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Filip P, Lerner DK, Kominsky E, Schupper A, Liu K, Khan NM, Roof S, Hadjipanayis C, Genden E, Iloreta AMC. 5-Aminolevulinic Acid Fluorescence-Guided Surgery in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2024; 134:741-748. [PMID: 37540051 DOI: 10.1002/lary.30910] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES To determine the utility of 5-aminolevulinic acid (5-ALA) fluorescence for resection of head and neck carcinoma. METHODS In this prospective pilot trial, 5-ALA was administered as an oral suspension 3-5 h prior to induction of anesthesia for resection of head and neck squamous cell carcinoma (HNSCC). Following resection, 405 nm blue light was applied, and fluorescence of the tumor as well as the surgical bed was recorded. Specimen fluorescence intensity was graded categorically as none (score = 0), mild (1), moderate (2), or robust (3) by the operating surgeon intraoperatively and corroborated with final pathologic diagnosis. RESULTS Seven patients underwent resection with 5-ALA. Five (83%) were male with an age range of 33-82 years (mean = 60). Sites included nasal cavity (n = 3), oral cavity (n = 3), and the larynx (n = 1). All specimens demonstrated robust fluorescence when 5-ALA was administered 3-5 h preoperatively. 5-ALA fluorescence predicted the presence of perineural invasion, a positive margin, and metastatic lymphadenopathy. Two patients had acute photosensitivity reactions, and one patient had a temporary elevation of hepatic enzymes. CONCLUSIONS 5-ALA induces robust intraoperative fluorescence of HNSCC, capable of demonstrating a positive margin, perineural invasion, and metastatic nodal disease. Although no conclusions are there about the safety of this drug in the head and neck cancer population, our study parallels the extensive safety data in the neurosurgical literature. Future applications may include intraoperative assessment of margin status, diagnostic accuracy, and impacts on survival. LEVEL OF EVIDENCE 4 Laryngoscope, 134:741-748, 2024.
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Affiliation(s)
- Peter Filip
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - David K Lerner
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Evan Kominsky
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Alexander Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Katherine Liu
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Nazir Mohemmed Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | | | - Eric Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Alfred M C Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
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Bloom JR, Rodriguez-Russo C, Hsieh K, Dickstein DR, Sheu RD, Jain M, Moshier E, Liu J, Gupta V, Kirke DN, Roof S, Misiukiewicz K, Posner M, Bakst R, Sindhu KK, Sharma S. Head and Neck Cancer Patient Population, Management, and Oncologic Outcomes from the COVID-19 Pandemic. Curr Oncol 2024; 31:436-446. [PMID: 38248114 PMCID: PMC10814981 DOI: 10.3390/curroncol31010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
The COVID-19 pandemic precipitated drastic changes in cancer care. Its impact on the U.S. head and neck cancer population has yet to be fully understood. This study aims to understand the impact of pandemic-related changes on the head and neck cancer population. An observational study of head and neck cancer patients at a single institution during the spring of 2020 and 2019 was performed. Clinical characteristics and survival outcomes were analyzed. In 2020, 54 head and neck cancer patients were evaluated in the department of radiation oncology vs. 74 patients seen in 2019; 42% of the patients were female in 2019 versus 24% in 2020 (p = 0.036). The median follow-up time was 19.4 and 31 months for 2020 and 2019, respectively. After adjusting for stage, the relapse-free survival probability at 6 and 12 months was 79% and 69% in 2020 vs. 96% and 89% in 2019, respectively (p = 0.036). There was no significant difference in the overall survival, with 94% and 89% in 2020 and 2019, respectively (p = 0.61). Twenty-one percent of patients received induction chemotherapy in 2020 versus 5% in 2019 (p = 0.011); significantly more treatment incompletions occurred in 2020, 9% vs. 0% in 2019 (p = 0.012). Moreover, the stage-adjusted RFS differed between cohorts, suggesting head and neck cancer patients seen during the initial wave of COVID-19 may experience worse oncologic outcomes.
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Affiliation(s)
- Julie R. Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Ren-Dih Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Mayuri Jain
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jerry Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Krzysztof Misiukiewicz
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Marshall Posner
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY 10029, USA
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Sonam Sharma
- Department of Radiation Oncology, Summit Health, Berkeley Heights, NJ 07922, USA
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3
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Mijares K, Ferrandino R, Chai R, Roof S, Bhardwaj S, Posner M, Westra WH. Circulating Tumor HPV DNA in Patients With Head and Neck Carcinoma: Correlation With HPV Genotyping. Am J Surg Pathol 2024; 48:80-87. [PMID: 37753709 DOI: 10.1097/pas.0000000000002134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Circulating tumor human papillomavirus DNA (ctHPVDNA) testing using digital-droplet polymerase chain reaction (PCR) detects fragments of tumor-modified human papillomavirus (HPV) in the plasma of patients with HPV-associated head and neck squamous cell carcinomas (HNSCCs). Its impact on tumor surveillance and primary diagnosis is limited by unresolved issues relating to sensitivity and specificity. The study population consisted of patients with HNSCC who had undergone ctHPVDNA testing. HPV status was determined by p16 immunohistochemistry and PCR-HPV genotyping on the tumor samples. For discrepant cases (HPV-positive/ctHPVDNA-negative), HPV status was confirmed by RNA in situ hybridization and, when possible, targeted single-nucleotide polymorphisms genotyping. A total of 167 patients had ctHPVDNA testing, and 141 tumors were HPV positive by p16 immunohistochemistry and PCR genotyping. Genotypes included types 16 (91.5%), 33 (4.3%), 35 (2.1%), and 18 (2.1%). ctHPVDNA was detected in 133 (94.3%) of HPV-positive HNSCCs but in none of the HPV-negative HNSCCs. Four of the 5 p16-positive cases that were negative by PCR and ctHPVDNA were positive by RNA in situ hybridization, and in 2 of these cases, rare high-risk genotypes were identified. ctHPVDNA had a sensitivity of 91.7%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 63.6%. The likelihood that patients with HPV-positive HNSCC have detectable ctHPVDNA is high. Non-HPV16 genotypes contribute to discrepancies but only in a small subset of cases. This finding validates ongoing efforts to use ctHPVDNA as a surveillance tool, and even as a primary diagnostic assay in patients presenting with masses in the neck and/or oropharynx.
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Affiliation(s)
| | | | - Raymond Chai
- Departments of Otolaryngology/Head and Neck Surgery
| | - Scott Roof
- Departments of Otolaryngology/Head and Neck Surgery
| | - Swati Bhardwaj
- Pathology, Icahn School of Medicine at Mount Sinai Hospital
| | - Marshall Posner
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
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Wang T, Roof S, Westra WH. Pulse granuloma presenting as a lateral neck mass: An unusual presentation of a fourth branchial cleft fistula. Head Neck 2023; 45:E49-E52. [PMID: 37646526 DOI: 10.1002/hed.27496] [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: 05/04/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The pulse granuloma (PG) is believed to represent a distinctive foreign body reaction to ingested particles of legumes. Its presentation in the neck is entirely unexpected. METHODS A woman presented with a mass of the lower neck that recurred following incision and drainage. The recurrent mass was found to be associated with an open sinus tract at the apex of the left pyriform sinus. The opening of the sinus tract was closed and the cyst was removed. RESULTS Histologic examination of the neck mass showed vegetable material with an associated granulomatous reaction known as PG. CONCLUSIONS The documentation of a PG arising in the neck would seemingly discredit the legume theory, but it only further supports it. Its association with a fourth branchial cleft cyst provides evidence for the existence of the complete fourth branchial cleft fistula with seeding of ingested material through sinus tract opening.
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Affiliation(s)
- Tiffany Wang
- The Department of Pathology, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Scott Roof
- The Department of Otolaryngology/Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - William H Westra
- The Department of Pathology, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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5
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Dickstein DR, Lehrer EJ, Bloom JR, Hsieh K, Jones B, Runnels J, Powers A, Barlow J, Chen S, Monrose E, Sindhu K, Factor O, Liu JT, Gupta V, Roof S, Kirke D, Misiukiewicz K, Posner M, Genden E, Bakst RL. Is 80 the New 70? Octogenarians with Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e577-e578. [PMID: 37785756 DOI: 10.1016/j.ijrobp.2023.06.1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) As the human papilloma virus (HPV) pandemic evolves and life expectancy increases, the number of older adults with oropharyngeal squamous cell carcinoma (OPSCC) continues to increase. However, there is a paucity of data regarding the fastest growing subset of this population: octogenarians (OGs). We sought to understand differences in treatment tolerability and clinical outcomes between septuagenarians (SGs) and OGs with OPSCC. MATERIALS/METHODS We identified SGs (age 70-79) and OGs (age 80-89) with OPSCC from a cohort of older adults with nonrecurrent, nonmetastatic head and neck squamous cell carcinoma (HNSCC) treated curatively from 2007-2020. We compared demographics, treatment characteristics and toxicities using Fischer's exact test. Time-to-event outcomes, overall survival (OS), locoregional control (LRC), and disease-specific survival (DSS), were evaluated using the Kaplan-Meier method. RESULTS Of 293 patients (age 70-89) with HNSCC, 39% (n = 114) had OPSCC: 93 SGs (median age: 73; interquartile range [IQR]: 71-76), and 21 OGs (median age: 81, IQR: 80-84). The median follow-up for included patients was 2.4 years; 82% were male, 64% white, 48% > 20 pack year smoking history, 37% ECOG 1. Patients had AJCC 8th edition Stage: I (27%); II (33%); III (18%); IV (22%) OPSCC. Treatment consisted of adjuvant radiation (RT) (19%), adjuvant chemoradiation (CRT) (8%), surgery alone (6%), induction/concurrent CRT (27%), concurrent CRT (28%), or RT (12%), with no significant differences in stage or treatment modalities noted between SGs and OGs. Of note, 69% of SGs and 76% of OGs were HPV+. Among 107 patients who received any RT, 24% experienced a treatment interruption (19% of SGs vs. 48% of OGs, p = 0.001) and 2 patients (both HPV- SGs) died on treatment due to unrelated health conditions. Percutaneous endoscopic gastrostomy (PEG) tubes were placed prior to or during treatment in 43% of SGs and 62% of OGs, with OGs more likely to have a PEG placed during treatment (p = 0.025). There was no difference in the prevalence of late (> 6 months) CTCAE grade 2+ dysphagia (36%) or xerostomia (31%) between SGs and OGs. Estimated 3-year LRC, DSS, and OS were not significantly different between SGs (LRC:85%; DSS:87%; OS:76%) and OGs (LRC: 81%; DSS:94%; OS: 55%, p-values: 0.98, 0.42, 0.052, respectively). However, HPV+ disease significantly increased estimated 3-year OS for both SGs (HPV+: 84%; HPV-: 56%, p = 0.0006) and OGs (HPV+: 68%; HPV-: 20%, p = 0.008). CONCLUSION In our cohort, OGs had a higher proportion of HPV+ OPSCC, which was associated with improved OS. This finding may provide insight into the latency of the virus. While there were similar amounts of toxicities among SGs and OGs, OGs more frequently underwent PEG tube placement and experienced more treatment interruptions. Given high rates of HPV+ OPSCC in OGs, our findings suggest that de-escalation strategies should be further investigated to improve tolerability and maximize outcomes for this neglected population.
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Affiliation(s)
- D R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J R Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - B Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Runnels
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - A Powers
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Barlow
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S Chen
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E Monrose
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - O Factor
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - V Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S Roof
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - D Kirke
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Misiukiewicz
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - M Posner
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E Genden
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - R L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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6
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Hanna GJ, Roof S, Jabalee J, Rettig EM, Ferrandino RM, Chen S, Posner M, Misiukiewicz KJ, Genden EM, Chai RL, Sims J, Thrash E, Stern SJ, Raben A, Clements LI, Mendelsohn AH, Kuperwasser C, Fitz CDV, Berger BM. Abstract 3360: Negative predictive value of circulating tumor tissue modified viral HPV DNA for identifying recurrence among patients treated for HPV-driven oropharyngeal cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Purpose: Despite favorable outcomes, up to 20% of patients with human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) will experience recurrence. Monitoring circulating tumor tissue modified viral (TTMV)-HPV DNA during post-treatment surveillance has emerged as a tool that has demonstrated >95% positive predictive value (PPV) for detecting recurrence. Here we describe a large real-world population with detailed clinical follow-up, permitting determination of the longitudinal negative predictive value (NPV) of the assay.
Patients and methods: This IRB-approved, retrospective observational cohort study included 312 patients across five U.S. centers who were ≥3 months post-treatment for HPV-driven OPSCC. Patients had one or more TTMV-HPV DNA results (NavDx®, Naveris Laboratories) obtained during surveillance between February 2020 and January 2021. A baseline TTMV-HPV DNA test was not required. HPV status was assessed by p16 immunohistochemistry or HPV PCR/ISH. Test results were correlated with physician-reported exam and imaging findings to assess disease status in follow-up.
Results: The cohort was mostly male (85%), had a median age of 61 (range: 27-81), included smokers (50%), and 282 (90%) had involved nodes (N1: 204, N2: 70, N3: 8) at initial staging. Curative-intent treatment involved surgery with or without another modality in 54% of cases (169/312). Median follow-up time was 23.5 months, and 39 patients (12.5%) had documented recurrence. Most patients had >1 TTMV-HPV DNA test result ≥3 months post-treatment (231, 74%), with 48 (15%) having 5 or more tests. Among patients with multiple negative surveillance tests, the median time between tests was 126 days (4.2 months, range: 0.37-24.2). The first TTMV-HPV DNA surveillance test was most often performed within the first year post-treatment (195, 63%). Across 812 test results, the NPV was 99.5%. There were 4 false negative tests among patients with confirmed p16-positive (3/4) or HPV PCR-positive (1/4) biopsy-proven recurrence. One of these patients had a subsequent positive TTMV-HPV DNA test during salvage immunotherapy. Only one of these patients had baseline TTMV-HPV DNA testing available, which showed a low positive <50 TTMV-HPV16 DNA Score, whereas the other three patients did not have a baseline result available.
Conclusion: Our findings further support the clinical potential of monitoring circulating TTMV-HPV DNA during post-treatment surveillance. We demonstrate a very high assay NPV correlated with physician-reported outcomes. TTMV-HPV DNA can be used to assist in surveillance and could inform imaging needs and future practice guidelines for HPV-driven head and neck cancer survivors.
Citation Format: Glenn J. Hanna, Scott Roof, James Jabalee, Eleni M. Rettig, Rocco M. Ferrandino, Sida Chen, Marshall Posner, Krzysztof J. Misiukiewicz, Eric M. Genden, Raymond L. Chai, John Sims, Elaine Thrash, Scott J. Stern, Adam Raben, Lydia I. Clements, Abie H. Mendelsohn, Charlotte Kuperwasser, Catherine Del Vecchio Fitz, Barry M. Berger. Negative predictive value of circulating tumor tissue modified viral HPV DNA for identifying recurrence among patients treated for HPV-driven oropharyngeal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3360.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Adam Raben
- 5Helen F. Graham Cancer Center, Newark, DE
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7
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Dickstein DR, Powers AE, Vujovic D, Roof S, Bakst RL. Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer. Clin Interv Aging 2023; 18:409-422. [PMID: 36959837 PMCID: PMC10029371 DOI: 10.2147/cia.s366155] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
Approximately 30% of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age, and this percentage is expected to increase as the population increases and lives longer. Elderly patients are underrepresented in head and neck oncology clinical trials, and there is minimal evidence on the management of HNSCC for this population. Subsequently, despite their best intentions, physicians may unknowingly recommend an ill-suited course of therapy, which may result in suboptimal oncological or functional outcomes or adverse events. Surgical approaches have the potential to carry a higher risk of morbidity and mortality in older adults, especially in patients with multiple comorbidities. Definitive radiation therapy treatment in patients with HNSCC frequently involves 7 weeks of daily radiation, sometimes with concurrent chemotherapy, and this demanding treatment can be difficult for older adult patients, which may lead to treatment interruptions, potential removal of concurrent systemic therapy, compromised outcomes, and diminished quality of life. There are clinical trials currently underway investigating altered fractionation regimens and novel, less toxic systemic treatments in this population. This review provides an overview of how best to approach an older adult with HNSCC, from initial work-up to treatment selection.
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Affiliation(s)
- Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann E Powers
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dragan Vujovic
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Roof
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Correspondence: Richard L Bakst, Icahn School of Medicine at Mount Sinai, 1184 5th Avenue 1st Fl, Box 1236, New York, NY, 10029, USA, Tel/Fax +1 212 241 3545, Email
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8
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Kao DD, Ferrandino RM, Bauml JM, Marshall DC, Bakst R, Roof S, Park YHA, Sigel KM. Prophylactic feeding tube placement for squamous cell carcinoma of the head and neck. Oral Oncol 2022; 135:106216. [PMID: 36326521 PMCID: PMC10363279 DOI: 10.1016/j.oraloncology.2022.106216] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/14/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastronomy (PEG) tubes are commonly used to administer enteral nutrition during head and neck cancer (HNC) treatment. However, the benefits of placing a prophylactic feeding tube (PFT; prior to radiotherapy [RT]) or reactive feeding tube (RFT, after RT initiation) are unclear. We sought to compare survival, body mass trends, and hospitalization rates between strategies. METHODS We conducted a retrospective cohort study of 11,473 Veterans with stages III-IVC HNC treated with chemoradiotherapy. Patients with PEG tube placement within 30 days prior to treatment initiation (PFT) were compared to all other patients (non-PFT) or patients with PEG tube placement within 3 months after treatment initiation placement (RFT). We compared survival, longitudinal body mass changes, and hospitalization rates for PFT versus non-PFT or RFT patients in propensity score (PS)-matched Cox regression models. RESULTS 3,186 (28 %) patients received PFT and 8,287 (72 %) were non-PFT, of which 1,874 (23 %) received RFT. After PS-matching, there were no significant differences in overall survival (HR 0.97, 95 % CI 0.92-1.02), HNC-specific survival (HR 0.98, 95 % CI 0.92-1.09), change in BMI (p = 0.24), or hospitalization rates between PFT and non-PFT groups. Significant differences in hospitalization rates between PFT and RFT groups persisted after PS-matching (-0.11 hospitalizations/month), but no differences were found for other outcomes. CONCLUSION Timing of PEG tube placement in Veterans with HNC was not associated with any significant survival or body mass advantage. However, patients who received PFT had a lower hospitalization rate than those who received RFT.
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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, NY, USA
| | - Rocco M Ferrandino
- Deparment of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua M Bauml
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Roof
- Deparment of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yeun-Hee A Park
- Department of Medicine, Division of Hematology/Oncology, James J. Peters VA Medical Center, Bronx, NY, USA; Department of Medicine, Division of Hematology/Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Keith M Sigel
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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9
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Hardman JC, Holsinger FC, Brady GC, Beharry A, Bonifer AT, D’Andréa G, Dabas SK, de Almeida JR, Duvvuri U, Floros P, Ghanem TA, Gorphe P, Gross ND, Hamilton D, Kurukulasuriya C, Larsen MHH, Lin DJ, Magnuson JS, Meulemans J, Miles BA, Moore EJ, Pantvaidya G, Roof S, Rubek N, Simon C, Subash A, Topf MC, Van Abel KM, Vander Poorten V, Walgama ES, Greenlay E, Potts L, Balaji A, Starmer HM, Stephen S, Roe J, Harrington K, Paleri V. Transoral Robotic Surgery for Recurrent Tumors of the Upper Aerodigestive Tract (RECUT): An International Cohort Study. J Natl Cancer Inst 2022; 114:1400-1409. [PMID: 35944904 PMCID: PMC9552281 DOI: 10.1093/jnci/djac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/04/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) is an emerging minimally invasive surgical treatment for residual, recurrent, and new primary head and neck cancers in previously irradiated fields, with limited evidence for its oncological effectiveness. METHODS A retrospective observational cohort study of consecutive cases performed in 16 high-volume international centers before August 2018 was conducted (registered at clinicaltrials.gov [NCT04673929] as the RECUT study). Overall survival (OS), disease-free survival, disease-specific survivals (DSS), and local control (LC) were calculated using Kaplan-Meier estimates, with subgroups compared using log-rank tests and Cox proportional hazards modeling for multivariable analysis. Maximally selected rank statistics determined the cut point for closest surgical resection margin based on LC. RESULTS Data for 278 eligible patients were analyzed, with median follow-up of 38.5 months. Two-year and 5-year outcomes were 69.0% and 62.2% for LC, 71.8% and 49.8% for OS, 47.2% and 35.7% for disease-free survival, and 78.7% and 59.1% for disease-specific survivals. The most discriminating margin cut point was 1.0 mm; the 2-year LC was 80.9% above and 54.2% below or equal to 1.0 mm. Increasing age, current smoking, primary tumor classification, and narrow surgical margins (≤1.0 mm) were statistically significantly associated with lower OS. Hemorrhage with return to theater was seen in 8.1% (n = 22 of 272), and 30-day mortality was 1.8% (n = 5 of 272). At 1 year, 10.8% (n = 21 of 195) used tracheostomies, 33.8% (n = 66 of 195) used gastrostomies, and 66.3% (n = 53 of 80) had maintained or improved normalcy of diet scores. CONCLUSIONS Data from international centers show TORS to treat head and neck cancers in previously irradiated fields yields favorable outcomes for LC and survival. Where feasible, TORS should be considered the preferred surgical treatment in the salvage setting.
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Affiliation(s)
- John C Hardman
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
| | - F Chris Holsinger
- Department of Otolaryngology—H&N Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Grainne C Brady
- Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, London, UK
| | - Avinash Beharry
- Department of Otolaryngology—H&N Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Alec T Bonifer
- Department of Otolaryngology—H&N Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Gregoire D’Andréa
- Head and Neck Oncology Department, Institute Gustave Roussy, Paris, France
| | - Surender K Dabas
- Department of Surgical Oncology and Robotic Surgery, BL Kapur Memorial Hospital, New Delhi, India
| | - John R de Almeida
- Department of Otolaryngology—H&N Surgery, University Health Network, Toronto, ON, Canada
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter Floros
- Department of Otolaryngology—H&N Surgery, Florida Hospital Group, Celebration, FL, USA
| | - Tamer A Ghanem
- Department of Otolaryngology—H&N Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Philippe Gorphe
- Head and Neck Oncology Department, Institute Gustave Roussy, Paris, France
| | - Neil D Gross
- Department of H&N Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - David Hamilton
- Department of Otolaryngology—H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK
| | - Chareeni Kurukulasuriya
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Daniel J Lin
- Department of Otolaryngology—H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK
| | - J Scott Magnuson
- Department of Otolaryngology—H&N Surgery, Florida Hospital Group, Celebration, FL, USA
| | - Jeroen Meulemans
- Otorhinolaryngology—Head & Neck Surgery, University Hospitals Leuven, and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Brett A Miles
- Department of Otolaryngology Head and Neck Surgery, Northwell Health System, New York, NY, USA
| | - Eric J Moore
- Department of Otolaryngology—H&N Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gouri Pantvaidya
- Department of H&N Surgery, Tata Memorial Hospital, Mumbai, India
| | - Scott Roof
- Department of Otolaryngology, Mount Sinai Hospital, New York City, NY, USA
| | - Niclas Rubek
- Department of Head and Neck Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Simon
- Department of Otolaryngology—H&N Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Anand Subash
- Department of Surgical Oncology and Robotic Surgery, BL Kapur Memorial Hospital, New Delhi, India
| | - Michael C Topf
- Department of Otolaryngology—H&N Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology—H&N Surgery, Mayo Clinic, Rochester, MN, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology—Head & Neck Surgery, University Hospitals Leuven, and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Evan S Walgama
- Department of H&N Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Greenlay
- Clinical Trials Unit, The Royal Marsden Hospital, London, UK
| | - Laura Potts
- Clinical Trials Unit, The Royal Marsden Hospital, London, UK
| | - Arun Balaji
- Department of H&N Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Heather M Starmer
- Department of Otolaryngology—H&N Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Sarah Stephen
- Department of Otolaryngology—H&N Surgery, The Newcastle upon Tyne Hospitals, Newcastle, UK
| | - Justin Roe
- Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, London, UK
| | | | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
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Kao D, Ferrandino R, Roof S, Sigel KM. Neutrophil-to-lymphocyte ratio as a predictor of survival in head and neck squamous cell carcinoma patients treated with cisplatin. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18004 Background: Neutrophil-to-lymphocyte ratio (NLR) is an easily attainable biomarker that is correlated with systemic inflammation and identifies increased risk of treatment complications and decreased survival in patients with cancer. Our objective was to investigate the use of NLR as an independent prognostic predictor of survival in patients with head and neck squamous cell carcinoma (HNSCC) treated with cisplatin chemotherapy. Methods: We conducted a retrospective study of 2,084 patients in the Veterans Health Affairs system with stages III–IVB head and neck squamous cell carcinoma diagnosed between 2000–2014 and treated with cisplatin-based chemoradiotherapy for curative intent. We calculated NLR values from laboratory values collected in the 30 days prior to initiation of chemoradiotherapy and dichotomized NLR using the Youden J-statistic (NLR = 3.64). We then compared outcomes using Cox proportional hazards methods, adjusting for sociodemographic characteristics (age, race, and sex), date of cancer diagnosis, smoking status, alcohol use, primary site of tumor, tumor characteristics (overall stage, T stage, and N stage), comorbidity score, eGFR, baseline neuropathy and hearing loss, BMI, and oncologic surgical procedures. Results: The cohort had a median age of 61. 99% of cases were male, 82% were white, 13% were black, and 4% were Hispanic. 36% of cases had an NLR > 3.64 prior to treatment initiation. Median overall survival was 32.6 months for the low-NLR group and 24.9 months for the high-NLR group. In unadjusted analyses, a high NLR was associated with an increased risk of all-cause death (hazard ratio [HR]: 1.21; 95% CI 1.08–1.34). In adjusted analyses, high NLR retained significance and predicted overall survival (HR: 1.15; 95% CI 1.02–1.30). We also performed a secondary analysis for death within six months of cancer diagnosis; high NLR was associated with > 50% increased risk of death after adjustment (HR: 1.56; 95% CI 1.04–2.33). Conclusions: In this large cohort of Veterans with advanced HNSCC undergoing chemoradiotherapy, NLR was an independent prognostic predictor of survival. NLR may be a useful clinical risk stratification tool prior to chemoradiotherapy initiation.
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Affiliation(s)
- Derek Kao
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Scott Roof
- Icahn School of Medicine at Mount Sinai, New York, NY
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Bhat S, Covas Moschovas M, Sandri M, Noel J, Rogers T, Pereira R, Reddy S, Roof S, Patel V. Outcomes of Salvage Robot-Assisted Radical Prostatectomy (S-RARP) post focal ablation for prostate cancer in comparison with primary Robot-assisted Radical Prostatectomy (RARP); A matched analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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12
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Covas Moschovas M, Chew C, Bhat S, Sandri M, Rogers T, Dell’oglio P, Roof S, Reddy S, Chiara Sighinolfi M, Rocco B, Patel V. Association between Oncotype DX Genomic Prostate Score (GPS) and adverse tumor pathology after radical prostatectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Covas Moschovas M, Bhat S, Sandri M, Rogers T, Mazzone E, Roof S, Mottrie A, Patel V. Comparing the approach to radical prostatectomy using the Da Vinci Xi and Da Vinci Single Port: A propensity score analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Roof S, Ferrandino R, Eden C, Khelemsky Y, Teng M, Genden E, DeMaria S, Miles BA. Local infusion of ropivacaine for pain control after osseous free flaps: Randomized controlled trial. Head Neck 2021; 43:1063-1072. [PMID: 33619855 DOI: 10.1002/hed.26562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/04/2020] [Accepted: 11/18/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Donor site pain after osteocutaneous free flap surgery contributes to postoperative morbidity and impairs recovery. We evaluated the efficacy of local infusion of ropivacaine for treating donor-site pain after surgery. METHODS We conducted a randomized, double-blind, placebo-controlled trial of patients undergoing osteocutaneous fibula or scapular tip free flaps for head and neck reconstruction at Mount Sinai Hospital. Patients were randomized to receive local infusion of ropivacaine or saline. We compared Visual Analog Scale pain scores for donor-site specific pain 48 hours after surgery. RESULTS There were 8 fibular free flap and 10 scapular free flap reconstructions. Average donor-site pain scores were 29 ± 22 and 31 ± 28 mm (P = .88) for placebo and ropivacaine arms, respectively. The trial was stopped after the planned interim analysis for futility of the intervention. CONCLUSIONS Local infusion of ropivacaine did not affect donor-site specific pain scores in this population. ClinicalTrials.gov Identifier: NCT03349034.
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Affiliation(s)
- Scott Roof
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Rocco Ferrandino
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Caroline Eden
- Department of Anesthesiology, Columbia University Medical Center, New York City, New York, USA
| | - Yury Khelemsky
- Department of Anesthesiology, Mount Sinai Hospital, New York City, New York, USA
| | - Marita Teng
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Eric Genden
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Mount Sinai Hospital, New York City, New York, USA
| | - Brett A Miles
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York City, New York, USA
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15
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Meyer A, Roof S, Gray ML, Fan CJ, Barber B, Miles BA, Teng M, Genden E, Rosenberg JD. Cover Image. Head Neck 2020. [DOI: 10.1002/hed.26466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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16
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Meyer A, Roof S, Gray ML, Fan CJ, Barber B, Miles BA, Teng M, Genden E, Rosenberg JD. Thermal imaging for microvascular free tissue transfer monitoring: Feasibility study using a low cost, commercially available mobile phone imaging system. Head Neck 2020; 42:2941-2947. [DOI: 10.1002/hed.26350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 05/10/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Annika Meyer
- Department of Otolaryngology—Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Scott Roof
- Department of Otolaryngology—Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Mingyang L. Gray
- Department of Otolaryngology—Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Caleb J. Fan
- Department of Otolaryngology—Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Brittany Barber
- Department of Otolaryngology—Head and Neck Surgery University of Washington Seattle Washington USA
| | - Brett A. Miles
- Department of Otolaryngology—Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Marita Teng
- Department of Otolaryngology—Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Eric Genden
- Department of Otolaryngology—Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Joshua D. Rosenberg
- Department of Otolaryngology—Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
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17
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Covas Moschovas M, Bhat S, Rogers T, Onol F, Roof S, Mazzone E, Mottrie A, Patel V. Adoption of a new robotic platform. Key technical modifications: A step-by-step approach to da Vinci SP radical prostatectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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18
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Ferrandino RM, Roof S, Garneau J, Haidar Y, Bates SE, Park YHA, Bauml JM, Genden EM, Miles B, Sigel K. Neutrophil-to-lymphocyte ratio as a prognostic indicator for overall and cancer-specific survival in squamous cell carcinoma of the head and neck. Head Neck 2020; 42:2830-2840. [PMID: 32592262 DOI: 10.1002/hed.26329] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/02/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) is a biomarker that is correlated with systemic inflammation and poor prognosis in solid tumors. We investigated the value of NLR in predicting survival in a large population of head and neck cancer patients in the United States. METHODS We performed a retrospective cohort study of Veterans Affairs patients with head and neck squamous cell carcinoma (HNSCC) diagnosed between January 2000 and December 2017. We compared 5-year overall survival and cancer-specific survival for different NLR tertiles using cox proportional hazards modeling with adjustment for covariates. RESULTS The primary cohort consisted of 14 644 subjects of which 99% were male. Relative to patients with NLRs in the lower tertile, patients with NLRs in the top tertile had an 71% increased hazard of all-cause mortality (P < .001) and 44% increased hazard of cancer-specific mortality (P < .001) at 5 years. CONCLUSIONS Elevated NLR in HNSCC confers a poor prognosis.
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Affiliation(s)
- Rocco M Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Jonathan Garneau
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Yarah Haidar
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Susan E Bates
- 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
| | - Yeun-Hee A Park
- Department of Medicine, Division of Hematology/Oncology, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Joshua M Bauml
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Keith Sigel
- Department of Medicine, Division of General Internal Medicine, Mount Sinai Hospital, New York, New York, USA
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Del Rio CL, Roof S, Anto AR, Anderson RL. P4465Acute Cardio-Selective Functional Modulation via a Small-Molecule Direct Myosin-Attenuator (MYK-581) Preserves Diaphragmatic Function in vivo: Comparison versus Disopyramide. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hypertrophic cardiomyopathy (HCM) is a heritable cardiac disease characterized by hyper-contractility, hindered relaxation, and impaired exercise capacity. Conventional negative inotropes can alleviate enhanced inotropy in HCM, but do not improve ventricular filling and have the potential to further decrease exercise capacity due to their off/on-target systemic effects. Recently, a novel small molecule cardiac-myosin attenuator, Mavacamten, has been shown to normalize hyper-contractility in the setting of HCM. This study evaluated and compared the in vivo functional selectivity of MYK-581, a mavacamten analog, with those of disopyramide (DISO), a commonly-used negative inotrope.
Methods
In vivo, the acute cardiac (left ventricular pressures) and neuro-muscular (force of diaphragmatic and skeletal muscle contractions) responses to MYK-581 (up to 0.5 mg/kg IV) and DISO (up to 10 mg/kg IV) were simultaneously evaluated using anesthetized and mechanically-ventilated Sprague-Dawley rats; diaphragmatic (both intrinsic and phrenic nerve stimulated) and skeletal contractions (stimulated quadriceps) were measured via strain gauges.
Results
MYK-581 decreased indices of systolic function (dP/dtmax: −32±2% and vmax: −14±2%, P<0.05 vs. pre-dose) and increased LV EDV (+9±2%, P<0.05), while preserving EDP (6±1 to 6±1 mmHg), suggesting improved ventricular distensibility. Despite these marked cardiac effects, MYK-581 preserved both diaphragmatic (23.7±2.0 to 23.3±2.2 g) and skeletal in situ function (14.9±1.4 to 13.9±0.8 g). In contrast, DISO at matched levels of negative inotropy (dP/dtmax: −25±2% and vmax: −19±2%, P<0.05 vs. pre-dose) depressed diaphragmatic force (−16±3%, 23.8±1.9 to 19.8±1.2 g, P<0.05). Finally, the cardiac selectivity of MYK-581 was confirmed in kinetic experiments evaluating the Ca2+-activated ATPase activity of both cardiac and diaphragmatic myofibrils.
Conclusions
Direct myosin modulation with MYK-581, a mavacamten analog, is characterized in vivo by reductions in systolic function with preserved filling pressures and improved LV compliance. Moreover, this cardiovascular profile was devoid in vivo of diaphragmatic/skeletal off-target effects that could further hinder exercise capacity in patients with HCM.
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Affiliation(s)
- C L Del Rio
- MyoKardia, San Francisco, United States of America
| | - S Roof
- QTest Labs, Safety Pharmacology, Columbus, United States of America
| | - A R Anto
- MyoKardia, San Francisco, United States of America
| | - R L Anderson
- MyoKardia, San Francisco, United States of America
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Ferrandino R, Garneau J, Roof S, Pacheco C, Poojary P, Saha A, Chauhan K, Miles B. The national landscape of unplanned 30-day readmissions after total laryngectomy. Laryngoscope 2017; 128:1842-1850. [PMID: 29152760 DOI: 10.1002/lary.27012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/11/2017] [Accepted: 10/20/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Examine rates of readmission after total laryngectomy and determine primary etiologies, timing, and risk factors for unplanned readmission. STUDY DESIGN Retrospective cohort study. METHODS The Nationwide Readmissions Database was queried for patients who underwent total laryngectomy between January 2013 and November 2013. Patient-, procedure-, admission-, and institution-level characteristics were compared for patients with and without unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission. RESULTS There were 2,931 total laryngectomies performed in 2013 with an unplanned readmission rate of 17.5%. Postoperative fistula accounted for 13.7% of readmissions. The odds of readmission were elevated for patients undergoing concurrent procedures, including primary tracheoesophageal fistulization (adjusted odds ratio [aOR]: 2.44, 95% confidence interval [CI]: 1.15-5.18, P = .02) and/or pedicle graft or flap procedures (aOR: 1.73, 95% CI: 1.13-2.66, P = .01). Additionally, patients with comorbid coagulopathy (aOR: 3.04, 95% CI: 1.13-8.22, P = .03), liver disease (aOR: 2.48, 95% CI: 1.08-5.71, P = .03), and valvular heart disease (aOR: 3.18, 95% CI: 1.20-8.41, P = .02) had increased risk for unplanned 30-day readmission. Private insurance and longer lengths of stay were associated with decreased odds of readmission. CONCLUSIONS Nearly one-fifth of total laryngectomy patients are readmitted to the hospital within 30 days of discharge. Risk factors identified in this nationally representative cohort should be carefully considered during the postoperative period to reduce preventable readmissions after total laryngectomy. LEVEL OF EVIDENCE 2c Laryngoscope, 1842-1850, 2018.
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Affiliation(s)
- Rocco Ferrandino
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jonathan Garneau
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Caitlin Pacheco
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Priti Poojary
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Aparna Saha
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Kinsuk Chauhan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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21
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Ferrandino R, Roof S, Ma Y, Chan L, Poojary P, Saha A, Chauhan K, Coca SG, Nadkarni GN, Teng MS. Unplanned 30-Day Readmissions after Parathyroidectomy in Patients with Chronic Kidney Disease: A Nationwide Analysis. Otolaryngol Head Neck Surg 2017; 157:955-965. [PMID: 28949797 DOI: 10.1177/0194599817721154] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To examine rates of readmission after parathyroidectomy in patients with chronic kidney disease and determine primary etiologies, timing, and risk factors for these unplanned readmissions. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Subjects and Methods The Nationwide Readmissions Database was queried for parathyroidectomy procedures performed in patients with chronic kidney disease between January 2013 and November 2013. Patient-, admission-, and hospital-level characteristics were compared for patients with and without at least 1 unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission. Results There were 2756 parathyroidectomies performed in patients with chronic kidney disease with an unplanned readmission rate of 17.2%. Hypocalcemia/hungry bone syndrome accounted for 40% of readmissions. Readmissions occurred uniformly throughout the 30 days after discharge, but readmissions for hypocalcemia/hungry bone syndrome peaked in the first 10 days and decreased over time. Weight loss/malnutrition at time of parathyroidectomy and length of stay of 5 to 6 days conferred increased risk of readmission with adjusted odds ratios (aOR) of 3.31 (95% confidence interval [CI], 1.55-7.05; P = .002) and 1.87 (95% CI, 1.10-3.19; P = .02), respectively. Relative to primary hyperparathyroidism, parathyroidectomies performed for secondary hyperparathyroidism (aOR, 2.53; 95% CI, 1.07-5.95; P = .03) were associated with higher risk of readmission. Conclusion Postparathyroidectomy readmission rates for patients with chronic kidney disease are nearly 5 times that of the general population. Careful consideration of postoperative care and electrolyte management is crucial to minimize preventable readmissions in this vulnerable population.
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Affiliation(s)
- Rocco Ferrandino
- 1 Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott Roof
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yue Ma
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lili Chan
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Priti Poojary
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Aparna Saha
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Kinsuk Chauhan
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Steven G Coca
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Girish N Nadkarni
- 3 Department of Nephrology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Marita S Teng
- 2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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22
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Dion GR, Jeswani S, Roof S, Fritz M, Coelho PG, Sobieraj M, Amin MR, Branski RC. Functional assessment of the ex vivo vocal folds through biomechanical testing: A review. Mater Sci Eng C Mater Biol Appl 2016; 64:444-453. [PMID: 27127075 DOI: 10.1016/j.msec.2016.04.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 03/21/2016] [Accepted: 04/06/2016] [Indexed: 11/25/2022]
Abstract
The human vocal folds are complex structures made up of distinct layers that vary in cellular and extracellular composition. The mechanical properties of vocal fold tissue are fundamental to the study of both the acoustics and biomechanics of voice production. To date, quantitative methods have been applied to characterize the vocal fold tissue in both normal and pathologic conditions. This review describes, summarizes, and discusses the most commonly employed methods for vocal fold biomechanical testing. Force-elongation, torsional parallel plate rheometry, simple-shear parallel plate rheometry, linear skin rheometry, and indentation are the most frequently employed biomechanical tests for vocal fold tissues and each provide material properties data that can be used to compare native tissue to diseased or treated tissue. Force-elongation testing is clinically useful, as it allows for functional unit testing, while rheometry provides physiologically relevant shear data, and nanoindentation permits micrometer scale testing across different areas of the vocal fold as well as whole organ testing. Thoughtful selection of the testing technique during experimental design to evaluate a hypothesis is critical to optimize biomechanical testing of vocal fold tissues.
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Affiliation(s)
- Gregory R Dion
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Seema Jeswani
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Scott Roof
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Mark Fritz
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States
| | - Michael Sobieraj
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States
| | - Milan R Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Ryan C Branski
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States.
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23
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Taliercio S, Cespedes M, Born H, Ruiz R, Roof S, Amin MR, Branski RC. Adult-Onset Recurrent Respiratory Papillomatosis. JAMA Otolaryngol Head Neck Surg 2015; 141:78-83. [DOI: 10.1001/jamaoto.2014.2826] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sal Taliercio
- NYU Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York
| | - Michelle Cespedes
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Hayley Born
- NYU Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York
| | - Ryan Ruiz
- NYU Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York
| | - Scott Roof
- NYU Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York
| | - Milan R. Amin
- NYU Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York
| | - Ryan C. Branski
- NYU Voice Center, Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York
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