and DOI across eight oral cavity subsites, was evaluated using multivariable-adjusted Cox proportional hazards modeling. RESULTS When stratified by tumor size ≤2 cm and >2 cm, DOI >5 mm and DOI >10 mm were only associated with worse overall survival, respectively, for tumors of the oral tongue (Tumor size ≤2 cm, DOI >5 mm v DOI ≤5 mm: HR: 1.31, 95% CI: 1.12-1.53, p < 0.001; Tumor size >2 cm, DOI >10 mm v DOI ≤10 mm: HR: 1.15, 95% CI: 1.01-1.30, p = 0.03). DOI >5 mm and DOI >10 mm was not prognostic for any other tumor location. CONCLUSIONS These findings suggest that the current staging schema for DOI in OCSCCa may not be prognostic across all oral cavity subsites.
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Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Barlow
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael H Berger
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Ferrandino RM, Chen S, Kappauf C, Barlow J, Gold BS, Berger MH, Westra WH, Teng MS, Khan MN, Posner MR, Misiukiewicz KJ, Bakst RL, Sindhu KK, Genden EM, Chai RL, Roof SA. Performance of Liquid Biopsy for Diagnosis and Surveillance of Human Papillomavirus-Associated Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:971-977. [PMID: 37422913 PMCID: PMC10331620 DOI: 10.1001/jamaoto.2023.1937] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 04/22/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Importance There is growing interest in the use of circulating plasma tumor human papillomavirus (HPV) DNA for diagnosis and surveillance of patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Recent advances in the assays, combining the identification of circulating HPV tumor DNA and tumor DNA fragment analysis (tumor tissue-modified viral [TTMV]-HPV DNA), have been shown to be highly accurate. However, use of these newer techniques has been limited to small cohort studies and clinical trials. Objective To establish the clinical efficacy of plasma TTMV-HPV DNA testing in the diagnosis and surveillance of HPV-associated OPSCC in a contemporary clinical setting. Design, Setting, and Participants This retrospective observational cohort study included patients with OPSCC who underwent TTMV-HPV DNA testing between April 2020 and September 2022 during the course of routine clinical care. For the diagnosis cohort, patients with at least 1 TTMV-HPV DNA measurement prior to initiation of primary therapy were included. Patients were included in the surveillance cohort if they had at least 1 TTMV-HPV DNA test performed after completion of definitive or salvage therapy. Main Outcomes and Measures Per-test performance metrics, including sensitivity, specificity, positive predictive value, and negative predictive value, for TTMV-HPV DNA testing. Results Of 399 patients included in the analysis, 163 were in the diagnostic cohort (median [IQR] age, 63 [56-68.5] years; 142 [87.1%] male), and 290 were in the surveillance cohort (median [IQR] age, 63 [57-70] years; 237 [81.7%] male). Of the 163 patients in the diagnostic cohort, 152 (93.3%) had HPV-associated OPSCC while 11 (6.7%) had HPV-negative OPSCC. The TTMV-HPV DNA sensitivity in pretreatment diagnosis was 91.5% (95% CI, 85.8%-95.4% [139 of 152 tests]), and the specificity was 100% (95% CI, 71.5%-100% [11 of 11 tests]). In the surveillance cohort, 591 tests conducted in 290 patients were evaluated. A total of 23 patients had molecularly confirmed pathologic recurrences. The TTMV-HPV DNA test demonstrated sensitivity of 88.4% (95% CI, 74.9%-96.1% [38 of 43 tests]) and specificity of 100% (95% CI, 99.3%-100% [548 of 548 tests]) in detecting the recurrences. Positive predictive value was 100% (95% CI, 90.7%-100% [38 of 38 tests]), and negative predictive value was 99.1% (95% CI, 97.9%-99.7% [548 of 553 tests]). The median (range) lead time from positive TTMV-HPV DNA test to pathologic confirmation was 47 (0-507) days. Conclusions and Relevance This cohort study demonstrated that when evaluated in a clinical setting, the TTMV-HPV DNA assay demonstrated 100% specificity in both diagnosis and surveillance. However, the sensitivity was 91.5% for the diagnosis cohort and 88.4% for the surveillance cohort, signifying that nearly 1 in 10 negative tests among patients with HPV-associated OPSCC was a false negative. Additional research is required to validate the assay's performance and, if validated, then further research into the implementation of this assay into standard clinical practice guidelines will be required.
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Affiliation(s)
- Rocco M. Ferrandino
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sida Chen
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catharine Kappauf
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Barlow
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brandon S. Gold
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael H. Berger
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William H. Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marita S. Teng
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohemmed N. Khan
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall R. Posner
- Department of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Krzysztof J. Misiukiewicz
- Department of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L. Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric M. Genden
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raymond L. Chai
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott A. Roof
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Hanna GJ, Roof SA, Jabalee J, Rettig EM, Ferrandino R, Chen S, Posner MR, Misiukiewicz KJ, Genden EM, Chai RL, Sims J, Thrash E, Stern SJ, Kalman NS, Yarlagadda S, Raben A, Clements L, Mendelsohn A, Kaczmar JM, Pandey Y, Bhayani M, Gupta P, Kuperwasser C, Del Vecchio Fitz C, Berger BM. Negative Predictive Value of Circulating Tumor Tissue Modified Viral (TTMV)-HPV DNA for HPV-driven Oropharyngeal Cancer Surveillance. Clin Cancer Res 2023; 29:4306-4313. [PMID: 37566241 PMCID: PMC10570676 DOI: 10.1158/1078-0432.ccr-23-1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/29/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Human papillomavirus (HPV) is causally linked to oropharyngeal squamous cell carcinoma (OPSCC). Consensus guidelines recommend clinical exams and imaging in decreasing frequency as part of posttreatment surveillance for recurrence. Plasma tumor tissue modified viral (TTMV)-HPV DNA testing has emerged as a biomarker which can inform disease status during surveillance. EXPERIMENTAL DESIGN This retrospective observational cohort study involved 543 patients who completed curative-intent therapy for HPV-associated OPSCC between February 2020 and January 2022 at eight U.S. cancer care institutions. We determined the negative predictive value (NPV) of TTMV-HPV DNA for recurrence when matched to physician-reported clinical outcome data (median follow-up time: 27.9 months; range: 4.5-154). RESULTS The cohort included mostly men with a median age of 61 who had locoregionally advanced disease. HPV status was determined by p16 positivity in 87% of patients, with a positive HPV PCR/ISH among 55%; while pretreatment TTMV-HPV DNA status was unknown for most (79%) patients. Patients had a mean of 2.6 tests and almost half had three or more TTMV-HPV DNA results during surveillance. The per-test and per-patient sensitivity of the assay was 92.5% [95% confidence interval (CI): 87.5-97.5] and 87.3% (95% CI: 79.1-95.5), respectively. The NPV for the assay was 99.4% (95% CI: 98.9-99.8) and 98.4% (95% CI: 97.3-99.5), respectively. CONCLUSIONS TTMV-HPV DNA surveillance testing yields few false negative results and few missed recurrences. These data could inform decisions on when to pursue reimaging following first disease restaging and could inform future surveillance practice. Additional study of how pretreatment TTMV-HPV DNA status impacts sensitivity for recurrence is needed.
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Affiliation(s)
- Glenn J. Hanna
- Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Scott A. Roof
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Eleni M. Rettig
- Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Rocco Ferrandino
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sida Chen
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall R. Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Eric M. Genden
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raymond L. Chai
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Sims
- CARTI Cancer Center, Little Rock, Arkansas
| | | | | | | | | | - Adam Raben
- Christiana Care, Helen F. Graham Cancer Center and Research Institute, Newark, Delaware
| | | | - Abie Mendelsohn
- David Geffen School of Medicine at University of California, Los Angeles, California
| | - John M. Kaczmar
- Medical College of South Carolina Health-University Medical Center, Charleston, South Carolina
| | - Yadav Pandey
- Medical College of South Carolina Health-University Medical Center, Charleston, South Carolina
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Gilja S, Kumar A, Vasan V, Roof SA, Genden EM, Kirke DN. The impact of undergoing surgical margin evaluation during endoscopic surgery for early-stage laryngeal squamous cell carcinoma. Head Neck 2023; 45:2680-2689. [PMID: 37642204 DOI: 10.1002/hed.27493] [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: 05/14/2023] [Revised: 07/19/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The impact of evaluating versus not evaluating surgical margins for early-stage laryngeal squamous cell carcinoma (LSCC) has not been evaluated. METHODS Overall survival was compared between patients who underwent endoscopic surgery for cT1-2, N0, M0 LSCC and had surgical margins evaluated versus not evaluated versus unevaluable in the National Cancer Database (2010-2019) using multivariable-adjusted Cox proportional hazards analyses. RESULTS 7597 patients met study eligibility criteria. 4123 (54.3%) patients underwent margin evaluation, 1631 (21.5%) did not undergo margin evaluation, and 1843 (24.3%) had unevaluable margins. Patients undergoing margin evaluation had better overall survival than patients who did not undergo margin evaluation (HR: 0.88, 95% CI: 0.78-1.00, p = 0.044) and patients with unevaluable margins (HR: 0.88, 95% CI: 0.78-0.98, p = 0.021). Patients undergoing margin evaluation received significantly less adjuvant radiation. CONCLUSIONS Surgical margin evaluation is an important prognostic factor for patients receiving endoscopic surgery for early-stage LSCC and should be conducted whenever possible.
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Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vikram Vasan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Kao DD, Ferrandino RM, Roof SA, Marshall DC, Khan MN, Chai RL, Park YHA, Sigel KM. Neutrophil-to-lymphocyte ratio as a predictor of surgical outcomes in head and neck cancer. Head Neck 2023. [PMID: 37204760 DOI: 10.1002/hed.27402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 02/17/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) is a biomarker of systemic inflammation that is associated with adverse oncologic and surgical outcomes. We investigated the use of NLR as a prognostic indicator of complications of head and neck cancer (HNC) surgeries. METHODS We conducted a retrospective study of 11 187 Veterans who underwent HNC surgery between 2000 and 2020. We calculated preoperative NLR values and fit logistic regression models adjusting for potential confounding factors, comparing high-NLR patients to low-NLR patients. RESULTS The cohort had a median age of 63 and was 98% men. High-NLR patients had increased odds of 30-day mortality (p < 0.001), having 1+ perioperative complications (p < 0.001), sepsis (p = 0.03), failure to wean from mechanical ventilation (p = 0.04), pneumonia (p < 0.001), and pulmonary embolism (p = 0.02) compared with low-NLR patients. CONCLUSION NLR was a robust, independent predictor of 30-day mortality, having 1+ surgical complications, sepsis, failure to wean from mechanical ventilation, pneumonia, and pulmonary embolism.
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Affiliation(s)
- Derek D Kao
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rocco M Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohemmed Nazir Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yeun-Hee A Park
- Department of Medicine, Division of Hematology/Oncology, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Medicine, Division of Hematology/Oncology, The College of Physicians and Surgeons at Columbia University, New York, New York, USA
| | - Keith M Sigel
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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11
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Sreenath SB, Grafmiller KT, Tang DM, Roof SA, Woodard TD, Kshettry VR, Recinos PF, Sindwani R, Fritz MA. Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era. Laryngoscope 2023; 133:562-568. [PMID: 35920134 DOI: 10.1002/lary.30315] [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: 03/18/2022] [Revised: 05/17/2022] [Accepted: 07/07/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Osteoradionecrosis (ORN) of the skull base and craniovertebral junction is a challenging complication of radiation therapy (RT). Severe cases often require surgical intervention through a multi-modal approach. With the evolution in endoscopic surgery and advances in skull base reconstruction, there is an increasing role for microvascular free tissue transfer (MFTT). We describe an endoscopic-assisted approach for the management of ORN of the skull base using fascia lata for MFTT. STUDY DESIGN Retrospective case series. METHODS Between 2017 and 2021, a review of all cases in which fascia lata MFTT was utilized for skull base ORN was performed. Patient demographics, preoperative characteristics, and postoperative outcomes with long-term follow-up were reviewed. RESULTS Five patients were identified. Mean duration to onset of ORN was 17 months following RT. A trial of antibiotics, hyperbaric oxygen (HBO), and/or limited debridement was attempted without success. Refractory pain and progressive osteomyelitis were unifying symptoms. All patients underwent endoscopic debridement of the affected region of ORN prior to MFTT. Vascularized fascia lata was inset through a combined endonasal and transoral corridor. There was improvement in chronic pain in the postop setting with no patients requiring continued antibiotics or HBO therapy. Mean post-op follow-up was 23 months. CONCLUSIONS With continued evolution in endoscopic, minimally invasive approaches, there is an expanding indication for early surgical management in refractory ORN. Fascia lata MFTT is a novel and effective strategy for the management of ORN of the skull base and upper cervical spine with excellent postoperative outcomes and limited patient morbidity. LEVEL OF EVIDENCE 4 Laryngoscope, 133:562-568, 2023.
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Affiliation(s)
- Satyan B Sreenath
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, U.S.A
| | - Kevin T Grafmiller
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Dennis M Tang
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Scott A Roof
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mt. Sinai, New York, New York, U.S.A
| | - Troy D Woodard
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, U.S.A.,Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Varun R Kshettry
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, U.S.A.,Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Pablo F Recinos
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, U.S.A.,Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, U.S.A.,Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Michael A Fritz
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, U.S.A
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12
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Chai RL, Ferrandino RM, Barron C, Donboli K, Roof SA, Khan MN, Teng MS, Posner MR, Bakst RL, Genden EM. The Sinai Robotic Surgery Trial in HPV-related oropharyngeal squamous cell carcinoma (SIRS 2.0 trial) – study protocol for a phase II non-randomized non-inferiority trial. Front Oncol 2022; 12:965578. [PMID: 36091121 PMCID: PMC9453550 DOI: 10.3389/fonc.2022.965578] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Human papillomavirus associated oropharyngeal squamous cell carcinoma (HPVOPSCC) usually affects a younger patient population. As such, the risk for long term toxicity associated with therapy is an important consideration. Multiple trials focused on de-escalation of therapy to preserve survival outcomes while minimizing treatment toxicity are currently in progress, however the question of which patients are ideal candidates for de-escalation remains unanswered. Circulating tumor DNA (cfHPVDNA) has emerged as a means of monitoring disease in patients with HPVOPSCC. Undetectable postoperative cfHPVDNA levels portend a better prognosis and by extension, may identify ideal candidates for de-escalation therapy. We propose an overview and rationale for a new institutional clinical trial protocol focusing on the use of cfHPVDNA to risk stratify patients for adjuvant therapy. We hypothesize that many surgical patients currently receiving radiation therapy may be clinically observed without adjuvant therapy. Methods Patients with measurable cfHPVDNA and clinically resectable HPVOPSCC will undergo TORS resection of tumors and neck dissection. Patients with undetectable cfHPVDNA at 3 weeks post-op will be allocated to low or high-risk treatment protocol groups. The low risk group consists of patients with <4 positive lymph nodes, ≤2 mm extranodal extension (ENE), and perineural invasion (PNI) or lymphovascular invasion (LVI) alone. The high-risk group is made up of patients with ≥4 positive lymph nodes, gross ENE, positive margins, N2c disease and/or the combination of both PNI and LVI. The low-risk group will be allocated to an observation arm, while the high-risk group will receive 46 Gy of adjuvant radiotherapy and weekly cisplatin therapy. The primary outcome of interest is 2-year disease recurrence with secondary outcomes of 2-year disease free survival, locoregional control, overall survival, and quality of life measures. A sample of 126 patients in the low-risk group and 73 patients in the high-risk group will be required to evaluate non-inferiority to the standard of care. Discussion This study will provide much needed recurrence and survival data for patients that undergo primary TORS followed by observation or de-escalated adjuvant therapy. Additionally, it will help delineate the role of cfHPVDNA in the risk stratification of patients that undergo treatment de-intensification.
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Affiliation(s)
- Raymond L. Chai
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- *Correspondence: Raymond L. Chai,
| | - Rocco M. Ferrandino
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Christine Barron
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kianoush Donboli
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Scott A. Roof
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mohemmed N. Khan
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marita S. Teng
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marshall R. Posner
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Richard L. Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eric M. Genden
- Department of Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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13
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Jones BM, Villavisanis DF, Lehrer EJ, Dickstein DR, Sindhu KK, Misiukiewicz KJ, Posner M, Liu JT, Gupta V, Sharma S, Roof SA, Teng M, Genden EM, Bakst RL. High Failure Rates in Young Nonsmoker Nondrinkers With Squamous Cell Carcinoma of the Oral Tongue. Laryngoscope 2022; 133:1110-1121. [PMID: 35716359 DOI: 10.1002/lary.30253] [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: 03/10/2022] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE(S) There has been a disproportionate increase in the incidence of young patients with squamous cell carcinoma of the oral tongue (SCCOT). The purpose of this study was to compare young patients to older patients with SCCOT without prior drinking or smoking history as this population is poorly characterized in the literature. METHODS A retrospective review of patients presenting to our institution with SCCOT was performed. The clinical and pathologic characteristics, as well as, outcomes were compared between younger patients (age ≤45) and older patients (age >45). Outcome analysis was performed using Kaplan Meier method. Multivariable Cox proportional hazard models were performed for age and stage. RESULTS Eighty-two patients (38 young, 44 old) were included in this study. Median follow-up was 29.4 months. When compared to the older cohort (age >45), the younger cohort (age ≤45) demonstrated lower rates of 5-year locoregional control (LC) (79.6% vs. 52.5%, p = 0.043) and distant metastasis-free survival (88.1% vs. 61.8%, p = 0.006). Both cohorts demonstrated similar overall survival rates (55.5% vs. 58.1%) and disease-specific survival (66.2% vs. 58.1%). Of patients experiencing locoregional failure with available radiation therapy plans and PET scans in younger cohorts (n = 7), 100% demonstrated in-field failures. Multivariable Cox proportional hazards demonstrated age was an independent predictor of DMFS (p = 0.004) and the advanced stage was a predictor of DSS (p = 0.03). CONCLUSIONS Young, nondrinker, nonsmokers with SCCOT demonstrate high rates of locoregional recurrence, distant metastasis, and in-field failures. Future studies are warranted to determine underlying mechanisms driving pathogenesis in this unique cohort. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Brianna M Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dillan F Villavisanis
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kunal K Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krzysztof J Misiukiewicz
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marshall Posner
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jerry T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marita Teng
- Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Genden
- Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Roof SA, Perez ER, Villavisanis DF, Khan MN, Ferrandino RM, Chouake RJ, Pacheco CW, Yao M, Teng MS, Genden EM, Miles BA. 2-Octyl cyanoacrylate to prevent salivary fistula formation following oral cavity microvascular reconstruction: A prospective trial. Am J Otolaryngol 2020; 41:102552. [PMID: 32505990 DOI: 10.1016/j.amjoto.2020.102552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Salivary fistulas remain a significant problem in patients undergoing major head and neck reconstructive surgery. Surgical sealants have become increasingly used in cutaneous and non-cutaneous wound closure, providing a barrier to fluids/gases and promoting healing. The purpose of this study was to determine the efficacy of a common surgical sealant, 2-Octyl Cyanoacrylate (2-OCA, Dermabond®), in the prevention of salivary fistulas following free flap reconstruction of the oral cavity. METHODS In this non-randomized, single arm prospective trial, patients undergoing free flap reconstruction of gravity-dependent oral cavity defects were recruited. Application of 2-OCA was performed along flap inset suture lines at the time of surgery. Prospectively collected trial data were propensity score matched to a control cohort to compare outcomes. Data collected include demographics, medical co-morbidities, previous treatments, primary tumor site, and subsites reconstructed. The primary outcome measure was rate of salivary fistula formation. Secondary outcomes were time to development of leak and percentage of patients tolerating oral feeding at one month post-operatively. RESULTS In the 46 propensity score matched pairs, eight (17.4%) out of 46 patients in the 2-OCA prospective cohort and seven (15.2%) out of 46 patients in the control cohort developed postoperative salivary fistulas within the one-month study interval (p = 1.00). The average time to postoperative leak in the 2-OCA group was 12.5 days versus 7.1 days in the control cohort (p = 0.10). In the 2-OCA group, 30 (65.2%) patients were tolerating regular diet at one month post-operatively compared to 33 (71.7%) in the control cohort (p = 0.65). CONCLUSION Salivary fistula rates after application of a 2-OCA surgical sealant were not improved compared to a control cohort in this single institutional trial. There are several surgical sealants available, each with varying elasticity and adhesiveness. Future studies are needed to identify surgical sealants that are able to provide sufficient strength and adhesion to seal closures and combat corrosive saliva, but elastic enough to handle motion related tension during swallowing and post-operative movements in the head and neck.
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Affiliation(s)
- Scott A Roof
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
| | - Enrique R Perez
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | | | - Mohemmed N Khan
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Rocco M Ferrandino
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Robert J Chouake
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Caitlin W Pacheco
- Department of Otolaryngology Head and Neck Surgery, Kaiser Permanente Oakland, Oakland, CA, USA
| | - Mike Yao
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Marita S Teng
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Eric M Genden
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Brett A Miles
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
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15
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Roof SA, Gray M, Meyer A, Ferrandino RM, Eden C, Kirke D, Courey MS. An Interactive Workshop to Increase Comfort and Knowledge Regarding Adult Tracheostomy Management: A Pilot Study. Journal of Scientific Innovation in Medicine 2020. [DOI: 10.29024/jsim.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Roof SA, Ferrandino RM, Villavisanis DF, Amato MV, Rubinstein BJ, Courey MS, Woo P. Infection Rates After Microlaryngeal and Open Phonosurgery: The Role of Postoperative Antibiotics. Laryngoscope 2019; 130:1128-1131. [PMID: 31424561 DOI: 10.1002/lary.28225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although it is known that the airway has bacterial contamination that seeds the surgical site during microlaryngeal surgery, literature on the use of postoperative antibiotics is lacking. We performed a retrospective analysis of open phonosurgical and phonomicrosurgical cases at a single institution to assess whether use of postoperative antibiotics impacts the incidence of surgical site infections (SSI). METHODS In this retrospective cohort study, we reviewed 228 phonomicrosurgery and 53 open phonosurgery cases performed for benign diseases. Surgeries were performed by two laryngologists between February 2016 and August 2018. The surgeons differ in their postoperative antibiotic regimens: no antibiotics versus a 5- to 7-day postoperative course. Data collected include demographics, medical comorbidities, type of benign laryngeal disease, and surgical procedure. The primary outcome measure was postoperative infection, defined as the patient requiring a new prescription for antibiotics, an extended course of antibiotics, or any mention of infection at follow-up/emergency visits within the first month postoperatively. RESULTS The overall rate of SSI was 3.1% and 0% for phonomicrosurgery and open phonosurgery cases, respectively. For phonomicrosurgery, there was no difference in the rate of SSI for patients who received or did not receive antibiotics perioperatively: 2.9% versus 3.2% (P = 0.99). Similarly, there was no difference in the infection rate for open phonosurgical cases. CONCLUSION Infection rates after endoscopic and open phonosurgery are low. In this study, we found no evidence to suggest a protective effect associated with postoperative use of antibiotics. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1128-1131, 2020.
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Affiliation(s)
- Scott A Roof
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Rocco M Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | | | - Michael V Amato
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Benjamin J Rubinstein
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Mark S Courey
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Peak Woo
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
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17
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Molfenter SM, Amin MR, Branski RC, Brumm JD, Hagiwara M, Roof SA, Lazarus CL. Age-Related Changes in Pharyngeal Lumen Size: A Retrospective MRI Analysis. Dysphagia 2015; 30:321-7. [PMID: 25750039 DOI: 10.1007/s00455-015-9602-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/16/2015] [Indexed: 11/29/2022]
Abstract
Age-related loss of muscle bulk and strength (sarcopenia) is often cited as a potential mechanism underlying age-related changes in swallowing. Our goal was to explore this phenomenon in the pharynx, specifically, by measuring pharyngeal wall thickness and pharyngeal lumen area in a sample of young versus older women. MRI scans of the neck were retrospectively reviewed from 60 women equally stratified into three age groups (20s, 60s, 70+). Four de-identified slices were extracted per scan for randomized, blinded analysis: one mid-sagittal and three axial slices were selected at the anterior inferior border of C2 and C3, and at the pit of the vallecula. Pixel-based measures of pharyngeal wall thickness and pharyngeal lumen area were completed using ImageJ and then converted to metric units. Measures of pharyngeal wall thickness and pharyngeal lumen area were compared between age groups with one-way ANOVAs using Sidak adjustments for post-hoc pairwise comparisons. A significant main effect for age was observed across all variables whereby pharyngeal wall thickness decreased and pharyngeal lumen area increased with advancing age. Pairwise comparisons revealed significant differences between 20s versus 70+ for all variables and 20s versus 60s for all variables except those measured at C2. Effect sizes ranged from 0.54 to 1.34. Consistent with existing sacropenia literature, the pharyngeal muscles appear to atrophy with age and consequently, the size of the pharyngeal lumen increases.
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Affiliation(s)
- Sonja M Molfenter
- Communicative Sciences & Disorders, Steinhardt, New York University, 665 Broadway, Room 934, New York, NY, 10012, USA,
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18
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Persky MJ, Roof SA, Fang Y, Jethanamest D, April MM. Cephalosporin use in penicillin-allergic patients: A survey of otolaryngologists and literature review. Laryngoscope 2015; 125:1822-6. [DOI: 10.1002/lary.25227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Michael J. Persky
- Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Scott A. Roof
- Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Yixin Fang
- Department of Population Health; New York University School of Medicine; New York New York U.S.A
- Department of Environmental Medicine; New York University School of Medicine; New York New York U.S.A
| | - Daniel Jethanamest
- Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Max M. April
- Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
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