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Mascarella MA, Ferdus J, Vendra V, Sridharan S, Sultanem K, Tsien C, Shenouda G, Bouganim N, Esfahani K, Richardson K, Mlynarek A, Sadeghi N, Hier M, Kergoat MJ. Sarcopenia predicts short-term treatment-related toxicity in patients undergoing curative-intent therapy for head and neck cancer: A systematic review and meta-analysis. Head Neck 2024; 46:1500-1509. [PMID: 38353170 DOI: 10.1002/hed.27688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/27/2023] [Accepted: 02/05/2024] [Indexed: 05/14/2024] Open
Abstract
Sarcopenia is an increasingly recognized biomarker associated with poorer outcomes. The objective of this study was to ascertain the effect of sarcopenia on treatment tolerance and short-term toxicity in head and neck cancer (HNC). A systematic review was performed using multiple databases. An inverse-variation, random-effects model was used to perform the meta-analysis to evaluate the effect of sarcopenia on severe treatment toxicity and poor treatment tolerance. Sixteen observational studies, including 3187 patients with HNC, were analyzed. The combined odds ratio (OR) for severe treatment toxicity and tolerance was 2.22 (95%CI 1.50-3.29) and 1.40 (95%CI 0.84-2.32), respectively. The effect of sarcopenia on short-term severe treatment toxicity was similar with upfront surgery (OR 2.03, 95%CI 1.22-3.37) and definitive radiotherapy (OR 2.24, 95%CI 1.18-4.27) Patients with sarcopenia are more than twice as likely to suffer a short-term treatment-related toxicity when undergoing curative-intent HNC treatment.
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Affiliation(s)
- Marco A Mascarella
- Department of Biomedical Sciences, Université de Montréal, Montreal, Quebec, Canada
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Jannatul Ferdus
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Varun Vendra
- Department of Otolaryngology - Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Shaum Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Christina Tsien
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - George Shenouda
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Nathaniel Bouganim
- Division of Medical Oncology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Khashayar Esfahani
- Division of Medical Oncology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Marie-Jeanne Kergoat
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-sud-de-l'Ile- de-Montréal, Montreal, Quebec, Canada
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Le Blanc G, Richardson K, Mlynarek A, Hier MP, Sadeghi N, Kergoat MJ, Mascarella M. Loss of Independence in Older Adults With Operable Oral Cavity Cancer: A Retrospective Cohort Study. Otolaryngol Head Neck Surg 2024. [PMID: 38643406 DOI: 10.1002/ohn.784] [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: 07/25/2023] [Revised: 01/05/2024] [Accepted: 02/17/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE To ascertain the effect of curative-intent surgery on loss of independence (LOI) in patients with oral cavity squamous cell carcinoma (OCSCC). STUDY DESIGN Retrospective observational study of patients diagnosed from 2014 to 2021. SETTING Single tertiary care academic center. Patients having undergone curative-intent surgical treatment for OCSCC from 2014 to 2021 in the cancer registry. METHODS LOI as the primary outcome was measured based on a combination of decrease in activities of daily living (ADLs) and/or decline in mobility during treatment. Descriptive statistics were used to compare baseline demographics and multivariable logistic regression was used to assess the association between LOI and perioperative variables of interest. RESULTS Of the 180 patients included in this study, 139 (79%) were fully independent in ADLs/instrumental ADLs prior to surgery. The average age of the cohort was 74 with 49% males. Thirty-seven (21%) experienced a decline in mobility or increased care needs following surgery, and 18 (10%) experienced an independent decline in functional status. Increasing age, osseous flap reconstruction, high Charlson Comorbidity Index, and major postoperative adverse events were associated with LOI. Fifty-five percent of patients with LOI had recovered to baseline within 7 months from surgery. LOI was associated with poor treatment tolerance (odds ratio: 4.77, 95% confidence interval: 1.87-12.2) while adjusting for multiple confounders. CONCLUSION LOI is common in older adults undergoing curative-intent surgery for OCSCC and associated with poor treatment tolerance.
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Affiliation(s)
- Gabriella Le Blanc
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael P Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Jeanne Kergoat
- Division of Geriatric Medicine, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Marco Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Muniz IDAF, Araujo M, Bouassaly J, Farshadi F, Atique M, Esfahani K, Bonan PRF, Hier M, Mascarella M, Mlynarek A, Alaoui-Jamali M, da Silva SD. Therapeutic Advances and Challenges for the Management of HPV-Associated Oropharyngeal Cancer. Int J Mol Sci 2024; 25:4009. [PMID: 38612819 PMCID: PMC11012756 DOI: 10.3390/ijms25074009] [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: 02/08/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
The use of conventional chemotherapy in conjunction with targeted and immunotherapy drugs has emerged as an option to limit the severity of side effects in patients diagnosed with head and neck cancer (HNC), particularly oropharyngeal cancer (OPC). OPC prevalence has increased exponentially in the past 30 years due to the prevalence of human papillomavirus (HPV) infection. This study reports a comprehensive review of clinical trials registered in public databases and reported in the literature (PubMed/Medline, Scopus, and ISI web of science databases). Of the 55 clinical trials identified, the majority (83.3%) were conducted after 2015, of which 77.7% were performed in the United States alone. Eight drugs have been approved by the FDA for HNC, including both generic and commercial forms: bleomycin sulfate, cetuximab (Erbitux), docetaxel (Taxotere), hydroxyurea (Hydrea), pembrolizumab (Keytruda), loqtorzi (Toripalimab-tpzi), methotrexate sodium (Trexall), and nivolumab (Opdivo). The most common drugs to treat HPV-associated OPC under these clinical trials and implemented as well for HPV-negative HNC include cisplatin, nivolumab, cetuximab, paclitaxel, pembrolizumab, 5-fluorouracil, and docetaxel. Few studies have highlighted the necessity for new drugs specifically tailored to patients with HPV-associated OPC, where molecular mechanisms and clinical prognosis are distinct from HPV-negative tumors. In this context, we identified most mutated genes found in HPV-associated OPC that can represent potential targets for drug development. These include TP53, PIK3CA, PTEN, NOTCH1, RB1, FAT1, FBXW7, HRAS, KRAS, and CDKN2A.
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Affiliation(s)
- Isis de Araújo Ferreira Muniz
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Graduate Program in Dentistry, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil
| | - Megan Araujo
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
| | - Jenna Bouassaly
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
| | - Fatemeh Farshadi
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
| | - Mai Atique
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Khashayar Esfahani
- Department of Oncology, McGill University, Montreal, QC HC3 1E2, Canada;
| | - Paulo Rogerio Ferreti Bonan
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Graduate Program in Dentistry, Federal University of Paraíba, João Pessoa 58051-900, PB, Brazil
| | - Michael Hier
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Marco Mascarella
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Alex Mlynarek
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Moulay Alaoui-Jamali
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
| | - Sabrina Daniela da Silva
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC HC3 1E2, Canada; (I.d.A.F.M.); (F.F.); (M.A.); (P.R.F.B.); (M.H.); (M.M.); (A.M.); (M.A.-J.)
- Division of Experimental Medicine and Oncology, Department of Medicine and Health Sciences, McGill University, Montreal, QC HC3 1E2, Canada; (M.A.); (J.B.)
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Bouassaly J, Karimi N, Kowalski LP, Sultanem K, Alaoui-Jamali M, Mlynarek A, Mascarella M, Hier M, Sadeghi N, da Silva SD. Rethinking treatment paradigms: Neoadjuvant therapy and de-escalation strategies in HPV-positive head and neck cancer. Crit Rev Oncol Hematol 2024; 196:104326. [PMID: 38479584 DOI: 10.1016/j.critrevonc.2024.104326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024] Open
Abstract
Head and neck cancer (HNC) is the 6th most common cancer across the world, with a particular increase in HNC associated with human papilloma virus (HPV) among younger populations. Historically, the standard treatment for this disease consisted of combined surgery and radiotherapy or curative platinum-based concurrent chemoradiotherapy, with associated long term and late toxicities. However, HPV-positive HNC is recognized as a unique cancer subtype, typically with improved clinical outcomes. As such, treatment de-escalation strategies have been widely researched to mitigate the adverse effects associated with the current standard of care without compromising efficacy. These strategies include treatment de-escalation, such as novel surgical techniques, alternative radiation technologies, radiation dose and volume reduction, as well as neoadjuvant chemotherapies, immunotherapies, and combined therapies. Although these therapies show great promise, many of them are still under investigation due to hesitation surrounding their widespread implementation. The objective of this review is to summarize the most recent progress in de-escalation strategies and neoadjuvant therapies designed for HPV-positive HNC. While specific treatments may require additional research before being widely adopted, encouraging results from recent studies have highlighted the advantages of neoadjuvant chemotherapy and immunotherapy, as well as radiation and surgical de-escalation approaches in managing HPV-positive HNC.
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Affiliation(s)
- Jenna Bouassaly
- Division of Experimental Medicine, McGill University, Montreal QC H4A 3J1, Canada; Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal QC H3T 1E2, Canada
| | - Naser Karimi
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Luiz Paulo Kowalski
- AC Camargo Cancer Center, Faculty of Medicine - University of Sao Paulo, Sao Paulo, Brazil
| | - Khalil Sultanem
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Moulay Alaoui-Jamali
- Division of Experimental Medicine, McGill University, Montreal QC H4A 3J1, Canada; Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal QC H3T 1E2, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Marco Mascarella
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Nader Sadeghi
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Sabrina Daniela da Silva
- Division of Experimental Medicine, McGill University, Montreal QC H4A 3J1, Canada; Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada; Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal QC H3T 1E2, Canada; AC Camargo Cancer Center, Faculty of Medicine - University of Sao Paulo, Sao Paulo, Brazil.
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Quttaineh D, Pusztaszeri M, Mlynarek A, Hier MP, Mascarella MA. Latent Granulomatous Foreign Body Reaction to Dermal Fillers: A Case Report. Ear Nose Throat J 2023:1455613231213256. [PMID: 38140878 DOI: 10.1177/01455613231213256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Affiliation(s)
- Danah Quttaineh
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
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Atique M, Muniz I, Farshadi F, Hier M, Mlynarek A, Macarella M, Maschietto M, Nicolau B, Alaoui-Jamali MA, da Silva SD. Genetic Mutations Associated with Inflammatory Response Caused by HPV Integration in Oropharyngeal Squamous Cell Carcinoma. Biomedicines 2023; 12:24. [PMID: 38275384 PMCID: PMC10813733 DOI: 10.3390/biomedicines12010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
(1) Background: Head and neck cancer (HNC) ranks as the sixth most prevalent cancer in the world. In addition to the traditional risk factors such as alcohol and tobacco consumption, the implication of the human papillomavirus (HPV) is becoming increasingly significant, particularly in oropharyngeal cancer (OPC). (2) Methods: This study is based on a review analysis of different articles and repositories investigating the mutation profile of HPV-related OPC and its impact on patient outcomes. (3) Results: By compiling data from 38 datasets involving 8311 patients from 12 countries, we identified 330 genes that were further analyzed. These genes were enriched for regulation of the inflammatory response (RB1, JAK2, FANCA, CYLD, SYK, ABCC1, SYK, BCL6, CEBPA, SRC, BAP1, FOXP1, FGR, BCR, LRRK2, RICTOR, IGF1, and ATM), among other biological processes. Hierarchical cluster analysis showed the most relevant biological processes were linked with the regulation of mast cell cytokine production, neutrophil activation and degranulation, and leukocyte activation (FDR < 0.001; p-value < 0.05), suggesting that neutrophils may be involved in the development and progression of HPV-related OPC. (4) Conclusions: The neutrophil infiltration and HPV status emerge as a potential prognostic factor for OPC. HPV-infected HNC cells could potentially lead to a decrease in neutrophil infiltration. By gaining a better molecular understanding of HPV-mediated neutrophil immunosuppression activity, it is possible to identify a meaningful target to boost antitumor immune response in HNC and hence to improve the survival of patients with HNC.
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Affiliation(s)
- Mai Atique
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC H3T 1E2, Canada; (M.A.); (I.M.); (F.F.); (M.H.); (A.M.); (M.M.)
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Departments of Medicine and Oncology, Sir Mortimer B. Davis-Jewish General Hospital, Faculty of Medicine, McGill University, Montreal, QC H3T 1E2, Canada;
| | - Isis Muniz
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC H3T 1E2, Canada; (M.A.); (I.M.); (F.F.); (M.H.); (A.M.); (M.M.)
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Departments of Medicine and Oncology, Sir Mortimer B. Davis-Jewish General Hospital, Faculty of Medicine, McGill University, Montreal, QC H3T 1E2, Canada;
- Graduate Program in Dentistry, Health Sciences Center, Federal University of Paraiba, Campus I, João Pessoa 58051-900, PB, Brazil;
| | - Fatemeh Farshadi
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC H3T 1E2, Canada; (M.A.); (I.M.); (F.F.); (M.H.); (A.M.); (M.M.)
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Departments of Medicine and Oncology, Sir Mortimer B. Davis-Jewish General Hospital, Faculty of Medicine, McGill University, Montreal, QC H3T 1E2, Canada;
| | - Michael Hier
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC H3T 1E2, Canada; (M.A.); (I.M.); (F.F.); (M.H.); (A.M.); (M.M.)
| | - Alex Mlynarek
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC H3T 1E2, Canada; (M.A.); (I.M.); (F.F.); (M.H.); (A.M.); (M.M.)
| | - Marco Macarella
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC H3T 1E2, Canada; (M.A.); (I.M.); (F.F.); (M.H.); (A.M.); (M.M.)
| | - Mariana Maschietto
- Department of Structural and Functional Biology, Institute of Biology, Universidade Estadual de Campinas (UNICAMP), Campinas 13084-225, SP, Brazil;
- Boldrini Children’s Center, Campinas 13084-225, SP, Brazil
| | - Belinda Nicolau
- Graduate Program in Dentistry, Health Sciences Center, Federal University of Paraiba, Campus I, João Pessoa 58051-900, PB, Brazil;
| | - Moulay A. Alaoui-Jamali
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Departments of Medicine and Oncology, Sir Mortimer B. Davis-Jewish General Hospital, Faculty of Medicine, McGill University, Montreal, QC H3T 1E2, Canada;
| | - Sabrina Daniela da Silva
- Department of Otolaryngology and Head and Neck Surgery, McGill University, Montreal, QC H3T 1E2, Canada; (M.A.); (I.M.); (F.F.); (M.H.); (A.M.); (M.M.)
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Departments of Medicine and Oncology, Sir Mortimer B. Davis-Jewish General Hospital, Faculty of Medicine, McGill University, Montreal, QC H3T 1E2, Canada;
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Henry M, Harvey R, Chen LM, Meaney M, Nguyen TTT, Kao HT, Rosberger Z, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Richardson K, Greenwood CMT, Melnychuk D, Gold P, Chartier G, Black M, Mascarella M, MacDonald C, Sadeghi N, Sultanem K, Shenouda G, Cury F, O'Donnell KJ. Genetic predisposition to depression and inflammation impacts symptom burden and survival in patients with head and neck cancer: A longitudinal study. J Affect Disord 2023; 331:149-157. [PMID: 36948466 DOI: 10.1016/j.jad.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The primary purpose of this study was to investigate the contribution of genetic predispositions to depression and inflammation, as measured through polygenic risk scores, on symptom burden (physical and psychological) in patients with head and neck cancer in the immediate post-treatment period (i.e., at three months post-diagnosis), as well as on 3-, 6-, 12-, 24- and 36-month survival. METHODS Prospective longitudinal study of 223 adults (72 % participation) newly diagnosed with a first occurrence of primary head and neck cancer, paired with genetic data (Illumina PsychArray), validated psychometric measures, Structured Clinical Interviews for DSM Disorders (SCID-I), and medical chart reviews. RESULTS Symptom burden at 3 months was predicted by (R2 adj. = 0.38, p < 0.001): a baseline SCID-I Anxiety Disorder (b = 1.69, B = 0.23, 95%CI = 0.43-2.94; p = 0.009), baseline levels of HADS anxiety (b = 0.20, B = 0.29, 95%CI = 0.07-0.34; p = 0.003), the polygenic risk score (PRS) for depression (b = 0.66, B = 0.18, 95%CI = 0.003-1.32; p = 0.049), and cumulated dose of radiotherapy (b = 0.002, B = 0.46, 95%CI = 0.001-0.003; p < 0.001). When controlling for factors known to be associated with cancer survival, patients with a higher PRS associated with depression and inflammation, respectively, presented higher risk of death within 36 months (b = 1.75, Exp(B) = 5.75, 95%CI = 1.55-21.27, p = 0.009 and b = 0.14, Exp(B) = 1.15, 95%CI = 1.01-1.30, p = 0.03). CONCLUSIONS Our results outline three potential pathways of symptom burden in patients with head and neck cancer: a genetic predisposition towards depression; an initial anxiety disorder upon being diagnosed with cancer or high levels of anxiety upon diagnosis; and a dose-related response to radiotherapy. One may want to investigate early interventions in these areas to alleviate symptom burden in patients faced with a life-threatening disease, as well as consider targeting genetic predisposition towards depression and inflammation implicated in survival. The high prevalence of distress in patients with head and neck cancer is an opportunity to study genetic predispositions, which could potentially be broadly generalized to other cancers and diseases.
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Affiliation(s)
- Melissa Henry
- McGill University, Canada; Jewish General Hospital, Canada; Lady-Davis Institute for Medical Research, Canada.
| | | | | | | | | | - Han-Tin Kao
- McGill University, Canada; Douglas Hospital, Canada
| | - Zeev Rosberger
- McGill University, Canada; Jewish General Hospital, Canada; Lady-Davis Institute for Medical Research, Canada
| | - Saul Frenkiel
- McGill University, Canada; Jewish General Hospital, Canada; Douglas Hospital, Canada
| | - Michael Hier
- McGill University, Canada; Jewish General Hospital, Canada; Lady-Davis Institute for Medical Research, Canada
| | - Anthony Zeitouni
- McGill University, Canada; McGill University Health Centre, Canada
| | - Karen Kost
- McGill University, Canada; McGill University Health Centre, Canada
| | - Alex Mlynarek
- McGill University, Canada; Jewish General Hospital, Canada; McGill University Health Centre, Canada
| | - Keith Richardson
- McGill University, Canada; McGill University Health Centre, Canada
| | - Celia M T Greenwood
- McGill University, Canada; Lady-Davis Institute for Medical Research, Canada
| | | | - Phil Gold
- McGill University, Canada; Jewish General Hospital, Canada
| | | | - Martin Black
- McGill University, Canada; Jewish General Hospital, Canada
| | - Marco Mascarella
- McGill University, Canada; McGill University Health Centre, Canada
| | | | - Nader Sadeghi
- McGill University, Canada; McGill University Health Centre, Canada
| | - Khalil Sultanem
- McGill University, Canada; McGill University Health Centre, Canada
| | - Georges Shenouda
- McGill University, Canada; McGill University Health Centre, Canada
| | - Fabio Cury
- McGill University, Canada; McGill University Health Centre, Canada
| | - Kieran John O'Donnell
- McGill University, Canada; Douglas Hospital, Canada; Yale Child Study Center, Yale School of Medicine, Yale University, United States of America; Department of Obstetrics Gynecology & Reproductive Sciences, Yale School of Medicine, Yale University, United States of America
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Semsar-Kazerooni K, Richardson K, Forest VI, Mlynarek A, Hier MP, Sadeghi N, Mascarella MA. Development and validation of the modified index of fragility in head and neck cancer surgery. J Otolaryngol Head Neck Surg 2023; 52:5. [PMID: 36703217 PMCID: PMC9878788 DOI: 10.1186/s40463-022-00607-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events. METHOD An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variables associated with frailty, cachexia, and sarcopenia, drawn from the literature (weight loss, low body mass index, dyspnea, diabetes, serum albumin, hematocrit, and creatinine). Multivariable logistic regression was used to model the association between mIFG, postoperative adverse events and death. A validation cohort was then used to ascertain the diagnostic accuracy of the mIFG. RESULTS A total of 23,438 cases were included (16,407 in the derivation group and 7031 in the validation group). There was a total of 4273 postoperative major adverse events (AE) and deaths, 1023 postoperative pulmonary complications and 1721 wound complications. Using the derivation cohort, the 7-item mIFG was independently associated with death, major AEs, pulmonary and wound complications, when controlling for significant covariates. The mIFG predicted death and major adverse events using the validation cohort with an accuracy of 0.70 (95% CI: 0.63-0.76) and 0.64 (95% CI: 0.63-0.66), respectively. The mIFG outperformed the modified Frailty index. CONCLUSION The modified index of fragility is a reliable and easily accessible tool to predict risk of postoperative adverse events and death in patients undergoing head and neck cancer surgery.
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Affiliation(s)
| | - Keith Richardson
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Véronique-Isabelle Forest
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Alex Mlynarek
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Michael P. Hier
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Nader Sadeghi
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada ,grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Center, Montreal, QC Canada
| | - Marco. A. Mascarella
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada ,grid.414980.00000 0000 9401 2774Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montréal, QC Canada ,grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Center, Montreal, QC Canada
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9
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Cherba M, Brummans BHJM, Hier MP, Giguère L, Chartier G, Jacobs H, Forest VI, Mlynarek A, Sultanem K, Henry M. Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions. Curr Oncol 2022; 29:3341-3363. [PMID: 35621662 PMCID: PMC9139818 DOI: 10.3390/curroncol29050272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 12/04/2022] Open
Abstract
Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.
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Affiliation(s)
- Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | | | - Michael P. Hier
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Lauriane Giguère
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Gabrielle Chartier
- Department of Nursing, Oncology Division, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Hannah Jacobs
- Department of Audiology and Speech-Language Pathology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Véronique-Isabelle Forest
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Alex Mlynarek
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Khalil Sultanem
- Division of Radiation Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
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10
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Palma DA, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Eskander A, Higgins K, Karam I, Poon I, Husain Z, Enepekides D, Hier M, Sultanem K, Richardson K, Mlynarek A, Johnson-Obaseki S, Odell M, Bayley A, Dowthwaite S, Jackson JE, Dzienis M, O'Neil J, Chandarana S, Banerjee R, Hart R, Chung J, Tenenholtz T, Krishnan S, Le H, Yoo J, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Chen J, Parker C, Wehrli B, Kwan K, Theurer J, Sathya J, Hammond JA, Read N, Venkatesan V, MacNeil SD, Fung K, Nichols AC. Assessment of Toxic Effects and Survival in Treatment Deescalation With Radiotherapy vs Transoral Surgery for HPV-Associated Oropharyngeal Squamous Cell Carcinoma: The ORATOR2 Phase 2 Randomized Clinical Trial. JAMA Oncol 2022; 8:1-7. [PMID: 35482348 PMCID: PMC9052108 DOI: 10.1001/jamaoncol.2022.0615] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The optimal approach for treatment deescalation in human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCCs) is unknown. Objective To assess a primary radiotherapy (RT) approach vs a primary transoral surgical (TOS) approach in treatment deescalation for HPV-related OPSCC. Design, Setting, and Participants This international, multicenter, open-label parallel-group phase 2 randomized clinical trial was conducted at 9 tertiary academic cancer centers in Canada and Australia and enrolled patients with T1-T2N0-2 p16-positive OPSCC between February 13, 2018, and November 17, 2020. Patients had up to 3 years of follow-up. Interventions Primary RT (consisting of 60 Gy of RT with concurrent weekly cisplatin in node-positive patients) vs TOS and neck dissection (ND) (with adjuvant reduced-dose RT depending on pathologic findings). Main Outcomes and Measures The primary end point was overall survival (OS) compared with a historical control. Secondary end points included progression-free survival (PFS), quality of life, and toxic effects. Results Overall, 61 patients were randomized (30 [49.2%] in the RT arm and 31 [50.8%] in the TOS and ND arm; median [IQR] age, 61.9 [57.2-67.9] years; 8 women [13.6%] and 51 men [86.4%]; 31 [50.8%] never smoked). The trial began in February 2018, and accrual was halted in November 2020 because of excessive toxic effects in the TOS and ND arm. Median follow-up was 17 months (IQR, 15-20 months). For the OS end point, there were 3 death events, all in the TOS and ND arm, including the 2 treatment-related deaths (0.7 and 4.3 months after randomization, respectively) and 1 of myocardial infarction at 8.5 months. There were 4 events for the PFS end point, also all in the TOS and ND arm, which included the 3 mortality events and 1 local recurrence. Thus, the OS and PFS data remained immature. Grade 2 to 5 toxic effects occurred in 20 patients (67%) in the RT arm and 22 (71%) in the TOS and ND arm. Mean (SD) MD Anderson Dysphagia Inventory scores at 1 year were similar between arms (85.7 [15.6] and 84.7 [14.5], respectively). Conclusions and Relevance In this randomized clinical trial, TOS was associated with an unacceptable risk of grade 5 toxic effects, but patients in both trial arms achieved good swallowing outcomes at 1 year. Long-term follow-up is required to assess OS and PFS outcomes. Trial Registration Clinicaltrials.gov Identifier: NCT03210103.
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Affiliation(s)
- David A Palma
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Berthelet
- Division of Radiation Oncology, Department of Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Tran
- Division of Radiation Oncology, Department of Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Hamilton
- Division of Radiation Oncology, Department of Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonn Wu
- Division of Radiation Oncology, Department of Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ian Poon
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Samuel Dowthwaite
- Department of Otolaryngology-Head and Neck Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - James E Jackson
- Icon Cancer Centre, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Marcin Dzienis
- Department of Medical Oncology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - John O'Neil
- Icon Cancer Centre, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Shamir Chandarana
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Robyn Banerjee
- Division of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Robert Hart
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jeffson Chung
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown
| | - Todd Tenenholtz
- Department of Radiation Oncology, West Virginia University, Morgantown
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Eric Winquist
- Division of Medical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Sara Kuruvilla
- Division of Medical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Paul Stewart
- Division of Medical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Andrew Warner
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Sylvia Mitchell
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Jeff Chen
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Christina Parker
- Department of Audiology, London Health Sciences Centre, London, Ontario, Canada
| | - Bret Wehrli
- Department of Pathology, Western University, London, Ontario, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, Ontario, Canada
| | - Julie Theurer
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Jinka Sathya
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - J Alex Hammond
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Nancy Read
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Varagur Venkatesan
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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11
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Henry M, Albert JG, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Richardson K, Mascarella M, Morand GB, Chartier G, Sadeghi N, Lo C, Rosberger Z. Body Image Concerns in Patients With Head and Neck Cancer: A Longitudinal Study. Front Psychol 2022; 13:816587. [PMID: 35401366 PMCID: PMC8988682 DOI: 10.3389/fpsyg.2022.816587] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Head and neck cancer (HNC) treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: (1) the prevalence, level, and course of body image concerns; (2) correlates of upon cancer diagnosis (pre-treatment) body image concerns; (3) predictors of immediate post-treatment body image concerns; and (4) association between body image concerns and levels of anxiety, depression, suicidal ideation, support (i.e., satisfaction with support from physician, social/family wellbeing, and unmet support needs), and alcohol and drug misuse. Methods Two hundred and twenty-three (participation rate = 72%), newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model. Results Sixty-eight percent of patients with HNC (n = 148 of 218) presented some level of body image concerns. Body image concerns at baseline (i.e., upon cancer diagnosis, pre-treatment) and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment (i.e., at 3 month follow-up), 89% (n = 132 of 148) presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism. Conclusion This longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions.
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Affiliation(s)
- Melissa Henry
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Oncology, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Justine G. Albert
- Department of Oncology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Saul Frenkiel
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Michael Hier
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Karen Kost
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Martin Black
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Christina MacDonald
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Marco Mascarella
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Gregoire B. Morand
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Gabrielle Chartier
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Christopher Lo
- Department of Psychology, College of Healthcare Sciences, James Cook University, Singapore, Singapore
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Zeev Rosberger
- Department of Oncology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
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12
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Nichols AC, Theurer J, Prisman E, Read N, Berthelet E, Tran E, Fung K, de Almeida JR, Bayley A, Goldstein DP, Hier M, Sultanem K, Richardson K, Mlynarek A, Krishnan S, Le H, Yoo J, MacNeil SD, Winquist E, Hammond JA, Venkatesan V, Kuruvilla S, Warner A, Mitchell S, Chen J, Corsten M, Johnson-Obaseki S, Odell M, Parker C, Wehrli B, Kwan K, Palma DA. Randomized Trial of Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Long-Term Results of the ORATOR Trial. J Clin Oncol 2022; 40:866-875. [PMID: 34995124 DOI: 10.1200/jco.21.01961] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has risen rapidly, because of an epidemic of human papillomavirus infection. The optimal management of early-stage OPSCC with surgery or radiation continues to be a clinical controversy. Long-term randomized data comparing these paradigms are lacking. METHODS We randomly assigned patients with T1-T2, N0-2 (≤ 4 cm) OPSCC to radiotherapy (RT) (with chemotherapy if N1-2) versus transoral robotic surgery plus neck dissection (TORS + ND) (with or without adjuvant therapy). The primary end point was swallowing quality of life (QOL) at 1-year using the MD Anderson Dysphagia Inventory. Secondary end points included adverse events, other QOL outcomes, overall survival, and progression-free survival. All analyses were intention-to-treat. Herein, we present long-term outcomes from the trial. RESULTS Sixty-eight patients were randomly assigned (n = 34 per arm) between August 10, 2012, and June 9, 2017. Median follow-up was 45 months. Longitudinal MD Anderson Dysphagia Inventory analyses demonstrated statistical superiority of RT arm over time (P = .049), although the differences beyond 1 year were of smaller magnitude than at the 1-year timepoint (year 2: 86.0 ± 13.5 in the RT arm v 84.8 ± 12.5 in the TORS + ND arm, P = .74; year 3: 88.9 ± 11.3 v 83.3 ± 13.9, P = .12). These differences did not meet the threshold to qualify as a clinically meaningful change at any timepoint. Certain differences in QOL concerns including more pain and dental concerns in the TORS + ND arm seen at 1 year resolved at 2 and 3 years; however, TORS patients started to use more nutritional supplements at 3 years (P = .015). Dry mouth scores were higher in RT patients over time (P = .041). CONCLUSION On longitudinal analysis, the swallowing QOL difference between primary RT and TORS + ND approaches persists but decreases over time. Patients with OPSCC should be informed about the pros and cons of both treatment options (ClinicalTrials.gov identifier: NCT01590355).
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Affiliation(s)
- Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Julie Theurer
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Eitan Prisman
- Department of Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Read
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Eric Berthelet
- Department of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Tran
- Department of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Eric Winquist
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - J Alex Hammond
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Varagur Venkatesan
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Sara Kuruvilla
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Sylvia Mitchell
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Jeff Chen
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Martin Corsten
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Christina Parker
- Department of Audiology, London Health Sciences Centre, London, Ontario, Canada
| | - Bret Wehrli
- Department of Pathology, Western University, London, Ontario, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, Western University, London, Ontario, Canada
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Henry M, Arnovitz E, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Richardson K, Mascarella M, Morand GB, Chartier G, Sadeghi N, Rosberger Z. Psychosocial outcomes of human papillomavirus (HPV)- and non-HPV-related head and neck cancers: A longitudinal study. Psychooncology 2022; 31:185-197. [PMID: 35122670 DOI: 10.1002/pon.5803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Human papillomavirus (HPV) has prompted a need to further investigate how this new biomarker changes the head and neck cancer (HNC) psychosocial landscape. This study aimed to: (a) characterize the sociodemographic, psychological, and social profiles of patients with HPV-positive versus -negative squamous cell carcinoma of the head and neck; and (b) identify how HPV status contributes to anxiety and depression (primary outcome), quality of life (QoL), and sexuality needs. METHODS We conducted a prospective longitudinal study of 146 patients newly diagnosed with oral, oropharyngeal, nasopharyngeal, and hypopharyngeal cancer. Seventy-nine patients were HPV-positive and 67 HPV-negative. Patients completed self-administered psychometric measures upon HNC and 3-month follow-up, and Structured Clinical Interviews for DSM Diagnoses. RESULTS Patients with HPV-negative tumors generally presented with higher anxiety and depression and lower QoL immediately post-HNC diagnosis (<2 weeks) compared to HPV-positive cancers. A Major Depressive Disorder (MDD) immediately post-HNC diagnosis negatively affected patients' anxiety and depression and QoL levels upon diagnosis only when the cancer was HPV-positive. Immediately posttreatment, HPV status was not associated with outcomes. A previous history of suicidal ideation, and upon cancer diagnosis cigarette smoking, anxiety and depression, and feeling close to one's partner were instead explanatory. CONCLUSION While patients with HPV-positive HNC generally present with initially lower psychological distress, their vulnerability immediately posttreatment indicates an equal need for support. Head and neck clinics may need to better address MDD, anxiety and depression, a prior history of suicidal ideation, health behavior change, and quality of relationships.
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Affiliation(s)
- Melissa Henry
- McGill University, Montreal, Quebec, Canada.,Jewish General Hospital, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Emily Arnovitz
- McGill University, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Saul Frenkiel
- McGill University, Montreal, Quebec, Canada.,Jewish General Hospital, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Hier
- McGill University, Montreal, Quebec, Canada.,Jewish General Hospital, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- McGill University, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | - Karen Kost
- McGill University, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | - Alex Mlynarek
- McGill University, Montreal, Quebec, Canada.,Jewish General Hospital, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | - Martin Black
- McGill University, Montreal, Quebec, Canada.,Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Keith Richardson
- McGill University, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | - Nader Sadeghi
- McGill University, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | - Zeev Rosberger
- McGill University, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada
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Turkdogan S, Roy CF, Chartier G, Payne R, Mlynarek A, Forest VI, Hier M. Effect of Perioperative Patient Education via Animated Videos in Patients Undergoing Head and Neck Surgery: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2022; 148:173-179. [PMID: 34967863 PMCID: PMC8719273 DOI: 10.1001/jamaoto.2021.3765] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Patient education and engagement is a pivotal component of surgical recovery. Ensuring proper patient education involves a thorough understanding of one's diagnosis and recovery plan, while reducing language and learning barriers to help patients make informed decisions and improve their hospital experience. Objective To assess whether using an animated surgical guide will help patients who are undergoing head and neck surgery feel more satisfied with their surgery and recovery process. Design, Setting, and Participants A randomized clinical trial was conducted between January and August 2020 at a single tertiary care academic center in Montreal, Canada. A consecutive sample of individuals who were undergoing any of the following surgical procedures was recruited: head and neck cancer resection with or without reconstruction, parotidectomy, thyroidectomy, parathyroidectomy, laryngectomy, or transoral robotic resection. The treating team was masked to group allocation, while study participants in the nonintervention group were unaware of the multimedia platform to avoid introducing bias in their survey responses. Interventions Patients were randomly allocated to either the treatment arm, in which they obtained access to a multimedia patient education platform, or the control arm, in which they received traditional patient education methods via clinical visits. Main Outcomes and Measures Primary analysis compared patient satisfaction scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire INFO 25, a validated questionnaire on the perceived quality of information received by patients with cancer (possible scores ranging from 20 to 80). Results A total of 100 patients (50 in each arm; 63 women [63%]; 6 African American [6%, 12 Hispanic/Latino [12%], 11 Middle Eastern [11%], and 78 White [78%] individuals) completed the preintervention and postintervention questionnaires. In those who received access to the patient education platform, there was an 11.3-point (Cohen d = 1.02; control group score, 61.1 of 80; treatment group score, 72.4 of 80) difference of greater postoperative satisfaction scores at 1 month. While both groups felt that they received an adequate amount of information concerning their disease process, patients in the treatment arm had significantly better satisfaction with information concerning their medical tests, treatments, and other services. Conclusions and Relevance This randomized clinical trial of patients undergoing head and neck cancer treatment demonstrates that multimedia patient education platforms may enhance current traditional methods, providing complementary information on patients' treatment plans and recovery process, mental health, family life, and supplementary services. Further research is currently underway to confirm whether this platform will lead to decreased hospital stay, shorter complication rates, and long-term effects. Trial Registration ClinicalTrials.gov Identifier: NCT04048538.
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Affiliation(s)
- Sena Turkdogan
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Catherine F. Roy
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Gabrielle Chartier
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Centre, Montreal, Québec, Canada,Department of Nursing, Jewish General Hospital, Montreal, Québec, Canada
| | - Richard Payne
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Centre, Montreal, Québec, Canada,Department of Otolaryngology Head & Neck Surgery, Jewish General Hospital, Montreal, Québec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head & Neck Surgery, Jewish General Hospital, Montreal, Québec, Canada
| | | | - Michael Hier
- Department of Otolaryngology Head & Neck Surgery, Jewish General Hospital, Montreal, Québec, Canada
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15
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Palma D, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Eskander A, Higgins K, Karam I, Poon I, Husain Z, Enepekides D, Hier M, Sultanem K, Richardson K, Mlynarek A, Johnson-Obaseki S, Eapen L, Odell M, Bayley A, Dowthwaite S, Jackson J, Dzienis M, O'Neil J, Chandarana S, Banerjee R, Hart R, Chung J, Tenenholz T, Krishnan S, Le H, Yoo J, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Chen J, Parker C, Wehrli B, Kwan K, Theurer J, Sathya J, Hammond J, Read N, Venkatesan V, MacNeil D, Fung K, Nichols A. A Randomized Trial of Radiotherapy vs. Trans-Oral Surgery for Treatment De-Escalation in HPV-Associated Oropharyngeal Squamous Cell Carcinoma (ORATOR2). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Mascarella MA, Muthukrishnan N, Maleki F, Kergoat MJ, Richardson K, Mlynarek A, Forest VI, Reinhold C, Martin DR, Hier M, Sadeghi N, Forghani R. Above and Beyond Age: Prediction of Major Postoperative Adverse Events in Head and Neck Surgery. Ann Otol Rhinol Laryngol 2021; 131:697-703. [PMID: 34416844 PMCID: PMC9203666 DOI: 10.1177/00034894211041222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Major postoperative adverse events (MPAEs) following head and neck surgery are not infrequent and lead to significant morbidity. The objective of this study was to ascertain which factors are most predictive of MPAEs in patients undergoing head and neck surgery. METHODS A cohort study was carried out based on data from patients registered in the National Surgical Quality Improvement Program (NSQIP) from 2006 to 2018. All patients undergoing non-ambulatory head and neck surgery based on Current Procedural Terminology codes were included. Perioperative factors were evaluated to predict MPAEs within 30-days of surgery. Age was classified as both a continuous and categorical variable. Retained factors were classified by attributable fraction and C-statistic. Multivariate regression and supervised machine learning models were used to quantify the contribution of age as a predictor of MPAEs. RESULTS A total of 43 701 operations were analyzed with 5106 (11.7%) MPAEs. The results of supervised machine learning indicated that prolonged surgeries, anemia, free tissue transfer, weight loss, wound classification, hypoalbuminemia, wound infection, tracheotomy (concurrent with index head and neck surgery), American Society of Anesthesia (ASA) class, and sex as most predictive of MPAEs. On multivariate regression, ASA class (21.3%), hypertension on medication (15.8%), prolonged operative time (15.3%), sex (13.1%), preoperative anemia (12.8%), and free tissue transfer (9%) had the largest attributable fractions associated with MPAEs. Age was independently associated with MPAEs with an attributable fraction ranging from 0.6% to 4.3% with poor predictive ability (C-statistic 0.60). CONCLUSION Surgical, comorbid, and frailty-related factors were most predictive of short-term MPAEs following head and neck surgery. Age alone contributed a small attributable fraction and poor prediction of MPAEs. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Nikesh Muthukrishnan
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Farhad Maleki
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Marie-Jeanne Kergoat
- Department of Geriatric Medicine, Geriatric Institute of Montreal, University of Montreal, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | | | - Caroline Reinhold
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Diego R Martin
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Reza Forghani
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada.,Segal Cancer Centre, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
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17
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Henry M, Sargi E, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Richardson K, Chartier G, Sadeghi N, Rosberger Z. Longitudinal study indicating antecedent psychosocial vulnerability as predictor of anxiety disorders post-treatment in people with head and neck cancer. Psychooncology 2021; 30:1910-1919. [PMID: 34190381 DOI: 10.1002/pon.5760] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to: (1) determine the contribution of pre-cancer psychosocial vulnerability as an independent predictor of anxiety disorder (AD) onset immediately post-treatment in patients diagnosed with a first occurrence of head and neck cancer (HNC), controlling for sociodemographics and medical variables; and (2) estimate prevalence of AD and identify trajectories from the moment of diagnosis to the immediate post-treatment (i.e., over a period of 3 months) in this population. METHODS Two-hundred twenty-four consecutive patients (participation rate = 72%) newly diagnosed with a primary HNC were assessed with a structured clinical interview for a mental disorder, validated psychometric measures, and medical chart reviews. RESULTS Twenty-five percent of patients presented a lifetime AD, 19.4% within 2 weeks of HNC diagnosis, and 16.6% immediately post-treatment; representing 26.7% of patients with AD at any timepoint from the moment of diagnosis to immediately post-treatment. Patients were more likely to present an AD immediately post-treatment when they: were diagnosed with advanced-stage cancer (OR = 3.40, p = 0.006), presented a upon cancer diagnosis AD (OR = 2.45, p = 0.008) and/or experienced childhood abuse (OR = 1.96, p = 0.03). CONCLUSIONS Several AD trajectories may arise when patients are diagnosed with primary HNC. Health professionals should address AD and screen for risk factors (i.e., advanced stage cancer, AD upon cancer diagnosis, history of childhood abuse) as early as possible to assure optimal mental health care in this vulnerable population.
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Affiliation(s)
- Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada
| | - Elyonora Sargi
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Saul Frenkiel
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Karen Kost
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Martin Black
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Christina MacDonald
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Nursing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Gabrielle Chartier
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Nursing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Zeev Rosberger
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
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18
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Mohtashami S, Richardson K, Forest VI, Mlynarek A, Payne RJ, Tamilia M, Pusztaszeri MP, Hier MP, Sadeghi N, Mascarella MA. Thyroidectomy for Graves' Disease Predicts Postoperative Neck Hematoma and Hypocalcemia: A North American cohort study. Ann Otol Rhinol Laryngol 2021; 131:341-351. [PMID: 34060342 PMCID: PMC8899812 DOI: 10.1177/00034894211021288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: Examine the association of Graves’ disease with the development of
postoperative neck hematoma. Design: A cohort of patients participating in the Thyroid Procedure-Targeted Database
of the National Surgical Quality Improvement Program from January 1, 2016 to
December 31, 2018. Setting: A North American surgical cohort study. Methods: 17 906 patients who underwent thyroidectomy were included. Propensity score
matching was performed to adjust for differences in baseline covariates.
Multivariate logistic regression was used to ascertain the association
between thyroidectomy for Graves’ disease and risk of postoperative adverse
events within 30 days of surgery. The primary outcome was postoperative
hematoma. Secondary outcomes were postoperative hypocalcemia and recurrent
laryngeal nerve injury. Results: One-to-three propensity score matching yielded 1207 patients with mean age
(SD) of 42.6 (14.9) years and 1017 (84.3%) female in the group with Graves’
disease and 3621 patients with mean age (SD) of 46.7 (15.0%) years and 2998
(82.8%) female in the group with indications other than Graves’ disease for
thyroidectomy. The cumulative 30-day incidence of postoperative hematoma was
3.1% (38/1207) in the Graves’ disease group and 1.9% (70/3621) in other
patients. The matched cohort showed that Graves’ disease was associated with
higher odds of postoperative hematoma (OR 1.65, 95% CI 1.10-2.46) and
hypocalcemia (OR 2.04, 95% CI 1.66-2.50) compared with other indications for
thyroid surgery. There was no difference in recurrent laryngeal nerve injury
among the 2 groups. Conclusions: Patients with Graves’ disease undergoing thyroidectomy are more likely to
suffer from postoperative hematoma and hypocalcemia compared to patients
undergoing surgery for other indications.
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Affiliation(s)
- Sadaf Mohtashami
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | | | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Michael Tamilia
- Division of Endocrinology, Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Michael P Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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19
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Hier J, Vachon O, Bernstein A, Ibrahim I, Mlynarek A, Hier M, Alaoui-Jamali MA, Maschietto M, da Silva SD. Portrait of DNA methylated genes predictive of poor prognosis in head and neck cancer and the implication for targeted therapy. Sci Rep 2021; 11:10012. [PMID: 33976322 PMCID: PMC8113272 DOI: 10.1038/s41598-021-89476-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/23/2021] [Indexed: 12/31/2022] Open
Abstract
In addition to chronic infection with human papilloma virus (HPV) and exposure to environmental carcinogens, genetic and epigenetic factors act as major risk factors for head and neck cancer (HNC) development and progression. Here, we conducted a systematic review in order to assess whether DNA hypermethylated genes are predictive of high risk of developing HNC and/or impact on survival and outcomes in non-HPV/non-tobacco/non-alcohol associated HNC. We identified 85 studies covering 32,187 subjects where the relationship between DNA methylation, risk factors and survival outcomes were addressed. Changes in DNA hypermethylation were identified for 120 genes. Interactome analysis revealed enrichment in complex regulatory pathways that coordinate cell cycle progression (CCNA1, SFN, ATM, GADD45A, CDK2NA, TP53, RB1 and RASSF1). However, not all these genes showed significant statistical association with alcohol consumption, tobacco and/or HPV infection in the multivariate analysis. Genes with the most robust HNC risk association included TIMP3, DCC, DAPK, CDH1, CCNA1, MGMT, P16, MINT31, CD44, RARβ. From these candidates, we further validated CD44 at translational level in an independent cohort of 100 patients with tongue cancer followed-up beyond 10 years. CD44 expression was associated with high-risk of tumor recurrence and metastasis (P = 0.01) in HPV-cases. In summary, genes regulated by methylation play a modulatory function in HNC susceptibility and it represent a critical therapeutic target to manage patients with advanced disease.
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Affiliation(s)
- Jessica Hier
- Department of Otolaryngology-Head and Neck Surgery, Lady Davis Institute for Medical Research and Segal Cancer Centre, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Olivia Vachon
- Department of Otolaryngology-Head and Neck Surgery, Lady Davis Institute for Medical Research and Segal Cancer Centre, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Allison Bernstein
- Department of Otolaryngology-Head and Neck Surgery, Lady Davis Institute for Medical Research and Segal Cancer Centre, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Iman Ibrahim
- Department of Otolaryngology-Head and Neck Surgery, Lady Davis Institute for Medical Research and Segal Cancer Centre, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, Lady Davis Institute for Medical Research and Segal Cancer Centre, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, Lady Davis Institute for Medical Research and Segal Cancer Centre, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Moulay A Alaoui-Jamali
- Segal Cancer Centre of the Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mariana Maschietto
- Department of Structural and Functional Biology, Institute of Biology, Universidade Estadual de Campinas (UNICAMP) and Boldrini Children's Center, Campinas, Sao Paulo, Brazil
| | - Sabrina Daniela da Silva
- Department of Otolaryngology-Head and Neck Surgery, Lady Davis Institute for Medical Research and Segal Cancer Centre, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada. .,Segal Cancer Centre of the Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada.
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20
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Hier J, Avior G, Pusztaszeri M, Krasner JR, Alyouha N, Forest VI, Hier MP, Mlynarek A, Richardson K, Sadeghi N, Tamilia M, Payne RJ. Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review. J Otolaryngol Head Neck Surg 2021; 50:29. [PMID: 33910629 PMCID: PMC8082804 DOI: 10.1186/s40463-021-00500-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background Molecular testing has been used for cytologically indeterminate thyroid nodules (Bethesda III and IV), where the risk of malignancy is 10–40%. However, to date, the role of molecular testing in cytologically suspicious or positive for malignancy (Bethesda V and VI) thyroid nodules has been controversial. The aim of this study was to determine whether patients who had molecular testing in Bethesda V and VI thyroid nodules had the optimal extent of surgery performed more often than patients who did not have molecular testing performed. Methods A retrospective chart review of 122 cases was performed: 101 patients from the McGill University teaching hospitals and 21 patients from the Hillel Yaffe Medical center, Technion University. Patients included in the study were those with Bethesda V or VI thyroid nodules who underwent molecular testing (ThyGenext® or ThyroseqV3®) (McGill n = 72, Hillel Yaffe n = 14). Patients with Bethesda V or VI thyroid nodules who did not undergo molecular testing were used as controls (McGill n = 29, Hillel Yaffe n = 7). Each case was reviewed in order to determine whether the patient had optimal surgery. This was defined as total thyroidectomy in the presence of either a positive lymph node, extrathyroidal extension, or an aggressive pathological variant of papillary thyroid carcinoma (tall cell, hobnail, columnar cell, diffuse sclerosing, and solid/trabecular) documented on the final pathology report. In all other cases, a lobectomy/hemi/subtotal thyroidectomy was considered as optimal surgery. Chi-squared testing was performed to compare groups. Results When molecular testing was done, 91.86% (79/86) of surgeries in the molecular testing group were optimal, compared to 61.11% (22/36) in the control group. At McGill University teaching hospitals and at Hillel Yaffe, 91.67% (66/72) and 92.86% (13/14) of surgeries in the intervention group were considered as optimal, respectively. This compares to 58.62% (17/29) at McGill and 71.43% (5/7) at Hillel Yaffe when molecular testing was not performed (p = .001, p = .186). Conclusions In this study, molecular testing in Bethesda V and VI thyroid tumors significantly improved the likelihood of optimal surgery. Therefore, molecular testing may have an important role in optimizing surgical procedures performed in the setting of Bethesda V and VI thyroid nodules. Prospective studies with larger sample sizes are required to further investigate this finding. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-021-00500-6.
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Affiliation(s)
- Jessica Hier
- Faculty of Medicine, McGill University, 845 Rue Sherbrooke West, Montreal, QC, Canada.
| | - Galit Avior
- Department of Otolaryngology Head and Neck Surgery, Hillel Yaffe Medical Centre, Technion University, Hadera, Israel
| | - Marc Pusztaszeri
- Department of Pathology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Joshua R Krasner
- Faculty of Pharmacology, McGill University, 845 Rue Sherbrooke West, Montreal, QC, Canada
| | - Noura Alyouha
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Veronique-Isabelle Forest
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology Head and Neck Surgery, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology Head and Neck Surgery, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Michael Tamilia
- Division of Endocrinology & Metabolism, Sir Mortimer B. David-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
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21
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Mascarella MA, Milad D, Richardson K, Mlynarek A, Payne RJ, Forest VI, Hier M, Sadeghi N, Mayo N. Preoperative Risk Index Among Patients Undergoing Thyroid or Parathyroid Surgery. JAMA Otolaryngol Head Neck Surg 2021; 146:7-12. [PMID: 31486838 DOI: 10.1001/jamaoto.2019.2413] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Frailty represents a multidimensional syndrome that is increasingly being used to stratify risk in surgical patients. Current frailty risk models are limited among those undergoing thyroid or parathyroid surgery. Objective To develop and compare preoperative risk indices to determine factors associated with short-term major postoperative adverse events in patients undergoing thyroid or parathyroid surgery. Design, Setting, and Participants This cohort study evaluated 154 895 patients in the American College of Surgeons National Surgical Quality Improvement Program who underwent thyroid or parathyroid surgery from January 1, 2007, to December 31, 2016. Exposures Preoperative frailty-related and surgical factors from a derivation cohort were evaluated using simple and multiple logistic regression. Variables potentially associated with postoperative adverse events were subsequently combined into a personalized preoperative Cervical Endocrine Surgery Risk Index (CESRI) and compared with existing risk models using the validation cohort. Main Outcomes and Measures Composite variable of any major postoperative adverse event, including death, within 30 days of surgery. Results Of the 154 895 operations reviewed, 3318 patients (2.1%; 2296 women and 1022 men; mean [SD] age, 56.1 [15.6] years) experienced a major postoperative adverse event, with 163 deaths (0.1%). Older age (age, ≥80 years: odds ratio [OR], 2.35; 95% CI, 1.74-3.13), inpatient status (OR, 3.55; 95% CI, 3.08-4.11), male sex (OR, 1.49; 95% CI, 1.29-1.71), current tobacco smoking (OR, 1.25; 95% CI, 1.05-1.48), dyspnea (OR, 1.58; 95% CI, 1.29-1.91), recent weight loss (OR, 1.88; 95% CI, 1.23-2.78), functional dependence (OR, 2.77; 95% CI, 2.05-3.69), obesity (OR, 1.33; 95% CI, 1.10-1.60), anemia (OR, 2.14; 95% CI, 1.82-2.52), leukocytosis (OR, 1.73; 95% CI, 1.38-2.14), hypoalbuminemia (OR, 1.87; 95% CI, 1.56-2.23), use of anticoagulation (OR, 2.16; 95% CI, 1.64-2.81), and length of surgery (>4 hours: OR, 2.92; 95% CI, 2.37-3.59) were independently associated with major adverse events or death on multiple regression analysis (C statistic, 0.77; 95% CI, 0.76-0.78). The area under the curve of the CESRI to determine major adverse events, including death, using the validation cohort was 0.63 (95% CI, 0.61-0.64), with a sensitivity of 0.66 (95% CI, 0.64-0.68) and specificity of 0.66 (95% CI, 0.65-0.66). The CESRI outperformed other risk models for determining adverse events (CESRI vs 5-Factor Modified Frailty Index: delta C index, 0.11; 95% CI, 0.09-0.13; CESRI vs American Society of Anesthesiologists Physical Status Classification System: delta C index, 0.05; 95% CI, 0.03-0.07; CESRI vs American College of Surgeons Risk Calculator: delta C index, 0.02; 95% CI, 0.01-0.03; and CESRI vs Head and Neck Surgery Risk Index: delta C index, 0.04; 95% CI, 0.03-0.06). Conclusions and Relevance This study suggests that the CESRI is able to determine major postoperative adverse events in patients undergoing thyroid or parathyroid surgery.
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Affiliation(s)
- Marco Antonio Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Daniel Milad
- Department of Medicine, Faculty of Medicine, Laval University, Quebec, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Nancy Mayo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,School of Physical & Occupational Health, McGill University, Montreal, Quebec, Canada
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22
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da Silva SD, Marchi FA, Su J, Yang L, Valverde L, Hier J, Bijian K, Hier M, Mlynarek A, Kowalski LP, Alaoui-Jamali MA. Co-Overexpression of TWIST1-CSF1 Is a Common Event in Metastatic Oral Cancer and Drives Biologically Aggressive Phenotype. Cancers (Basel) 2021; 13:cancers13010153. [PMID: 33466385 PMCID: PMC7795342 DOI: 10.3390/cancers13010153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
Invasive oral squamous cell carcinoma (OSCC) is often ulcerated and heavily infiltrated by pro-inflammatory cells. We conducted a genome-wide profiling of tissues from OSCC patients (early versus advanced stages) with 10 years follow-up. Co-amplification and co-overexpression of TWIST1, a transcriptional activator of epithelial-mesenchymal-transition (EMT), and colony-stimulating factor-1 (CSF1), a major chemotactic agent for tumor-associated macrophages (TAMs), were observed in metastatic OSCC cases. The overexpression of these markers strongly predicted poor patient survival (log-rank test, p = 0.0035 and p = 0.0219). Protein analysis confirmed the enhanced expression of TWIST1 and CSF1 in metastatic tissues. In preclinical models using OSCC cell lines, macrophages, and an in vivo matrigel plug assay, we demonstrated that TWIST1 gene overexpression induces the activation of CSF1 while TWIST1 gene silencing down-regulates CSF1 preventing OSCC invasion. Furthermore, excessive macrophage activation and polarization was observed in co-culture system involving OSCC cells overexpressing TWIST1. In summary, this study provides insight into the cooperation between TWIST1 transcription factor and CSF1 to promote OSCC invasiveness and opens up the potential therapeutic utility of currently developed antibodies and small molecules targeting cancer-associated macrophages.
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Affiliation(s)
- Sabrina Daniela da Silva
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (L.V.); (J.H.); (M.H.); (A.M.)
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, QC H3T 1E2, Canada; (J.S.); (K.B.)
- Correspondence: or (S.D.d.S.); (M.A.A.-J.); Tel.: +1-514-340-8222 (S.D.d.S.)
| | - Fabio Albuquerque Marchi
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center and National Institute of Science and Technology on Oncogenomics (INCITO), São Paulo 01509-010, Brazil; (F.A.M.); (L.P.K.)
| | - Jie Su
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, QC H3T 1E2, Canada; (J.S.); (K.B.)
| | - Long Yang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China;
| | - Ludmila Valverde
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (L.V.); (J.H.); (M.H.); (A.M.)
| | - Jessica Hier
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (L.V.); (J.H.); (M.H.); (A.M.)
| | - Krikor Bijian
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, QC H3T 1E2, Canada; (J.S.); (K.B.)
| | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (L.V.); (J.H.); (M.H.); (A.M.)
| | - Alex Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (L.V.); (J.H.); (M.H.); (A.M.)
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center and National Institute of Science and Technology on Oncogenomics (INCITO), São Paulo 01509-010, Brazil; (F.A.M.); (L.P.K.)
| | - Moulay A. Alaoui-Jamali
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, QC H3T 1E2, Canada; (J.S.); (K.B.)
- Correspondence: or (S.D.d.S.); (M.A.A.-J.); Tel.: +1-514-340-8222 (S.D.d.S.)
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23
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Kowalski LP, Coletta RD, Salo T, Maschietto M, Chojniak R, Lima JM, Mlynarek A, Hier MP, Alaoui-Jamali MA, Silva SD. Head and neck cancer: Emerging concepts in biomarker discovery and opportunities for clinical translation. Clin Transl Med 2020; 10:e209. [PMID: 33252865 PMCID: PMC7668191 DOI: 10.1002/ctm2.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center and National Institute of Science and Technology on Oncogenomics (INCITO), Sao Paulo, Brazil
| | - Ricardo Della Coletta
- Department of Oral Diagnosis, School of Dentistry, University of Campinas, Sao Paulo, Brazil
| | - Tuula Salo
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland.,Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | | | - Rubens Chojniak
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center and National Institute of Science and Technology on Oncogenomics (INCITO), Sao Paulo, Brazil
| | - Jefferson Muniz Lima
- Otolaryngology-Head and Neck Surgery Department, Jewish General Hospital-Segal Cancer Center, McGill University, Montreal, Canada
| | - Alex Mlynarek
- Otolaryngology-Head and Neck Surgery Department, Jewish General Hospital-Segal Cancer Center, McGill University, Montreal, Canada
| | - Michael P Hier
- Otolaryngology-Head and Neck Surgery Department, Jewish General Hospital-Segal Cancer Center, McGill University, Montreal, Canada
| | - Moulay A Alaoui-Jamali
- Segal Cancer Centre, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada
| | - Sabrina Daniela Silva
- Otolaryngology-Head and Neck Surgery Department, Jewish General Hospital-Segal Cancer Center, McGill University, Montreal, Canada.,Segal Cancer Centre, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada
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24
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de Lima JM, Morand GB, Macedo CCS, Diesel L, Hier MP, Mlynarek A, Kowalski LP, Maschietto M, Alaoui-Jamali MA, da Silva SD. NDRG1 deficiency is associated with regional metastasis in oral cancer by inducing epithelial-mesenchymal transition. Carcinogenesis 2020; 41:769-777. [PMID: 32112078 DOI: 10.1093/carcin/bgaa017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/13/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Regional metastasis is the single most important prognostic factor in oral squamous cell carcinoma (OSCC). Abnormal expression of N-myc downstream-regulated genes (NDRGs) has been identified to occur in several tumor types and to predict poor prognosis. In OSCC, the clinical significance of deregulated NDRG expression has not been fully established. In this study, NDRG1 relevance was assessed at gene and protein levels in 100 OSCC patients followed up by at least 10 years. Survival outcome was analyzed using a multivariable analysis. Tumor progression and metastasis was investigated in preclinical model using oral cancer cell lines (HSC3 and SCC25) treated with epidermal growth factor (EGF) and orthotopic mouse model of metastatic murine OSCC (AT84). We identified NDRG1 expression levels to be significantly lower in patients with metastatic tumors compared with patients with local disease only (P = 0.001). NDRG1 expression was associated with MMP-2, -9, -10 (P = 0.022, P = 0.002, P = 0.042, respectively) and BCL2 (P = 0.035). NDRG1 lower expression was able to predict recurrence and metastasis (log-rank test, P = 0.001). In multivariable analysis, the expression of NDRG1 was an independent prognostic factor (Cox regression, P = 0.013). In invasive OSCC cells, NDRG1 expression is diminished in response to EGF and this was associated with a potent induction of epithelial-mesenchymal transition phenotype. This result was further confirmed in an orthotopic OSCC mouse model. Together, this data support that NDRG1 downregulation is a potential predictor of metastasis and approaches aimed at NDRG1 signaling rescue can serve as potential therapeutic strategy to prevent oral cancer progression to metastasis.
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Affiliation(s)
- Jefferson Muniz de Lima
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Grégoire B Morand
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada.,Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Carolina Carneiro Soares Macedo
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Luciana Diesel
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Luiz P Kowalski
- AC Camargo Cancer Center and National Institute of Science and Technology on Oncogenomics (INCITO), Sao Paulo, Sao Paulo, Brazil
| | | | - Moulay A Alaoui-Jamali
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada.,Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sabrina Daniela da Silva
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada.,Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, QC, Canada
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25
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Mascarella MA, Richardson K, Mlynarek A, Forest VI, Hier M, Sadeghi N, Mayo N. Evaluation of a Preoperative Adverse Event Risk Index for Patients Undergoing Head and Neck Cancer Surgery. JAMA Otolaryngol Head Neck Surg 2020; 145:345-351. [PMID: 30789650 DOI: 10.1001/jamaoto.2018.4513] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Patients 65 years or older are the most frequent users of operative resources and are also the most vulnerable to postoperative adverse events (AEs). Frailty indices are increasingly being used for preoperative risk stratification within head and neck cancer surgery, but most models lack a multifactorial basis and cannot be directly applied to clinical practice. A practical risk index is needed for clinicians to gauge risk factors preoperatively. Objective To develop a preoperative risk index of short-term major postoperative AEs for patients undergoing head and neck cancer surgery. Design Cohort analysis of patients from multiple medical centers undergoing inpatient ablative or reconstructive head and neck cancer surgery and registered in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) from 2006 to 2016. Exposures Inpatient ablative or reconstructive head and neck cancer surgery. Main Outcomes and Measures Sociodemographic, frailty-related, and surgical factors in the derivation cohort were evaluated using simple and multiple logistic regression. Risk factors were subsequently integrated into a preoperative head and neck surgery risk index (HNSRI) and compared with existing models using the validation cohort. A composite variable of major postoperative AEs was used, including death within 30 days of surgery. Results A total of 43 968 operations were found using the ACS NSQIP database. Of these, 12 569 cases were excluded as non-head and neck cancer or emergency surgery. Of the included 31 399 operations reviewed, the mean (SD) patient age was 56.9 (15.4) years, and 16 994 of the patients were women (54.1%). A total of 4556 (14.5%) patients had a major postoperative AE, and 209 (0.7%) died. Older age, male sex, smoking, anticoagulation, recent weight loss, functional dependence, free-tissue transfer, tracheotomy, duration of surgery, wound classification, anemia, leukocytosis, and hypoalbuminemia were independently associated with major AEs or death on multiple regression analysis (C statistic, 0.83). The area under the curve of the HNSRI to predict major AEs including death using the validation cohort (n = 15 699) was 0.84 (95% CI, 0.83-0.85) with a sensitivity of 80.1% (95% CI, 79.4%-80.8%) and specificity, 72.3% (95% CI, 70.3%-74.2%). The HNSRI outperformed existing risk models for prediction of AEs: delta C index of the HNSRI to the modified frailty index 11, 0.23 (95% CI, 0.22-0.25); the American Society of Anesthesiologists classification, 0.14 (95% CI, 0.13-0.16); and the ACS risk calculator, 0.02 (95% CI, 0.01-0.03). Conclusions and Relevance The proposed HNSRI demonstrated a high sensitivity and specificity for major postoperative AEs and death in the studied population. This risk index can be used to counsel patients awaiting head and neck cancer surgery.
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Affiliation(s)
- Marco Antonio Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Nancy Mayo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,School of Physical and Occupational Health, McGill University, Montreal, Quebec, Canada
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26
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Nichols AC, Lang P, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Fung K, de Almeida JR, Bayley A, Goldstein DP, Eskander A, Husain Z, Bahig H, Christopoulous A, Hier M, Sultanem K, Richardson K, Mlynarek A, Krishnan S, Le H, Yoo J, MacNeil SD, Mendez A, Winquist E, Read N, Venkatesan V, Kuruvilla S, Warner A, Mitchell S, Corsten M, Rajaraman M, Johnson-Obaseki S, Eapen L, Odell M, Chandarana S, Banerjee R, Dort J, Matthews TW, Hart R, Kerr P, Dowthwaite S, Gupta M, Zhang H, Wright J, Parker C, Wehrli B, Kwan K, Theurer J, Palma DA. Treatment de-escalation for HPV-associated oropharyngeal squamous cell carcinoma with radiotherapy vs. trans-oral surgery (ORATOR2): study protocol for a randomized phase II trial. BMC Cancer 2020; 20:125. [PMID: 32059705 PMCID: PMC7023689 DOI: 10.1186/s12885-020-6607-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/06/2020] [Indexed: 11/28/2022] Open
Abstract
Background Patients with human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPC) have substantially better treatment response and overall survival (OS) than patients with HPV-negative disease. Treatment options for HPV+ OPC can involve either a primary radiotherapy (RT) approach (± concomitant chemotherapy) or a primary surgical approach (± adjuvant radiation) with transoral surgery (TOS). These two treatment paradigms have different spectrums of toxicity. The goals of this study are to assess the OS of two de-escalation approaches (primary radiotherapy and primary TOS) compared to historical control, and to compare survival, toxicity and quality of life (QOL) profiles between the two approaches. Methods This is a multicenter phase II study randomizing one hundred and forty patients with T1–2 N0–2 HPV+ OPC in a 1:1 ratio between de-escalated primary radiotherapy (60 Gy) ± concomitant chemotherapy and TOS ± de-escalated adjuvant radiotherapy (50–60 Gy based on risk factors). Patients will be stratified based on smoking status (< 10 vs. ≥ 10 pack-years). The primary endpoint is OS of each arm compared to historical control; we hypothesize that a 2-year OS of 85% or greater will be achieved. Secondary endpoints include progression free survival, QOL and toxicity. Discussion This study will provide an assessment of two de-escalation approaches to the treatment of HPV+ OPC on oncologic outcomes, QOL and toxicity. Results will inform the design of future definitive phase III trials. Trial Registration Clinicaltrials.gov identifier: NCT03210103. Date of registration: July 6, 2017, Current version: 1.3 on March 15, 2019.
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Affiliation(s)
- Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Eric Berthelet
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Eric Tran
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Hamilton
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Jonn Wu
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Houda Bahig
- Department of Radiation Oncology, CHUM, Université de Montréal, Montreal, QC, Canada
| | - Apostolos Christopoulous
- Department of Otorhinolaryngology - Head and Neck Surgery, CHUM, Université de Montréal, Montreal, QC, Canada
| | - Michael Hier
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Suren Krishnan
- Department of Otolaryngology - Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Eric Winquist
- Department of Medical Oncology, Western University, London, ON, Canada
| | - Nancy Read
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Varagur Venkatesan
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Sara Kuruvilla
- Department of Medical Oncology, Western University, London, ON, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Sylvia Mitchell
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Martin Corsten
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Murali Rajaraman
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | | | - Libni Eapen
- Department of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Michael Odell
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Shamir Chandarana
- Section of Otolaryngology - Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
| | - Robyn Banerjee
- Department of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - Joseph Dort
- Section of Otolaryngology - Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
| | - T Wayne Matthews
- Section of Otolaryngology - Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
| | - Robert Hart
- Section of Otolaryngology - Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
| | - Paul Kerr
- Department of Otolaryngology, University of Manitoba, Winnipeg, MB, Canada
| | - Samuel Dowthwaite
- Department of Otolaryngology - Head and Neck Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael Gupta
- Division of Otolaryngology - Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Han Zhang
- Division of Otolaryngology - Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Jim Wright
- Department of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Christina Parker
- Department of Audiology, London Health Sciences Centre, London, ON, Canada
| | - Bret Wehrli
- Department of Pathology, Western University, London, ON, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, ON, Canada
| | - Julie Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada.
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Palma D, Theurer J, Prisman E, Read N, Berthelet E, Tran E, Fung K, de Almeida J, Hope A, Goldstein D, Hier M, Sultanem K, Richardson K, Mlynarek A, Krishnan S, Le H, Yoo J, MacNeil D, Winquist E, Hammond A, Venkatesan V, Kuruvilla S, Warner A, Mitchell S, Chen J, Corsten M, Johnson-Obaseki S, Eapen L, Odell M, Parker C, Wehrli B, Kwan K, Nichols A. 88 Radiotherapy Versus Trans-Oral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Results of a Randomized Trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33379-1] [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: 10/25/2022]
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28
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Palma D, Theurer J, Prisman E, Read N, Berthelet E, Fung K, de Almeida J, Bayley A, Richardson K, Mlynarek A, Krishnan S, Le H, Mitchell S, Chen J, Corsten M, Johnson-Obaseki S, Odell M, Parker C, Kwan K, Nichols A. Radiotherapy vs. Trans-Oral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma (OPSCC): Results of a Randomized Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Nichols AC, Theurer J, Prisman E, Read N, Berthelet E, Tran E, Fung K, de Almeida JR, Bayley A, Goldstein DP, Hier M, Sultanem K, Richardson K, Mlynarek A, Krishnan S, Le H, Yoo J, MacNeil SD, Winquist E, Hammond JA, Venkatesan V, Kuruvilla S, Warner A, Mitchell S, Chen J, Corsten M, Johnson-Obaseki S, Eapen L, Odell M, Parker C, Wehrli B, Kwan K, Palma DA. Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial. Lancet Oncol 2019; 20:1349-1359. [PMID: 31416685 DOI: 10.1016/s1470-2045(19)30410-3] [Citation(s) in RCA: 263] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Transoral robotic surgery (TORS) with concurrent neck dissection has supplanted radiotherapy in the USA as the most common treatment for oropharyngeal squamous cell carcinoma (OPSCC), yet no randomised trials have compared these modalities. We aimed to evaluate differences in quality of life (QOL) 1 year after treatment. METHODS The ORATOR trial was an investigator-initiated, multicentre, international, open-label, parallel-group, phase 2, randomised study. Patients were enrolled at six hospitals in Canada and Australia. We randomly assigned (1:1) patients aged 18 years or older, with Eastern Cooperative Oncology Group scores of 0-2, and with T1-T2, N0-2 (≤4 cm) OPSCC tumour types to radiotherapy (70 Gy, with chemotherapy if N1-2) or TORS plus neck dissection (with or without adjuvant chemoradiotherapy, based on pathology). Following stratification by p16 status, patients were randomly assigned using a computer-generated randomisation list with permuted blocks of four. The primary endpoint was swallowing-related QOL at 1 year as established using the MD Anderson Dysphagia Inventory (MDADI) score, powered to detect a 10-point improvement (a clinically meaningful change) in the TORS plus neck dissection group. All analyses were done by intention to treat. This study is registered with ClinicalTrials.gov (NCT01590355) and is active, but not currently recruiting. FINDINGS 68 patients were randomly assigned (34 per group) between Aug 10, 2012, and June 9, 2017. Median follow-up was 25 months (IQR 20-33) for the radiotherapy group and 29 months (23-43) for the TORS plus neck dissection group. MDADI total scores at 1 year were mean 86·9 (SD 11·4) in the radiotherapy group versus 80·1 (13·0) in the TORS plus neck dissection group (p=0·042). There were more cases of neutropenia (six [18%] of 34 patients vs none of 34), hearing loss (13 [38%] vs five [15%]), and tinnitus (12 [35%] vs two [6%]) reported in the radiotherapy group than in the TORS plus neck dissection group, and more cases of trismus in the TORS plus neck dissection group (nine [26%] vs one [3%]). The most common adverse events in the radiotherapy group were dysphagia (n=6), hearing loss (n=6), and mucositis (n=4), all grade 3, and in the TORS plus neck dissection group, dysphagia (n=9, all grade 3) and there was one death caused by bleeding after TORS. INTERPRETATION Patients treated with radiotherapy showed superior swallowing-related QOL scores 1 year after treatment, although the difference did not represent a clinically meaningful change. Toxicity patterns differed between the groups. Patients with OPSCC should be informed about both treatment options. FUNDING Canadian Cancer Society Research Institute Grant (#701842), Ontario Institute for Cancer Research Clinician-Scientist research grant, and the Wolfe Surgical Research Professorship in the Biology of Head and Neck Cancers grant.
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Affiliation(s)
- Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada.
| | - Julie Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Eitan Prisman
- Department of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Nancy Read
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - Eric Berthelet
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Eric Tran
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Eric Winquist
- Department of Medical Oncology, Western University, London, ON, Canada
| | - J Alex Hammond
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - Varagur Venkatesan
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - Sara Kuruvilla
- Department of Medical Oncology, Western University, London, ON, Canada
| | - Andrew Warner
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - Sylvia Mitchell
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - Jeff Chen
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - Martin Corsten
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | | | - Libni Eapen
- Department of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Christina Parker
- Department of Audiology, London Health Sciences Centre, London, ON, Canada
| | - Bret Wehrli
- Department of Pathology, Western University, London, ON, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, ON, Canada
| | - David A Palma
- Department of Radiation Oncology, Western University, London, ON, Canada
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Mascarella MA, Azzi JL, Silva SD, Mlynarek A, Forest V, Hier M, Richardson K, Sadeghi N. Postoperative infection predicts poor survival in locoregionally advanced oral cancer. Head Neck 2019; 41:3624-3630. [DOI: 10.1002/hed.25885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Marco A. Mascarella
- Department of Otolaryngology—Head and Neck SurgeryMcGill University Health Centre Quebec Canada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill University Quebec Canada
| | - Jayson Lee Azzi
- Faculty of MedicineUniversity of Ottawa Ottawa Ontario Canada
| | - Sabrina Daniela Silva
- Department of Otolaryngology—Head and Neck SurgeryMcGill University Health Centre Quebec Canada
| | - Alex Mlynarek
- Department of Otolaryngology—Head and Neck SurgeryJewish General Hospital Quebec Canada
| | | | - Michael Hier
- Department of Otolaryngology—Head and Neck SurgeryJewish General Hospital Quebec Canada
| | - Keith Richardson
- Department of Otolaryngology—Head and Neck SurgeryMcGill University Health Centre Quebec Canada
| | - Nader Sadeghi
- Department of Otolaryngology—Head and Neck SurgeryMcGill University Health Centre Quebec Canada
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31
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Henry M, Fuehrmann F, Hier M, Zeitouni A, Kost K, Richardson K, Mlynarek A, Black M, MacDonald C, Chartier G, Zhang X, Rosberger Z, Frenkiel S. Contextual and historical factors for increased levels of anxiety and depression in patients with head and neck cancer: A prospective longitudinal study. Head Neck 2019; 41:2538-2548. [PMID: 30887617 DOI: 10.1002/hed.25725] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study aimed at examining predictors of clinical anxiety and depressive symptoms in patients with head and neck cancer (HNC) at 3, 6, and 12 months post-diagnosis, with a particular interest in contextual and historical factors. METHODS Prospective longitudinal study of 219 consecutive patients newly diagnosed with a first occurrence of primary HNC, including psychometric measures, Structured Clinical Interview for DSM-IV Diagnoses (SCID), and medical chart reviews. RESULTS Point prevalence of clinical anxiety symptoms (Hospital Anxiety and Depression Scale-Anxiety subscale) was 32.0%, 21.9%, 12.1%, and 12.6% at baseline, 3, 6, and 12 months; and clinical depressive symptoms on the Depression Subscale was 19.4%, 21.9%, 13.5%, and 9.2%, respectively. Predictors of anxiety and depressive symptoms included upon diagnosis SCID major depressive or anxiety disorder, stressful life events in previous year, neuroticism, and levels of anxiety and depressive symptoms upon cancer diagnosis. CONCLUSIONS This study emphasizes the predictive contribution of broader personal contextual and historical factors that increase psychological vulnerability in HNC and merit consideration.
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Affiliation(s)
- Melissa Henry
- Department of Oncology, McGill University, Montreal, Quebec, Canada.,Department of Oncology, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Fabienne Fuehrmann
- Department of Oncology, McGill University, Montreal, Quebec, Canada.,Department of Oncology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Oncology, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | - Karen Kost
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,McGill University Health Centre, Montreal, Quebec, Canada
| | - Martin Black
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Gabrielle Chartier
- Department of Nursing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Xun Zhang
- McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Zeev Rosberger
- Department of Oncology, McGill University, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Saul Frenkiel
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
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Henry M, Ho A, Lambert SD, Carnevale FA, Greenfield B, MacDonald C, Mlynarek A, Zeitouni A, Rosberger Z, Hier M, Black M, Kost K, Frenkiel S. Looking beyond Disfigurement: The experience of Patients with Head and Neck Cancer. J Palliat Care 2018. [DOI: 10.1177/082585971403000102] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the frequent occurrence of head and neck cancer (HNC) disfigurement, little is known about its psychosocial impact on patients. This study aimed to understand the lived experience of disfigurement in HNC and explore what patients considered to be its influences. Fourteen disfigured HNC patients participated in a 45-to-120-minute in-depth, semi-structured interview, which was analyzed qualitatively using interpretive phenomenology. A majority of participants (64 percent) were considered to be at an advanced cancer stage (stage III or stage IV). Patients’ experiences revolved around the concept of a ruptured self-image (a discontinuity in sense of self). Forces triggering this ruptured self-image created a sense of “embodied angst”, in which disfigurement served as a constant reminder of the patient's cancer and associated foundational malaise. Other influences fostered a sense of normalcy, balance, and acceptance. Participants oscillated between these two states as they grew to accept their disfigurement. This study's findings could guide supportive interventions aimed at helping patients face head and neck surgery.
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Affiliation(s)
- Melissa Henry
- M Henry (corresponding author): Departments of Psychology and Oncology, McGill University; Department of Otolaryngology — Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Angela Ho
- Department of Otolaryngology — Head and Neck Surgery, Jewish General Hospital; Louise-Granofsky Psychosocial Oncology Program, Segal Cancer Centre, Jewish General Hospital, 3755 Côte Ste. Catherine Rd, Room E-904, Montreal, Quebec, Canada, H3T 1E2; SD Lambert: Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Sylvie D. Lambert
- A Ho: Faculty of Medicine, McGill University, Montreal, Quebec, Canada; FA Carnevale: School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Franco A. Carnevale
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec Canada; B Greenfield: Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Brian Greenfield
- Department of Psychiatry, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christina MacDonald
- C MacDonald: Department of Otolaryngology — Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Alex Mlynarek
- A Mlynarek: Department of Otolaryngology — Head and Neck Surgery, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology — Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada; A Zeitouni: Department of Otolaryngology — Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology — Head and Neck Surgery, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Zeev Rosberger
- Z Rosberger: Departments of Psychology and Oncology, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Louise-Granofsky Psychosocial Oncology Program, Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada
| | - Martin Black
- M Hier: Departments of Oncology and Otolaryngology — Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Karen Kost
- Department of Otolaryngology — Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada; M Black, S Frenkiel: Department of Otolaryngology — Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Saul Frenkiel
- Department of Otolaryngology — Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
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Henry M, Alias A, Frenkiel S, Richardson K, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Chartier G, Rosberger Z. Contribution of psychiatric diagnoses to extent of opioid prescription in the first year post-head and neck cancer diagnosis: A longitudinal study. Psychooncology 2018; 28:107-115. [PMID: 30308695 DOI: 10.1002/pon.4917] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/05/2018] [Revised: 08/31/2018] [Accepted: 10/06/2018] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of this study was to determine, within the first-year post-head and neck cancer (HNC) diagnosis, the contribution of past and upon HNC psychiatric diagnoses (ie, substance use disorder, major depressive disorder, and anxiety disorder) to the extent (ie, cumulated dose) of opioid prescription. METHODS Prospective longitudinal study of 223 consecutive adults (on 313 approached; 72% participation) newly diagnosed (<2 weeks) with a first occurrence of primary HNC, including Structured Clinical Interviews for DSM-IV disorders, validated psychometric measures, and medical chart reviews. Opioid doses were translated into standardized morphine milligram equivalents (MME) using CDC guidelines. A model of variables was tested using multiple linear regression. RESULTS Fifty-five percent (123/223) of patients received opioids at some point during the first 12 months post-HNC diagnosis, 37.7% (84/223) upon HNC diagnosis (pre-treatment), 40.8% (91/223) during treatments, and 31.4% (70/223) post-treatment. The multiple linear regression indicated that an AD (P = 0.04) upon HNC diagnosis in early stage contributes to cumulated MME dose in the first year post-HNC diagnosis. CONCLUSION This study underlines how anxiety has important repercussions on the management of pain and illustrates the importance of screening for AD upon HNC diagnosis to allow for early prophylactic treatment and support.
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Affiliation(s)
- Melissa Henry
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada
| | | | - Saul Frenkiel
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Keith Richardson
- McGill University, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Michael Hier
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada
| | - Anthony Zeitouni
- McGill University, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Karen Kost
- McGill University, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Alex Mlynarek
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Martin Black
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada
| | | | | | - Zeev Rosberger
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada
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34
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Rodriguez AM, Frenkiel S, Desroches J, De Simone A, Chiocchio F, MacDonald C, Black M, Zeitouni A, Hier M, Kost K, Mlynarek A, Bolster-Foucault C, Rosberger Z, Henry M. Development and validation of the McGill body image concerns scale for use in head and neck oncology (MBIS-HNC): A mixed-methods approach. Psychooncology 2018; 28:116-121. [PMID: 30312500 DOI: 10.1002/pon.4918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/23/2018] [Accepted: 09/05/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to develop and validate a patient-reported outcome measure to evaluate body image concerns in head and neck cancer (HNC) patients. METHODS Items were created using a combination of deductive (eg, US Food and Drug Administration Qualification of Clinical Outcome Assessments, literature review) and inductive approaches (eg, subject matter experts, HNC patients). Items were translated for use in both Canadian English and Canadian French using back-translation. A two-step empirical validation process using the Classical Test Theory (CTT) and Rasch Measurement Theory (RMT) was conducted with 224 and 258 HNC patients, respectively, having undergone disfiguring surgery within the past 3 years. RESULTS Analyses suggest two subscales for MBIS-HNC: social discomfort (10 items) and negative self-image (11 items). The McGill Body Image Concerns Scale-Head and Neck Cancer (MBIS-HNC) is reliable with high internal consistency (0.98), high test-retest reliability over a two-week period (ICC = 0.88), moderate to high convergent validity (range r = 0.43-0.81), and divergent validity (range r = 0.12-0.15). RMT was used in addition to CTT. Disordered thresholds led to the modification of the number of response options, and items were deleted based on differential item functioning and high local dependency. Unidimensionality of both subscales and supporting a total score was confirmed. The measure was however characterized by the presence of an important floor effect, confirmed with poor targeting as demonstrated by the person-item threshold distribution. CONCLUSION Evidence gathered from our theory-driven validation study using CTT and RMT provides practitioners and researchers with a useful and easy to use self-report measure.
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Affiliation(s)
- Ana Maria Rodriguez
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Saul Frenkiel
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.,Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Canada
| | - Justin Desroches
- Faculty of Medicine, McGill University, McGill University, Montreal, Canada
| | - Avina De Simone
- Faculty of Medicine, McGill University, McGill University, Montreal, Canada
| | | | | | - Martin Black
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.,Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.,Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | - Michael Hier
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.,Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Canada
| | - Karen Kost
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.,Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | - Alex Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.,Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Canada.,Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | | | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychology, McGill University, Montreal, Canada.,Department of Oncology, McGill University, Montreal, Canada
| | - Melissa Henry
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.,Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Oncology, McGill University, Montreal, Canada.,Department of Psychology, Jewish General Hospital, Montreal, Canada.,Department of Oncology, Jewish General Hospital, Montreal, Canada
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35
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Cohen A, Ianovski LE, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Richardson K, Black M, MacDonald C, Chartier G, Rosberger Z, Henry M. Barriers to psychosocial oncology service utilization in patients newly diagnosed with head and neck cancer. Psychooncology 2018; 27:2786-2793. [DOI: 10.1002/pon.4889] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Alexandra Cohen
- McGill University; Montreal Canada
- Jewish General Hospital; Montreal Canada
| | | | - Saul Frenkiel
- McGill University; Montreal Canada
- Jewish General Hospital; Montreal Canada
- McGill University Health Centre; Montreal Canada
| | - Michael Hier
- McGill University; Montreal Canada
- Jewish General Hospital; Montreal Canada
| | - Anthony Zeitouni
- McGill University; Montreal Canada
- McGill University Health Centre; Montreal Canada
| | - Karen Kost
- McGill University; Montreal Canada
- McGill University Health Centre; Montreal Canada
| | - Alex Mlynarek
- McGill University; Montreal Canada
- Jewish General Hospital; Montreal Canada
- McGill University Health Centre; Montreal Canada
| | - Keith Richardson
- McGill University; Montreal Canada
- McGill University Health Centre; Montreal Canada
| | - Martin Black
- McGill University; Montreal Canada
- Jewish General Hospital; Montreal Canada
| | | | | | - Zeev Rosberger
- McGill University; Montreal Canada
- Jewish General Hospital; Montreal Canada
| | - Melissa Henry
- McGill University; Montreal Canada
- Jewish General Hospital; Montreal Canada
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Almarzouki H, Niazi T, Hier M, Mlynarek A, Lavoie I, Sultanem K. Local Failure Rate in Oropharyngeal Carcinoma Patients Treated with Intensity-modulated Radiotherapy Without High-dose Clinical Target Volume. Cureus 2018; 10:e2958. [PMID: 30214846 PMCID: PMC6132597 DOI: 10.7759/cureus.2958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Our purpose was to evaluate whether omitting high-dose clinical target volume radiation (CTV-HD) around the gross tumor volume (GTV) in patients with oropharyngeal squamous cell carcinoma (OSCC) treated with intensity-modulated radiotherapy (IMRT) was associated with increased local failure. Methods and materials: Patients diagnosed with stage I to stage IV OSCC between December 2004 and April 2017 were retrospectively reviewed. All patients were treated with radical radiotherapy using IMRT, with or without neoadjuvant or concurrent chemotherapy. In accordance with institution guidelines, CTV-HD was not used. Local failure was defined as disease persistence or reappearance at the primary tumor site. When primary failure was documented, the computed tomography/positron emission tomography (CT/PET) scan that showed primary failure was fused with the original treatment scan. Each recurrent tumor was contoured to evaluate the pattern of recurrence. Recurrences were categorized as in-field, marginal, or out-of-field if >95%, 20%-95%, or <20% of the recurrent tumor volume, respectively, was encompassed by the 95% high-dose prescription isodose line of the original treatment plan. We then determined whether omitting CTV-HD was associated with increased locoregional failure. Results: A total of 272 patients with OSCC were assessed. The median follow-up from initial treatment was 43 months (range: 3-194 months). Seven patients were lost to follow-up. The overall five-year survival rate was 87%. The three- and five-year disease-free survival rates were 86% and 83%, respectively. Forty-one patients had 53 treatment failures (16 were local, eight were regional, and 29 were distant; some patients had treatment failures in multiple locations). Fourteen (87.5%) of the local recurrences were in-field, one (6.25%) was marginal, and one (6.25%) was out-of-field. Conclusion: Our analysis of patients with oropharyngeal cancer suggests that local failure is mostly in-field and potentially due to radioresistance, rather than a marginal miss of the tumor. It suggests that omitting CTV-HD is feasible and safe.
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Affiliation(s)
| | - Tamim Niazi
- Oncology, Jewish General Hospital, Montreal, CAN
| | - Michael Hier
- Otolaryngology, Jewish General Hospital, McGill University, Montreal, CAN
| | - Alex Mlynarek
- Otolaryngology, Jewish General Hospital, McGill University, Montreal, CAN
| | - Isabelle Lavoie
- Radiation Oncology, McGill University/Jewish General Hospital, Montreal, CAN
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Henry M, Rosberger Z, Bertrand L, Klassen C, Hier M, Zeitouni A, Kost K, Mlynarek A, Richardson K, Black M, MacDonald C, Zhang X, Chartier G, Frenkiel S. Prevalence and Risk Factors of Suicidal Ideation among Patients with Head and Neck Cancer: Longitudinal Study. Otolaryngol Head Neck Surg 2018; 159:843-852. [PMID: 29865939 DOI: 10.1177/0194599818776873] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) Determine 1-year period prevalence of suicidal ideation, suicide attempt, and completed suicide among patients newly diagnosed with a first occurrence of head and neck cancer (HNC). (2) Characterize stability and trajectory of suicidal ideation over the year following cancer diagnosis. (3) Identify patients at risk of suicidal ideation. STUDY DESIGN Prospective longitudinal study with 1-year follow-up. SETTING Three university-affiliated outpatient departments of otolaryngology-head and neck surgery. SUBJECTS AND METHODS The study comprised a representative sample of 223 consecutive patients who were newly diagnosed (<2 weeks) with a first occurrence of primary HNC, were ≥18 years old and able to consent, and had a Karnofsky Performance Scale score ≥60. Patients completed the Beck Scale for Suicidal Ideation and Structured Clinical Interview for DSM-IV-TR Axis I Disorders. RESULTS Sixteen percent (15.7%) of patients with HNC were suicidal <1 year from diagnosis, with point prevalences of 8.1% <2 weeks, 14.8% at 3 months, 9.4% at 6 months, and 10.4% at 12 months; 0.4% committed suicide within 3 months, and 0.9% attempted suicide. An a priori comprehensive conceptual model revealed 2 predictors of 1-year period prevalence of suicidal ideation in HNC: psychiatric history ( P = .017, β = 2.1, 95% CI = 0.4-3.8) and coping with the diagnosis by using substances (alcohol/drugs; P = .008, β = 0.61, 95% CI = 0.16-1.06). All other predictors, including medical predictors, were nonsignificant. A clinical suicide risk assessment revealed low risk among 71.4% and medium to high risk among 28.6%. CONCLUSION Suicide prevention strategies are clearly needed as part of routine clinical care in head and neck oncology, as well as their integration into clinical practice guidelines for HNC.
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Affiliation(s)
- Melissa Henry
- 1 McGill University, Montreal, Quebec, Canada.,2 Jewish General Hospital, Montreal, Quebec, Canada
| | - Zeev Rosberger
- 1 McGill University, Montreal, Quebec, Canada.,2 Jewish General Hospital, Montreal, Quebec, Canada
| | | | | | - Michael Hier
- 1 McGill University, Montreal, Quebec, Canada.,2 Jewish General Hospital, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- 1 McGill University, Montreal, Quebec, Canada.,3 McGill University Health Centre, Montreal, Quebec, Canada
| | - Karen Kost
- 1 McGill University, Montreal, Quebec, Canada.,3 McGill University Health Centre, Montreal, Quebec, Canada
| | - Alex Mlynarek
- 1 McGill University, Montreal, Quebec, Canada.,2 Jewish General Hospital, Montreal, Quebec, Canada.,3 McGill University Health Centre, Montreal, Quebec, Canada
| | - Keith Richardson
- 1 McGill University, Montreal, Quebec, Canada.,3 McGill University Health Centre, Montreal, Quebec, Canada
| | - Martin Black
- 1 McGill University, Montreal, Quebec, Canada.,2 Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Xun Zhang
- 1 McGill University, Montreal, Quebec, Canada.,3 McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Saul Frenkiel
- 1 McGill University, Montreal, Quebec, Canada.,2 Jewish General Hospital, Montreal, Quebec, Canada.,3 McGill University Health Centre, Montreal, Quebec, Canada
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Henry M, Rosberger Z, Ianovski LE, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Richardson K, Zhang X, Fuhrmann F, Chartier G, Frenkiel S. A screening algorithm for early detection of major depressive disorder in head and neck cancer patients post-treatment: Longitudinal study. Psychooncology 2018. [DOI: 10.1002/pon.4705] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Melissa Henry
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Department of Psychology; McGill University; Montreal Quebec Canada
- Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Lady-Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
- Department of Otolaryngology-Head and Neck Surgery; Jewish General Hospital; Montreal Quebec Canada. Department of Oncology and Segal Cancer Center; Jewish General Hospital; Montreal Quebec Canada. Louise-Granofsky Psychosocial Oncology Program (LG-POP); Jewish General Hospital; Montreal Quebec Canada
| | - Zeev Rosberger
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Department of Psychology; McGill University; Montreal Quebec Canada
- Lady-Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
- Department of Oncology and Segal Cancer Center; Jewish General Hospital; Montreal Quebec Canada
- Louise-Granofsky Psychosocial Oncology Program (LG-POP); Jewish General Hospital; Montreal Quebec Canada
| | - Lola E. Ianovski
- Lady-Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
| | - Michael Hier
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Lady-Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
- Department of Otolaryngology-Head and Neck Surgery; Jewish General Hospital; Montreal Quebec Canada
- Department of Oncology and Segal Cancer Center; Jewish General Hospital; Montreal Quebec Canada
| | - Anthony Zeitouni
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Department of Otolaryngology-Head and Neck Surgery; McGill University Health Centre; Montreal Quebec Canada
| | - Karen Kost
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Department of Otolaryngology-Head and Neck Surgery; McGill University Health Centre; Montreal Quebec Canada
| | - Alex Mlynarek
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Lady-Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
- Department of Otolaryngology-Head and Neck Surgery; Jewish General Hospital; Montreal Quebec Canada
- Department of Oncology and Segal Cancer Center; Jewish General Hospital; Montreal Quebec Canada. Department of Otolaryngology-Head and Neck Surgery; McGill University Health Centre; Montreal Quebec Canada
| | - Martin Black
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Lady-Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
- Department of Otolaryngology-Head and Neck Surgery; Jewish General Hospital; Montreal Quebec Canada
- Department of Oncology and Segal Cancer Center; Jewish General Hospital; Montreal Quebec Canada
| | - Christina MacDonald
- Department of Otolaryngology-Head and Neck Surgery; Jewish General Hospital; Montreal Quebec Canada
- Department of Nursing; Jewish General Hospital; Montreal Quebec Canada
| | - Keith Richardson
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Department of Otolaryngology-Head and Neck Surgery; McGill University Health Centre; Montreal Quebec Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation; Research Institute of the McGill University Health Centre; Montreal Quebec Canada
| | - Fabienne Fuhrmann
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Lady-Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
| | - Gabrielle Chartier
- Department of Otolaryngology-Head and Neck Surgery; Jewish General Hospital; Montreal Quebec Canada
- Department of Nursing; Jewish General Hospital; Montreal Quebec Canada
| | - Saul Frenkiel
- Faculty of Medicine, Department of Oncology; McGill University; Montreal Quebec Canada
- Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Lady-Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
- Department of Otolaryngology-Head and Neck Surgery; Jewish General Hospital; Montreal Quebec Canada
- Department of Oncology and Segal Cancer Center; Jewish General Hospital; Montreal Quebec Canada. Department of Otolaryngology-Head and Neck Surgery; McGill University Health Centre; Montreal Quebec Canada
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Roskies MG, Fang D, Abdallah MN, Charbonneau AM, Cohen N, Jordan JO, Hier MP, Mlynarek A, Tamimi F, Tran SD. Three-dimensionally printed polyetherketoneketone scaffolds with mesenchymal stem cells for the reconstruction of critical-sized mandibular defects. Laryngoscope 2017; 127:E392-E398. [PMID: 28776691 DOI: 10.1002/lary.26781] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/21/2017] [Accepted: 06/05/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Additive manufacturing offers a tailored approach to tissue engineering by providing anatomically precise scaffolds onto which stem cells and growth factors can be supplied. Polyetherketoneketone (PEKK), an ideal candidate biomaterial, is limited by a poor implant-bone interface but can be functionalized with adipose-derived stem cells (ADSC) to promote integration. This in vivo study examined the interaction of a three-dimensional printed PEKK/ADSC implant within the critical-sized mandibular defect in a rabbit model. STUDY DESIGN/METHODS Trapezoidal porous scaffolds with dimensions of 1.5 × 1.0 × 0.5 cm were printed using selective laser sintering. ADSCs were seeded on the scaffolds that were then implanted in marginal defects created in New Zealand rabbits. Rabbits were euthanized at 10- and 20-week intervals. Microcomputed tomography was used to characterize bone ingrowth and was correlated with histological analysis. Stress testing was performed on the scaffolds before and after implantation. RESULTS All scaffolds were well integrated into adjacent bone. Bone-to-tissue volume increased from 30.34% ( ± 12.46) to 61.27% ( ± 8.24), and trabecular thickness increased from 0.178 mm ( ± 0.069) to 0.331 mm ( ± 0.0306) in the 10- and 20-week groups, respectively, compared to no bone regrowth on the control side (P < 0.05). Histology confirmed integration at the bone-implant interface. Biomechanical testing revealed a compressive resistance 15 times that of bone alone (P < 0.05) CONCLUSION: 3D-printed PEKK scaffolds combined with ADSCs present a promising solution to improve the bone-implant interface and increase the resistance to forces of mastication after mandibular reconstruction. LEVEL OF EVIDENCE NA. Laryngoscope, 127:E392-E398, 2017.
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Affiliation(s)
- Michael G Roskies
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Craniofacial Stem Cells and Tissue Engineering Laboratory, McGill University, Montreal, Quebec, Canada
| | - Dongdong Fang
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,Craniofacial Stem Cells and Tissue Engineering Laboratory, McGill University, Montreal, Quebec, Canada
| | | | - Andre M Charbonneau
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,Craniofacial Stem Cells and Tissue Engineering Laboratory, McGill University, Montreal, Quebec, Canada
| | - Navi Cohen
- Faculty of Engineering, McGill University, Montreal, Quebec, Canada
| | - Jack O Jordan
- Craniofacial Stem Cells and Tissue Engineering Laboratory, McGill University, Montreal, Quebec, Canada
| | - Michael P Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Simon D Tran
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,Craniofacial Stem Cells and Tissue Engineering Laboratory, McGill University, Montreal, Quebec, Canada
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Lubov J, Maschietto M, Ibrahim I, Mlynarek A, Hier M, Kowalski LP, Alaoui-Jamali MA, da Silva SD. Meta-analysis of microRNAs expression in head and neck cancer: uncovering association with outcome and mechanisms. Oncotarget 2017; 8:55511-55524. [PMID: 28903437 PMCID: PMC5589676 DOI: 10.18632/oncotarget.19224] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/05/2017] [Indexed: 11/25/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is often diagnosed at advanced stages, incurring significant high mortality and morbidity. This review explored the risk stratification of miRNAs, and investigated the impact of miRNA networking in HNSCC prognostication. We performed a meta-analysis and a systematic literature search on online databases for papers published prior to December 1, 2016. The list of miRNAs was uploaded to MetacoreTM to construct a protein-protein interaction network, which was used to identify targets of the miRNAs and potential drugs. In addition, a representative network was further validated by immunohistochemistry in a cohort of 100 patients. We found 116 studies that included 8,194 subjects, in which the relationship between miRNA expression and prognosis of HNSCC were analyzed. Significant elevated expressions of 27 miRNAs and decreased expression of 26 miRNAs were associated with poor outcome. After excluding the studies causing heterogeneity, a fixed model was applied, which showed a statistically significant association between increased expression of miR-21 and poor survival (Pooled HR = 1.81,95% CI = 0.66-2.95, P < 0.005). We identified four networks affected by the miRNAs expression and enriched in genes related to metabolic processes and regulation of cell mitogenesis in response to extracellular stimuli. One network point out to 16 miRNAs directly or indirectly involved in the regulation of androgen-receptor (AR). Evaluation of AR protein expression in our cohort revealed that patients with upregulation of AR had poor survival rates (log-rank test, P < 0.005). This study showed that miRNAs have potential prognostic value to serve as screening tool for HNSCC during the follow-up. In addition, the implementation of a network-based analysis may reveal proteins with potential to be used as a biomarker.
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Affiliation(s)
- Joshua Lubov
- Department of Otolaryngology Head and Neck Surgery, Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada
| | - Mariana Maschietto
- Brazilian Biosciences National Laboratory, National Center for Research in Energy and Materials, Campinas, SP, Brazil
| | - Iman Ibrahim
- Department of Otolaryngology Head and Neck Surgery, Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada
| | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Moulay A Alaoui-Jamali
- Department of Otolaryngology Head and Neck Surgery, Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada
| | - Sabrina Daniela da Silva
- Department of Otolaryngology Head and Neck Surgery, Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada
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41
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Jooya A, Saliba J, Blackburn A, Tamilia M, Hier MP, Mlynarek A, Forest VI, Rochon L, Florea A, Wang H, Payne RJ. The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules. J Otolaryngol Head Neck Surg 2016; 45:51. [PMID: 27756425 PMCID: PMC5070180 DOI: 10.1186/s40463-016-0164-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/10/2016] [Indexed: 01/21/2023] Open
Abstract
Background Management decisions are not straightforward when the Ultrasound Guided Fine Needle Aspiration (USFNA) demonstrates a Bethesda score of either category III or IV, and a diagnostic hemi-thyroidectomy or a repeat USFNA (r-USFNA) could be performed. The aim of this study is to assess the effectiveness of r-USFNA in the management of indeterminate thyroid nodules by evaluating the likelihood of obtaining a definite diagnosis. Methods We reviewed the medical records of all patients with thyroid nodules between 2011 and 2015 at the Jewish General Hospital (Montreal, Canada). Three hundred fifty-one patients who had undergone a surgical procedure (hemi or total thyroidectomy) and a diagnosis of B3 or B4 on the primary USFNA (p-USFNA) were included in the study. Ninety-six of the included patients also had a repeat USFNA prior to the surgery. Demographic data, type of procedure, and McGill Thyroid Nodule Score (MTNS) were obtained from the medical records. Malignancy rates were calculated based on the final surgical histopathology report. Results Upon r-USFNA, an average 76 % of patients did not change Bethesda categories, 7.4 % downgraded to a benign category. The results showed that, on an average 17.3 % of patients with p-USFNA of B3 and 20 % of patients with p-USFNA of B4, upgraded to a malignant or suspicious for malignancy category, thus changing the clinical management to total thyroidectomy. Our data demonstrates that r-USFNA facilitates choosing the correct surgery of total thyroidectomy in about 20 % of nodules that have upgraded from B3/B4 to a more definite malignant category. Conclusions r-USFNA in patients with indeterminate diagnoses (B3 or B4) increases categorization into more definite categories. Approximately 20 % of patients are found to have malignant thyroid nodules and suspicious for malignancy thyroid nodules upon repeating the biopsy, hence a diagnostic hemi-thyroidectomy was avoided and a more definitive surgery could be performed. Furthermore, repeat USFNA results in a fewer number of hemi-thyroidectomy and completion thyroidectomy procedures.
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Affiliation(s)
- Alborz Jooya
- Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada
| | - Joe Saliba
- Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada
| | - Audrey Blackburn
- Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada
| | - Michael Tamilia
- Division of Endocrinology, Jewish General Hospital - McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada
| | - Véronique-Isabelle Forest
- Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada
| | - Louise Rochon
- Department of Pathology, Jewish General Hospital - McGill University, Montreal, QC, Canada
| | - Anca Florea
- Department of Pathology, Jewish General Hospital - McGill University, Montreal, QC, Canada
| | - Hangjun Wang
- Department of Pathology, Jewish General Hospital - McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada.
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Roskies M, Kay-Rivest E, Mascarella MA, Sultanem K, Mlynarek A, Hier M. Survival outcomes in patients with oropharyngeal cancer treated with carboplatin/paclitaxel and concurrent radiotherapy. J Otolaryngol Head Neck Surg 2016; 45:50. [PMID: 27724969 PMCID: PMC5057223 DOI: 10.1186/s40463-016-0163-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 10/05/2016] [Indexed: 11/22/2022] Open
Abstract
Background A commonly employed treatment for advanced staged oropharyngeal squamous cell carcinoma (OPSCC) is concurrent radiation and chemotherapy with cisplatin as the gold standard. Carboplatin is reported to have the same radiopotentiation properties and a superior side effect profile; however, its use in head and neck cancer has been limited due to the paucity of data and reported hematologic side effects. In this study, we describe our institution’s experience with carboplatin, paclitaxel and radiation in the treatment of oropharyngeal squamous cell carcinoma over a 10 year period. Methods A retrospective chart review of patients aged 18 to 80 years old with stage III-IV OPSCC treated with weekly carboplatin, paclitaxel and intensity modulated radiotherapy (IMRT) was performed. Data collected included patient demographics, tumor location and stage and survival outcomes. In addition, we noted treatment morbidities according to the Radiation Therapy Oncology Group (RTOG) scoring criteria scale. The data was analyzed using the student’s t-test and analysis of variables. Results Over a 10 year period, 160 patients received chemoradiation with carboplatin and paclitaxel for OPSCC. One-hundred-four and 65 patients were followed for at least 3 and 5 years, respectively. Overall survival for all patients was 81.7 and 70.7 % at 3 and 5 years, respectively. Disease free survival and locoregional recurrence-free survival at 5 years was 64.6 and 89.2 %, respectively. There was no association of survival with stage, regional nodal status or subsite. The most common side effect attributed to treatment was acute dysphagia (75.25 %) followed by odynophagia, xerostomia and hypogeusia. Hospitalizations and non-hospitalization emergency department visits attributed to treatment totalled 33 and 11, respectively. Hematologic toxicities greater than grade II were: 11.9 % neutropenia, 6.3 % anemia, 1.8 % thrombocytopenia. The incidence of febrile neutropenia was 5.0 % (8/160). Conclusion In conclusion, the overall, disease-free and locoregional recurrence-free survival of patients treated with carboplatin and radiotherapy for advanced stage OPSCC parallels what has been described in the literature for cisplatin, with an acceptable side effect profile.
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Affiliation(s)
- M Roskies
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - E Kay-Rivest
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - M A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - K Sultanem
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - A Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - M Hier
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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da Silva SD, Marchi FA, Xu B, Bijian K, Alobaid F, Mlynarek A, Rogatto SR, Hier M, Kowalski LP, Alaoui-Jamali MA. Predominant Rab-GTPase amplicons contributing to oral squamous cell carcinoma progression to metastasis. Oncotarget 2016; 6:21950-63. [PMID: 26110570 PMCID: PMC4673138 DOI: 10.18632/oncotarget.4277] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/03/2015] [Indexed: 11/25/2022] Open
Abstract
Metastatic oral squamous cell carcinoma (OSCC) is frequently associated with recurrent gene abnormalities at specific chromosomal loci. Here, we utilized array comparative genomic hybridization and genome-wide screening of metastatic and non-metastatic tongue tumors to investigate genes potentially contributing to OSCC progression to metastasis. We identified predominant amplifications of chromosomal regions that encompass the RAB5, RAB7 and RAB11 genes (3p24-p22, 3q21.3 and 8p11-12, respectively) in metastatic OSCC. The expression of these Rab GTPases was confirmed by immunohistochemistry in OSCC tissues from a cohort of patients with a follow-up of 10 years. A significant overexpression of Rab5, Rab7 and Rab11 was observed in advanced OSCC cases and co-overexpression of these Rabs was predictive of poor survival (log-rank test, P = 0.006). We generated a Rab interaction network and identified central Rab interactions of relevance to metastasis signaling, including focal adhesion proteins. In preclinical models, mRNA and protein expression levels of these Rab members were elevated in a panel of invasive OSCC cell lines, and their down-regulation prevented cell invasion at least in part via inhibition of focal adhesion disassembly. In summary, our results provide insights into the cooperative role of Rab gene amplifications in OSCC progression and support their potential utility as prognostic markers and therapeutic approach for advanced OSCC.
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Affiliation(s)
- Sabrina Daniela da Silva
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Canada.,Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Canada.,Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center and National Institute of Science and Technology on Oncogenomics (INCITO), Brazil
| | - Fabio Albuquerque Marchi
- NeoGene Laboratory, Department of Urology, Faculty of Medicine, UNESP, and International Research Center (CIPE), AC Camargo Cancer Center, Brazil.,Inter-Institutional Grad Program on Bioinformatics, University of São Paulo, Brazil
| | - Bin Xu
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Canada
| | - Krikor Bijian
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Canada
| | - Faisal Alobaid
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Canada
| | - Silvia Regina Rogatto
- NeoGene Laboratory, Department of Urology, Faculty of Medicine, UNESP, and International Research Center (CIPE), AC Camargo Cancer Center, Brazil
| | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Canada
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center and National Institute of Science and Technology on Oncogenomics (INCITO), Brazil
| | - Moulay A Alaoui-Jamali
- Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Departments of Medicine, Oncology, and Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Canada
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Hosseini S, Payne RJ, Zawawi F, Mlynarek A, Hier MP, Tamilia M, Forest VI. Can preoperative thyroglobulin antibody levels be used as a marker for well differentiated thyroid cancer? J Otolaryngol Head Neck Surg 2016; 45:31. [PMID: 27179632 PMCID: PMC4868007 DOI: 10.1186/s40463-016-0143-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/02/2015] [Accepted: 05/04/2016] [Indexed: 11/21/2022] Open
Abstract
Background It has been reported that thyroglobulin antibody are more frequently elevated in patients with thyroid cancercompared to general population. This study aims at evaluating whether preoperative thyroglobulin antibody (TgAb) levels increase the likelihood that a thyroid nodule is malignant. Methods A retrospective review of 586 patients who underwent thyroidectomy was conducted. Demographic data, TgAb levels, and final histopathology were recorded. Patients were divided into two groups: TgAb positive (defined as TgAb ≥ 30 IU/ml) and TgAb low/negative (defined as TgAb < 30). Results Preoperative TgAb levels were available in 405 patients. There were 353 (87 %) patients in the TgAblow/negative group (malignancy rate: 50.42 %) and 52 (13 %) patients in the TgAb positive group (malignancy rate: 65.38 %). The sensitivity, specificity, positive predictive value and negative predictive value of TgAb ≥ 30 IU/ml for thyroid malignancy were 16.04 %, 90.67 %, 65.38 % and 49.58 %, respectively. The relative risk of having a malignant thyroid nodule when the TgAb titers were≥30 IU/ml was 1.30 (CI1.04-1.62) and the odds ratio was 1.86 (CI 1.01-3.41). Both the Pearson chi-square test (p = 0.024) and Fisher’s exact test (p = 0.017) yielded statistical significance between the two groups. Conclusions In this study, patients with preoperative TgAb ≥ 30 IU/ml had a higher rate of malignancy when compared topatients with TgAb < 30 IU/ml. This suggests that an elevated TgAb level may indicate that a thyroid nodule is at an increased risk for malignancy.
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Affiliation(s)
- S Hosseini
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - R J Payne
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - F Zawawi
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Department Otolaryngology - Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - A Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - M P Hier
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - M Tamilia
- Division of Endocrinology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - V I Forest
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada.
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45
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Roskies M, Jordan JO, Fang D, Abdallah MN, Hier MP, Mlynarek A, Tamimi F, Tran SD. Improving PEEK bioactivity for craniofacial reconstruction using a 3D printed scaffold embedded with mesenchymal stem cells. J Biomater Appl 2016; 31:132-9. [DOI: 10.1177/0885328216638636] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective Polyetheretherketone (PEEK) is a bioinert thermoplastic that has been investigated for its potential use in craniofacial reconstruction; however, its use in clinical practice is limited by a poor integration with adjacent bone upon implantation. To improve the bone–implant interface, two strategies have been employed: to modify its surface or to impregnate PEEK with bioactive materials. This study attempts to combine and improve upon the two approaches by modifying the internal structure into a trabecular network and to impregnate PEEK with mesenchymal stem cells. Furthermore, we compare the newly designed PEEK scaffolds' interactions with both bone-derived (BMSC) and adipose (ADSC) stem cells. Design Customized PEEK scaffolds were designed to incorporate a trabecular microstructure using a computer-aided design program and then printed via selective laser sintering (SLS), a 3D-printing process with exceptional accuracy. The scaffold structure was evaluated using microCT. Scanning electron microscopy (SEM) was used to evaluate scaffold morphology with and without mesenchymal stem cells (MSCs). Adipose and bone marrow mesenchymal cells were isolated from rats and cultured on scaffolds. Cell proliferation and differentiation were assessed using alamarBlue and alkaline phosphatase assays, respectively. Cell morphology after one week of co-culturing cells with PEEK scaffolds was evaluated using SEM. Results SLS 3D printing fabricated scaffolds with a porosity of 36.38% ± 6.66 and density of 1.309 g/cm2. Cell morphology resembled viable fibroblasts attaching to the surface and micropores of the scaffold. PEEK scaffolds maintained the viability of both ADSCs and BMSCs; however, ADSCs demonstrated higher osteodifferentiation than BMSCs ( p < 0.05). Conclusions This study demonstrates for the first time that SLS 3D printing can be used to fabricate customized porous PEEK scaffolds that maintain the viability of adipose and bone marrow-derived MSCs and induce the osteodifferentiation of the adipose-derived MSCs. The combination of 3D printed PEEK scaffolds with MSCs could overcome some of the limitations using PEEK biopolymers for load-bearing bone regeneration in craniofacial reconstruction.
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Affiliation(s)
- Michael Roskies
- Department of Otolaryngology – Head & Neck Surgery, McGill University, Montreal, QC, Canada
- Craniofacial Stem Cell and Tissue Engineering Laboratory, McGill University, Montreal, QC, CA
| | - Jack O Jordan
- Craniofacial Stem Cell and Tissue Engineering Laboratory, McGill University, Montreal, QC, CA
| | - Dongdong Fang
- Craniofacial Stem Cell and Tissue Engineering Laboratory, McGill University, Montreal, QC, CA
| | | | - Michael P Hier
- Department of Otolaryngology – Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology – Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Simon D Tran
- Craniofacial Stem Cell and Tissue Engineering Laboratory, McGill University, Montreal, QC, CA
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
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46
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Roskies M, Liu X, Hier MP, Payne RJ, Mlynarek A, Forest V, Levental M, Forghani R. 3-phase dual-energy CT scan as a feasible salvage imaging modality for the identification of non-localizing parathyroid adenomas: a prospective study. J Otolaryngol Head Neck Surg 2015; 44:44. [PMID: 26521153 PMCID: PMC4628333 DOI: 10.1186/s40463-015-0098-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 05/28/2015] [Accepted: 10/19/2015] [Indexed: 12/12/2022] Open
Abstract
Objectives Accurate pre-operative imaging of parathyroid adenomas (PAs) is essential for successful minimally invasive surgery; however, rates of non-localizing PAs can be as high as 18 %. Multiphasic dual-energy CT (DECT) has the potential to increase accuracy of PA detection by enabling creation of paired material maps and spectral tissue characterization. This study prospectively evaluated the utility of 3-phase DECT for PA identification in patients with failed localizatio n via standard imaging. Methods Patients with primary hyperparathyroidism and non-localizing PAs underwent a 3 phase post-contrast DECT scan acquired at 25, 55, and 85 s. The scans were prospectively evaluated by two head and neck radiologists. Pre-operative localization was compared to intraoperative localization and final histopathology. A post-hoc DECT spectral density characterization was performed on pathologically-proven PAs. Results Out of 29 patients with primary hyperparathyroidism and non-localized PAs, DECT identified candidates in 26. Of the 23 patients who underwent parathyroidectomy, DECT provided precise anatomic localization in 20 patients (PPV = 87.0 %), one with multi-gland disease. The virtual unenhanced images were not found to be useful for diagnosis but successful diagnosis was made without an unenhanced phase regardless. Spectral analysis demonstrated a distinct spectral Hounsfield attenuation curve for PAs compared to lymph nodes on arterial phase images. Conclusion 3-phase DECT without an unenhanced phase is a feasible salvage imaging modality for previously non-localizing parathyroid adenomas. Optimal interpretation is achieved based on a combination of perfusion characteristics and other morphologic features. Advanced spectral DECT analysis has the potential for further increasing accuracy of PA identification in the future.
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Affiliation(s)
- Michael Roskies
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital & McGill University, Montreal, Quebec, Canada
| | - Xiaoyang Liu
- Department of Radiology, Jewish General Hospital & McGill University, Montreal, Quebec, Canada
| | - Michael P Hier
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital & McGill University, Montreal, Quebec, Canada
| | - Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital & McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital & McGill University, Montreal, Quebec, Canada
| | - Veronique Forest
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital & McGill University, Montreal, Quebec, Canada
| | - Mark Levental
- Department of Radiology, Jewish General Hospital & McGill University, Montreal, Quebec, Canada
| | - Reza Forghani
- Department of Radiology, Jewish General Hospital & McGill University, Montreal, Quebec, Canada. .,Segal Cancer Centre and Lady Davis Institute for Medical Research, Jewish General Hospital & McGillUniversity, Montreal, Quebec, Canada.
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47
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Al-Qahtani K, Mlynarek A, Adamis J, Harris J, Seikaly H, Islam T. Intraoperative localization of the marginal mandibular nerve: a landmark study. BMC Res Notes 2015; 8:382. [PMID: 26310931 PMCID: PMC4549948 DOI: 10.1186/s13104-015-1322-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 01/21/2014] [Accepted: 08/06/2015] [Indexed: 11/18/2022] Open
Abstract
Background Identification and preservation of the marginal mandibular nerve (MMN) remains an important step in otolaryngology procedures. Current publications place the MMN at least 1 cm below the mandible. This study will evaluate the accuracy of the method of determining the surgical location of this branch of the facial nerve in vivo. Methods MMN were examined in 52 consecutive otolaryngology patients. Using a validated landmarking scheme, distances were measured from the inferior edge of the mandible and the lowest point of the nerve. A comparison of 33 nerves pairs was undertaken. Effect of patient’s age was analysed. Results Eighty five nerves were landmarked. The mean position of the nerve was 0.2–3.4 mm higher than the margin of the mandible. There were no significant difference in position with respect to age and left versus right comparisons. Conclusion The marginal mandibular nerve (MMN) is significantly higher than previously published. The location of the nerve on the right does not correlate with the left. Location of the nerve does not correlate with patient’s age.
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Affiliation(s)
- Khalid Al-Qahtani
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada. .,Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. .,King Abdul Aziz University Hospital, King Saud University, PO Box no-245, Riyadh, 11411, Kingdom of Saudi Arabia.
| | - Alex Mlynarek
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada.
| | - Jon Adamis
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada.
| | - Jeffery Harris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada.
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada.
| | - Tahera Islam
- College of Medicine and Research Center, King Saud University, Riyadh, Saudi Arabia.
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Livingstone D, Alghonaim Y, Jowett N, Sela E, Mlynarek A, Forghani R. Silver nitrate mimicking a foreign body in the pharyngeal mucosal space. World J Radiol 2015; 7:100-103. [PMID: 26029352 PMCID: PMC4444602 DOI: 10.4329/wjr.v7.i5.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/09/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
Silver nitrate is sometimes used as a means of chemical cauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography (CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.
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Varshney R, Forest VI, Mascarella MA, Zawawi F, Rochon L, Hier MP, Mlynarek A, Tamilia M, Payne RJ. The Mcgill thyroid nodule score - does it help with indeterminate thyroid nodules? J Otolaryngol Head Neck Surg 2015; 44:2. [PMID: 25645364 PMCID: PMC4323228 DOI: 10.1186/s40463-015-0058-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 09/08/2014] [Accepted: 01/16/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Ultrasound guided fine-needle aspiration (USFNA) biopsy of thyroid nodules often gives a result of indeterminate pathology, placing thyroid specialists in difficult management situations. The aim of this study is to evaluate the incidence of malignancy in patients undergoing surgery and to correlate these results with the McGill Thyroid Nodule Score (MTNS). METHODS We performed a retrospective study comparing USFNA results, MTNS and histopathology of patients undergoing thyroid surgery between 2010 and 2012. Pre-operative USFNA results were divided into three subgroups: benign, indeterminate and suspicious for/malignant. The indeterminate USFNA subgroup comprised of Bethesda type III (atypia of undetermined significance) and Bethesda type IV (follicular neoplasms, including Hurthle cell neoplasms) lesions. Post-operative histopathology was divided into benign or malignant groups. RESULTS Of the 437 patient charts reviewed, 57.0% had an indeterminate USFNA biopsy. Within the indeterminate group, the malignancy rate was 39.8%. For indeterminate USFNA, the median MTNS was 7 (32% risk of malignancy) for benign nodules and 9 (63% risk of malignancy) for malignant nodules on post-operative histopathology (p < 0.05). CONCLUSION The rate of malignancy in operated patients with an indeterminate USFNA result was 39.8%. The MTNS can be of value to thyroid specialists in pre-operative decision-making when dealing with an indeterminate result of a thyroid nodule on USFNA.
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Affiliation(s)
- Rickul Varshney
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Veronique-Isabelle Forest
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Marco A Mascarella
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Faisal Zawawi
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada. .,King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Louise Rochon
- Department of Pathology, Jewish General Hospital, McGill University, 3755 Côte-Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada.
| | - Michael P Hier
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Alex Mlynarek
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Michael Tamilia
- Department of Endocrinology and Metabolism, Jewish General Hospital, McGill University, 3755 Côte-Ste-Catherine Road, Montreal, Canada.
| | - Richard J Payne
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
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50
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Merchavy S, Marom T, Forest VI, Hier M, Mlynarek A, McHugh T, Payne R. Comparison of the incidence of postoperative hypocalcemia following total thyroidectomy vs completion thyroidectomy. Otolaryngol Head Neck Surg 2014; 152:53-6. [PMID: 25358344 DOI: 10.1177/0194599814556250] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study the rate of postoperative hypocalcemia following completion thyroidectomy (CT), in comparison with the hypocalcemia rate following total thyroidectomy (TT). STUDY DESIGN AND SETTING A retrospective study, performed at the McGill University Thyroid Cancer Center, Montreal, Quebec, Canada, from 2007 to 2012. SUBJECTS AND METHODS Medical records of adult patients undergoing CT and TT operated by a single surgeon were reviewed. Data were extracted for demographics, postoperative calcium levels, surgical logs, and final surgical pathology. Hypocalcemia was defined as corrected serum calcium level ≤ 1.90 mmol/L, with concurrent serum parathyroid hormone <8 ng/L, and/or any signs or symptoms of hypocalcemia. RESULTS There were 68 CTs and 146 TTs. Transient hypocalcemia occurred in 1 of 68 (1.5%) and 18 of 146 (12.5%) patients in the CT and TT groups, respectively. The rate of hypocalcemia was significantly lower in the CT compared with the TT group (P = .02). In both groups, there were no cases of permanent hypocalcemia. CONCLUSION The risk of transient of hypocalcemia in patients undergoing CT is significantly lower than the rate of hypocalcemia in patients undergoing TT.
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Affiliation(s)
- Shlomo Merchavy
- Department of Otolaryngology-Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Quebec, Canada Department of Medicine, Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Quebec, Canada Department of Otolaryngology-Head and Neck Surgery, Padeh Medical Center, Poriya, Israel
| | - Tal Marom
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA
| | - Veronique-Isabelle Forest
- Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Tobial McHugh
- Department of Otolaryngology-Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Richard Payne
- Department of Otolaryngology-Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Quebec, Canada
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