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Blitzer GC, Paz C, Glassey A, Ganz OR, Giri J, Pennati A, Meyers RO, Bates AM, Nickel KP, Weiss M, Morris ZS, Mattison RJ, McDowell KA, Croxford E, Chappell RJ, Glazer TA, Rogus-Pulia NM, Galipeau J, Kimple RJ. Functionality of bone marrow mesenchymal stromal cells derived from head and neck cancer patients - A FDA-IND enabling study regarding MSC-based treatments for radiation-induced xerostomia. Radiother Oncol 2024; 192:110093. [PMID: 38224919 PMCID: PMC10922976 DOI: 10.1016/j.radonc.2024.110093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Salivary dysfunction is a significant side effect of radiation therapy for head and neck cancer (HNC). Preliminary data suggests that mesenchymal stromal cells (MSCs) can improve salivary function. Whether MSCs from HNC patients who have completed chemoradiation are functionally similar to those from healthy patients is unknown. We performed a pilot clinical study to determine whether bone marrow-derived MSCs [MSC(M)] from HNC patients could be used for the treatment of RT-induced salivary dysfunction. METHODS An IRB-approved pilot clinical study was undertaken on HNC patients with xerostomia who had completed treatment two or more years prior. Patients underwent iliac crest bone marrow aspirate and MSC(M) were isolated and cultured. Culture-expanded MSC(M) were stimulated with IFNγ and cryopreserved prior to reanimation and profiling for functional markers by flow cytometry and ELISA. MSC(M) were additionally injected into mice with radiation-induced xerostomia and the changes in salivary gland histology and salivary production were examined. RESULTS A total of six subjects were enrolled. MSC(M) from all subjects were culture expanded to > 20 million cells in a median of 15.5 days (range 8-20 days). Flow cytometry confirmed that cultured cells from HNC patients were MSC(M). Functional flow cytometry demonstrated that these IFNγ-stimulated MSC(M) acquired an immunosuppressive phenotype. IFNγ-stimulated MSC(M) from HNC patients were found to express GDNF, WNT1, and R-spondin 1 as well as pro-angiogenesis and immunomodulatory cytokines. In mice, IFNγ-stimulated MSC(M) injection after radiation decreased the loss of acinar cells, decreased the formation of fibrosis, and increased salivary production. CONCLUSIONS MSC (M) from previously treated HNC patients can be expanded for auto-transplantation and are functionally active. Furthermore IFNγ-stimulated MSC(M) express proteins implicated in salivary gland regeneration. This study provides preliminary data supporting the feasibility of using autologous MSC(M) from HNC patients to treat RT-induced salivary dysfunction.
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Affiliation(s)
- Grace C Blitzer
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Cristina Paz
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Annemarie Glassey
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Olga R Ganz
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Jayeeta Giri
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Andrea Pennati
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Ross O Meyers
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Amber M Bates
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Kwangok P Nickel
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Marissa Weiss
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Zachary S Morris
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Ryan J Mattison
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Kimberly A McDowell
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Emma Croxford
- Department of Biostatistics and Medical Informatics, 610 Walnut Street, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53726 USA
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics, 610 Walnut Street, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53726 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Tiffany A Glazer
- Department of Surgery, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Nicole M Rogus-Pulia
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; Geriatric Research Education and Clinical Center, 2500 Overlook Terrace, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
| | - Jacques Galipeau
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Randall J Kimple
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA.
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Rudningen K, Sable KA, Glazer TA, Hu R, Lasarev MR, Xu YG. Contrast tomography (CT) performed to detect nodal metastasis for high-risk cutaneous squamous cell carcinomas of the head and neck has a high negative predictive value but a poor positive predictive value. JAAD Int 2023; 13:37-38. [PMID: 37663165 PMCID: PMC10471915 DOI: 10.1016/j.jdin.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Affiliation(s)
- Kyle Rudningen
- Department of Dermatology, CentraCare, St. Cloud, Minnesota
| | - Kimberly A. Sable
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tiffany A. Glazer
- Division of Otolaryngology-Head & Neck Surgery, UW Department of Surgery, Clinical Science Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Rong Hu
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Michael R. Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yaohui Gloria Xu
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Mann H, Seligman K, Colwell N, Burr A, Glazer TA. Management of Subglottic Cancer. Otolaryngol Clin North Am 2023; 56:305-312. [PMID: 37030943 DOI: 10.1016/j.otc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Primary subglottic carcinoma is a rare subgroup of laryngeal malignancy with exact incidence unknown due to the lack of a standard definition of its anatomic boundaries. Early-stage subglottic carcinoma can be treated with either primary radiation or surgery with similar overall survival rates. Most patients present at an advanced stage due to a paucity of symptoms, and these patients are treated in a multidisciplinary fashion. Particular attention should be paid to the prelaryngeal and pretracheal nodal basins, as well as the stoma region, when managing these patients.
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Affiliation(s)
- Hayley Mann
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin Hospital & Clinics, 600 Highland Avenue, K4/723, Madison, WI 53792, USA
| | - Kristen Seligman
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin Hospital & Clinics, 600 Highland Avenue, K4/723, Madison, WI 53792, USA
| | - Nicholas Colwell
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin Hospital & Clinics, 600 Highland Avenue, K4/723, Madison, WI 53792, USA
| | - Adam Burr
- Department of Human Oncology, University of Wisconsin Hospital & Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Tiffany A Glazer
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin Hospital & Clinics, 600 Highland Avenue, K4/723, Madison, WI 53792, USA.
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4
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Merfeld EC, Witek ME, Francis DM, Burr AR, Wallace CR, Kuczmarska-Haas A, Lamichhane N, Kimple RJ, Glazer TA, Wieland AM, McCulloch TM, Hartig GK, Harari PM. Interstitial Brachytherapy for Lip Cancer: Technical Aspects to Individualize Treatment Approach and Optimize Outcomes. Pract Radiat Oncol 2023:S1879-8500(23)00006-1. [PMID: 36709044 DOI: 10.1016/j.prro.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
Primary radiation therapy using interstitial brachytherapy (IBT) provides excellent local tumor control for early-stage squamous cell carcinoma of the lip. Technical aspects of treatment are important to optimize outcomes. In this report, we discuss patient selection criteria, procedural details, and dosimetric considerations for performing IBT for cancers of the lip. Catheters are inserted across the length of tumor entering and exiting approximately 5 mm beyond the palpable tumor extent. A custom mouthpiece is fabricated to facilitate normal tissue sparing. Patients undergo computed tomography imaging, the gross tumor volume is contoured based on physical examination and computed tomography findings, and an individualized brachytherapy plan is generated with the goals of achieving gross tumor volume D90% ≥ 90% and minimizing V150%. Ten patients with primary (n = 8) or recurrent (n = 2) cancers of the lip who received high-dose-rate lip IBT using 2.0- to 2.5-week treatment regimens are described (median prescription: 47.6 Gy in 14 fractions of 3.4 Gy). Local tumor control was 100%. There were no cases of acute grade ≥4 or late grade ≥2 toxicity, and cosmesis scores were graded as good to excellent in all patients. IBT represents an excellent treatment option for patients with lip squamous cell carcinoma. With careful attention to technical considerations furthered described in the present report, high rates of tumor control, low rates of toxicity, and favorable esthetic and functional outcomes can be achieved with IBT for lip cancer.
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Affiliation(s)
- Emily C Merfeld
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Matthew E Witek
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - David M Francis
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Adam R Burr
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Charles R Wallace
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aleksandra Kuczmarska-Haas
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Narottam Lamichhane
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tiffany A Glazer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Wieland
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Timothy M McCulloch
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory K Hartig
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Bethel JA, McCarthy DP, Weisman PS, Glazer TA, Hanna AS. A combined, supraclavicular, infraclavicular, transaxillary, and posterior subscapular approaches for en bloc resection of giant myxofibrosarcoma. Surg Neurol Int 2023; 14:144. [PMID: 37151449 PMCID: PMC10159300 DOI: 10.25259/sni_273_2023] [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: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Background Myxofibrosarcoma (MFS) is a rare and locally infiltrative tumor that commonly occurs in extremities in older adults; however, truncal and head and neck cases have been reported. They are characterized by multinodular growth, incomplete fibrous septa, and myxoid stroma. Surgical resection is the mainstay of treatment. Case Description The authors report a case of a combined, supraclavicular, infraclavicular, transaxillary, and posterior subscapular approaches for resection of giant MFS. Conclusion The anatomical complexity and rarity of tumors involving the brachial plexus impose many challenges onto surgeons performing surgical resections. Treatment choices and surgical outcomes rely heavily on meticulous multidisciplinary planning, anatomical knowledge, careful dissection, and extent of resection. This case is unique in utilizing four different approaches to the brachial plexus to resect one tumor.
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Affiliation(s)
- Jacob A. Bethel
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Daniel P. McCarthy
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Paul S. Weisman
- Department of Pathology and Laboratory Medicine, Madison, Wisconsin, United States
| | - Tiffany A. Glazer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Amgad S. Hanna
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, United States
- Corresponding author: Amgad S. Hanna, MD, Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, United States.
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6
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Colevas SM, Merfeld EC, Pflum ZE, Gessert TG, Wieland AM, Glazer TA, Burr AR, Harari PM, Hartig GK. Functional Outcomes After Transoral Plus Lateral Pharyngotomy Approach for Advanced Oral and Oropharyngeal Tumors. OTO Open 2023; 7:e35. [PMID: 36998565 PMCID: PMC10046711 DOI: 10.1002/oto2.35] [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] [Received: 10/19/2022] [Revised: 01/05/2023] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Objective The aim of this study was to evaluate our institutional experience with the combined transoral plus lateral pharyngotomy (TO+LP) approach in a subset of patients with advanced or recurrent oral and oropharyngeal malignancy. Study Design A retrospective study of procedures utilizing TO+LP for cancer resection between January 2007 and July 2019. Setting Tertiary academic medical center. Methods Thirty-one patients underwent a TO+LP approach for the resection of oral and oropharyngeal tumors. Functional and oncologic outcomes were analyzed. Results Eighteen (58.1%) patients were treated with TO+LP for recurrent disease. Twenty-nine required free tissue transfer and 2 (6.5%) had positive margins. The median time to decannulation was 22 days (range 6-100 days). Thirteen (41.9%) patients still required enteral feeding at their most recent follow-up. Patients without a history of prior radiation were decannulated sooner (p = .009) and were less likely to require enteral feeding at the first postoperative follow-up (p = .034) than those who had prior head and neck radiotherapy. Conclusion A TO+LP approach can be used to achieve good functional and oncologic results for selected patients with advanced or recurrent oral and oropharyngeal cancer when minimally invasive options such as transoral robotic surgery, transoral laser microsurgery, or radiotherapy are not possible.
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Affiliation(s)
- Sophia M. Colevas
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Emily C. Merfeld
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Zachary E. Pflum
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Thomas G. Gessert
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Aaron M. Wieland
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Tiffany A. Glazer
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Adam R. Burr
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Paul M. Harari
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Gregory K. Hartig
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
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Abstract
OPINION STATEMENT At the University of Wisconsin, all treatment of head and neck cancer patients begins with discussion at our multi-disciplinary tumor board. Most patients with T4 disease, with existing laryngeal dysfunction, considered unlikely to complete definitive CRT or who have a high risk of persistent aspiration after non-operative management undergo total laryngectomy. A laryngeal sparing approach is attempted on most other patients. Radiotherapy is delivered over 6.5 weeks, preferably with concurrent weekly cisplatin. If the patient is hesitant of chemotherapy or has contraindications to cisplatin, concurrent cetuximab may be offered. Patients treated with RT alone are often treated to the same dose, but via an accelerated schedule by adding a 6th fraction per week. The 6th fraction is given by delivering two treatments at least 6 h apart on a weekday of the patient's choosing. We consider the following to be major risk factors for clinically significant weight loss during treatment: a 10% or greater loss of weight in the 6 months prior to starting treatment, delivery of concurrent cisplatin, and treatment of the bilateral neck with radiation. Patients who have 2-3 of these characteristics are often given gastrostomy tubes prophylactically. Patients are seen 2 weeks after completion of therapy, and then every 3 months after completion for 2 years. A CT neck and PET-CT are performed at the first 3-month visit. They are seen twice in year three, and then yearly until years 5-7. At each of these visits, we have a low threshold to present the patient at our multidisciplinary tumor board for consideration of salvage laryngectomy if there are signs of progression.
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Affiliation(s)
- Graham Campbell
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tiffany A Glazer
- Department of Surgery - Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Justine Yang Bruce
- Department of Medicine - Medical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA. .,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, USA.
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Gessert TG, Pflum ZE, Thompson JD, Hoffman MR, Sanchez R, Glazer TA, Wieland AM, McCulloch TM, Hartig GK. The radial forearm snake flap: An underutilized technique for fasciocutaneous and osteocutaneous forearm flaps with primary closure. Head Neck 2022; 44:1106-1113. [DOI: 10.1002/hed.27004] [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] [Received: 12/01/2021] [Revised: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Thomas G. Gessert
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Kansas City Kansas USA
| | - Zachary E. Pflum
- Department of Otolaryngology Head & Neck Surgery Aurora St. Luke's Medical Center Milwaukee Wisconsin USA
| | - James D. Thompson
- Department of Otolaryngology Head & Neck Surgery Spectrum Health Grand Rapids Michigan USA
| | - Matthew R. Hoffman
- Division of Otolaryngology, Department of Surgery University of Utah Salt Lake City Utah USA
| | | | - Tiffany A. Glazer
- Division of Otolaryngology, Department of Surgery University of Wisconsin‐Madison Madison Wisconsin USA
| | - Aaron M. Wieland
- Division of Otolaryngology, Department of Surgery University of Wisconsin‐Madison Madison Wisconsin USA
| | - Timothy M. McCulloch
- Division of Otolaryngology, Department of Surgery University of Wisconsin‐Madison Madison Wisconsin USA
| | - Gregory K. Hartig
- Division of Otolaryngology, Department of Surgery University of Wisconsin‐Madison Madison Wisconsin USA
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Blitzer GC, Rogus-Pulia NM, Mattison RJ, Varghese T, Ganz O, Chappell R, Galipeau J, McDowell KA, Meyers RO, Glazer TA, Kimple RJ. Marrow-Derived Autologous Stromal Cells for the Restoration of Salivary Hypofunction (MARSH): Study protocol for a phase 1 dose-escalation trial of patients with xerostomia after radiation therapy for head and neck cancer. Cytotherapy 2022; 24:534-543. [PMID: 35183442 PMCID: PMC9038658 DOI: 10.1016/j.jcyt.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/11/2021] [Accepted: 11/03/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Xerostomia, or dry mouth, is a common side effect of head and neck radiation. Current treatment options for radiation-induced xerostomia are generally supportive in nature. Adult stem cells are the ultimate source for replenishment of salivary gland tissue. Bone marrow-derived mesenchymal stromal cells (BM-MSCs) are a viable cell-based therapy for xerostomia. We have undertaken studies enabling U.S. Food and Drug Administration Investigational New Drug status, demonstrating the normal phenotype, intact functionality, and pro-growth secretome of interferon-γ (IFNγ)-stimulated BM-MSCs taken from patients with head and neck cancer who have undergone radiation ± chemotherapy. Here we present the protocol of MARSH, a first-in-human clinical trial of bone marrow-derived, IFNγ-activated BM-MSCs for the treatment of radiation-induced xerostomia. METHODS This single-center phase 1 dose-escalation with expansion cohort, non-placebo-controlled study will assess the safety and tolerability of BM-MSCs for the treatment of radiation-induced xerostomia in patients who had head and neck cancer. The phase 1 dose-escalation study will be a 3 + 3 design with staggered enrollment. A total of 21 to 30 subjects (9 to 18 in phase 1 study, 12 in expansion cohort) will be enrolled. The primary endpoint is determining the recommended phase 2 dose (RP2D) of IFNγ-stimulated BM-MSCs to enable further studies on the efficacy of BM-MSCs. Patients' bone marrow will be aspirated, and BM-MSCs will be expanded, stimulated with IFNγ, and injected into the submandibular gland. The RP2D will be determined by dose-limiting toxicities occurring within 1 month of BM-MSC injection. Secondary outcomes of saliva amounts and composition, ultrasound of salivary glands, and quality of life surveys will be taken at 3-, 6-, 12-, and 24-month visits. DISCUSSION Autotransplantation of IFNγ-stimulated BM-MSCs in salivary glands after radiation therapy or chemoradiation therapy may provide an innovative remedy to treat xerostomia and restore quality of life. This is the first therapy for radiation-induced xerostomia that may be curative. TRIAL REGISTRATION World Health Organization International Clinical Trials Registry Platform: NCT04489732.
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Cheng CF, Knewitz AP, Pasic TR, Glazer TA. How We Do It: Otolaryngology Applicant Impressions of Virtual Meet and Greets at a Single Institution. J Surg Educ 2022; 79:40-45. [PMID: 34452854 DOI: 10.1016/j.jsurg.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The COVID-19 pandemic altered residency recruitment in the 2021 application cycle. As a result, many programs adapted by creating virtual opportunities to connect with applicants such as clerkships, open houses, meet and greets, and interviews. Recent research has explored applicant impressions on virtual interviews and open houses, but none have assessed the utility of meet and greets, optimal structure, or desired topics to be addressed. METHODS We hosted two virtual meet and greets for otolaryngology applicants and subsequently conducted a structured survey to assess the benefit, gather insight into desired topics, and determine how future sessions could be optimized. RESULTS Twenty of 65 participants responded to the survey (31% response rate). The majority of participants learned about the event through social media (n = 15) or online resources such as OtoMatch or HeadMirror (n = 12). Desired topics to be addressed included faculty-resident relationships (85%), research (80%), the city of Madison (75%), breadth and depth of faculty (75%), and ability to train residents for future positions and fellowships (75%), among others. Overall, participants found the events helpful in conveying the culture and environment, exposure to faculty and residents, addressing questions, and providing insight into intangible aspects of the program. The main area of improvement identified was related to having breakout rooms, longer sessions, and varying the topics for breakout rooms. CONCLUSION Virtual meet and greets facilitate outreach and provide opportunities for applicants to engage with residency programs and demonstrate interest. While initially implemented due to the COVID-19 pandemic, they will likely remain helpful in generating interest, reaching broader audiences, and possibly facilitating a successful match. It is critical to understand and incorporate the content that applicants wish to learn about at virtual meet and greets to best address questions, highlight key features, and demonstrate the intangible aspects of a residency program.
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Affiliation(s)
- Christie F Cheng
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Allison P Knewitz
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Thomas R Pasic
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Tiffany A Glazer
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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11
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Perkins SJ, Gao R, Glazer TA, Zhao CX, Basura G, McKean EL. Treatment and Prognosis of Inflammatory Pseudotumor of the Skull Base. J Neurol Surg B Skull Base 2021; 83:e555-e563. [DOI: 10.1055/s-0041-1735558] [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] [Received: 04/12/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background Inflammatory pseudotumor (IPT) of the skull base is a rare, locally destructive lesion managed with a variety of treatments. We explore the impact of treatment on outcome and assess the prognosis of IPT.
Methods This is a retrospective review of IPT of the skull base at a tertiary academic medical center. The primary outcome was radiographic progression after treatment. Outcome versus tumor location was also examined and a prognostic model was developed using a logistic regression.
Results The demographics of 21 patients with IPT are reported. Treatment consisted of corticosteroids (in 80.1% of patients), disease modifying antirheumatic drugs (DMARDs; 33.3%), surgical resection (28.6%), radiation (23.8%), antibiotics (14.3%), chemotherapy (rituximab; 9.5%), and antivirals (4.8%). At 50.7 months, 50.8% had radiographic progression. Local therapy trended toward having a better response than systemic therapy (p = 0.60). IPT of the orbit required 2.4 treatment modalities, compared with 2.0 for pharyngeal IPT, and 1.3 for posterior skull base masses (p = 0.14). A total of 75% orbital IPT underwent radiographic progression, compared with 71% of pharyngeal IPT and 50% of posterior skull base masses (p = 0.62). Sixteen patients were used to create the logistic model of radiographic progression. The Cox–Snell R
2 was 0.71 (p = 0.03). No individual variables were statistically significant.
Conclusion To our knowledge, this is among the largest sample of cases describing the presentation, treatment, and prognosis of IPT of the skull base. Our data suggest that there may be an improved response with local therapy over systemic therapy and better prognosis among posterolateral skull base masses.
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Affiliation(s)
- Sidney J. Perkins
- Medical School, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Rebecca Gao
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Tiffany A. Glazer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, United States
| | - Cher X. Zhao
- Department of Otolaryngology, Harvard Medical School, Pediatric Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States
| | - Gregory Basura
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Erin L. McKean
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
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12
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Thompson JD, Avey GD, Wieland AM, Harari PM, Glazer TA, McCulloch TM, Hartig GK. Auriculotemporal Nerve Involvement in Parotid Bed Malignancy. Ann Otol Rhinol Laryngol 2019; 128:647-653. [PMID: 30894024 DOI: 10.1177/0003489419837574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify and evaluate patients with parotid bed malignancy demonstrating radiographic findings of auriculotemporal (AT) nerve involvement. METHODS A retrospective review of patients with parotid bed malignancy was performed to identify patients with imaging findings of AT nerve involvement and record associated clinical findings, symptoms, and pathology information. Independent, blinded review of radiographic images by a senior neuroradiologist was performed to identify imaging characteristics and categorize patients into highly likely or possible involvement groups. RESULTS Of 547 patients identified with parotid bed malignancy, 23 patients exhibited radiographic findings suggestive of AT nerve involvement. Thirteen patients met criteria for highly likely involvement, and 10 patients met criteria for possible involvement. Cutaneous malignancy with metastasis to the parotid bed accounted for 11 of 23 patients, and the most common histology was squamous cell carcinoma (9 patients). Primary parotid malignancy accounted for 12 of 23 patients, and the most common histology was salivary ductal carcinoma (3 patients). All 13 highly likely patients reported periauricular pain, and 11 of 13 demonstrated facial weakness. Features suggesting advanced disease included radiographic findings of intracranial involvement (10/23 patients), nonsurgical primary treatment (13/23 patients), and positive margins on pathology report (7/10 patients). CONCLUSION AT nerve involvement is an uncommon but important phenomenon that often occurs in the setting of advanced disease and is commonly associated with periauricular pain and coexisting facial weakness. Awareness of the associated clinical features and imaging patterns can allow for appropriate identification of this pattern of spread and help to optimize treatment planning.
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Affiliation(s)
- James D Thompson
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory D Avey
- 2 Department of Radiology-Division of Neuroradiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron M Wieland
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Paul M Harari
- 3 Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tiffany A Glazer
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Timothy M McCulloch
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory K Hartig
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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13
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Wertz A, Tillman BN, Brinkmeier JV, Glazer TA, Kroeker AD, Sullivan SE, McKean EL. Minimally Invasive Approach for Resection of Parameningeal Rhabdomyosarcoma. J Neurol Surg B Skull Base 2017; 78:210-214. [PMID: 28593107 DOI: 10.1055/s-0036-1597279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022] Open
Abstract
Background About one-third of rhabdomyosarcomas arise in the head and neck, with parameningeal primaries accounting for half of these. Principles of management involve chemotherapy, radiation, or both, in addition to surgical biopsy, debulking, and complete or near-complete resection. In the head and neck, diagnostic biopsies have historically been performed without attempt at resection due to proximity to critical structures and cosmetic considerations. Methods Retrospective chart review of three cases of rhabdomyosarcoma at the cranial base managed through minimally invasive endoscopic surgical resection and adjuvant therapy. Results Three patients were identified as having undergone endoscopic surgical debulking or margin-negative resection of a rhabdomyosarcoma of the cranial base. Two of three patients had complete resection based on intraoperative margin control. All three patients underwent adjuvant therapy within 1 month of diagnosis. Follow-up time ranged from 5 months to 3 years with all patients disease-free at last follow-up. Conclusion Skull base surgeons should routinely be involved in multidisciplinary treatment planning for parameningeal rhabdomyosarcomas, as surgical options have evolved to allow for potential endoscopic resection with low morbidity and no or minimal delay in additional treatment options.
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Affiliation(s)
- Aileen Wertz
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Brittny N Tillman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Jennifer V Brinkmeier
- Department of Otolaryngology, Saint Louis University, Saint Louis, Missouri, United States
| | - Tiffany A Glazer
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Andrew D Kroeker
- Department of Otolaryngology, Kaiser Permanente Health Northwest, Portland, Oregon, United States
| | - Steven E Sullivan
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Erin L McKean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States
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Abstract
Context: As of 2015, more than 23 million scuba diver certifications have been issued across the globe. Given the popularity of scuba diving, it is incumbent on every physician to know and understand the specific medical hazards and conditions associated with scuba diving. Evidence Acquisition: Sources were obtained from PubMed, MEDLINE, and EBSCO databases from 1956 onward and ranged from diverse fields including otologic reviews and wilderness medicine book chapters. Study Design: Clinical review. Level of Evidence: Level 5. Results: Otologic hazards can be categorized into barotrauma-related injuries or decompression sickness. Conclusion: When combined with a high index of suspicion, the physician can recognize these disorders and promptly initiate proper treatment of the potentially hazardous and irreversible conditions related to scuba diving.
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Affiliation(s)
- Tiffany A. Glazer
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
- Tiffany A. Glazer, MD, Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, 1500 East Medical Center Drive, 1904 TC, SPC 5312, Ann Arbor, MI 48109-5312 ()
| | - Steven A. Telian
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
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15
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Meraj TS, Muenz DG, Glazer TA, Harvey RS, Spector ME, Hoff PT. Does drug-induced sleep endoscopy predict surgical success in transoral robotic multilevel surgery in obstructive sleep apnea? Laryngoscope 2016; 127:971-976. [PMID: 27796047 DOI: 10.1002/lary.26255] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/06/2016] [Accepted: 07/25/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to determine if drug-induced sleep endoscopy (DISE) was predictive of success for patients undergoing transoral robotic surgery (TORS) and multilevel procedures for sleep apnea. STUDY DESIGN Retrospective case series of patients who underwent TORS surgery for sleep apnea METHODS: Before and after polysomnograms were analyzed to assess improvement, success, and cure. Improvement was defined as any decrease in apnea-hypopnea index (AHI), success as an AHI <20 with a decrease >50%, and cure as an AHI <5. DISE videos were scored using the NOHL (nose, oropharynx, hypopharynx, larynx) and VOTE (velum, oropharynx, tongue, epiglottis) classification systems. RESULTS One hundred one patients were available for analysis. Eighty-seven percent of patients had an improvement in their AHI. Fifty-one percent met criteria for success, whereas 17% were cured. The degree of collapse at individual NOHL and VOTE subsites as well as total additive scores did not predict improvement, success, or cure. Patients with no oropharyngeal lateral collapse in the VOTE classification system were more likely to improve following surgery (P = .001); however, this effect did not hold for success or cure. Multivariate analysis of DISE variables was not predictive of success. CONCLUSIONS In obstructive sleep apnea patients, there is a 51% success rate and a 17% cure rate. DISE, as scored by the NOHL and VOTE system, did not readily identify patients who would benefit most from surgery. Patients with lateral oropharyngeal collapse may be poorer candidates. Prospective, larger studies are required to further evaluate the use of DISE in predicting success following TORS. LEVEL OF EVIDENCE 4 Laryngoscope, 127:971-976, 2017.
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Affiliation(s)
- Taha S Meraj
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Daniel G Muenz
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Tiffany A Glazer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Rebecca S Harvey
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
| | - Paul T Hoff
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, U.S.A
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16
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Glazer TA, Meraj T, Lyden TH, Spector ME. In-Office Secondary Tracheoesophageal Puncture with Immediate Prosthesis Placement. Otolaryngol Head Neck Surg 2016; 155:360-3. [DOI: 10.1177/0194599816642175] [Citation(s) in RCA: 4] [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: 11/25/2015] [Accepted: 03/10/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Tiffany A. Glazer
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Taha Meraj
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Teresa H. Lyden
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Matthew E. Spector
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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17
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Abstract
Salivary gland neoplasms are rare and diverse tumors with variable disease courses, making it difficult to concisely summarize the management of distant metastases (DM). Nonetheless, there are trends of DM in salivary gland cancer that can be contextualized and reviewed. In general, the primary tumor characteristics that predict DM include the primary tumor site, tumor stage and grade, perineural spread, cervical nodal status, and genomic signatures. The most common site of DM is the lung, followed by the bone, liver, and brain. Depending on the clinical presentation, DM can be treated with watchful waiting, local therapies (surgery and/or radiation), or systemic therapy (cytotoxic or targeted chemotherapy). In general, DM confer a poor prognosis, and any cancer-directed treatment options should be carefully considered in the context of specific goals of care, symptom burden, and patient preference.
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18
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Spector ME, Glazer TA, Hoff PT. Addressing the Retrolingual Space in Obstructive Sleep Apnea: Outcomes Stratified by Friedman Stage in Patients Undergoing Transoral Robotic Surgery. ORL J Otorhinolaryngol Relat Spec 2015; 78:1-8. [DOI: 10.1159/000441456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/29/2015] [Indexed: 11/19/2022]
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Tillman BN, Glazer TA, Ray A, Brenner JC, Spector ME. A lean neck mass clinic model: Adding value to care. Laryngoscope 2015; 125:2509-13. [PMID: 26256915 DOI: 10.1002/lary.25535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/23/2015] [Accepted: 07/06/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To demonstrate that ultrasound-guided fine needle aspiration (USFNA) with on-site cytopathologic analysis eliminates unnecessary diagnostic testing, return visits, and repeat procedures and optimizes quality of care. STUDY DESIGN Retrospective cohort. METHODS Sixty-one new patients (28 female; 33 male; age range=19-85 years) were seen in our dedicated neck mass clinic over a 1-year period. All patients underwent USFNA of masses located in neck levels I-VI (n=40), parotid gland (n=20), or parapharyngeal space (n=1). Each patient underwent two USFNA passes followed by on-site cytopathologic analysis with additional passes if required for diagnosis. RESULTS Diagnosis was made in 93.4% (n=57) of patients, allowing for counseling and treatment planning at the first visit. To obtain a diagnosis, more than half (57.4%, n=35) of our patients required additional passes, which implies that they would have required an additional visit without on-site cytopathologic analysis. Treatment included observation in 42.6% (n=26) of patients, surgery in 32.8 % (n=20) of patients, and nonsurgical treatment (chemotherapy, radiation, other) in 24.6% (n=15) of patients. The average time from check-in to checkout including the clinic visit, biopsy, and treatment counseling was 103 minutes, and the average round trip mileage traveled per patient was 127.6 miles. CONCLUSIONS The adult neck mass is a commonly encountered scenario in otolaryngology. For the patient, this can be a stressful situation in which timely and accurate diagnosis is critical. A dedicated lean neck mass clinic model with USFNA and on-site cytopathologic analysis can be both an efficient part of one's practice and a valuable addition to patient care. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | | | - Amrita Ray
- Department of Otolaryngology-Head and Neck Surgery
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery.,Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery.,Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
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20
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Affiliation(s)
- Tiffany A. Glazer
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Paul T. Hoff
- Department of Otolaryngology–Head and Neck Surgery, St Joseph Mercy Health System, Ann Arbor, Michigan
| | - Matthew E. Spector
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
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21
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Hoff PT, Glazer TA, Spector ME. Body Mass Index Predicts Success in Patients Undergoing Transoral Robotic Surgery for Obstructive Sleep Apnea. ORL J Otorhinolaryngol Relat Spec 2014; 76:266-72. [DOI: 10.1159/000368415] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/12/2014] [Indexed: 11/19/2022]
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22
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Glazer TA, Spector ME, McHugh J, Hogikyan ND. Osteoblastoma of the thyroid cartilage treated with voice preserving laryngeal framework resection. Laryngoscope 2013; 123:1948-51. [PMID: 23729184 DOI: 10.1002/lary.23972] [Citation(s) in RCA: 2] [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: 10/05/2012] [Revised: 11/30/2012] [Accepted: 12/12/2012] [Indexed: 01/26/2023]
Abstract
OBJECTIVES/HYPOTHESIS Osteoblastoma is a slow-growing, locally destructive benign bone neoplasm, rarely occurring in the laryngeal cartilage. We present the case of a professional voice user diagnosed with laryngeal osteoblastoma after microdirect laryngoscopy and endoscopic biopsy. Her treatment required a unique operation, with elements of partial laryngectomy and maintenance of vital endolaryngeal soft tissues, in order to optimize vocal outcome.
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Affiliation(s)
- Tiffany A Glazer
- Department of Otolaryngology Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA.
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