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Jones AJ, Naik AN, Moore MG, Chen DW, Yesensky JA, Mantravadi AV, Campbell DA, Sim MW. Elective nodal dissection for cN0 intermediate-grade parotid mucoepidermoid carcinoma: A NCDB study. Am J Otolaryngol 2024; 45:104214. [PMID: 38218029 DOI: 10.1016/j.amjoto.2023.104214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE To determine the occult nodal disease rate and whether elective regional lymph node dissection (RLND) confers any 10-year overall survival (OS) in cN0 intermediate-grade mucoepidermoid carcinoma (MEC) of the parotid gland. MATERIALS & METHODS The National Cancer Database was reviewed from 2004 to 2016 on adults with cT1-4aN0M0 intermediate-grade parotid MEC undergoing resection with/without RLND. Comparisons between patients with and without RLND were made. Occult nodal rate and 10-year overall survival (OS) were determined. RESULTS Out of 898 included patients with cN0 intermediate grade parotid MEC undergoing elective RLND, the occult nodal rate was 7.6%. This was significantly different from low-grade (3.9%) and high-grade (25.7%) cN0 disease. When stratified by pT-classification, marginal differences were identified between low-grade and intermediate-grade tumors, whereas high-grade tumors demonstrated increased occult nodal disease with low T-stage (pT1-pT2, 20.4% vs. 5.1%) and high T-stage (pT3-pT4a, 32.1% vs. 17.6%). Patients undergoing elective RLND were more often treated at an academic facility (53.8% vs. 41.2%), had higher pT3-pT4 tumors (19.2% vs. 10.4%), and more frequently underwent total/radical parotidectomy (46.0% vs. 29.9%) with adjuvant radiation therapy (53.8% vs. 41.0%) Cox-proportional hazard modeling did not identify RLND, regardless if stratified by nodal yield or pT-classification, nor nodal positivity as significant predictors of 10-year OS. CONCLUSIONS The occult nodal disease in intermediate-grade parotid MEC is low and similar to low-grade. Elective RLND may have a limited impact on OS, though its effect on locoregional control remains unknown. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexander J Jones
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States.
| | - Akash N Naik
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Michael G Moore
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Diane W Chen
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Jessica A Yesensky
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Avinash V Mantravadi
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - David A Campbell
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Michael W Sim
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
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Balanta-Melo J, Jones AJ, Novinger LJ, Moore MG, Bonetto A. Masseter muscle thickness is predictive of cancer cachexia in patients with head and neck cancer. Head Neck 2024. [PMID: 38661244 DOI: 10.1002/hed.27789] [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: 02/08/2024] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Cancer cachexia is prevalent in head and neck cancer patients. The L3 skeletal muscle index (SMI) is often used to assess sarcopenia and cachexia but is infrequently able to be measured in this population. Masseter muscle thickness (MT) may serve as an alternative predictor of cachexia. METHODS SMI and MT were calculated from 20 trauma (CTRL) and 40 cachectic (CA-CX) and non-cachectic (CA-NCX) head and neck cancer patients. Area Under the Curve of the Receiver Operating Characteristics (AUC-ROC) analysis was performed for SMI and MT. RESULTS Both SMI and MT were significantly decreased in CA-CX patients (vs. CA-NCX mean difference -19.5 cm2/m2 and -2.06 mm, respectively) and significant predictors of CA-CX (AUC = 0.985 and 0.805, respectively). When analyzed by sex, the same findings were observed for MT in males and trended toward significance in females. CONCLUSIONS Compared with SMI, MT is a good alternative prognostic biomarker to determine CA-CX status in HNC patients.
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Affiliation(s)
- Julián Balanta-Melo
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Prosthodontics, Universidad del Valle School of Dentistry, Cali, Colombia
| | - Alexander J Jones
- Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leah J Novinger
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael G Moore
- Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Bonetto
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Papazian MR, Chow M, Weed D, Liu JC, Bewley AF, Moore MG, Givi B. Virtual Tumor Boards for Remote Learning in Head and Neck Surgical Oncology. JAMA Otolaryngol Head Neck Surg 2023; 149:899-903. [PMID: 37615974 PMCID: PMC10450583 DOI: 10.1001/jamaoto.2023.2332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/24/2023] [Indexed: 08/25/2023]
Abstract
Importance In addition to their patient management value, multidisciplinary tumor boards have been recognized as effective learning tools. However, the value of using a virtual tumor board as a learning tool for head and neck surgical oncology fellows has not been studied. Objective To describe the structure and content of the American Head and Neck Society (AHNS) Virtual Tumor Board and assess its educational value as perceived by attendees. Design, Setting, and Participants All sessions of the AHNS Virtual Tumor Board from April 8, 2020, to June 1, 2022, were reviewed. Topics, presenters, participants, and viewership data were collected as of October 15, 2022, from session recordings posted to an online video sharing and social media platform. Additionally, an anonymous, 14-question online survey was designed to elicit feedback from head and neck surgery trainees on virtual tumor board engagement, strengths, and weaknesses. The survey was electronically distributed in June and July 2022 to the 101 fellows enrolled in AHNS-accredited programs between July 1, 2020, and June 30, 2022. Main Outcomes and Measures The primary aim was to tabulate online viewership of the sessions. The secondary aim was to qualitatively assess the experience of head and neck trainees with the AHNS Virtual Tumor Board using a survey. Results Forty-two sessions of the virtual tumor board were held between April 8, 2020, and June 1, 2022. Almost all sessions (41 [98%]) were case based. One hundred and sixteen cases were presented, representing 2 to 3 cases per session, by 75 unique faculty members. Each session was viewed a mean of 217 times (range, 64-2216 views). In the 2021 to 2022 academic year, a mean of 60 viewers (range, 30-92 viewers) attended each live session. In all, 29 survey responses were collected from 101 fellows in AHNS-accredited programs (29% response rate). Most respondents felt the format allowed for excellent teaching (18 of 26 respondents [69%]) and discussion (19 of 26 respondents [73%]). Most respondents (22 of 29 respondents [76%]) believed that practicing head and neck surgeons would benefit from the sessions. Conclusions and Relevance This survey study found that the AHNS Virtual Tumor Board was well-attended and well-reviewed by head and neck surgical oncology trainees. The virtual tumor board format could be used as model of remote learning for other organizations.
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Affiliation(s)
- Michael R. Papazian
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
- Now Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Chow
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Donald Weed
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeffrey C. Liu
- Department of Otolaryngology–Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Arnaud F. Bewley
- Department of Otolaryngology–Head and Neck Surgery, University of California-Davis, Sacramento
| | - Michael G. Moore
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Babak Givi
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Birkeland AC, Kademani D, Moore MG, Blair EA. Practice patterns for initial management of oral leukoplakia amongst otolaryngologists and oral and maxillofacial surgeons. Oral Oncol 2023; 139:106341. [PMID: 36842197 DOI: 10.1016/j.oraloncology.2023.106341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/04/2023] [Accepted: 02/14/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE Oral leukoplakia is encountered frequently by otolaryngologists and oral and maxillofacial surgeons (OMFS). There are no consensus practice management guidelines for oral leukoplakia, resulting in heterogeneity in practice patterns. Characterization of practice patterns of providers who treat oral leukoplakia will be valuable to establish standards of care and future practice guidelines. MATERIAL AND METHODS A survey was designed by the American Head and Neck Society Cancer Prevention Service collecting demographic and practice management data for treating oral leukoplakia. The survey was approved and distributed to members of the American Academy of Otolaryngology-Head and Neck Surgery and American Association of Oral and Maxillofacial Surgeons. Data analysis was performed using chi square and t-test where appropriate. RESULTS 396 responses were collected: 83 OMFS, 81 head and neck fellowship-trained providers, and 232 otolaryngologists (non-head and neck fellowship-trained). Providers saw a wide volume of oral leukoplakia (23.0% >30 cases/year, 35.1% 11-30 cases/year, 41.2% 10 or less cases/year), with OMFS seeing more cases of oral leukoplakia. Factors most associated with consideration of initial biopsy included physical exam findings (94.4%), erythroplakia (82.3%), and smoking status (81.6%). The majority of respondents saw patients in follow-up within 1 month (24.8%) or within 1-3 months (46.5%). CONCLUSION This survey identifies a range of practice patterns in initial management of oral leukoplakia, including indications for biopsy, and time for follow-up. This data provide insight into practice patterns amongst different groups of providers and can potentially lead to consensus guidelines for initial management of oral leukoplakia.
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Affiliation(s)
- Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Sacramento, CA, USA.
| | - Deepak Kademani
- Department of Oral and Maxillofacial Surgery, North Memorial Medical Center, Robbinsdale, MN, USA
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth A Blair
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, IL, USA
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Riggins TE, Whitsitt QA, Saxena A, Hunter E, Hunt B, Thompson CH, Moore MG, Purcell EK. Gene Expression Changes in Cultured Reactive Rat Astrocyte Models and Comparison to Device-Associated Effects in the Brain. bioRxiv 2023:2023.01.06.522870. [PMID: 36712012 PMCID: PMC9881929 DOI: 10.1101/2023.01.06.522870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Implanted microelectrode arrays hold immense therapeutic potential for many neurodegenerative diseases. However, a foreign body response limits long-term device performance. Recent literature supports the role of astrocytes in the response to damage to the central nervous system (CNS) and suggests that reactive astrocytes exist on a spectrum of phenotypes, from beneficial to neurotoxic. The goal of our study was to gain insight into the subtypes of reactive astrocytes responding to electrodes implanted in the brain. In this study, we tested the transcriptomic profile of two reactive astrocyte culture models (cytokine cocktail or lipopolysaccharide, LPS) utilizing RNA sequencing, which we then compared to differential gene expression surrounding devices inserted into rat motor cortex via spatial transcriptomics. We interpreted changes in the genetic expression of the culture models to that of 24 hour, 1 week and 6 week rat tissue samples at multiple distances radiating from the injury site. We found overlapping expression of up to ∼250 genes between in vitro models and in vivo effects, depending on duration of implantation. Cytokine-induced cells shared more genes in common with chronically implanted tissue (≥1 week) in comparison to LPS-exposed cells. We revealed localized expression of a subset of these intersecting genes (e.g., Serping1, Chi3l1, and Cyp7b1) in regions of device-encapsulating, glial fibrillary acidic protein (GFAP)-expressing astrocytes identified with immunohistochemistry. We applied a factorization approach to assess the strength of the relationship between reactivity markers and the spatial distribution of GFAP-expressing astrocytes in vivo . We also provide lists of hundreds of differentially expressed genes between reactive culture models and untreated controls, and we observed 311 shared genes between the cytokine induced model and the LPS-reaction induced control model. Our results show that comparisons of reactive astrocyte culture models with spatial transcriptomics data can reveal new biomarkers of the foreign body response to implantable neurotechnology. These comparisons also provide a strategy to assess the development of in vitro models of the tissue response to implanted electrodes.
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Talwar A, Gordon AJ, Bewley AF, Fancy T, Lydiatt WM, Weed D, Moore MG, Givi B. Distribution of the head and neck surgical oncology workforce in the United States. Head Neck 2022; 44:2537-2544. [PMID: 35942943 DOI: 10.1002/hed.27157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recent trends in education and geographic distribution of the head and neck surgery workforce have not been studied extensively. METHODS We reviewed publicly available sources to locate all fellowship-trained head and neck surgeons and recent graduates. The number of surgeons in each state was compared against head and neck cancer incidence data from the Centers for Disease Control. RESULTS The number of graduates increased annually by 1 per 100 000 000 people from 2011-2020. The average number of fellowship-trained surgeons per state was 10 (SD: 12). The average number of new head and neck cancer cases per surgeon was 247 (SD: 135). Ten states (20%) had cases >1 SD above the national average/surgeon, while 3 (6%) had cases >1 SD below the national average. CONCLUSION Head and neck surgeons are located in most states, but not uniformly. Most states have approximately average density of surgeons; however, several states are outliers.
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Affiliation(s)
- Abhinav Talwar
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex J Gordon
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Tanya Fancy
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - William M Lydiatt
- Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Donald Weed
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Babak Givi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
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Moore MG, Thompson CH, Reimers MA, Purcell EK. Differential Co-Expression Analysis of RNA-Seq Data Reveals Novel Potential Biomarkers of Device-Tissue Interaction. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:3072-3076. [PMID: 36085767 PMCID: PMC9724584 DOI: 10.1109/embc48229.2022.9871437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The biological response to electrodes implanted in the brain has been a long-standing barrier to achieving a stable tissue device-interface. Understanding the mechanisms underlying this response could explain phenomena including recording instability and loss, shifting stimulation thresholds, off-target effects of neuromodulation, and stimulation-induced depression of neural excitability. Our prior work detected differential expression in hundreds of genes following device implantation. Here, we extend upon that work by providing new analyses using differential co-expression analysis, which identifies changes in the correlation structure between groups of genes detected at the interface in comparison to control tissues. We used an "eigengene" approach to identify hub genes associated with each module. Our work adds to a growing body of literature which applies new techniques in molecular biology and computational analysis to long-standing issues surrounding electrode integration with the brain.
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Jones AJ, Davis KP, Novinger LJ, Bonetto A, Mantravadi AV, Sim MW, Yesensky JA, Moore MG. Postoperative consequences of cancer cachexia after head and neck free flap reconstruction. Head Neck 2022; 44:1665-1677. [PMID: 35488469 DOI: 10.1002/hed.27072] [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: 01/03/2022] [Revised: 04/02/2022] [Accepted: 04/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cachexia is detrimental for patients with head and neck cancer (HNC). However, postoperative consequences of HNC cachexia remain unknown. METHODS A 2014-2019 retrospective review was performed of adults undergoing aerodigestive HNC resection with free tissue reconstruction. Propensity score matching using inverse probability of treatment weighting (IPTW) of cachectic and control groups was employed to adjust for covariate imbalances followed by binary logistic regression on postoperative outcomes. RESULTS Out of 252 total patients, 135 (53.6%) had cancer cachexia. The cohort was predominantly white (94.4%) males (65.1%) aged 61.5 ± 11.5 years with stage III-IV (84.1%) malignancy of the oral cavity (66.3%). After matching cohort pre- and intra-operative covariates using IPTW, cancer cachexia remained a strong, significant predictor of serious National Surgical Quality Improvement Program (NSQIP) complications (OR [95%CI] = 3.84 [1.80-8.21]) and major Clavien-Dindo complications (OR [95%CI] = 3.00 [1.18-7.60]). CONCLUSIONS Cancer cachexia is associated with worse HNC free flap reconstruction outcomes.
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Affiliation(s)
- Alexander Joseph Jones
- Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kyle Patrick Davis
- Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leah J Novinger
- Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Bonetto
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Avinash V Mantravadi
- Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael W Sim
- Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica A Yesensky
- Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael G Moore
- Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Beydoun AS, Koss K, Nielsen T, Holcomb AJ, Pichardo P, Purdy N, Zebolsky AL, Heaton CM, McMullen CP, Yesensky JA, Moore MG, Goyal N, Kohan J, Sajisevi M, Tan K, Petrisor D, Wax MK, Kejner AE, Hassan Z, Trott S, Larson A, Richmon JD, Graboyes EM, Wood CB, Jackson RS, Pipkorn P, Bruening J, Massey B, Puram SV, Zenga J. Perioperative Topical Antisepsis and Surgical Site Infection in Patients Undergoing Upper Aerodigestive Tract Reconstruction. JAMA Otolaryngol Head Neck Surg 2022; 148:547-554. [PMID: 35476816 PMCID: PMC9047735 DOI: 10.1001/jamaoto.2022.0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgical site infections (SSIs) after vascularized reconstruction of the upper aerodigestive tract (UADT) are associated with considerable morbidity. The association between perioperative prophylaxis practices, particularly topical antisepsis, and SSIs remains uncertain. Objective To assess the association between perioperative topical antisepsis and SSIs in patients undergoing vascularized reconstruction of the UADT. Design, Setting, and Participants This cohort study included patients from 12 academic tertiary care centers over an 11-month period, from July 1, 2020, to June 1, 2021. Patients undergoing open surgical procedures requiring a communication between the UADT and cervical skin with a planned regional pedicled flap, free flap, or both were included. Patients with an active infection at the time of surgical procedure were excluded. Main Outcomes and Measures The primary outcome measure was an SSI within 30 days of surgery. The association of demographic characteristics, perioperative antibiotic prophylaxis, surgical technique, and postoperative care with SSIs was assessed using univariable and multivariable analyses. The relative risk ratio and 95% CIs for developing SSI were calculated for each of the variables based on predetermined categories. Variables for which the relative risk 95% CI did not include the value of zero effect (relative risk = 1.00) were included in the multivariable model. Results A total of 554 patients (median age, 64 years; range, 21-95 years; 367 men [66.2%]) were included. Cancer ablation was the most frequent reason for surgery (n = 480 [86.6%]). Overall, the SSI rate was 20.9% (n = 116), with most infections involving the head and neck surgical site only (91 [78.4%]). The median time to SSI diagnosis was 11 days (range, 1-28 days). Topical antisepsis mucosal preparation was performed preoperatively in 35.2% (195) and postoperatively in 52.2% (289) of cases. Ampicillin and sulbactam was the most common systemic antibiotic prophylaxis agent used (n = 367 [66.2%]), with 24 hours being the most common duration (n = 363 [65.5%]). On multivariable analysis, preoperative topical antisepsis mucosal preparation (odds ratio [OR], 0.49; 95% CI, 0.30-0.77) and systemic prophylaxis with piperacillin and tazobactam (OR, 0.42; 95% CI, 0.21-0.84) were associated with a decreased risk of a postoperative SSI. The use of an osseous vascularized flap was associated with an increased risk of postoperative SSI (OR, 1.76; 95% CI, 1.13-2.75). Conclusions and Relevance Findings of this study suggest that preoperative topical antisepsis mucosal preparation was independently associated with a decreased risk of SSIs in a 12-center multi-institutional cohort. Further investigation of the association between individual perioperative practices and the incidence of postoperative SSIs is necessary to develop evidence-based protocols to reduce SSIs after UADT reconstruction.
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Affiliation(s)
- Ahmed Sam Beydoun
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Kevin Koss
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Tyson Nielsen
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, Nebraska
| | - Andrew James Holcomb
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, Nebraska
| | - Priscilla Pichardo
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Nicholas Purdy
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Aaron L Zebolsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Chase M Heaton
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Caitlin P McMullen
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jessica A Yesensky
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Michael G Moore
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joshua Kohan
- Division of Otolaryngology, Department of Surgery, University of Vermont Medical Center, Burlington
| | - Mirabelle Sajisevi
- Division of Otolaryngology, Department of Surgery, University of Vermont Medical Center, Burlington
| | - Kenneth Tan
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Daniel Petrisor
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington
| | - Zain Hassan
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington
| | - Skylar Trott
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington
| | - Andrew Larson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - C Burton Wood
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jennifer Bruening
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Becky Massey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
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Gordon AJ, Patel A, Weed D, Bewley AF, Moore MG, Givi B. Qualitative assessment of online information available on accredited head and neck surgery fellowship programs. Head Neck 2022; 44:1136-1141. [DOI: 10.1002/hed.27009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alex J. Gordon
- Department of Otolaryngology‐Head and Neck Surgery NYU Grossman School of Medicine New York New York USA
| | - Aneek Patel
- Department of Otolaryngology‐Head and Neck Surgery NYU Grossman School of Medicine New York New York USA
| | - Donald Weed
- Department of Otolaryngology University of Miami Miller School of Medicine Miami Florida USA
| | - Arnaud F. Bewley
- Department of Otolaryngology University of California Davis School of Medicine Sacramento California USA
| | - Michael G. Moore
- Department of Otolaryngology‐Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana USA
| | - Babak Givi
- Department of Otolaryngology‐Head and Neck Surgery NYU Grossman School of Medicine New York New York USA
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Yan F, Rauscher E, Hollinger A, Caputo MA, Ready J, Nguyen SA, Fakhry C, Nathan CAO, Leonardis C, Yearout D, Day TA, Moore MG. Concerns and Needs of Patients With Head and Neck Cancer in the COVID-19 Era. OTO Open 2021; 5:2473974X211047794. [PMID: 34616997 PMCID: PMC8489761 DOI: 10.1177/2473974x211047794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the concerns and needs of patients and survivors of head and neck cancer (HNC) in the COVID-19 era. Study Design Prospective cross-sectional survey. Setting Contact lists of 5 North American HNC advocacy groups. Methods A 14-question survey was distributed to the contact lists of 5 HNC advocacy groups evaluating patient and survivor needs and concerns related to their cancer care and COVID-19. Results There were 171 respondents, with 75% in the posttreatment period. The most common concern was contraction of COVID-19 (49%). More patients in active treatment preferred in-person visits than those in the early (≤5 years) and late (>5) survivorship period (72% vs 61% vs 40%, P < .001). A higher percentage of late survivors preferred virtual visits (38% vs 28%, P = .001). In total, 91 (53.2%) respondents sought emotional support outside of immediate family and friends. This included cancer support groups (36.2%), the medical team (29.7%), and other sources outside of these (34.1%), including faith-based organizations and online communities. A higher proportion of women than men (62% vs 41%, P = .001) were seeking emotional support outside of immediate family and friends. Conclusions During the early stages of the COVID-19 pandemic, patients with HNC who were actively undergoing treatment had increased need for support resources and preferred in-person provider visits. Alternatively, a higher percentage of patients >5 years from treatment preferred virtual visits. Emotional support outside of family and friends was sought out by a majority of respondents. Further research is needed to determine what support and educational resources are needed to best aid these various populations.
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Affiliation(s)
- Flora Yan
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Erika Rauscher
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Amanda Hollinger
- The Head and Neck Cancer Alliance, Charleston, South Carolina, USA
| | - Mary Ann Caputo
- Support for People With Oral and Head and Neck Cancer, Locust Valley, New York, USA
| | - John Ready
- Foundation for Voice Restoration, Greenville, Carolina, USA
| | - Shaun A Nguyen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carole Fakhry
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cherie-Ann O Nathan
- Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Chris Leonardis
- Support for People With Oral and Head and Neck Cancer, Locust Valley, New York, USA
| | | | - Terry A Day
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael G Moore
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
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12
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Geiger JL, Ismaila N, Beadle B, Caudell JJ, Chau N, Deschler D, Glastonbury C, Kaufman M, Lamarre E, Lau HY, Licitra L, Moore MG, Rodriguez C, Roshal A, Seethala R, Swiecicki P, Ha P. Management of Salivary Gland Malignancy: ASCO Guideline. J Clin Oncol 2021; 39:1909-1941. [PMID: 33900808 DOI: 10.1200/jco.21.00449] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Marnie Kaufman
- Adenoid Cystic Carcinoma Research Foundation, Needham, MA
| | | | | | - Lisa Licitra
- Istituto Nazionale Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | | | | | | | - Patrick Ha
- University of California San Francisco, San Francisco, CA
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13
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Jones AJ, Campiti VJ, Alwani M, Novinger LJ, Tucker BJ, Bonetto A, Yesensky JA, Sim MW, Moore MG, Mantravadi AV. Sarcopenia is associated with blood transfusions in head and neck cancer free flap surgery. Laryngoscope Investig Otolaryngol 2021; 6:200-210. [PMID: 33869752 PMCID: PMC8035950 DOI: 10.1002/lio2.530] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/29/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine if sarcopenia is a predictor of blood transfusion requirements in head and neck cancer free flap reconstruction (HNCFFR). METHODS A single-institution, retrospective review was performed of HNCFFR patients with preoperative abdominal imaging from 2014 to 2019. Demographics, comorbidities (modified Charlson Comorbidity Index [mCCI]), skeletal muscle index (cm2/m2), oncologic history, intraoperative data, and 30-day postoperative complications (Clavien-Dindo score [CD]) were collected. Binary logistic regression was performed to determine predictors of transfusion. RESULTS Eighty (33.5%), 66 (27.6%), and 110 (46.0%) of n = 239 total patients received an intraoperative, postoperative, or any perioperative blood transfusion, respectively. Sixty-two (25.9%) patients had sarcopenia. Patients receiving intraoperative transfusions had older age (P = .035), more frequent alcoholism (P = .028) and sarcopenia (P < .001), greater mCCI (P < .001), lower preoperative hemoglobin (P < .001), reconstruction with flaps other than forearm (P = .003), and greater operative times (P = .001), intravenous fluids (P < .001), and estimated blood loss (EBL, P < .001). Postoperative transfusions were associated with major complications (CD ≥ 3; P < .001). Multivariate regression determined sarcopenia (P = .023), mCCI (P = .013), preoperative hemoglobin (P = .002), operative time (P = .036), and EBL (P < .001) as independent predictors of intraoperative transfusion requirements. Postoperative transfusions were predicted by preoperative hemoglobin (P = .007), osseous flap (P = .036), and CD ≥ 3 (P < .001). A perioperative transfusion was predicted by sarcopenia (P = .021), preoperative hemoglobin (P < .001), operative time (P = .008), and CD ≥ 3 (P = .018). CONCLUSION Sarcopenia is associated with increased blood transfusions in HNCFFR. Patients should be counseled preoperatively on the associated risks, and the increased blood product requirement should be accounted in resource-limited scenarios. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Alexander Joseph Jones
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Vincent J. Campiti
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Mohamedkazim Alwani
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Leah J. Novinger
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Brady Jay Tucker
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Andrea Bonetto
- Department of SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jessica A. Yesensky
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Michael W. Sim
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Michael G. Moore
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Avinash V. Mantravadi
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
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14
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Nwosu OI, Jones AJ, Alwani M, Einhorn LH, Moore MG, Mantravadi AV. Surgical Management of Cervical Non-seminomatous Germ Cell Tumor Metastases. Laryngoscope 2021; 131:1528-1534. [PMID: 33421136 DOI: 10.1002/lary.29364] [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: 11/17/2020] [Accepted: 12/18/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE/HYPOTHESIS Testicular cancer is the most common malignancy of young males. Limited reports describe perioperative and long-term outcomes after surgical resection of metastatic, cervical, non-seminomatous germ cell tumors (NSGCT). The objective of this study was to investigate the effectiveness and safety of cervical lymphadenectomy in the management of metastatic NSGCT. STUDY DESIGN Retrospective case series. METHODS A single institution, retrospective review from 1998 to 2020 of patients with metastatic NSGCT who underwent cervical lymphadenectomy was conducted. Clinicopathological, surgical, and postoperative data were collected and analyzed. RESULTS Sixty-eight predominantly white (91.0%) male patients with mean age 33.0 ± 11.3 years were included. Most (82.2%) presented with stage III disease at initial diagnosis. All patients had undergone primary platinum-based chemotherapy 1.0 to 22.7 months prior to selective ND. Surgery mainly involved nodal levels III (67.6%), IV (92.6%) and/or Vb (77.9%) and was frequently performed with concomitant thoracoabdominal NSGCT resections (63.2%). Cervical specimens predominantly revealed mature teratoma (83.8%) as solitary (69.1%) or component of mixed (14.7%) NSGCT. Ten (14.7%) perioperative complications occurred as vocal cord paresis (n = 6) from thoracic surgery and chyle leakage (n = 4). All resolved conservatively except two vocal cord paralyzes that required surgical repair due to tumor involvement of vagus nerve. Six instances of cervical recurrence occurred at median 12.5 (range, 5.8-38.6) months from ND, all re-demonstrating purely mature teratoma. The two-year cervical, non-cervical, and overall recurrence-free survivals were 83%, 55%, and 55%, respectively. Two-year disease-free and overall survivals were both 93%. CONCLUSIONS Selective neck dissection is a safe, effective method for managing cervical NSGCT metastases. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1528-1534, 2021.
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Affiliation(s)
- Obi I Nwosu
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Alexander J Jones
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Mohamedkazim Alwani
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Lawrence H Einhorn
- Department of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Michael G Moore
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Avinash V Mantravadi
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
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15
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Jones AJ, Campiti VJ, Alwani M, Novinger LJ, Bonetto A, Sim MW, Yesensky JA, Moore MG, Mantravadi AV. Skeletal Muscle Index's Impact on Discharge Disposition After Head and Neck Cancer Free Flap Reconstruction. Otolaryngol Head Neck Surg 2020; 165:59-68. [PMID: 33290190 DOI: 10.1177/0194599820973232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/21/2022]
Abstract
OBJECTIVE To determine the role of skeletal muscle index (SMI) in the assessment of frailty and determination of discharge to post-acute care facilities (PACF) after head and neck cancer free flap reconstruction (HNCFFR). STUDY DESIGN Retrospective cohort. SETTING Single-institution, academic tertiary referral center. METHODS Adult patients undergoing HNCFFR from 2014 to 2019 with preoperative abdominal computed tomography imaging were retrospectively analyzed. Patient demographics, 5-factor modified frailty index (5-mFI), body mass index (BMI), SMI at the third lumbar vertebra, oncologic history, perioperative data, and Clavien-Dindo (CD) complications were collected. Binary logistic regression was used to identify independent predictors of discharge disposition. RESULTS The cohort consisted of 206 patients, 62 (30.1%) of whom were discharged to PACF. Patients discharged to PACF were of older age (65.4 vs 57.1 years, P < .0001) and had a lower SMI (38.8 vs 46.8 cm2/m2, P < .0001), higher 5-mFI (≥3; 25.8% vs 4.2%, P < .0001), and greater incidence of stage IV (80.6% vs 64.1%, P = .0211) aerodigestive cancer (80.6% vs 66.7%, P = .0462). Patients discharged to PACF experienced more blood transfusions (74.2% vs 35.4%, P < .0001), major postoperative complications (CD ≥3, 40.3% vs 12.9%, P < .0001), and delirium (33.9% vs 4.2%, P < .0001). After adjusting for pre- and postoperative factors, multivariate binary logistic regression identified age (P = .0255), 5-mFI (P < .0042), SMI (P = .0199), stage IV cancer (P = .0250), aerodigestive tumor (P = .0366), delirium (P < .0001), and perioperative blood transfusion (P = .0144) as independent predictors of discharge to PACF. CONCLUSIONS SMI and 5-mFI are independently associated with discharge to PACF after HNCFFR and should be considered in preoperative planning and assessment of frailty.
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Affiliation(s)
- Alexander Joseph Jones
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Mohamedkazim Alwani
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leah J Novinger
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Bonetto
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael W Sim
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica A Yesensky
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael G Moore
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Avinash V Mantravadi
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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16
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Affiliation(s)
- Cherie-Ann O. Nathan
- Department of Otolaryngology–Head and Neck Surgery, LSU Health Shreveport, Shreveport, Louisiana
| | - Carole Fakhry
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael G. Moore
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
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17
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Givi B, Schiff BA, Chinn SB, Clayburgh D, Iyer NG, Jalisi S, Moore MG, Nathan CA, Orloff LA, O'Neill JP, Parker N, Zender C, Morris LGT, Davies L. Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg 2020; 146:579-584. [PMID: 32232423 DOI: 10.1001/jamaoto.2020.0780] [Citation(s) in RCA: 381] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance The rapidly expanding novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged the medical community to an unprecedented degree. Physicians and health care workers are at added risk of exposure and infection during the course of patient care. Because of the rapid spread of this disease through respiratory droplets, health care workers who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures, such as otolaryngologists-head and neck surgeons, are particularly at risk. A set of safety recommendations was created based on a review of the literature and communications with physicians with firsthand knowledge of safety procedures during the COVID-19 pandemic. Observations A high number of health care workers were infected during the first phase of the pandemic in the city of Wuhan, China. Subsequently, by adopting strict safety precautions, other regions were able to achieve high levels of safety for health care workers without jeopardizing the care of patients. The most common procedures related to the examination and treatment of upper aerodigestive tract diseases were reviewed. Each category was reviewed based on the potential risk imposed to health care workers. Specific recommendations were made based on the literature, when available, or consensus best practices. Specific safety recommendations were made for performing tracheostomy in patients with COVID-19. Conclusions and Relevance Preserving a highly skilled health care workforce is a top priority for any community and health care system. Based on the experience of health care systems in Asia and Europe, by following strict safety guidelines, the risk of exposure and infection of health care workers could be greatly reduced while providing high levels of care. The provided recommendations, which may evolve over time, could be used as broad guidance for all health care workers who are involved in the care of patients with COVID-19.
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Affiliation(s)
- Babak Givi
- Department of Otolaryngology, NYU Langone Health, New York, New York
| | - Bradley A Schiff
- Department of Otolaryngology, Montefiore Medical Center, New York, New York
| | - Steven B Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Daniel Clayburgh
- Department of Otolaryngology, Oregon Health & Science University, Portland
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, Singapore General Hospital and National Cancer Centre, Singapore
| | - Scharukh Jalisi
- Department of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael G Moore
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
| | - Cherie-Ann Nathan
- Department of Otolaryngology, Louisiana State University, Shreveport
| | - Lisa A Orloff
- Department of Otolaryngology, Stanford University, Palo Alto, California
| | - James P O'Neill
- Department of Otolaryngology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noah Parker
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
| | - Chad Zender
- Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
| | - Luc G T Morris
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Louise Davies
- Department of Veterans Affairs, White River Junction, Vermont
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18
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Sandelski MM, Rabbani CC, Moore MG, Sim MW. Flap demise reversed after central venous access device removal: A case report. Clin Case Rep 2020; 8:1631-1634. [PMID: 32983465 PMCID: PMC7495769 DOI: 10.1002/ccr3.2970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/24/2020] [Accepted: 05/02/2020] [Indexed: 11/09/2022] Open
Abstract
Patients undergoing head and neck free flap reconstruction should be evaluated for radiation-induced venous stenosis and presence of central venous port as a potential risk for flap failure.
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Affiliation(s)
| | - Cyrus C. Rabbani
- Department of Otolaryngology – Head and Neck SurgeryIndiana University School of MedicineIndianapolisINUSA
| | - Michael G. Moore
- Department of Otolaryngology – Head and Neck SurgeryIndiana University School of MedicineIndianapolisINUSA
| | - Michael W. Sim
- Department of Otolaryngology – Head and Neck SurgeryIndiana University School of MedicineIndianapolisINUSA
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19
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Ye MJ, Sharma D, Rubel KE, Lebo NL, Burgin SJ, Illing EA, Ting JY, Moore MG, Yesensky JA, Mantravadi AV, Sim MW. Droplet Exposure Risk to Providers From In-Office Flexible Laryngoscopy: A COVID-19 Simulation. Otolaryngol Head Neck Surg 2020; 164:93-96. [PMID: 32808872 DOI: 10.1177/0194599820952800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To provide data on risk of respiratory droplets from common otolaryngologic procedures during the COVID-19 pandemic, a novel simulation of droplet exposure from flexible laryngoscopy was performed. After completion of a nasal symptom questionnaire, topical fluorescein spray was administered into the nasal and oropharynx of 10 healthy volunteers, who then underwent flexible laryngoscopy under 2 conditions: routine without provoked response and with prompted sneeze/cough. After each, droplets on the proceduralist and participant were counted under ultraviolet A light. Droplets were observed on 1 of 10 volunteers after routine laryngoscopy and 4 of 10 during laryngoscopy with sneeze/cough. A nasal symptom score based on congestion and rhinorrhea was significantly elevated among droplet producers after sneeze/cough (P = .0164). No droplets were observed on the provider. Overall, with adequate personal protective equipment, flexible laryngoscopy poses minimal droplet risk to providers. Nasal symptoms can identify patients more likely to produce droplets after sneeze/cough.
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Affiliation(s)
- Michael J Ye
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Dhruv Sharma
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Kolin E Rubel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Nicole L Lebo
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Sarah J Burgin
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Jessica A Yesensky
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Avinash V Mantravadi
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Michael W Sim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
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20
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Moore MG, Yueh B, Lin DT, Bradford CR, Smith RV, Khariwala SS. Controversies in the Workup and Surgical Management of Parotid Neoplasms. Otolaryngol Head Neck Surg 2020; 164:27-36. [PMID: 32571148 DOI: 10.1177/0194599820932512] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Parotid neoplasms are a rare heterogeneous group of tumors with varied clinical presentation and behavior. Here we provide an evidence-based review of the contemporary approach to evaluation and surgical management of parotid tumors. DATA SOURCE PubMed and Web of Science Databases. REVIEW METHODS Searches of the PubMed and Web of Science databases were performed on subjects related to the diagnosis and surgical management of parotid neoplasms. Particular emphasis was placed on the following areas: evaluation of parotid tumors, including imaging workup and the utility of fine-needle aspiration; extent of surgery of the primary lesion, including the extent of parotidectomy as well as oncologic management of the facial nerve; the extent of surgery of involved and at-risk cervical lymphatics; and parotid bed reconstruction. Articles published from 2014 to the present were prioritized, supplementing with information from prior studies in areas where data are lacking. CONCLUSION A summary of the literature in these areas is outlined to provide an evidence-based approach to evaluation and management of parotid neoplasms. IMPLICATIONS FOR PRACTICE While data are available to help guide many aspects of workup and management of parotid neoplasms, further research is needed to refine protocols for this heterogeneous group of diseases.
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Affiliation(s)
- Michael G Moore
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bevan Yueh
- The University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Derrick T Lin
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | | | | | - Samir S Khariwala
- The University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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21
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Gill AS, Kinzinger M, Moore MG. Abstract B19: Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.aacrahns19-b19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: 1. To understand practice patterns among head and neck surgeons and radiation oncologists in the assessment and management of malnutrition in head and neck cancer patients. 2. To identify barriers that prevent the identification of and intervention upon malnutrition.
Background: Among patients who undergo surgery for head and neck cancer, there is a strong association between severe malnutrition and increased postoperative complications, length of stay, and cost of care. We aim to evaluate the association between the type of head and neck cancer provider and their comfort with the diagnosis and management of malnutrition in this patient population.
Methods: A 17-question survey was distributed to 1,392 members of the American Head and Neck Society (AHNS) between 04/01/2018 and 04/18/2018. Chi squared testing was used to perform subgroup analysis by hospital type, fellowship training, clinical experience, and specialty.
Results: The response rate among AHNS members was 9%, with 124 total respondents, including both otolaryngologists and radiation oncologists. There was strong agreement among respondents that malnutrition is important to identify and negatively impacts the quality of life, cost of care, length of hospital stay, mortality, and postoperative complications. The majority of respondents stated that although they were comfortable with screening for malnutrition, they were not familiar with the National Comprehensive Cancer Network (NCCN) guidelines on nutrition screening and intervention. Respondents reported use of various screening tools including serum markers, body mass index (BMI), and weight loss. Subgroup analysis demonstrated that otolaryngologists and academic hospitals were significantly more likely to screen by lab markers compared to radiation oncologists and community hospitals (p<0.05). Furthermore, although familiarity with NCCN guidelines was poor, fellowship-trained head and neck surgeons felt significantly more comfortable in their knowledge of NCCN guidelines than those without additional training (p<0.05). Barriers to screening for malnutrition included lack of training or familiarity with screening tools and guidelines, as well as lack of access to ancillary staff, such as nutritionists and speech therapists.
Conclusion: There was a strong consensus among respondents that identification and management of malnutrition among head and neck cancer patients is important. However, familiarity with guidelines on screening and treating malnutrition was lacking, occasionally leading to practice patterns that deviated from the best available evidence.
Citation Format: Amarbir S. Gill, Michael Kinzinger, Michael G. Moore. Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B19.
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Novinger LJ, Cannady SB, Wurtz LD, Sim MW, Moore MG, Mantravadi AV, Shipchandler TZ. Anterolateral thigh osteomyocutaneous femur (ALTO) flap reconstruction for composite mandible and near total tongue defect utilizing a retrograde intramedullary femoral nail stabilization technique: Report of a first case. Otolaryngology Case Reports 2020. [DOI: 10.1016/j.xocr.2020.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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23
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Yan F, Rauscher E, Hollinger A, Caputo MA, Ready J, Fakhry C, Nathan CAO, Leonardis C, Yearout D, Tsue TT, Day TA, Moore MG. The role of head and neck cancer advocacy organizations during the COVID-19 pandemic. Head Neck 2020; 42:1526-1532. [PMID: 32468607 PMCID: PMC7283757 DOI: 10.1002/hed.26287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
The COVID-19 pandemic has had a significant impact on many aspects of head and neck cancer (HNC) care. The uncertainty and stress resulting from these changes has led many patients and caregivers to turn to HNC advocacy groups for guidance and support. Here we outline some of the issues being faced by patients with HNC during the current crisis and provide examples of programs being developed by advocacy groups to address them. We also highlight the increased utilization of these organizations that has been observed as well as some of the challenges being faced by these not-for-profit groups as they work to serve the head and neck community.
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Affiliation(s)
- Flora Yan
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Erika Rauscher
- The Thyroid and Head and Neck Cancer Foundation, New York, New York, USA
| | - Amanda Hollinger
- The Head and Neck Cancer Alliance, Charleston, South Carolina, USA
| | - Mary Ann Caputo
- Support for People with Oral and Head and Neck Cancer, Locust Valley, New York, USA
| | - John Ready
- Foundation for Voice Restoration, Greenville, California, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Chris Leonardis
- Support for People with Oral and Head and Neck Cancer, Locust Valley, New York, USA
| | - Danielle Yearout
- The Head and Neck Cancer Living Foundation, Overland Park, Kansas, USA
| | - Terance T Tsue
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Givi B, Moore MG, Bewley AF, Coffey CS, Cohen MA, Hessel AC, Jalisi S, Kang S, Newman JG, Puscas L, Shindo M, Shuman A, Thakkar P, Weed DT, Chalian A. Advanced head and neck surgery training during the
COVID
‐19 pandemic. Head Neck 2020; 42:1411-1417. [DOI: 10.1002/hed.26252] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Babak Givi
- Department of OtolaryngologyNYU Langone Health New York New York USA
| | - Michael G. Moore
- Department of OtolaryngologyIndiana University Indianapolis Indiana USA
| | - Arnaud F. Bewley
- Department of OtolaryngologyUniversity of California Davis California USA
| | - Charles S. Coffey
- Department of Surgery, Division of OtolaryngologyUniversity of California San Diego California USA
| | - Marc A. Cohen
- Head and Neck ServiceMemorial Sloan‐Kettering Cancer Center New York New York USA
| | - Amy C. Hessel
- Department of Head and Neck SurgeryMD Anderson Cancer Center Houston Texas USA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Steven Kang
- Department of OtolaryngologyOhio State University Columbus Ohio USA
| | - Jason G. Newman
- Department of OtolaryngologyUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | - Liana Puscas
- Department of Head and Neck SurgeryDuke University Durham North Carolina USA
| | - Maisie Shindo
- Department of OtolaryngologyOregon Health and Science University Portland Oregon USA
| | - Andrew Shuman
- Department of OtolaryngologyUniversity of Michigan Ann Arbor Michigan USA
| | - Punam Thakkar
- Division of OtolaryngologyThe George Washington University Washington DC USA
| | - Donald T. Weed
- Department of OtolaryngologyUniversity of Miami Coral Gables Florida USA
| | - Ara Chalian
- Department of OtolaryngologyUniversity of Pennsylvania Philadelphia Pennsylvania USA
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25
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Alwani MM, Jones AJ, Novinger LJ, Pittelkow E, Bonetto A, Sim MW, Moore MG, Mantravadi AV. Erratum: Impact of Sarcopenia on Outcomes of Autologous Head and Neck Free Tissue Reconstruction. J Reconstr Microsurg 2020; 36:e1. [PMID: 32252095 DOI: 10.1055/s-0040-1709121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mohamedkazim M Alwani
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexander J Jones
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Leah J Novinger
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Eric Pittelkow
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrea Bonetto
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael W Sim
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Avinash V Mantravadi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
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26
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Zafereo M, Yu J, Onakoya PA, Aswani J, Baidoo K, Bogale M, Cairncross L, Cordes S, Daniel A, Diom E, Maurice ME, Mohammed GM, Biadgelign MG, Koné FI, Itiere A, Koch W, Konney A, Kundiona I, Macharia C, Mashamba V, Moore MG, Mugabo RM, Noah P, Omutsani M, Orloff LA, Otiti J, Randolph GW, Sebelik M, Todsen T, Twier K, Fagan JJ. African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings. Head Neck 2020; 42:1746-1756. [PMID: 32144948 DOI: 10.1002/hed.26094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/07/2019] [Revised: 10/11/2019] [Accepted: 01/15/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. METHODS Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. RESULTS Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. CONCLUSIONS Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources.
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Affiliation(s)
- Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Justin Yu
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Paul A Onakoya
- Department of Otorhinolaryngology, University of Ibadan, Ibadan, Nigeria
| | - Joyce Aswani
- Department of Surgery, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Kenneth Baidoo
- Department of Otolaryngology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Mesele Bogale
- Department of Surgery, Adama Hospital Medical College, Adama, Ethiopia
| | - Lydia Cairncross
- Department of Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Adekunle Daniel
- Department of Otorhinolaryngology, University of Ibadan, Ibadan, Nigeria
| | - Evelyne Diom
- Department of Otolaryngology, Assane Seck University, Ziguinchor, Senegal
| | - Mpessa E Maurice
- Department of Otolaryngology, University Hospital of Yopougon, Abidjan, Ivory Coast
| | - Garba M Mohammed
- Department of Otolaryngology, Kaduna State University, Kaduna, Nigeria
| | | | - Fatogoma I Koné
- Department of Head and Neck Surgery, Gabriel Touré University Hospital, Bamako, Mali
| | - Arnaud Itiere
- Department of Otorhinolaryngology, General Hospital of Brazzaville, Brazzaville, Congo
| | - Wayne Koch
- Department of ORL/Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Anna Konney
- Department of Otolaryngology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Innocent Kundiona
- Department of Otolaryngology, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Chege Macharia
- Department of General Surgery, AIC Kijabe Hospital, Kenya
| | - Victor Mashamba
- Department of Otorhinolaryngology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Rajab M Mugabo
- Department of Otolaryngology, King Faisal Hospital, Kigali, Rwanda
| | - Patrick Noah
- Department of Surgery, University of Malawi, Zomba, Malawi
| | - Mary Omutsani
- Department of Otolaryngology-Head and Neck Surgery, Kenyatta National Hospital, Nairobi, Kenya
| | - Lisa A Orloff
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey Otiti
- Department of Otolaryngology, Uganda Cancer Institute, Kampala, Uganda
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Merry Sebelik
- Department of Otolaryngology, Head and Neck Surgery, Emory School of Medicine, Atlanta, Georgia
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Khaled Twier
- Department of Otohinolaryngology, University of Cape Town, Cape Town, South Africa
| | - Johannes J Fagan
- Department of Otohinolaryngology, University of Cape Town, Cape Town, South Africa
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27
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Alwani MM, Jones AJ, Novinger LJ, Pittelkow E, Bonetto A, Sim MW, Moore MG, Mantravadi AV. Impact of Sarcopenia on Outcomes of Autologous Head and Neck Free Tissue Reconstruction. J Reconstr Microsurg 2020; 36:369-378. [PMID: 32088918 DOI: 10.1055/s-0040-1701696] [Citation(s) in RCA: 19] [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: 10/24/2022]
Abstract
BACKGROUND Sarcopenia has been implicated as a positive predictor of postsurgical complications. Its role in head and neck (H&N) free flap reconstruction has yet to be examined. Our study aimed to determine the clinical impact of sarcopenia on postoperative outcomes in patients receiving autologous free tissue reconstruction for H&N cancer (HNC). METHODS A retrospective case-control study was conducted at our tertiary referral center. Patients with HNC who received oncologic resection followed by autologous free tissue reconstruction were included. Preoperative abdominal computed tomography (CT) imaging was analyzed at the third lumbar vertebra (L3) to calculate skeletal muscle cross-sectional area (CSA, cm2). Skeletal muscle index (SMI, cm2/m2) was calculated by normalizing CSA to patient height. Sarcopenia at L3 was defined as SMI ≤ 41.6 cm2/m2 for males and ≤ 32.0 cm2/m2 for females. Data analyses were performed to compare postoperative outcomes. RESULTS Of the 168 patients who met inclusion criteria, 47 patients (28.0%) were determined to have preoperative sarcopenia. The sarcopenic group was older (63 vs. 58 years, p = 0.017), had lower body mass index (BMI; 21.2 vs. 27.2, p < 0.001), had greater incidence of alcohol abuse (55.3 vs. 23.1%, OR = 4.11, p < 0.001). Intraoperatively, sarcopenic patients were found to have greater rates of blood transfusions (63.8 vs. 29.8%, p < 0.001). Postoperatively, sarcopenic patients had higher rates of pneumonia (p < 0.01), venous thromboembolism (p < 0.01), prolonged ventilation (p < 0.01), delirium (p < 0.01), fistula (p < 0.05), wound disruption (p < 0.05), and longer intensive care unit stays (p < 0.05). Sarcopenic patients were ultimately found to have higher overall rates of general postoperative complications (p < 0.001) and flap-specific complications (p < 0.01). CONCLUSION Sarcopenia was found to be a predictor of postoperative complications in H&N free flap reconstruction, signifying its value as a negative prognostic factor in surgical outcomes. This study reflects level of evidence IV.
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Affiliation(s)
- Mohamedkazim M Alwani
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexander J Jones
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Leah J Novinger
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Eric Pittelkow
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrea Bonetto
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael W Sim
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Avinash V Mantravadi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
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28
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Harris BN, Pipkorn P, Nguyen KNB, Jackson RS, Rao S, Moore MG, Farwell DG, Bewley AF. Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck. JAMA Otolaryngol Head Neck Surg 2020; 145:153-158. [PMID: 30570645 DOI: 10.1001/jamaoto.2018.3650] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignant tumors worldwide. There is conflicting evidence regarding the indications for and benefits of adjuvant radiation therapy for advanced CSCC tumors of the head and neck. Objective To assess indications for adjuvant radiation therapy in patients with CSCC. Design, Setting, and Participants Retrospective analysis of 349 patients with head and neck CSCC treated with primary resection with or without adjuvant radiation therapy at 2 tertiary referral centers from January 1, 2008, to June 30, 2016. Main Outcomes and Measures Data were compared between treatment groups with a χ2 analysis. Disease-free survival (DFS) and overall survival (OS) were analyzed using a Kaplan-Meier survival analysis with log-rank test and a Cox proportional hazards multivariate regression. Results A total of 349 patients had tumors that met the inclusion criteria (mean [SD] age, 70 [12] years; age range, 32-94 years; 302 [86.5%] male), and 191 (54.7%) received adjuvant radiation therapy. The 5-year Kaplan-Meier estimates were 59.4% for DFS and 47.4% for OS. Patients with larger, regionally metastatic, poorly differentiated tumors with perineural invasion (PNI) and younger immunosuppressed patients were more likely to receive adjuvant radiation therapy. On Cox proportional hazards multivariate regression, patients with periorbital tumors (hazard ratio [HR], 2.48; 95% CI, 1.00-6.16), PNI (HR, 1.90; 95% CI, 1.12-3.19), or N2 or greater nodal disease (HR, 2.16; 95% CI, 1.13-4.16) had lower DFS. Immunosuppressed patients (HR, 2.17; 95% CI, 1.12-4.17) and those with N2 or greater nodal disease (HR, 2.43; 95% CI, 1.42-4.17) had lower OS. Adjuvant radiation therapy was associated with improved OS for the entire cohort (HR, 0.59; 95% CI, 0.38-0.90). In a subset analysis of tumors with PNI, adjuvant radiation therapy was associated with improved DFS (HR, 0.47; 95% CI, 0.23-0.93) and OS (HR, 0.44; 95% CI, 0.24-0.86). Adjuvant radiation therapy was also associated with improved DFS (HR, 0.36; 95% CI, 0.15-0.84) and OS (HR, 0.30; 95% CI, 0.15-0.61) in patients with regional disease. Conclusions and Relevance Among patients with advanced CSCC, receipt of adjuvant radiation therapy was associated with improved survival in those with PNI and regional disease.
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Affiliation(s)
- Brianna N Harris
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ky Nam Bai Nguyen
- Department of Radiation Oncology, University of California, Davis, Sacramento
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Shyam Rao
- Department of Radiation Oncology, University of California, Davis, Sacramento
| | - Michael G Moore
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - D Gregory Farwell
- Department of Otolaryngology, University of California, Davis, Sacramento
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California, Davis, Sacramento
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29
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Weyers BW, Marsden M, Sun T, Bec J, Bewley AF, Gandour-Edwards RF, Moore MG, Farwell DG, Marcu L. Fluorescence lifetime imaging for intraoperative cancer delineation in transoral robotic surgery. Transl Biophotonics 2019; 1. [PMID: 32656529 PMCID: PMC7351319 DOI: 10.1002/tbio.201900017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/08/2022] Open
Abstract
This study evaluates the potential for fluorescence lifetime imaging (FLIm) to enhance intraoperative decisionmaking during robotic-assisted surgery of oropharyngeal cancer. Using a custom built FLIm instrument integrated with the da Vinci robotic surgical platform, we first demonstrate that cancer in epithelial tissue diagnosed by histopathology can be differentiated from surrounding healthy epithelial tissue imaged in vivo prior to cancer resection and ex vivo on the excised specimen. Second, we study the fluorescence properties of tissue imaged in vivo at surgical resection margins (tumor bed). Fluorescence lifetimes and spectral intensity ratios were calculated for three spectral channels, producing a set of six FLIm parameters. Current results from 10 patients undergoing TORS procedures demonstrate that healthy epithelium can be resolved from cancer (P < .001) for at least one FLIm parameter. We also showed that a multiparameter linear discriminant analysis approach provides superior discrimination to individual FLIm parameters for tissue imaged both in vivo and ex vivo. Overall, this study highlights the potential for FLIm to be developed into a diagnostic tool for clinical cancer applications of the oropharynx. This technique could help to circumvent the issues posed by the lack of tactile feedback associated with robotic surgical platforms to better enable cancer delineation.
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Affiliation(s)
- Brent W Weyers
- Department of Biomedical Engineering, University of California, Davis, California
| | - Mark Marsden
- Department of Biomedical Engineering, University of California, Davis, California
| | - Tianchen Sun
- Department of Computer Science, University of California, Davis, California
| | - Julien Bec
- Department of Biomedical Engineering, University of California, Davis, California
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California, Davis, California
| | | | - Michael G Moore
- Department of Otolaryngology, University of California, Davis, California
| | - D Gregory Farwell
- Department of Otolaryngology, University of California, Davis, California
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, California
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Phillips TJ, Harris BN, Moore MG, Farwell DG, Bewley AF. Pathological margins and advanced cutaneous squamous cell carcinoma of the head and neck. J Otolaryngol Head Neck Surg 2019; 48:55. [PMID: 31653276 PMCID: PMC6815033 DOI: 10.1186/s40463-019-0374-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 03/01/2019] [Accepted: 09/21/2019] [Indexed: 11/26/2022] Open
Abstract
Objective The recommended treatment for cutaneous squamous cell cancer (CuSCC) of the head and neck is Mohs surgical excision or wide local excision. Excision is recommended to a gross surgical margin of 4–6 mm however this is based on limited evidence and specify a goal histologic margin. The objective of this study was therefore to examine the reported histological margin distance following WLE of advanced CuSCC and its association with recurrence and survival. Study design Retrospective database review. Setting All patients included received treatment at UC Davis Department of Otolaryngology-Head and Neck Surgery and/or Radiation Oncology in Sacramento, California. Subjects and methods The patients included were treated for advanced CuSCC with primary surgery with or without adjuvant therapy. Kaplan Meier survival curves with log rank analysis were then performed to compare 5-year recurrence free survival, and disease-specific survival for patients with different margin distances. Results Total number of subjects was 92. The overall 5-year DSS and RFS was 68.8 and 51.0% respectively. When the pathological margin distance was ≥5 mm, 5-year disease specific survival was improved when compared to margin distance less than 5 mm (94.7 vs 60.7 p = 0.034). Conclusion The findings of this study suggest that a histologic margin of at least 5 mm may increase survival in advanced head and neck CuSCC patients.
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Affiliation(s)
- T J Phillips
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA. .,Division of Head and Neck Surgery, Kingston Health Science Center, Queen's University, 2nd Floor Murray Building, Hotel Dieu Hospital, Bagot Street, Kingston, Ontario, Canada.
| | - B N Harris
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA
| | - M G Moore
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA
| | - D G Farwell
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA
| | - A F Bewley
- Department of Otolaryngology-Head and Neck Surgery, UC Davis, Sacramento, California, USA
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31
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Gill AS, Kinzinger M, Bewley AF, Farwell DG, Moore MG. Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists. Head Neck 2019; 41:3850-3857. [PMID: 31403751 DOI: 10.1002/hed.25909] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/08/2019] [Accepted: 07/30/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Physician practice patterns regarding diagnosis and management of malnutrition in the head and neck cancer patient population are not well studied. METHODS A 17-question survey was distributed to 1392 members of the American Head and Neck Society (AHNS). The impact of hospital type, fellowship training, experience, and specialty was assessed. RESULTS Among AHNS members, there were 124 total respondents (9% response rate), including both otolaryngologists and radiation oncologists. Respondents strongly agreed (90%) that malnutrition negatively impacts patient outcomes. The majority (63%) felt comfortable screening for malnutrition, but 13% reported no routine assessment of malnutrition; 57% were unfamiliar with relevant guidelines. Barriers to screening included lack of familiarity with screening tools/guidelines, lack of time, and lack of access to dietitian. CONCLUSION Although there was a strong consensus among respondents that the identification and management of malnutrition among head and neck cancer patients is critical, familiarity with relevant guidelines was poor.
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Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Michael Kinzinger
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Arnaud F Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California
| | - D Gregory Farwell
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Michael G Moore
- Head and Neck Surgery, Indiana University, Indianapolis, Indiana
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32
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Chu LP, Franck D, Parachoniak CA, Gregg JP, Moore MG, Farwell DG, Rao S, Heilmann AM, Erlich RL, Ross JS, Miller VA, Ali S, Riess JW. MET Genomic Alterations in Head and Neck Squamous Cell Carcinoma (HNSCC): Rapid Response to Crizotinib in a Patient with HNSCC with a Novel MET R1004G Mutation. Oncologist 2019; 24:1305-1308. [PMID: 31391294 DOI: 10.1634/theoncologist.2019-0230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/27/2019] [Indexed: 12/21/2022] Open
Abstract
Identification of effective targeted therapies for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) remains an unmet medical need. A patient with platinum-refractory recurrent oral cavity HNSCC underwent comprehensive genomic profiling (CGP) that identified an activating MET mutation (R1004). The patient was treated with the oral MET tyrosine kinase inhibitor crizotinib with rapid response to treatment.Based on this index case, we determined the frequency of MET alterations in 1,637 HNSCC samples, which had been analyzed with hybrid capture-based CGP performed in the routine course of clinical care. The specimens were sequenced to a median depth of >500× for all coding exons from 182 (version 1, n = 24), 236 (version 2, n = 326), or 315 (version 3, n = 1,287) cancer-related genes, plus select introns from 14 (version 1), 19 (version 2), or 28 (version 3) genes frequently rearranged in cancer. We identified 13 HNSCC cases (0.79%) with MET alterations (4 point mutation events and 9 focal amplification events). MET-mutant or amplified tumors represent a small but potentially actionable molecular subset of HNSCC. KEY POINTS: This case report is believed to be the first reported pan-cancer case of a patient harboring a MET mutation at R1004 demonstrating a clinical response to crizotinib, in addition to the first documented case of head and neck squamous cell carcinoma (HNSCC) with any MET alteration responding to crizotinib.The positive response to MET inhibition in this patient highlights the significance of comprehensive genomic profiling in advanced metastatic HNSCC to identify actionable targetable molecular alterations as current treatment options are limited.
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Affiliation(s)
- Lisa Pei Chu
- Department of Internal Medicine, Division of Hematology/Oncology, UC Davis School of Medicine, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Debra Franck
- Foundation Medicine, Cambridge, Massachusetts, USA
| | | | - Jeffrey P Gregg
- Department of Pathology, UC Davis School of Medicine, Sacramento, California, USA
| | - Michael G Moore
- Department of Otolaryngology, UC Davis School of Medicine, Sacramento, California, USA
| | - D Gregory Farwell
- Department of Otolaryngology, UC Davis School of Medicine, Sacramento, California, USA
| | - Shyam Rao
- Department of Radiation Oncology, UC Davis School of Medicine, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | | | | | | | | | - Siraj Ali
- Foundation Medicine, Cambridge, Massachusetts, USA
| | - Jonathan W Riess
- Department of Internal Medicine, Division of Hematology/Oncology, UC Davis School of Medicine, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
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Timbang MR, Sim MW, Bewley AF, Farwell DG, Mantravadi A, Moore MG. HPV-related oropharyngeal cancer: a review on burden of the disease and opportunities for prevention and early detection. Hum Vaccin Immunother 2019; 15:1920-1928. [PMID: 31050595 PMCID: PMC6746516 DOI: 10.1080/21645515.2019.1600985] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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: 10/01/2018] [Revised: 03/07/2019] [Accepted: 03/23/2019] [Indexed: 12/21/2022] Open
Abstract
The incidence of oropharyngeal cancer (OPC) related to infection with human papillomavirus (HPV) is rising, making it now the most common HPV-related malignancy in the United States. These tumors present differently than traditional mucosal head and neck cancers, and those affected often lack classic risk factors such as tobacco and alcohol use. Currently, there are no approved approaches for prevention and early detection of disease, thus leading many patients to present with advanced cancers requiring intense surgical or nonsurgical therapies resulting in significant side effects and cost to the health-care system. In this review, we outline the evolving epidemiology of HPV-related OPC. We also summarize the available evidence corresponding to HPV-related OPC prevention, including efficacy and safety of the HPV vaccine in preventing oral HPV infections. Finally, we describe emerging techniques for identifying and screening those who may be at high risk for developing these tumors.
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Affiliation(s)
- Mary Roz Timbang
- Department of Otolaryngology-Head and Neck Surgery, The University of California, Davis, Sacramento, CA, USA
| | - Michael W. Sim
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology-Head and Neck Surgery, The University of California, Davis, Sacramento, CA, USA
| | - D. Gregory Farwell
- Department of Otolaryngology-Head and Neck Surgery, The University of California, Davis, Sacramento, CA, USA
| | - Avinash Mantravadi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Michael G. Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
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Gill AS, Nittur VR, Moore MG, Farwell DG, Bewley AF. Oncologic outcomes after surgery for locally aggressive basal cell carcinoma of the head and neck. Laryngoscope 2019; 130:115-119. [PMID: 30835833 DOI: 10.1002/lary.27882] [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] [Accepted: 01/30/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although basal cell carcinoma (BCC) is the most common skin cancer, locally aggressive BCC of the head and neck is rare and not well studied. STUDY DESIGN Retrospective review of patients who underwent primary surgical resection of locally aggressive head and neck BCC at a single tertiary academic center. RESULTS Eighty-seven patients with 98 tumors demonstrated a 5-year Kaplan-Meier estimated recurrence-free survival of 64.5%, overall survival of 83.3%, and disease-specific survival of 98.3%. Intraoperative positive frozen section margin was a strong independent predictor of local recurrence (hazard ratio 6.88, P = 0.038) and was more likely to occur in tumors previously treated with radiation (odds ratio 6.47 = 0.05). CONCLUSION Locally aggressive BCCs of the head and neck have high rates of local recurrence but low disease-specific mortality when treated with primary surgery and selected use of adjuvant therapy. Intraoperative positive frozen section margin is a strong independent predictor of local recurrence and is more likely in tumors that were previously treated with radiation therapy. LEVEL OF EVIDENCE 4 Laryngoscope, 130:115-119, 2020.
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Affiliation(s)
- Amarbir S Gill
- Division of Otolaryngology-Head and Neck Surgery, The University of California, Davis , Sacramento, California, U.S.A
| | - Vinay R Nittur
- Division of Otolaryngology-Head and Neck Surgery, The University of California, Davis , Sacramento, California, U.S.A
| | - Michael G Moore
- Division of Otolaryngology-Head and Neck Surgery, The University of California, Davis , Sacramento, California, U.S.A
| | - D Gregory Farwell
- Division of Otolaryngology-Head and Neck Surgery, The University of California, Davis , Sacramento, California, U.S.A
| | - Arnaud F Bewley
- Division of Otolaryngology-Head and Neck Surgery, The University of California, Davis , Sacramento, California, U.S.A
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Gill A, Givi B, Moore MG. AHNS Series - Do you know your guidelines?: Assessment and management of malnutrition in patients with head and neck cancer: Review of the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines). Head Neck 2018; 41:577-583. [PMID: 30597657 DOI: 10.1002/hed.24866] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/22/2017] [Indexed: 01/08/2023] Open
Abstract
This article is a part of the "Do you know your guidelines" series by the Education Committee of the American Head and Neck Society. The aim is to summarize the core principles outlined by the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines® ) on management of malnutrition in patients with head and neck cancer. We outline the current recommendations from the National Comprehensive Cancer Network® (NCCN® ) for the screening and management of malnutrition, including indications for nutritional supplementation and placement of a nasogastric or gastrostomy tube. We also include a brief review of the available literature on additional screening tools, alternative guidelines, as well as an update on the emerging data surrounding the use of immune-enhancing nutrition.
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Affiliation(s)
- Amarbir Gill
- University of California at Davis, Department of Otolaryngology - Head and Neck Surgery, Sacramento, California
| | - Babak Givi
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Medical Center, New York, New York
| | - Michael G Moore
- University of California at Davis, Department of Otolaryngology - Head and Neck Surgery, Sacramento, California
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Mantravadi AV, Moore MG, Rassekh CH. AHNS series: Do you know your guidelines? Diagnosis and management of salivary gland tumors. Head Neck 2018; 41:269-280. [PMID: 30548929 DOI: 10.1002/hed.25499] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/23/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022] Open
Abstract
This article is the next installment of the series "Do you know your guidelines" presented by the Education Committee of the American Head and Neck Society. Guidelines for the workup and management of tumors of the major and minor salivary glands are reviewed.
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Affiliation(s)
- Avinash V Mantravadi
- Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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LaGrow TJ, Moore MG, Prasad JA, Davenport MA, Dyer EL. Approximating Cellular Densities from High-Resolution Neuroanatomical Imaging Data. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:1-4. [PMID: 30440243 DOI: 10.1109/embc.2018.8512220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Characterizing the cellular architecture (cytoar-chitecture) of tissues in the nervous system is critical for modeling disease progression, defining boundaries between brain regions, and informing models of neural information processing. Extracting this information from anatomical data requires the expertise of trained neuroanatomists, and is a challenging task for inexperienced analysts. To address this need, we present an unbiased, automated method to estimate cellular density of retinal and neocortical datasets. Our approach leverages the fact that within retinal and neurocortical datasets, cells are organized into "layers" of constant density to approximate cytoarchitecture with a small number of known basis elements. We introduce methods for patch extraction, cell detection, and sparse approximation of inhomogeneous Poisson processes to differentiate changes in cellular densities and detect layers. Our results demonstrate the feasibility of using automation to reveal the cytoarchitecture of large-scale biological samples.
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Gill A, Farwell DG, Moore MG. Nutrition and Perioperative Care for the Patient with Head and Neck Cancer. Oral Maxillofac Surg Clin North Am 2018; 30:411-420. [DOI: 10.1016/j.coms.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Harris BN, Bayoumi A, Rao S, Moore MG, Farwell DG, Bewley AF. Factors Associated with Recurrence and Regional Adenopathy for Head and Neck Cutaneous Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 156:863-869. [DOI: 10.1177/0194599817697053] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignancies worldwide. With advanced CSCC of the head and neck, there is conflicting evidence on what constitutes high-risk disease. Our objective is to evaluate which factors are predictive of recurrence and nodal spread and survival. Study Design Case series with chart review. Setting Tertiary academic institution. Subjects and Methods Patients with advanced head and neck CSCC treated with primary resection identified by chart review. Results A total of 212 patients met inclusion criteria, with a mean age of 70.4 years; 87.3% were men. Mean tumor diameter was 3.65 cm, with an average depth of invasion of 1.38 cm. The mean follow-up time was 35 months (median, 21.5), and over that period 67 recurrences were recorded, 49 of which were local. The 5-year Kaplan-Meier estimate of disease-free survival for the cohort was 53.2%. On Cox multivariate analysis, recurrent disease, perineural invasion (PNI), and poorly differentiated histology were independent predictors of recurrence. On multinomial logistic regression, patients with primary tumors on the ear, cheek, temple, or lip, as well as those with PNI, were more likely to present with nodal metastasis. Conclusion For advanced CSCCs of the head and neck, patients with recurrent disease, PNI, and poorly differentiated tumors are at highest risk for local recurrence. Patients with tumors or the ear, cheek, temple, or lip, as well as those with PNI, are at increased risk of harboring nodal disease.
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Affiliation(s)
- Brianna N. Harris
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - Ahmed Bayoumi
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - Shyam Rao
- Department of Radiation Oncology, University of California–Davis, Sacramento, California, USA
| | - Michael G. Moore
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - D. Gregory Farwell
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
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Schneider AL, Deig CR, Prasad KG, Nelson BG, Mantravadi AV, Brigance JS, Langer MP, McDonald MW, Johnstone PA, Moore MG. Ability of the National Surgical Quality Improvement Program Risk Calculator to Predict Complications Following Total Laryngectomy. JAMA Otolaryngol Head Neck Surg 2016; 142:972-979. [DOI: 10.1001/jamaoto.2016.1809] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexander L. Schneider
- Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Christopher R. Deig
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kumar G. Prasad
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Benton G. Nelson
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Avinash V. Mantravadi
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Joseph S. Brigance
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark P. Langer
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark W. McDonald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | - Michael G. Moore
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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McDonald MW, Zolali-Meybodi O, Lehnert SJ, Estabrook NC, Liu Y, Cohen-Gadol AA, Moore MG. Reirradiation of Recurrent and Second Primary Head and Neck Cancer With Proton Therapy. Int J Radiat Oncol Biol Phys 2016; 96:808-819. [PMID: 27788954 DOI: 10.1016/j.ijrobp.2016.07.037] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 06/10/2016] [Accepted: 07/27/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the clinical outcomes of head and neck reirradiation with proton therapy. METHODS AND MATERIALS From 2004 to 2014, 61 patients received curative-intent proton reirradiation, primarily for disease involving skull base structures, at a median of 23 months from the most recent previous course of radiation. Most had squamous cell (52.5%) or adenoid cystic (16.4%) carcinoma. Salvage surgery before reirradiation was undertaken in 47.5%. Gross residual disease was present in 70.5%. For patients with microscopic residual disease, the median dose of reirradiation was 66 Gy (relative biological effectiveness), and for gross disease was 70.2 Gy (relative biological effectiveness). Concurrent chemotherapy was given in 27.9%. RESULTS The median follow-up time was 15.2 months and was 28.7 months for patients remaining alive. The 2-year overall survival estimate was 32.7%, and the median overall survival was 16.5 months. The 2-year cumulative incidence of local failure with death as a competing risk was 19.7%; regional nodal failure, 3.3%; and distant metastases, 38.3%. On multivariable analysis, Karnofsky performance status ≤70%, the presence of a gastrostomy tube before reirradiation, and an increasing number of previous courses of radiation therapy were associated with a greater hazard ratio for death. A cutaneous primary tumor, gross residual disease, increasing gross tumor volume, and a lower radiation dose were associated with a greater hazard ratio for local failure. Grade ≥3 toxicities were seen in 14.7% acutely and 24.6% in the late setting, including 3 treatment-related deaths. CONCLUSIONS Reirradiation with proton therapy, with or without chemotherapy, provided reasonable locoregional disease control, toxicity profiles, and survival outcomes for an advanced-stage and heavily pretreated population. Additional data are needed to identify which patients are most likely to benefit from aggressive efforts to achieve local disease control and to evaluate the potential benefit of proton therapy relative to other modalities of reirradiation.
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Affiliation(s)
- Mark W McDonald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
| | - Omid Zolali-Meybodi
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen J Lehnert
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Neil C Estabrook
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Prasad KG, Nelson BG, Deig CR, Schneider AL, Moore MG. ACS NSQIP Risk Calculator. Otolaryngol Head Neck Surg 2016; 155:740-742. [DOI: 10.1177/0194599816655976] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/01/2016] [Indexed: 11/17/2022]
Abstract
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator is meant to provide an estimation of perioperative risk. Our goal was to determine the clinical applicability of the calculator in major head and neck surgery. A retrospective chart review was completed for major head and neck operations performed at 1 institution from 2013 to 2014. The calculated perioperative complication risks from the ACS NSQIP calculator were compared with observed complication rates. Overall, the ACS NSQIP calculator had little predictive value for pneumonia, surgical site infection, 30-day return to operating room, or length of stay within this cohort ( P > .05). The calculator appears to have some value predicting total numbers of complications but has poor performance predicting an individual’s risk of suffering a perioperative complication. In conclusion, in our small cohort of patients, the ACS NSQIP calculator was a poor predictor of perioperative complications following major head and neck operations.
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Affiliation(s)
- Kumar G. Prasad
- Department of Otolaryngology–Head and Neck Surgery, Meritas Health, North Kansas City, Missouri, USA
| | - Benton G. Nelson
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christopher R. Deig
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander L. Schneider
- Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael G. Moore
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Moore MG, Deschler DG, McKenna MJ, Varvares MA, Lin DT. Management outcomes following lateral temporal bone resection for ear and temporal bone malignancies. Otolaryngol Head Neck Surg 2016; 137:893-8. [DOI: 10.1016/j.otohns.2007.09.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 08/17/2007] [Accepted: 09/10/2007] [Indexed: 11/29/2022]
Abstract
Objective To evaluate clinical outcomes following lateral temporal bone resection (LTBR) for management of malignancies involving the ear or temporal bone. Subjects and Methods A retrospective medical record review was performed on patients receiving LTBR for management of malignancies involving the ear or temporal bone between 1990 and 2007. Results In this group of 35 patients, the mean age was 62.7 years, with tumor histopathologies including squamous cell carcinoma (SCC, 20), basal cell carcinoma (BCC, 7), adenoid cystic carcinoma (ACC, 7), and adenocarcinoma (1). The 5-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 77%, 79%, and 52%, respectively. Complete resection resulted in improved OS, DSS, and DFS ( P < 0.004 for each) and reduced local recurrence ( P < 0.001). Conclusions In patients with carcinomas of the ear and temporal bone, upfront excision including LTBR is an effective management when combined with postoperative radiation therapy. Complete removal of all disease may improve survival and decrease recurrence.
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Affiliation(s)
- Michael G. Moore
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | | | | | | | - Derrick T. Lin
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
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McDonald MW, Liu Y, Moore MG, Johnstone PAS. Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy. Radiat Oncol 2016; 11:32. [PMID: 26922239 PMCID: PMC4769827 DOI: 10.1186/s13014-016-0600-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 10/21/2015] [Accepted: 01/23/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT). METHODS Forty patients received comprehensive head and neck radiation including bilateral cervical nodal radiation, given with or without chemotherapy, for tumors of the nasopharynx, nasal cavity or paranasal sinuses, any T stage, N0-2. Fourteen received comprehensive treatment with proton therapy, and 26 were treated with IMRT, either comprehensively or matched to proton therapy delivered to the primary tumor site. Toxicity endpoints assessed included g-tube dependence at the completion of radiation and at 3 months after radiation, opioid pain medication requirement compared to pretreatment normalized as equivalent morphine dose (EMD) at completion of treatment, and at 1 and 3 months after radiation. RESULTS In a multivariable model including confounding variables of concurrent chemotherapy and involved nodal disease, comprehensive head and neck radiation therapy using proton therapy was associated with a lower opioid pain requirement at the completion of radiation and a lower rate of gastrostomy tube dependence by the completion of radiation therapy and at 3 months after radiation compared to IMRT. Proton therapy was associated with statistically significant lower mean doses to the oral cavity, esophagus, larynx, and parotid glands. In subgroup analysis of 32 patients receiving concurrent chemotherapy, there was a statistically significant correlation with a greater opioid pain medication requirement at the completion of radiation and both increasing mean dose to the oral cavity and to the esophagus. CONCLUSIONS Proton therapy was associated with significantly reduced radiation dose to assessed non-target normal tissues and a reduced rate of gastrostomy tube dependence and opioid pain medication requirements. This warrants further evaluation in larger studies, ideally with patient-reported toxicity outcomes and quality of life endpoints.
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Affiliation(s)
- Mark W McDonald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd NE Suite A1300, Atlanta, GA, 30322, USA.
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, GA, USA.
| | - Michael G Moore
- Department of Otolaryngology/Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Peter A S Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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Moore MG, Netterville JL, Mendenhall WM, Isaacson B, Nussenbaum B. Head and Neck Paragangliomas. Otolaryngol Head Neck Surg 2016; 154:597-605. [DOI: 10.1177/0194599815627667] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022]
Abstract
Objective Head and neck paragangliomas are a group of slow-growing hypervascular tumors associated with the paraganglion system. The approach to evaluate and treat these lesions has evolved over the last 2 decades. While radical surgery had been the traditional approach, improvements in diagnostic imaging as well as radiation therapy techniques have led to an emphasis on observation and nonsurgical therapy in many patients. This article reviews the contemporary approach to the workup and management of head and neck paragangliomas. Data Source Articles were identified from PubMed. Review Methods PubMed searches with the following keywords were performed: carotid body paraganglioma management, vagal paraganglioma management, jugulotympanic paraganglioma management, imaging of head and neck paragangliomas, head and neck paraganglioma embolization, paraganglioma radiation, head and neck paraganglioma management, observation of head and neck paragangliomas, bilateral carotid body paragangliomas, and genetics of paragangliomas. Review and original research articles available in the English language and published during or after 2009 were selected on the basis of their clinical relevance and scientific strength. Certain articles published prior to 2009 were also included if they provided background information that was relevant. Conclusions/Implications for Practice Workup and treatment of head and neck paragangliomas are changing. With more now known regarding the longitudinal behavior of these tumors, observation and nonsurgical therapy are indicated in many instances. For patients where surgery is the most appropriate option, improved diagnostic and perioperative techniques are allowing patients to tolerate resection, often with reduced morbidity.
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Affiliation(s)
- Michael G. Moore
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James L. Netterville
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida School of Medicine, Gainesville, Florida, USA
| | - Brandon Isaacson
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brian Nussenbaum
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Booth M, Hill G, Moore MJ, Dalla D, Moore MG, Messenger A. The new Australian Primary Health Networks: how will they integrate public health and primary care? Public Health Res Pract 2016; 26:e2611603. [PMID: 26863166 DOI: 10.17061/phrp2611603] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
On 1 July 2015, the Australian Government established 31 new Primary Health Networks (PHNs), following a review by its former Chief Medical Officer, John Horvath, of 61 Medicare Locals created under the previous Labor administration. The Horvath review recommended, among other things, that new, larger primary health organisations be established to reduce fragmentation of care by integrating and coordinating health services, supporting the role of general practice, and leveraging and administering health program funding. The two main objectives of the new PHNs, as stated on the Department of Health's website, are "increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time". Below are three viewpoints, commissioned for this primary health care themed issue of Public Health Research & Practice, from the Australian Government Department of Health, the Public Health Association of Australia and a Sydney-based PHN. We asked the authors to focus particularly on how the newly established networks might help to integrate public health within the primary health care landscape. Our authors have pointed out the huge overlap between public health and primary care and looked at evidence showing the great benefits for health systems of collaboration between the two. Challenges ahead include a possible government focus on delivery of 'frontline' medical services, which may come at the expense of population health, and the complexity of dealing with all primary health care stakeholders, including health professionals, Local Health Districts, nongovernment organisations, research institutions and local communities.
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Affiliation(s)
- Mark Booth
- Health Systems Policy Division, Strategic Policy and Innovation Group, Australian Government Department of Health, Canberra, ACT, Australia
| | - Graham Hill
- Health Systems Policy Division, Strategic Policy and Innovation Group, Australian Government Department of Health, Canberra, ACT, Australia
| | - Michael J Moore
- Public Health Association of Australia, Canberra, ACT, Australia
| | - Danielle Dalla
- Public Health Association of Australia, Canberra, ACT, Australia
| | - Michael G Moore
- Central and Eastern Sydney Primary Health Network, NSW, Australia
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Royer AK, Royer MC, Ting JY, Weisberger EC, Moore MG. The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature. J Med Case Rep 2015; 9:251. [PMID: 26520064 PMCID: PMC4628779 DOI: 10.1186/s13256-015-0728-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 06/02/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The closure of complex tracheocutaneous fistulae is a surgical challenge. We describe a staged approach for management of a patient with a large tracheocutaneous fistula in the setting of prior surgery and local radiation therapy. CASE PRESENTATION A 66-year-old Caucasian man who had undergone prior surgery and radiation therapy to the lower neck presented to our hospital for treatment of a large tracheocutaneous fistula that had developed with an adjacent area of tracheal stenosis. A prefabricated composite graft made up of an inner mucosal lining (buccal mucosa), a central cartilage structure (conchal cartilage), and external skin lining was constructed on the patient's distal volar forearm and subsequently harvested in a staged fashion. This graft was transferred as a free flap and successfully used to close the patient's defect following revascularization. Sixty months after surgery, the patient had no airway compromise or new dysphonia. CONCLUSIONS The use of a prefabricated mucosally lined composite graft can allow for successful closure of large tracheocutaneous fistulae, even in the setting of prior radiation therapy.
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Affiliation(s)
- Allison K Royer
- Columbus ENT and Allergy, Columbus Regional Health, Columbus, IN, USA.
| | - Mark C Royer
- Columbus ENT and Allergy, Columbus Regional Health, Columbus, IN, USA.
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 550 North University Boulevard, Room 3170, Indianapolis, IN, 46202, USA.
| | - Edward C Weisberger
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 550 North University Boulevard, Room 3170, Indianapolis, IN, 46202, USA.
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 550 North University Boulevard, Room 3170, Indianapolis, IN, 46202, USA.
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Linton OR, Moore MG, Brigance JS, Summerlin DJ, McDonald MW. Proton therapy for head and neck adenoid cystic carcinoma: initial clinical outcomes. Head Neck 2015; 37:117-24. [PMID: 25646551 DOI: 10.1002/hed.23573] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to report outcomes of proton therapy in head and neck adenoid cystic carcinoma. METHODS We conducted a retrospective analysis of 26 patients treated between 2004 and 2012. Twenty patients (77%) had base of skull involvement; 19 (73%) were treated for initial disease and 7 (27%) for recurrent disease. Twenty patients were treated postoperatively, 6 after biopsy alone and 24 had positive margins or gross residual disease.Median dose delivered was 72 Gy (relative biological effectiveness[RBE]). RESULTS Median follow-up was 25 months (range, 7–50 months). The 2-year overall survival was 93% for initial disease course and 57% for recurrent disease (p5.19). The 2-year local control was 95% for initial disease and 86% for recurrent disease (p5.48). The 2-year distant metastatic rate was 25%. Late toxicity of grade 0 or 1 was seen in 17 patients, grade 2 in 5, grade 3 in 2, grade 4 in 1, and grade 5 in 1. CONCLUSION Initial outcomes of proton therapy are encouraging. Longer follow-up is required.
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Khariwala SS, Moore MG, Malloy KM, Gosselin B, Smith RV. The "HPV Discussion": Effective Use of Data to Deliver Recommendations to Patients Impacted by HPV. Otolaryngol Head Neck Surg 2015. [PMID: 26220060 DOI: 10.1177/0194599815597200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 12/12/2022]
Abstract
OBJECTIVE The dramatic rise in oropharyngeal squamous cell carcinoma associated with the human papilloma virus (HPV) has brought significant change to the interaction between patients and head and neck oncologists. HPV-induced cancers are generally the result of elements from the patient's sexual history, and otolaryngologists are generally less experienced than primary care physicians in addressing patient questions relating to sexual history and practices. This article addresses questions commonly posed by patients relating to HPV-induced head and neck cancers, issues related to HPV vaccination, and surveillance of HPV-related lesions. Supporting data are provided such that physicians may be better equipped to sufficiently address patient queries on this topic. DATA SOURCES Available peer-reviewed literature and clinical practice guidelines. REVIEW METHODS Assessment and discussion of specific topics by authors selected from the Head and Neck Surgery Education Committee of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. RESULTS An educational "miniseminar" resulted in a notable increase in attendee knowledge and comfort regarding oropharyngeal squamous cell carcinoma counseling for patients in the setting of HPV-positive disease. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The dramatic increase in HPV-associated head and neck cancers has resulted in a changed paradigm of the physician-patient interaction. Care providers in today's environment must be prepared to counsel patients regarding sexually transmitted diseases and high-risk sexual behaviors. Examination of the existing data provides the foundation with which to construct a framework in which physicians can effectively communicate information and recommendations as they pertain to HPV-related carcinoma.
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Affiliation(s)
- Samir S Khariwala
- Department Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael G Moore
- Department Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Kelly M Malloy
- Department Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benoit Gosselin
- Department Otolaryngology-Head and Neck Surgery, Dartmouth Medical Center, Manchester, New Hampshire, USA
| | - Richard V Smith
- Department Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
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Franco J, Hansen LA, Miyamoto RT, Tann M, Moore MG. Sentinel lymph node mapping for malignant melanoma of the external auditory canal. World J Surg Proced 2015; 5:173-176. [DOI: 10.5412/wjsp.v5.i1.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/10/2014] [Revised: 11/04/2014] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
We describe a novel technique for sentinel lymph node mapping and biopsy of a primary cutaneous malignant melanoma in the medial portion of the external auditory canal. The approach is illustrated through a case report and technical description of a procedure performed under general anesthesia on a 19-year-old female patient. Due to the hidden and sensitive location of the primary tumor in the medial external auditory canal, the lymphoscintigraphy injection had to be performed by the surgeon immediately prior to the resection of her cT2aN0M0 lesion. Final pathology revealed clear margins at the primary site resection and 2 intraparotid sentinel lymph nodes with microscopic foci of metastatic malignant melanoma, which led to further surgical management. A completion left parotidectomy and neck dissection yielded no additional metastatic disease in the fifty-five nodes that were evaluated. Using this technique, sentinel lymph node mapping and biopsy accurately predicted the highest risk lymph nodes for the primary lesion of the medial portion of the external auditory canal.
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