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Nyirjesy SC, McCrary HC, Zhao S, Judd RT, Farlow JL, Seim NB, Ozer E, Agrawal A, Old MO, Rocco JW, Kang SY, Haring CT. National Trends in 30-Day Readmission Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2024; 150:133-141. [PMID: 38153724 PMCID: PMC10853828 DOI: 10.1001/jamaoto.2023.4025] [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] [Received: 07/17/2023] [Accepted: 10/27/2023] [Indexed: 12/29/2023]
Abstract
Importance As the incidence of oropharyngeal squamous cell carcinoma (OPSCC) continues to rise in the US, an increasing number of patients are being treated with transoral robotic surgery (TORS). Readmission following surgery can potentially delay initiation of adjuvant treatment and affect survival outcomes. Objective To identify risk factors for 30-day postoperative readmission in patients undergoing TORS for OPSCC. Design, Setting, and Participants This retrospective, population-based cohort study used data from the Nationwide Readmissions Database from 2010 to 2017. All patients undergoing TORS for OPSCC were identified using International Classification of Diseases codes and included. Exclusion criteria were age younger than 18 years or incomplete information regarding index admission or readmission. The analysis was performed from April to October 2023. Exposure TORS for OPSCC. Main Outcomes and Measures Univariate and multivariate analyses were performed to determine factors associated with 30-day readmission. Covariates included demographics and medical comorbidities, socioeconomic factors, hospital characteristics, and surgical details. Trends in readmission over time, reasons for readmission, and characteristics of the readmission were also examined. Results A weighted total of 5544 patients (mean [SD] age, 60.7 [0.25] years; 4475 [80.7%] male) underwent TORS for OPSCC. The overall readmission rate was 17.5% (n = 971), and these rates decreased over the study period (50 of 211 patients [23.7%] in 2010 vs 58 of 633 patients [9.1%] in 2017). Risk factors associated with readmission included male sex (adjusted odds ratio [AOR], 1.54; 95% CI, 1.07-2.20) and a diagnosis of congestive heart failure (AOR, 2.42; 95% CI, 1.28-4.58). Factors associated with decreased rate of readmission included undergoing concurrent selective neck dissection (AOR, 0.30; 95% CI, 0.22-0.41). Among the 971 readmissions, the most common readmission diagnoses were bleeding (151 [15.6%]), electrolyte and digestive problems (44 [4.5%]), pneumonia (44 [4.5%]), and sepsis (26 [2.7%]). Conclusions and Relevance In this cohort study, readmission rates following TORS for oropharynx cancer decreased over time; however, a subset of patients required readmission most commonly related to bleeding, infection, and electrolyte imbalance. Concurrent neck dissection may be protective against readmission. Elucidation of risk factors for readmission after TORS for OPSCC offers opportunities for evidence-based shared decision-making, quality improvement initiatives, and improved patient counseling.
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Affiliation(s)
- Sarah C. Nyirjesy
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Hilary C. McCrary
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University College of Medicine, Columbus
| | - Ryan T. Judd
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Janice L. Farlow
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Nolan B. Seim
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Enver Ozer
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Amit Agrawal
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Matthew O. Old
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - James W. Rocco
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Stephen Y. Kang
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Catherine T. Haring
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
- The James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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Judd RT, McCrary HC, Farlow JL, Li M, Godsell J, Kneuertz PJ, Ozer E. Pedicled osteomyocutaneous pectoralis major flap with osseous rib harvest for salvage mandibular reconstruction: Case and technique. Head Neck 2024; 46:447-451. [PMID: 38050748 DOI: 10.1002/hed.27586] [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: 09/17/2023] [Revised: 10/25/2023] [Accepted: 11/16/2023] [Indexed: 12/06/2023] Open
Abstract
In the era of free flap reconstruction, mandibular defects are routinely reconstructed with osseous free flaps, and non-free flap bony reconstruction options are limited. A patient with T4N0 mandibular squamous cell carcinoma underwent resection with fibula free flap reconstruction of a parasymphyseal to angle defect. After free flap failure due to venous congestion, the flap was explanted. He declined additional free flap reconstruction and elected to proceed with pedicled osteomyocutaneous pectoralis major with rib. In this case presentation, we discuss the technical details of harvest of this flap using the 6th rib. The pedicled osteomyocutaneous pectoralis major flap with osseous rib harvest, which is infrequently described in the literature, remains a viable option for bony reconstruction, particularly in the salvage setting.
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Affiliation(s)
- Ryan T Judd
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Hilary C McCrary
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Michael Li
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Jeremy Godsell
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Peter J Kneuertz
- Division of Thoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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McCrary HC, Meeker M, Farlow JL, Seim NB, Old MO, Ozer E, Agrawal A, Rocco JW, Kang SY, Bradford CR, Haring CT. Demographic and Academic Productivity Trends Among American Head & Neck Society Fellows Over a 20-Year Period. JAMA Otolaryngol Head Neck Surg 2023; 149:987-992. [PMID: 37561525 PMCID: PMC10416085 DOI: 10.1001/jamaoto.2023.2021] [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] [Received: 05/18/2023] [Accepted: 06/08/2023] [Indexed: 08/11/2023]
Abstract
Importance Historical data reveal that, compared with women, men are more likely to pursue a head and neck surgical oncology fellowship, but little is known about possible gender differences in academic productivity. Objective To assess demographic trends and academic productivity among American Head & Neck Society (AHNS) fellowship graduates. Design, Setting, and Participants This cross-sectional study used electronically published data from the AHNS on fellowship graduates in the US and Canada from July 1, 1997, to June 30, 2022. Scopus was used to extract h-indices for each graduate. Exposure Scholarly activity. Main Outcomes and Measures Main outcomes were changes in demographic characteristics and academic productivity among AHNS graduates over time. Data analysis included effect size, η2, and 95% CIs. Results A total of 691 AHNS fellowship graduates (525 men [76%] and 166 women [24%]) were included. Over the study period, there was an increase in the number of programs offering a fellowship (η2, 0.84; 95% CI, 0.68-0.89) and an increase in the absolute number of women who completed training (η2, 0.66; 95% CI, 0.38-0.78). Among early-career graduates pursuing an academic career, there was a small difference in the median h-index scores between men and women (median difference, 1.0; 95% CI, -1.1 to 3.1); however, among midcareer and late-career graduates, there was a large difference in the median h-index scores (midcareer graduates: median difference, 4.0; 95% CI, 1.2-6.8; late-career graduates: median difference, 6.0; 95% CI, 1.0-10.9). A higher percentage of women pursued academic positions compared with men (106 of 162 [65.4%] vs 293 of 525 [55.8%]; difference, 9.6%; 95% CI, -5.3% to 12.3%). Conclusions and Relevance This cross-sectional study suggests that women in head and neck surgery begin their careers with high levels of academic productivity. However, over time, a divergence in academic productivity between men and women begins to develop. These data argue for research to identify possible reasons for this observed divergence in academic productivity and, where possible, develop enhanced early faculty development opportunities for women to promote their academic productivity, promotion, and advancement into leadership positions.
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Affiliation(s)
- Hilary C. McCrary
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Molly Meeker
- The Ohio State University College of Medicine, Columbus
| | - Janice L. Farlow
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Nolan B. Seim
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Matthew O. Old
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Enver Ozer
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Amit Agrawal
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - James W. Rocco
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Stephen Y. Kang
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Carol R. Bradford
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
- The Ohio State University College of Medicine, Columbus
| | - Catherine T. Haring
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
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Rind F, Zhao S, Haring C, Kang SY, Agrawal A, Ozer E, Old MO, Carrau RL, Seim NB. Body Mass Index (BMI) Related Morbidity with Thyroid Surgery. Laryngoscope 2023; 133:2823-2830. [PMID: 37265205 DOI: 10.1002/lary.30789] [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: 03/07/2023] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The increase in incidence of thyroid cancer correlates with strict increases in body mass index (BMI) and obesity in the United States. Thyroid hormone dysregulation has been shown to precipitate circulatory volume, peripheral resistance, cardiac rhythm, and even cardiac muscle health. Theoretically, thyroid surgery could precipitate injury to the cardiopulmonary system. METHODS The American College of Surgery National Quality Improvement Program database was queried for thyroidectomy cases in the 2007-2020 Participant User files. Continuous and categorical associations between BMI and cardiopulmonary complications were investigated as reported in the database. RESULTS The query resulted 186,095 cases of thyroidectomy procedures in which the mean age was 51.3 years and sample was 79.3% female. No correlation was evident in univariate and multivariate analyses between BMI and the incidence of postoperative stroke or myocardial infarction. The incidence of complications was extremely low. However, risk of deep venous thrombosis correlated with BMI in the categorical, univariate, and multivariate (OR 1.036, CI 1.014-1.057, p < 0.01) regression analysis. Additionally, increased BMI was associated with increased risk of pulmonary embolism (PE) (OR 1.050 (1.030, 1.069), p < 0.01), re-intubation (OR 1.012 (1.002, 1.023), p = 0.02), and prolonged intubation (OR 1.031 (1.017, 1.045), p < 0.01). CONCLUSION Despite the rarity of cardiopulmonary complications during thyroid surgery, patients with very high BMI carry a significant risk of deep venous thrombosis, PE, and prolonged intubation. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2823-2830, 2023.
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Affiliation(s)
- Fahad Rind
- Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
| | - Songzhu Zhao
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Catherine Haring
- Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen Y Kang
- Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amit Agrawal
- Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Enver Ozer
- Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew O Old
- Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nolan B Seim
- Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Ozer E, Cagliyan E, Cagaptay S. Vaccination is preventing development of placental pathologies in SARS-CoV-2 infected pregnant patients. J Neonatal Perinatal Med 2023:NPM221141. [PMID: 37270814 DOI: 10.3233/npm-221141] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The coronavirus disease (COVID-19) has created a serious health problem in pregnant people. We aimed to address whether vaccination can prevent development of placental disease in SARS-CoV-2 infected mothers. METHODS We reported the pathology findings obtained from routine histopathological examination of placentas of overall 38 cases. RESULTS We found low prevalence of placental pathology in vaccinated pregnant people with active SARS-CoV-2 infection in comparison to those unvaccinated cases. CONCLUSION Based on our findings, SARS-CoV-2 vaccination can prevent development of placental pathological lesions and may lower the risk of serious illness in pregnant people.
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Affiliation(s)
- E Ozer
- Department of Pathology, Dokuz Eylul University Hospital, Izmir, Turkey
| | - E Cagliyan
- Department of Obstetrics & Gynecology, Dokuz Eylul University Hospital, Izmir, Turkey
| | - S Cagaptay
- Department of Pathology, Dokuz Eylul University Hospital, Izmir, Turkey
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Zhang L, Judd RT, Zhao S, Rygalski C, Li M, Briody A, Swendseid B, Blakaj DM, Agrawal A, Ozer E, Carrau RL, Teknos TN, VanKoevering K, Rocco JW, Old MO, Seim NB, Puram SV, Haring CT, Kang SY. Immediate resection of positive margins improves local control in oral tongue cancer. Oral Oncol 2023; 141:106402. [PMID: 37094500 DOI: 10.1016/j.oraloncology.2023.106402] [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: 11/07/2022] [Revised: 04/08/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES This study investigates the impact of immediate resection of positive margins on local control of oral tongue cancer. MATERIALS AND METHODS We analyzed 273 consecutive oral tongue cancers resected from 2013 to 2018. Additional resection was performed in cases during the initial operation based on surgeon inspection of the specimen and/or frozen margins. Positive margins were defined as invasive carcinoma/high-grade dysplasia < 1 mm from the inked edge. Patients were grouped as follows: negative margin (Group 1); positive margin with immediate additional tissue resection (Group 2); and positive margin without additional tissue resection (Group 3). RESULTS Overall, the rate of local recurrence was 7.7 % (21/273), and the rate of positive main specimen margin was 17.9 %. Of these patients, 38.8 % (19/49) underwent immediate additional resection of the presumed positive margin. Group 3 had higher local recurrence rates than Group 1 after adjustment for T-stage (aHR 2.8 [95 % CI 1.0-7.7], p = 0.04). Group 2 had similar rates of local recurrence (aHR 0.45 [95 % CI 0.06-3.6], p = 0.45). Three year local recurrence free survival for Groups 1, 2, and 3 were 91 %, 92 % and 73 %, respectively. Compared to the main specimen margin, sensitivity of intraoperative frozen tumor bed margins was 17.4 %, and specificity was 95 %. CONCLUSION In patients with positive main specimen margins, anticipation and detection in real-time with immediate additional tissue resection reduced local recurrence to rates similar to those with negative main specimen margins. These findings support the use of technology to provide real-time intraoperative margin data and guide additional resection for improved local control.
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Affiliation(s)
- Lisa Zhang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Ryan T Judd
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Songzhu Zhao
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Chandler Rygalski
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Michael Li
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | | | - Brian Swendseid
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Dukagjin M Blakaj
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Amit Agrawal
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Enver Ozer
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Ricardo L Carrau
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Theodoros N Teknos
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Kyle VanKoevering
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - James W Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Matthew O Old
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Nolan B Seim
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Sidharth V Puram
- Department of Otolaryngology, Division of Head and Neck Surgery, Washington University School of Medicine, USA
| | - Catherine T Haring
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA.
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Hutcheson K, Peterson C, Barbon C, Quon H, Mehra R, Ringash J, Lewin J, Flamand Y, Duvvuri U, Ozer E, Thomas G, Kupferman M, Koch W, Bell R, Saba N, Panwar A, Annino Jr D, Wagner L, Ferris R, Burtness B. Reduced Aspiration Rates for 50 Gy Postoperative Radiation in HPV-Associated Oropharynx Cancer in E3311: A Trial of the ECOG-ACRIN Cancer Research Group. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Nyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, Agrawal A, Old MO, Seim NB, Carrau RL, Rocco JW, VanKoevering KK. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol 2022; 132:105976. [PMID: 35809506 DOI: 10.1016/j.oraloncology.2022.105976] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 01/12/2023]
Abstract
Microvascular free flap reconstruction has remained the standard of care in reconstruction of large tissue defects following ablative head and neck oncologic surgery, especially for bony structures. Computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensionally (3D) printed models and devices offer novel solutions for reconstruction of bony defects. Conventional free hand techniques have been enhanced using 3D printed anatomic models for reference and pre-bending of titanium reconstructive plates, which has dramatically improved intraoperative and microvascular ischemia times. Improvements led to current state of the art uses which include full virtual planning (VP), 3D printed osteotomy guides, and patient specific reconstructive plates, with advanced options incorporating dental rehabilitation and titanium bone replacements into the primary surgical plan through use of these tools. Limitations such as high costs and delays in device manufacturing may be mitigated with in house software and workflows. Future innovations still in development include printing custom prosthetics, 'bioprinting' of tissue engineered scaffolds, integration of therapeutic implants, and other possibilities as this technology continues to rapidly advance. This review summarizes the literature and serves as a summary guide to the historic, current, advanced, and future possibilities of 3D printing within head and neck oncologic surgery and bony reconstruction. This review serves as a summary guide to the historic, current, advanced, and future roles of CAD/CAM and 3D printing within the field of head and neck oncologic surgery and bony reconstruction.
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Affiliation(s)
- Sarah C Nyirjesy
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Margaret Heller
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Natalia von Windheim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amelia Gingras
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Stephen Y Kang
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Enver Ozer
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amit Agrawal
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Matthew O Old
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Nolan B Seim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Ricardo L Carrau
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - James W Rocco
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Kyle K VanKoevering
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States.
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Agarwal R, Freeman TE, Li MM, Naik AN, Philips RW, Kang SY, Ozer E, Agrawal A, Carrau RL, Rocco JW, Old MO, Seim NB. Outcomes with culture-directed antibiotics following microvascular free tissue reconstruction for osteonecrosis of the jaw. Oral Oncol 2022; 130:105878. [DOI: 10.1016/j.oraloncology.2022.105878] [Citation(s) in RCA: 1] [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] [Received: 11/10/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
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10
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Mehra R, Flamand Y, Quon H, Garcia JJ, Weinstein GS, Duvvuri U, O'Malley BW, Ozer E, Thomas GR, Koch W, Gross ND, Bell RB, Saba NF, Lango M, Bayon R, Burtness B, Ferris RL. Outcomes by tobacco history in E3311, a phase II trial of transoral surgery (TOS) followed by pathology-based adjuvant treatment in HPV-associated (HPV+) oropharynx cancer (OPC): A trial of the ECOG-ACRIN Cancer Research Group. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6077] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6077 Background: E3311 is a phase II randomized study which showed favorable outcomes among intermediate (INT) risk HPV+ OPC patients (pts) who underwent TOS followed by pathology-guided or adapted, deintensified adjuvant treatment. Among HPV+ pts treated with definitive chemoradiation, survival outcomes are worse among those who smoked > 10 pack years (pk-yrs). Methods: We retrospectively analyzed demographics, pathologic results, and efficacy outcomes from E3311 by smoking group (current (C) vs. former (F) and > 10 vs. ≤10 pk-yrs the latter a pre-specified stratification factor for INT patients). Binary and categorical variables were compared using a chi-square test (or Fishers exact test for small sample sizes). Ordinal variables were compared using a Wilcoxon rank sum test. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared using a log-rank test. Results: Among 359 evaluable pts, performance status (PS) was significantly worse for pts with > 10 pk-yrs vs. ≤10 pk-yrs (15.4% vs. 7.9% with PS of 1, p = 0.034). Primary site, margin status, histologic grade, stage, and extranodal extension were not significantly different between the groups of > 10 vs. ≤10 pk-yrs. Smoking status (F vs. C) was available for 182 pts with a history of smoking. Slightly more C vs. F smokers had tonsil as primary site (79.5% vs. 65.0%, p = 0.09). Positive margins were significantly more frequent among C smokers (10.3% vs. 2.1%; p = 0.029). Overall, there were no significant differences in PFS (p = 0.55) or OS (p = 0.94), comparing those with > 10 vs. ≤10 pk-yrs, or comparing C vs. F smokers (p = 0.76, p = 0.82, respectively). Similarly, no significant differences were observed within the treatment arms. (Table 1) Conclusions: In this analysis of smoking status in E3311, INT risk HPV+ OPC pts who are C smokers or have a history of > 10 pk-yrs had favorable 3-yr PFS and OS rates that were not significantly worse than those with < 10 pk-yrs history. This data represents the first treatment approach for HPV+ OPC in which outcomes were not influenced by smoking status. Clinical trial information: NCT01898494. [Table: see text]
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Affiliation(s)
- Ranee Mehra
- Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD
| | - Yael Flamand
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Joaquin J. Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | | | - Enver Ozer
- The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | | | - Wayne Koch
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Neil D. Gross
- The University of Texas MD Anderson Cancer Center, Department of Head and Neck Surgery, Houston, TX
| | - Richard Bryan Bell
- Earle A. Chiles Research Institute at Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR
| | - Nabil F. Saba
- Winship Cancer Institute Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Robert L. Ferris
- University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA
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Baliga S, Klamer B, Palmer J, Wells S, Gamez M, Jhawar S, Mitchell D, Grecula J, Kang S, Seim N, Ozer E, Agrawal A, VanKoevering K, Karivedu V, Bhateja P, Bonomi M, Old M, Rocco J, Carrau R, Blakaj D. Defining the Psychiatric and Financial Landscape of Mental and Substance Use Disorders in Head and Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Judd R, Zhang L, Zhao S, Rygalski C, Li M, Swendseid B, Blakaj D, Agrawal A, Ozer E, Carrau R, Teknos T, VanKoevering K, Rocco J, Old M, Seim N, Haring C, Kang S. Management of Positive Main Specimen Margin in Oral Tongue Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Cherny K, Balaji A, Mukherjee J, Goo Y, Hauser A, Ozer E, Satchell K, Bachta K, Kochan T, Mitra S, Kociolek L. Identification of Clostridium innocuum hypothetical protein that is cross-reactive with C. difficile anti-toxin antibodies. Anaerobe 2022; 75:102555. [DOI: 10.1016/j.anaerobe.2022.102555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/01/2022]
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14
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Tamaki A, Sethuraman S, Shi L, Zhao S, Carver KC, Hatef A, Luttrull M, Seim NB, Kang SY, Ozer E, Agrawal A, Old MO. Bone Union of Osseous Microvascular Free Tissue Transfer in Mandibular Reconstruction. OTO Open 2022; 6:2473974X211070258. [PMID: 35047718 PMCID: PMC8761882 DOI: 10.1177/2473974x211070258] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives Osseous microvascular free tissue transfer (MFTT) is the gold standard for reconstruction for most segmental mandibulectomy defects. The most common osseous MFTT utilized in reconstruction is the fibular, scapular, and osteocutaneous radial forearm (OCRF) free flap. We evaluated postoperative bone union as well as clinical complications following MFTT and the impact of various patient and reconstructive characteristics, including type of osseous MFTT. Study Design Retrospective cohort study. Setting Tertiary care academic hospital. Methods This study examined patients who underwent osseous MFTT for mandibular defects from January 2017 to January 2019. Results An overall 144 osteotomies in 58 patients were evaluated. Of the 144 junctions, 28 (19.4%) showed radiographic nonunion. Patients who underwent preoperative (odds ratio [OR] = 0.30, P = .027) and postoperative (OR = 0.28, P = .003) radiation had a significantly lower bone union score. Time from surgery to postoperative imaging was associated with higher bone union scores (OR = 1.07, P = .024). When bone union scores were compared among types of MFTT, fibular (OR = 5.62, P = .008) and scapular (OR = 4.69, P = .043) MFTT had significantly higher scores than OCRF MFTT. Twelve (20.7%) patients had postoperative complications. There was no statistically significant correlation between clinical complications and various variables, including type of osseous MFTT. Conclusion Pre- and postoperative radiation and time from surgery have an impact on bone union. Regarding the type of MFTT, fibular and scapular MFTT appeared to have higher bone union when compared with OCRF. There was no impact of bone union or type of osseous MFTT on clinical complications.
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Affiliation(s)
- Akina Tamaki
- Department of Otolaryngology–Head and Neck Surgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Akina Tamaki, MD, Department of Otolaryngology–Head and Neck Surgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Shruthi Sethuraman
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lucy Shi
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Keith C. Carver
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Angel Hatef
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Luttrull
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nolan B. Seim
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen Y. Kang
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Enver Ozer
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amit Agrawal
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew O. Old
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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15
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Ferris RL, Flamand Y, Weinstein GS, Li S, Quon H, Mehra R, Garcia JJ, Chung CH, Gillison ML, Duvvuri U, O'Malley BW, Ozer E, Thomas GR, Koch WM, Gross ND, Bell RB, Saba NF, Lango M, Méndez E, Burtness B. Phase II Randomized Trial of Transoral Surgery and Low-Dose Intensity Modulated Radiation Therapy in Resectable p16+ Locally Advanced Oropharynx Cancer: An ECOG-ACRIN Cancer Research Group Trial (E3311). J Clin Oncol 2022; 40:138-149. [PMID: 34699271 PMCID: PMC8718241 DOI: 10.1200/jco.21.01752] [Citation(s) in RCA: 152] [Impact Index Per Article: 76.0] [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: 07/16/2021] [Revised: 07/30/2021] [Accepted: 09/17/2021] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Definitive or postoperative chemoradiation (CRT) is curative for human papillomavirus-associated (HPV+) oropharynx cancer (OPC) but induces significant toxicity. As a deintensification strategy, we studied primary transoral surgery (TOS) and reduced postoperative radiation therapy (RT) in intermediate-risk HPV+ OPC. METHODS E3311 is a phase II randomized trial of reduced- or standard-dose postoperative RT for resected stage III-IVa (American Joint Committee on Cancer-seventh edition) HPV+ OPC, determined by pathologic parameters. Primary goals were feasibility of prospective multi-institutional study of TOS for HPV+ OPC, and oncologic efficacy (2-year progression-free survival) of TOS and adjuvant therapy in intermediate-risk patients after resection. TOS plus 50 Gy was considered promising if the lower limit of the exact 90% binomial confidence intervals exceeded 85%. Quality of life and swallowing were measured by functional assessment of cancer therapy-head and neck and MD Anderson Dysphagia Index. RESULTS Credentialed surgeons performed TOS for 495 patients. Eligible and treated patients were assigned as follows: arm A (low risk, n = 38) enrolled 11%, intermediate risk arms B (50 Gy, n = 100) or C (60 Gy, n = 108) randomly allocated 58%, and arm D (high risk, n = 113) enrolled 31%. With a median 35.2-month follow-up for 359 evaluable (eligible and treated) patients, 2-year progression-free survival Kaplan-Meier estimate is 96.9% (90% CI, 91.9 to 100) for arm A (observation), 94.9% (90% CI, 91.3 to 98.6]) for arm B (50 Gy), 96.0% (90% CI, 92.8 to 99.3) for arm C (60 Gy), and 90.7% (90% CI, 86.2 to 95.4) for arm D (66 Gy plus weekly cisplatin). Treatment arm distribution and oncologic outcome for ineligible or step 2 untreated patients (n = 136) mirrored the 359 evaluable patients. Exploratory comparison of functional assessment of cancer therapy-head and neck total scores between arms B and C is presented. CONCLUSION Primary TOS and reduced postoperative RT result in outstanding oncologic outcome and favorable functional outcomes in intermediate-risk HPV+ OPC.
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Affiliation(s)
| | - Yael Flamand
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Shuli Li
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | - Neil D. Gross
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | | | - Nabil F. Saba
- Winship Cancer Institute at Emory University, Atlanta, GA
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16
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Symer DE, Akagi K, Geiger HM, Song Y, Li G, Emde AK, Xiao W, Jiang B, Corvelo A, Toussaint NC, Li J, Agrawal A, Ozer E, El-Naggar AK, Du Z, Shewale JB, Stache-Crain B, Zucker M, Robine N, Coombes KR, Gillison ML. Diverse tumorigenic consequences of human papillomavirus integration in primary oropharyngeal cancers. Genome Res 2021; 32:55-70. [PMID: 34903527 PMCID: PMC8744672 DOI: 10.1101/gr.275911.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
Abstract
Human papillomavirus (HPV) causes 5% of all cancers and frequently integrates into host chromosomes. The HPV oncoproteins E6 and E7 are necessary but insufficient for cancer formation, indicating that additional secondary genetic events are required. Here, we investigate potential oncogenic impacts of virus integration. Analysis of 105 HPV-positive oropharyngeal cancers by whole-genome sequencing detects virus integration in 77%, revealing five statistically significant sites of recurrent integration near genes that regulate epithelial stem cell maintenance (i.e., SOX2, TP63, FGFR, MYC) and immune evasion (i.e., CD274). Genomic copy number hyperamplification is enriched 16-fold near HPV integrants, and the extent of focal host genomic instability increases with their local density. The frequency of genes expressed at extreme outlier levels is increased 86-fold within ±150 kb of integrants. Across 95% of tumors with integration, host gene transcription is disrupted via intragenic integrants, chimeric transcription, outlier expression, gene breaking, and/or de novo expression of noncoding or imprinted genes. We conclude that virus integration can contribute to carcinogenesis in a large majority of HPV-positive oropharyngeal cancers by inducing extensive disruption of host genome structure and gene expression.
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Affiliation(s)
- David E Symer
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Keiko Akagi
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | | | - Yang Song
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Gaiyun Li
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | | | - Weihong Xiao
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Bo Jiang
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - André Corvelo
- New York Genome Center, New York, New York 10013, USA
| | | | - Jingfeng Li
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, Ohio 43210, USA
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA
| | - Adel K El-Naggar
- Division of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Zoe Du
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Jitesh B Shewale
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | | | - Mark Zucker
- Department of Biomedical Informatics, Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA
| | | | - Kevin R Coombes
- Department of Biomedical Informatics, Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA
| | - Maura L Gillison
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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17
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Karivedu V, Bonomi M, Issa M, Blakaj A, Klamer BG, Pan X, Old M, Bhateja P, Kang S, Seim N, Ozer E, Agrawal A, Mitchell D, Gamez ME, Grecula J, Jhawar SR, Baliga S, Carrau RL, Rocco J, Blakaj D. Treatment Outcomes of Head and Neck Cancer Patients in the Elderly Receiving Different Chemoradiation Combinations: A Single-Center Experience. Oncol Res Treat 2021; 44:521-529. [PMID: 34515190 DOI: 10.1159/000518548] [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: 10/13/2020] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to assess the effect of definitive or adjuvant concurrent chemoradiation (CRT) among elderly patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC). MATERIALS AND METHODS We retrospectively analyzed 150 elderly LA HNSCC patients (age ≥70) at a single institution. Demographics, disease control outcomes, and toxicities with different chemotherapy regimens were reviewed. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS) estimates. RESULTS Median age at diagnosis was 74 years (range 70-88). Of the cohort, 98 (65.3%) patients received definitive and 52 (34.7%) received adjuvant CRT; 44 (29.3%) patients received weekly carboplatin and paclitaxel, 43 (28.7%) weekly cetuximab, 33 (22%) weekly carboplatin, and 30 (20%) weekly cisplatin. The OS at 2 years was 70% (95% confidence interval [CI]: 63-79%), and PFS at 2 years was 61% (95% CI: 53-70%). There was no significant difference in OS or PFS between definitive and adjuvant CRT (p = 0.867 and p = 0.475, respectively). Type of chemotherapy regimen (single-agent carboplatin vs. others) (95% CI: 1.1-3.9; p = 0.009) was a key prognostic factor in predicting OS in multivariable analysis. Concurrent use of cetuximab was associated with increased risk of PEG tube dependence at 6 months (p < 0.001). CONCLUSIONS Management of LA HNSCC in the elderly is a challenging scenario. Our study shows that CRT is a feasible treatment modality for elderly patients with LA HNSCC. We recommend CRT with weekly cisplatin or weekly carboplatin and paclitaxel. A chemotherapy regimen should be carefully selected in this difficult to treat population.
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Affiliation(s)
- Vidhya Karivedu
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA,
| | - Marcelo Bonomi
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Majd Issa
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adriana Blakaj
- Department of Radiation Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brett G Klamer
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Xueliang Pan
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Matthew Old
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Priyanka Bhateja
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen Kang
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nolan Seim
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Darrion Mitchell
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mauricio E Gamez
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John Grecula
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sachin R Jhawar
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sujith Baliga
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James Rocco
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dukagjin Blakaj
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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18
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Ferris RL, Flamand Y, Weinstein GS, Li S, Quon H, Mehra R, Garcia JJ, Ringash J, Lewin JS, Duvvuri U, O'Malley BW, Ozer E, Thomas GR, Koch W, Kupferman ME, Bell RB, Saba NF, Lango M, Wagner LI, Burtness B. Updated report of a phase II randomized trial of transoral surgical resection followed by low-dose or standard postoperative therapy in resectable p16+ locally advanced oropharynx cancer: A trial of the ECOG-ACRIN cancer research group (E3311). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6010 Background: Definitive or postoperative chemoradiation (CRT) is highly curative for human papillomavirus-associated (HPV+) oropharynx cancer (OPC) but induces significant toxicity. As a potential deintensification strategy, we studied primary transoral surgery (TOS) and, in intermediate pathologic risk patients, reduced dose postoperative RT (PORT). Methods: E3311 is a phase II trial with randomization to reduced- or standard-dose PORT for resected stage III-IVa (AJCC7) intermediate pathologic risk HPV+ OPC, stratified by smoking history. Primary endpoints have been reported; we now present updated 3-year PFS and patient-reported outcomes (PRO), including head and neck-cancer specific quality of life (FACT-H&N) and swallowing perception and performance (MDADI). Results: Of 519 enrolled patients, 495 underwent TOS. The primary oncologic endpoint was 2-year PFS for 50 Gy (Arm B) or 60Gy (Arm C). Among 360 eligible and treated patients (ETP), Arm A (observation, N = 38) enrolled 11%, Arms B (N = 100) or C (N = 109) randomized 58%, and Arm D (66Gy + weekly cisplatin, N = 113) enrolled 31%. With 35.1 months median follow-up, 3-year PFS Kaplan-Meier estimate is 96.9% (90% CI [91.9%, 100%]) for Arm A; 94.9% (90% CI [91.3%, 98.6%]) for Arm B; 93.5% (90% CI [89.4%, 97.9%]) for Arm C; and 90.7% (90% CI [86.2%, 95.4%]) for Arm D. Recurrences and death without recurrence were 4 and 1 in Arm B, and 5 and one in Arm C. Smokers ( > 10 pack-years) did not have worse 3-year PFS in Arms B or C. Treatment arm distribution and outcome for ineligible patients who started adjuvant therapy mirrored the 360 ETP. A comparison combining arms B/C versus arm D in the proportion of patients stable/improved in FACT-H&N total score, from baseline to 6 months post-treatment as a pre-specified endpoint, was 56% vs. 38% (p value = 0.011, one-sided Fisher’s exact test); however, underlying differences in treatment and risk may be confounding. An exploratory comparison between Arms B and C revealed improvement in FACT H&N (63% in Arm B vs. 49% in Arm C had a stable/improved score, p-value = 0.056). Conclusions: Primary TOS and reduced PORT retained outstanding oncologic outcome at 35 months follow up, with favorable QOL and functional outcomes, in intermediate risk HPV+ OPC. Clinical trial information: NCT 01898494.
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Affiliation(s)
- Robert L. Ferris
- University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | | | - Shuli Li
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | | | - Joaquin J. Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jan S. Lewin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Enver Ozer
- The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | | | - Wayne Koch
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Richard Bryan Bell
- Earle A. Chiles Research Institute at Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR
| | - Nabil F. Saba
- Winship Cancer Institute of Emory University, Atlanta, GA
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19
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Aydin I, Sehitoglu I, Ozer E, Kalkan Y, Tumkaya L, Cure MC, Cure E. High dose zoledronic acid increases ischemia-reperfusion damage of the liver. Eur Rev Med Pharmacol Sci 2021. [PMID: 34002831 DOI: 10.26355/eurrev_202105_25839.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Zoledronic acid (ZA), a nitrogen-containing bisphosphonate, has been reported to exhibit a protective effect against cancers and prevent bone fractures. It also induces apoptosis by increasing proinflammatory cytokines and oxidative stress. Oxidative stress increases significantly during ischemia-reperfusion (IR) injury. The liver is highly sensitive to IR injury. In this study, we aim to investigate whether high-dose ZA treatment affects the liver during IR. MATERIALS AND METHODS We used twenty-one Sprague-Dawley male rats in our study, and they were subdivided randomly into three groups, each containing seven rats. A single dose of 100 μg/kg ZA was administered via the intraperitoneal route in the ZA group. Forty-eight hours after the ZA administration, infrarenal abdominal aortic cross ligation was performed on the ZA and IR groups. After 2 hours of ischemia, 2 hours of reperfusion was applied. RESULTS The malondialdehyde (MDA) level of the control group was significantly lower than the IR (p = 0.006) and ZA (p<0.001) groups. However, the superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) values of the control group were significantly higher than the values of the IR group (p<0.05, p<0.001, and p<0.05) and ZA group (p = 0.002, p<0.001, and p<0.001). Caspase-3 activity was significantly higher in the IR group as compared to the control group (p<0.001). The caspase-3 activity in the ZA group, on the other hand, was higher than both the control (p<0.001) and IR groups (p<0.001). CONCLUSIONS High-dose ZA may exacerbate liver injury during IR by increasing reactive oxygen species production and apoptosis.
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Affiliation(s)
- I Aydin
- Department of General Surgery, Health Science University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
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Sethia R, Freeman T, Mead K, Selhorst A, Vala K, Skoracki L, Adelman M, VanKoevering K, Kang SY, Ozer E, Agrawal A, Old MO, Carrau RL, Rocco JW, Seim NB. Patient-Directed Home Drain Removal in Head and Neck Surgery. Laryngoscope 2021; 131:2471-2477. [PMID: 33847392 DOI: 10.1002/lary.29556] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to evaluate the efficacy and safety of at home drain removal in head and neck surgery patients. METHODS The study population included patients who underwent head and neck surgery at an academic tertiary care center between February 2020 and November 2020 and were discharged with one to four drains with instructions for home removal. Prior to discharge, patients received thorough drain removal education. Patients were prospectively followed to evaluate for associated outcomes. RESULTS One hundred patients were evaluated in the study. There was record for ninety-seven patients receiving education at discharge. The most common methods of education were face-to-face education and written instructions with educational video link provided. Of 123 drains upon discharge, 110 drains (89.4%) were removed at home while 13 (10.6%) were removed in office. Most drains were located in the neck (86.4%). There was one seroma, two hematomas, two drain site infections, and five ED visits; however, none of these complications were directly associated with the action of drain removal at home. Calculated cost savings for travel and lost wages was $259.82 per round trip saved. CONCLUSIONS The results demonstrate that home drain removal can provide a safe and efficacious option for patients following head and neck surgery. This approach was safe and associated with patient cost savings and better utilization of provider's time. Furthermore, patients and healthcare providers avoided additional in-person encounters and exposures during the COVID-19 pandemic. Our findings warrant further investigation into cost savings and formal patient satisfaction associated with home drain removal. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Rishabh Sethia
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Taylor Freeman
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Katherine Mead
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amanda Selhorst
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Kelly Vala
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Laura Skoracki
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Megan Adelman
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
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21
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Seim NB, Ozer E, Valentin S, Agrawal A, VanPutten M, Kang SY, Old MO. Custom Presurgical Planning for Midfacial Reconstruction. Facial Plast Surg 2020; 36:696-702. [PMID: 33368124 DOI: 10.1055/s-0040-1721812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Resection and reconstruction of midface involve complex ablative and reconstructive tools in head and oncology and maxillofacial prosthodontics. This region is extraordinarily important for long-term aesthetic and functional performance. From a reconstructive standpoint, this region has always been known to present challenges to a reconstructive surgeon due to the complex three-dimensional anatomy, the variable defects created, combination of the medical and dental functionalities, and the distance from reliable donor vessels for free tissue transfer. Another challenge one faces is the unique features of each individual resection defect as well as individual patient factors making each preoperative planning session and reconstruction unique. Understanding the long-term effects on speech, swallowing, and vision, one should routinely utilize a multidisciplinary approach to resection and reconstruction, including head and neck reconstructive surgeons, prosthodontists, speech language pathologists, oculoplastic surgeons, dentists, and/or craniofacial teams as indicated and with each practice pattern. With this in mind, we present our planning and reconstructive algorithm in midface reconstruction, including a dedicated focus on dental rehabilitation via custom presurgical planning.
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Affiliation(s)
- Nolan B Seim
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sasha Valentin
- Department of Dentistry - Maxillofacial Prosthodontics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mead VanPutten
- Department of Dentistry - Maxillofacial Prosthodontics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew O Old
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Abstract
Hyperbaric oxygen (HBO) is a treatment modality with the primary mechanism of therapy being the delivery of oxygen to hypoxic tissues. A review of HBO applications in the field of head and neck reconstruction and facial cosmetic surgery is provided. HBO can be useful in the management of radiation sequelae and treatment of compromised flaps and grafts. It may also have application in tissue compromise following cosmetic surgery and dermal fillers. We provide evidence from the available literature as well as highlight our experience in using HBO in head and neck reconstruction.
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Affiliation(s)
- Akina Tamaki
- Department of Otolaryngology - Head and Neck Surgery, James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Dustin A Silverman
- Department of Otolaryngology - Head and Neck Surgery, James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
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Eckstein J, Healy E, Jain A, Hawkins D, Ho Q, Agrawal A, Ozer E, Rupert R, Diavolitsis VM, Bhatt AD. A series of typical and atypical cases of Bazex syndrome: Identifying the red herring to avoid delaying cancer treatment. Clin Case Rep 2020; 8:2259-2264. [PMID: 33235772 PMCID: PMC7669396 DOI: 10.1002/ccr3.3133] [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: 03/12/2020] [Revised: 05/25/2020] [Accepted: 06/13/2020] [Indexed: 11/12/2022] Open
Abstract
Bazex syndrome is a rare paraneoplastic dermatosis that precedes diagnosis of cancer. Awareness of this syndrome is important, as it allows early detection of underlying malignancy and may prevent misdiagnosis and delays in cancer treatment.
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Affiliation(s)
- Jacob Eckstein
- Radiation OncologyLong Island Jewish Medical CenterNorthwell Health Cancer InstituteNew Hyde ParkNYUSA
| | - Erin Healy
- Radiation OncologyThe Ohio State University Medical CenterColumbusOHUSA
| | - Angita Jain
- Kasturba Medical College MangaloreMangaloreIndia
| | - Daniel Hawkins
- Radiation OncologySeidman Cancer CenterUniversity HospitalsClevelandOHUSA
| | - Quoc‐Anh Ho
- Radiation OncologyThe Ohio State University Medical CenterColumbusOHUSA
| | - Amit Agrawal
- OtolaryngologyThe Ohio State University Medical CenterColumbusOHUSA
| | - Enver Ozer
- OtolaryngologyThe Ohio State University Medical CenterColumbusOHUSA
| | - Robert Rupert
- Medical OncologyThe Ohio State University Medical CenterColumbusOHUSA
| | | | - Aashish D. Bhatt
- Radiation OncologySeidman Cancer CenterUniversity HospitalsClevelandOHUSA
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Patel KB, Martin D, Zhao S, Kumar B, Carrau R, Ozer E, Agrawal A, Kang S, Rocco JW, Schuller D, Teknos T, Brock G, Old M. Impact of age and comorbidity on survival among patients with oral cavity squamous cell carcinoma. Head Neck 2020; 43:268-277. [PMID: 32996249 DOI: 10.1002/hed.26487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/03/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To identify predictors of overall survival (OS) and to stratify patients according to significant prognostic variables. METHODS A retrospective study of 274 consecutive patients with primary Oral Cavity Squamous Cell Carcinoma. Kaplan-Meier, Cox proportional hazard models, and recursive partitioning analysis (RPA) were used for analysis of OS. These results were further validated using National Cancer Database cohort of 21 895 patients. RESULTS Median OS was 3.65 years. T-classification and N-classification, alcoholic beverages/week, age, and adjuvant treatment were significant predictors of OS. RPA identified high-risk subpopulations: N0-1 patients with CCI ≥ 4.5 and N2-3 patients ordered by those not receiving adjuvant treatment, those with T3-4 disease despite adjuvant therapy, and those having T1-2 disease with adjuvant therapy. CONCLUSIONS This study utilized significant prognostic indicators and RPA to highlight the importance of age, N-classification, T-classification, comorbidity, and adjuvant therapy in conjunction with American Joint Committee on Cancer staging to improve preoperative counseling.
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Affiliation(s)
- Krupal B Patel
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Daniel Martin
- School of Medicine & Dentistry, University of Rochester, Rochester, New York, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Bhavna Kumar
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Ricardo Carrau
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Stephen Kang
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - David Schuller
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Theodoros Teknos
- Department of Otolaryngology-Head and Neck Surgery, Case Western University, Cleveland, Ohio, USA
| | - Guy Brock
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Matthew Old
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
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Naik AN, Freeman T, Li MM, Marshall S, Tamaki A, Ozer E, Agrawal A, Kang SY, Old MO, Seim NB. The Use of Vasopressor Agents in Free Tissue Transfer for Head and Neck Reconstruction: Current Trends and Review of the Literature. Front Pharmacol 2020; 11:1248. [PMID: 32982724 PMCID: PMC7485519 DOI: 10.3389/fphar.2020.01248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background/Objectives Microvascular free tissue transfer has become essential to head and neck reconstruction and recent advancements in microvascular surgery have led to excellent surgical outcomes. However, there continues to be controversy and a stigma associated with the use of perioperative intravenous vasopressor agents among both surgeons and anesthesiologists. Due to concern for vasoconstriction of peripheral vasculature flowing to the denervated tissue flap, there remains concerns about potential thrombosis, decreased tissue perfusion and ultimately flap failure. This topic becomes even more important as vasopressors play an essential role in new Extended Recovery After Surgery (ERAS) protocols being put in place to optimize postoperative recovery for patients. The purpose of this study was to comprehensively review the role and safety as well as discuss current trends with intraoperative vasopressor agents in free tissue transfer for head and neck reconstruction. Methods A scoping literature review was conducted of all studies that examined the use of vasopressor agents during head and neck free flap tissue transfer. Primary and secondary outcomes included free flap survival, arterial thrombosis, venous congestion, need for revision surgery, and other postoperative complications. Results One prospective and nine retrospective studies were identified. Phenylephrine and ephedrine were the most common vasopressors reported; the rate of vasopressor use ranged from 53% to 85% and administration methods included both bolus and infusion. The included studies did not show any significant association between the use of vasopressors and free flap failure, pedicle thrombosis, or other flap complications. Conclusion The administration of vasopressors during microvascular free tissue transfer for head and neck reconstruction does not seem to be associated with increased flap failure rates or other postoperative morbidities. Moreover, vasopressors may provide overall improved hemodynamic stability and help to limit overall fluid administration and subsequent postoperative complications. Additional prospective investigation is warranted to further elucidate and establish evidence-based recommendations regarding the type, timing, and dose of vasopressors to further enhance free flap survival and patient outcomes.
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Affiliation(s)
- Akash N Naik
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Taylor Freeman
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Michael M Li
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Scarlett Marshall
- Department of Anesthesia, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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26
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Issa M, Schultz T, Xu M, Bhateja P, Karivedu V, Dibs K, Old M, Kang S, Gamez M, Grecula J, Jhawar S, Mitchell D, Seim N, Agrawal A, Ozer E, Baliga S, Carrau R, Rocco J, Blakaj D, Bonomi M. 948P Pre-treatment characteristics and long-term outcomes of recurrent-metastatic head and neck cancer patients treated with immune checkpoint inhibitors. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1063] [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: 11/26/2022] Open
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Abstract
OBJECTIVE Extensive mandibulofacial defects can be challenging to reconstruct. We present the case of a complex mandibulofacial defect reconstructed with a mega, chimeric fibula free flap. METHODS Ablation of the oral cavity tumor resulted in a large defect involving mandible, floor of mouth, and tongue. Skin of the chin and neck as well as the lower lip were also resected. A fibula free flap was harvested with the skin paddle involving most of the lateral compartment. RESULTS The fibula free flap was split into proximal (80 cm2) and distal (120 cm2) skin paddle islands, which were supplied by separate perforators off the peroneal artery. The intraoral soft tissue defect was reconstructed with the proximal skin paddle while the skin was recreated with the distal skin paddle. A Karapandzic flap was used to reconstruct the lower lip. CONCLUSIONS The traditional fibula free flap skin paddle often does not provide sufficient soft tissue coverage for large mandibulofacial defects. Some surgeons opt to harvest a second free flap. We describe our technique for using the mega fibula free flap - one of the largest reported in the literature - as a single mode of reconstruction.
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Affiliation(s)
- Chen Lin
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Akina Tamaki
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Ferris RL, Flamand Y, Holsinger FC, Weinstein GS, Quon H, Mehra R, Garcia JJ, Hinni ML, Gross ND, Sturgis EM, Duvvuri U, Méndez E, Ridge JA, Magnuson JS, Higgins KA, Patel MR, Smith RB, Karakla DW, Kupferman ME, Malone JP, Judson BL, Richmon J, Boyle JO, Bayon R, O'Malley BW, Ozer E, Thomas GR, Koch WM, Bell RB, Saba NF, Li S, Sigurdson ER, Burtness B. A novel surgeon credentialing and quality assurance process using transoral surgery for oropharyngeal cancer in ECOG-ACRIN Cancer Research Group Trial E3311. Oral Oncol 2020; 110:104797. [PMID: 32679405 DOI: 10.1016/j.oraloncology.2020.104797] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 02/21/2020] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Understanding the role of transoral surgery in oropharyngeal cancer (OPC) requires prospective, randomized multi-institutional data. Meticulous evaluation of surgeon expertise and surgical quality assurance (QA) will be critical to the validity of such trials. We describe a novel surgeon credentialing and QA process developed to support the ECOG-ACRIN Cancer Research Group E3311 (E3311) and report outcomes related to QA. PATIENTS AND METHODS E3311 was a phase II randomized clinical trial of transoral surgery followed by low- or standard-dose, risk-adjusted post-operative therapy with stage III-IVa (AJCC 7th edition) HPV-associated OPC. In order to be credentialed to accrue to this trial, surgeons were required to demonstrate active hospital credentials and technique-specific surgical expertise with ≥20 cases of transoral resection for OPC. In addition, 10 paired operative and surgical pathology reports from the preceding 24 months were reviewed by an expert panel. Ongoing QA required <10% rate of positive margins, low oropharyngeal bleeding rates, and accrual of at least one patient per 12 months. Otherwise surgeons were placed on hold and not permitted to accrue until re-credentialed using a new series of transoral resections. RESULTS 120 surgeons trained in transoral minimally invasive surgery applied for credentialing for E3311 and after peer-review, 87 (73%) were approved from 59 centers. During QA on E3311, positive final pathologic margins were reported in 19 (3.8%) patients. Grade III/IV and grade V oropharyngeal bleeding was reported in 29 (5.9%) and 1 (0.2%) of patients. CONCLUSIONS We provide proof of concept that a comprehensive credentialing process can support multicenter transoral head and neck surgical oncology trials, with low incidence of positive margins and *grade III/V oropharyngeal bleeding.
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Affiliation(s)
| | - Yael Flamand
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, United States
| | | | | | - Harry Quon
- Johns Hopkins University, Baltimore, MD, United States
| | - Ranee Mehra
- University of Maryland, Baltimore, MD, United States
| | | | | | - Neil D Gross
- The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Erich M Sturgis
- The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, PA, United States
| | | | | | - Mihir R Patel
- Winship Cancer Institute at Emory University, Atlanta, GA, United States
| | | | | | - Michael E Kupferman
- The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - James P Malone
- UPMC Pinnacle Cancer Center, Harrisburg, PA, United States
| | - Benjamin L Judson
- Yale School of Medicine and Yale Cancer Center, New Haven, CT, United States
| | - Jeremy Richmon
- Massachusetts Eye and Ear, Harvard University, Boston, MA, United States
| | - Jay O Boyle
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | | | - Enver Ozer
- The Ohio State University, Columbus, OH, United States
| | - Giovana R Thomas
- University of Miami Leonard Miller School of Medicine, Miami, FL, United States
| | - Wayne M Koch
- Johns Hopkins University, Baltimore, MD, United States
| | - R Bryan Bell
- Providence Cancer Institute, Portland, OR, United States
| | - Nabil F Saba
- Winship Cancer Institute at Emory University, Atlanta, GA, United States
| | - Shuli Li
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, United States
| | | | - Barbara Burtness
- Yale School of Medicine and Yale Cancer Center, New Haven, CT, United States
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29
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Ferris RL, Flamand Y, Weinstein GS, Li S, Quon H, Mehra R, Garcia JJ, Chung CH, Gillison ML, Duvvuri U, O'malley BW, Ozer E, Thomas GR, Koch W, Kupferman ME, Bell RB, Saba NF, Lango M, Mendez E, Burtness B. Transoral robotic surgical resection followed by randomization to low- or standard-dose IMRT in resectable p16+ locally advanced oropharynx cancer: A trial of the ECOG-ACRIN Cancer Research Group (E3311). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6500] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6500 Background: ECOG-ACRIN 3311 examines reduced postoperative therapy in patients with “intermediate risk” p16+ oropharynx cancer (OPC) undergoing primary transoral surgical management. We report the primary endpoint of 2-year progression free survival (PFS) for patients randomized to 50Gy vs 60Gy without chemotherapy. Methods: Between December 2013 and July 2017, 82 credentialed surgeons performed transoral resection (TOS) for 519 OPC patients (cT1-2 stage III/IV AJCC7 without matted neck nodes); post-operative management was determined by pathologically assessed risk. Among 353 eligible and treated patients, Arm A enrolled 10% (N=37) for clear margins, 0-1 nodes, no extranodal extension (ENE)), Arms B (50Gy, N=102) or C (60Gy, N=104) randomized 58%, for clear/close margins, 2-4 + nodes, or ENE ≤1mm, while Arm D (N=110, 60-66Gy plus weekly cisplatin, 40 mg/m2, positive margin with any T stage, >4 + nodes, or >1mm ENE) enrolled 31%. Arm D assignment was based on >1mm ENE (76%), > 4 nodes (27%), and/or positive margins (11%). Intermediate-risk patients were stratified by smoking history (>10 pk-yr). Of the 80 pts (15%) deemed ineligible, 28 had scans/labs not done per protocol, however treatment arm distribution for all patients mirrored that for the 353 pts eligible and treated. Results: Median follow-up was 31.8 months. 2 yr PFS for Arms A, B and C were 93.9% (90% CI=87.3%, 100%), 95.0% (90% CI=91.4%, 98.6%) and 95.9% (90% CI=92.6%, 99.3%) respectively, while Arm D was 90.5% (90% CI=85.9%, 95.3%). The regimen of TOS + low-dose radiation is considered worthy of further study, since the primary endpoint of the upper bound of the 90% CI (in the intermediate risk group) exceeding 85% was met. Of 17 progression events, 7 were locoregional. There were 10 distant recurrences: Arm A=1, Arm B=2, Arm C=4, Arm D=3. Grade III/IV treatment-related AE rates were 15%/2% during surgery, 13%/2% for Arm B and 25%/0% for Arm C. There were 2 treatment-related deaths (one surgical and one Arm D). Conclusions: Transoral resection of p16+ OPC is safe and results in good oncologic outcome, presenting a promising deintensification approach. For patients with low-risk disease, 2-yr PFS is favorable without post-operative therapy. For those with uninvolved surgical margins, <5 involved nodes, and minimal (<1mm) ENE, reduced dose postoperative RT without chemotherapy appears sufficient. Transoral surgery plus 50Gy should be compared to optimal non-surgical therapy in a phase III trial. Clinical trial information: NCT01898494 .
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Affiliation(s)
- Robert L. Ferris
- University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | | | - Shuli Li
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Ranee Mehra
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | | | | | - Enver Ozer
- The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | | | - Wayne Koch
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Richard Bryan Bell
- Earle A. Chiles Research Institute at Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR
| | - Nabil F. Saba
- Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Eduardo Mendez
- Department of Otolaryngology: Head and Neck Surgery, University of Washington, Seattle, WA
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Lancione PJ, Kumar B, Zhao S, Mroz EA, Brock G, Rocco JW, Carrau RL, Agrawal A, Seim N, Kang SY, Ozer E, Old MO. A potential protective effect of metformin in adenoid cystic carcinoma. Oral Oncol 2020; 107:104726. [PMID: 32388409 DOI: 10.1016/j.oraloncology.2020.104726] [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: 03/03/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Peter J Lancione
- The Ohio State University College of Medicine, 370 W 9(th) Ave, Columbus, OH 43210, USA.
| | - Bhavna Kumar
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA.
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, 320 Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43210, USA.
| | - Edmund A Mroz
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA.
| | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, 320 Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43210, USA
| | - James W Rocco
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA.
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA.
| | - Amit Agrawal
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA.
| | - Nolan Seim
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA.
| | - Stephen Y Kang
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA.
| | - Enver Ozer
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA.
| | - Matthew O Old
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA.
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Mladkova N, Olausson A, Gamez M, Grecula J, Miller E, Jhawar S, Bhateja P, Old M, Agrawal A, Ozer E, Carrau R, Kang S, Seim N, Rocco J, Bonomi M, Blakaj D. Body-Mass Index (BMI) and early stage as predictors of papillomavirus infection in H&N cancers. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.182] [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: 11/30/2022]
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Li MM, Tamaki A, Seim NB, Kang SY, Ozer E, Agrawal A, Old MO. Utilization of microvascular couplers in salvage arterial anastomosis in head and neck free flap surgery: Case series and literature review. Head Neck 2020; 42:E1-E7. [PMID: 32196817 DOI: 10.1002/hed.26139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/30/2019] [Revised: 02/09/2020] [Accepted: 03/05/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In microvascular reconstruction of ablative oncologic defects, coupler devices have traditionally been used for venous anastomosis, whereas the arterial anastomosis is hand-sewn. In the setting of repeated intraoperative arterial anastomotic thrombosis, a coupler device may be of use in reducing the risk of rethrombosis. METHODS Two patients were seen with advanced stage head and neck cancer and underwent oncologic resection. During microvascular reconstruction, a clot at the arterial anastomosis was encountered in both cases. RESULTS After starting therapeutic anticoagulation and attempting unsuccessful suture reanastomosis, coupler devices were used for arterial anastomosis, resulting in viable free-tissue transfer. CONCLUSIONS Although traditionally used for venous anastomosis, coupler devices may serve a purpose in the salvage setting when facing repeated intraoperative arterial thrombosis.
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Affiliation(s)
- Michael M Li
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Densky J, Eskander A, Kang S, Chan J, Tweel B, Sitapara J, Ozer E, Agrawal A, Carrau R, Rocco J, Teknos TN, Old M. Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction. JAMA Otolaryngol Head Neck Surg 2020; 145:216-221. [PMID: 30605208 DOI: 10.1001/jamaoto.2018.3820] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Postoperative delirium (POD) is associated with an increased rate of adverse events, higher health care costs, and longer hospital stays. At present, limited data are available regarding the risk factors for developing POD in patients undergoing head and neck free flap reconstruction. Identification of patients at high risk of developing POD will allow implementation of risk-mitigation strategies. Objective To determine the frequency of and risk factors associated with POD in patients undergoing free flap reconstruction secondary to head and neck disease. Design, Setting, and Participants This retrospective cohort study included 515 patients undergoing free flap reconstruction from January 1, 2006, through December 31, 2012, at the James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Care Center, a tertiary care cancer hospital. Preoperative, intraoperative, and postoperative data were collected retrospectively. Data from January 1, 2006, through December 31, 2012, were analyzed, and the final date of data analysis was January 8, 2018. Interventions Head and neck free flap reconstruction. Main Outcomes and Measures The primary outcome was the development of POD as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Univariable and multivariable logistic regression were used to identify risk factors associated with POD. Results Five hundred fifteen patients underwent free flap reconstruction during the study period (66.2% male; mean [SD] age, 60.1 [12.8] years). Of these, 56 patients (10.9%) developed POD. On multivariable analysis, risk factors associated with POD included increased age (odds ratio [OR], 1.06; 95% CI, 1.02-1.11), male sex (OR, 5.02; 95% CI, 1.47-17.20), increased operative time (OR for each 1-minute increase, 1.004 [95% CI, 1.001-1.006]; OR for each 1-hour increase, 1.26 [95% CI, 1.08-1.46]), advanced nodal disease (OR, 3.00; 95% CI, 1.39-6.46), and tobacco use (OR, 7.23; 95% CI, 1.43-36.60). Preoperative abstinence from alcohol was identified as a protective factor (OR, 0.24; 95% CI, 0.12-0.51). Conclusions and Relevance This study identified variables associated with a higher risk of developing POD. Although many of these risk factors are nonmodifiable, they provide a target population for quality improvement initiatives. Furthermore, preoperative alcohol abstinence may be useful in preventing POD.
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Affiliation(s)
- Jaron Densky
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Stephen Kang
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Jon Chan
- Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond
| | - Ben Tweel
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jigar Sitapara
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Enver Ozer
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Amit Agrawal
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Ricardo Carrau
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - James Rocco
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Ted N Teknos
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Matthew Old
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
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Zhan KY, Puram SV, Li MM, Silverman DA, Agrawal AA, Ozer E, Old MO, Carrau RL, Rocco JW, Higgins KM, Enepekides DJ, Husain Z, Kang SY, Eskander A. National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma. Cancer 2019; 126:1295-1305. [DOI: 10.1002/cncr.32654] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Kevin Y. Zhan
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Sidharth V. Puram
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Michael M. Li
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Dustin A. Silverman
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Amit A. Agrawal
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Enver Ozer
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Matthew O. Old
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Ricardo L. Carrau
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - James W. Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Kevin M. Higgins
- Department of Otolaryngology–Head and Neck Surgery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
| | - Danny J. Enepekides
- Department of Otolaryngology–Head and Neck Surgery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
| | - Zain Husain
- Department of Radiation Oncology Sunnybrook Health Sciences Centre and Odette Cancer Centre University of Toronto Toronto Ontario Canada
| | - Stephen Y. Kang
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
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Mousa L, Issa M, Klamer B, Pan J, Old M, Kang S, Agrawal A, Ozer E, Carrau R, Bhateja P, Rupert R, Jhawar S, Mitchell D, Gamez M, Rocco J, Blakaj D, Bonomi M. A nomogram based prognostic score to predict overall survival (OS) in recurrent-metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients (pts) treated with immune checkpoint inhibitors (ICI). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.054] [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: 11/13/2022] Open
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Issa M, Mousa L, Blakaj D, Klamer B, Pan J, Old M, Kang S, Rupert R, Mitchell D, Ozer E, Agrawal A, Bhateja P, Gamez M, Miller E, Jhawar S, Carrau R, Rocco J, Bonomi M. Treatment outcomes of head and neck cancer patients 70 years and older receiving different chemo-radiation combinations. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.018] [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: 11/14/2022] Open
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Affiliation(s)
- Rishabh Sethia
- Department of Otolaryngology-Head & Neck Surgery, 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amrita Hari-Raj
- College of Medicine, 12306The Ohio State University, Columbus, OH, USA
| | - Maria Koenigs
- Department of Otolaryngology-Head & Neck Surgery, 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Enver Ozer
- Department of Otolaryngology-Head & Neck Surgery, 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
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Sethia R, Allarakhia Z, Puram S, Kang S, Ozer E, Agrawal A, Carrau R, Rocco J, Old M. Free flap salvage from venous thrombosis by creation of a venocutaneous fistula: Case report and review of the literature. Head Neck 2019; 41:E159-E162. [PMID: 31512798 DOI: 10.1002/hed.25957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/08/2019] [Accepted: 08/26/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Venous congestion is the most frequently reported complication of free flap tissue transfer in head and neck patient with cancer. Numerous methods are utilized and prompt correction is necessary to prevent flap failure. METHODS A 77-year-old woman underwent oral cavity resection and neck dissection for squamous cell carcinoma followed by radial forearm free flap for reconstruction. Three days later, the flap became congested and surgical exploration revealed extensive venous thrombosis throughout the free flap venous system and internal jugular vein. The flap vein was evacuated and flowing, and a venocutaneous fistula was created thereafter. RESULTS Venocutaneous fistula resulted in flap decongestion and successful salvage. The patient was discharged from the hospital with no further flap or surgical complications. CONCLUSION When anatomical revision of the venous anastomosis is not feasible in a venous-congested free flap, the creation of a venocutaneous fistula should be considered as a viable option for salvage.
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Affiliation(s)
- Rishabh Sethia
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Sidharth Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri.,Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Stephen Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Ricardo Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - James Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Matthew Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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Kaka AS, Zhao S, Ozer E, Agrawal A, Kang S, Rocco J, Carrau R, Teknos T, Clapp JD, Weed H, Old MO. Comparison of Clinical Outcomes Following Head and Neck Surgery Among Patients Who Contract to Abstain From Alcohol vs Patients Who Abuse Alcohol. JAMA Otolaryngol Head Neck Surg 2019; 143:1181-1186. [PMID: 28447103 DOI: 10.1001/jamaoto.2017.0553] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Azeem S Kaka
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Songzhu Zhao
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Enver Ozer
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Amit Agrawal
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Stephen Kang
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - James Rocco
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Ricardo Carrau
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Theodoros Teknos
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - John D Clapp
- The Ohio State University College of Social Work, Columbus
| | - Harrison Weed
- Division of General Medicine, Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus
| | - Matthew O Old
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
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Patel KB, Lin C, Kramer S, Fada C, Ozer E. Transoral robotic excision of laryngocele: Surgical considerations. Head Neck 2019; 41:1140-1143. [PMID: 30652374 DOI: 10.1002/hed.25612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/06/2018] [Revised: 10/28/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) has emerged as a novel, safe, and feasible procedure for the resection of malignant supraglottic laryngeal cancers. The purpose of this study was to demonstrate the surgical technique with extension of the use of TORS to excise a laryngeal cyst. RESULTS Laryngeal cyst resection, along with its tract, was accomplished with preservation of both false and true vocal cords. There was no perioperative or early postoperative complications. The patient was extubated immediately after surgery. Oral diet was initiated within 24 hours. No tracheostomy was required. A video demonstration of the surgical technique is included on Head & Neck's website. CONCLUSION TORS is a safe and feasible procedure for excision of selected laryngeal cysts.
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Affiliation(s)
- Krupal B Patel
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Chen Lin
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Scott Kramer
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Craig Fada
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Teknos TN, Grecula J, Agrawal A, Old MO, Ozer E, Carrau R, Kang S, Rocco J, Blakaj D, Diavolitsis V, Kumar B, Kumar P, Pan Q, Palettas M, Wei L, Baiocchi R, Savvides P. A phase 1 trial of Vorinostat in combination with concurrent chemoradiation therapy in the treatment of advanced staged head and neck squamous cell carcinoma. Invest New Drugs 2018; 37:702-710. [PMID: 30569244 DOI: 10.1007/s10637-018-0696-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
Purpose Vorinostat is a potent HDAC inhibitor that sensitizes head and neck squamous cell carcinoma (HNSCC) to cytotoxic therapy while sparing normal epithelium. The primary objective of this Phase I study was to determine the maximally tolerated dose (MTD) and safety of Vorinostat in combination with standard chemoradiation therapy treatment in HNSCC. Patients and Methods Eligible patients had pathologically confirmed Stage III, IVa, IVb HNSCC, that was unresectable or borderline resectable involving the larynx, hypopharynx, nasopharynx, and oropharynx. Vorinostat was administered at the assigned dosage level (100-400 mg, three times weekly) in a standard 3 + 3 dose escalation design. Vorinostat therapy began 1 week prior to initiation of standard, concurrent chemoradiation therapy and continued during the entire course of therapy. Results Twenty six patients met eligibility criteria and completed the entire protocol. The primary tumor sites included tonsil (12), base of tongue (9), posterior pharyngeal wall (1), larynx (4) and hypopharynx (3). Of the 26 patients, 17 were HPV-positive and 9 were HPV-negative. The MTD of Vorinostat was 300 mg administered every other day. Anemia (n = 23/26) and leukopenia (n = 20/26) were the most commonly identified toxicities. The most common Grade3/4 events included leukopenia (n = 11) and lymphopenia (n = 17). No patient had Grade IV mucositis, dermatitis or xerostomia. The median follow time was 33.8 months (range 1.6-82.9 months). Twenty four of 26 (96.2%) patients had a complete response to therapy. Conclusion Vorinostat in combination with concurrent chemoradiation therapy is a safe and highly effective treatment regimen in HNSCC. There was a high rate of complete response to therapy with toxicity rates comparable, if not favorable to existing therapies. Further investigation in Phase II and III trials is strongly recommended.
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Affiliation(s)
- Theodoros N Teknos
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA. .,Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - J Grecula
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - A Agrawal
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - M O Old
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - E Ozer
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - R Carrau
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - S Kang
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - J Rocco
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - D Blakaj
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - V Diavolitsis
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - B Kumar
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - P Kumar
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - Q Pan
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - M Palettas
- Center for Biostatistics, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - L Wei
- Center for Biostatistics, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - R Baiocchi
- Hematology-Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - P Savvides
- Hematology-Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
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Blakaj D, Custer A, Zoller W, Wolfe A, Bhatt A, Grams S, Old M, Kang S, Agrawal A, Ozer E, Wobb J, Rupert R, Mitchell D, Verschraegen C, Rocco J, Bonomi M. A Prospective Analysis of Ototoxicity in Modern Radiation Therapy Treatments for Head and Neck Squamous Cell Carcinoma (HNSCC) Patients Receiving Concomitant Chemo-Radiation (CRT) with Weekly or Tri-weekly Cisplatin (Cis). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.786] [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: 11/16/2022]
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Ozer E, Çetinkaya G, Deligonul A, Melek H, Sevinç T, Kurt E, Bayram A, Evrensel T, Gebitekin C. P2.17-24 Does the Change in Body Mass Index During Induction Chemo/Chemoradiotherapy Affect the Outcome of Surgery in Locally Advanced NSCLC? J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1550] [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: 11/26/2022]
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Melek H, Çetinkaya G, Bayram A, Akyildiz E, Yenturk E, Ozer E, Sevinç T, Gebitekin C. P2.16-33 Adenosquamous Carcinoma of the Lung: Comparison of Surgical Outcomes with Squamous Cell and Adenocarcinoma. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Varma VR, Eskander A, Kang SY, Kumar B, Brown NV, Zhao S, Brock G, Agrawal A, Carrau RL, Old MO, Ozer E, Rocco JW, Schuller DE, Dziegielewski PT, Cipolla MJ, Teknos TN. Predictors of gastrostomy tube dependence in surgically managed oropharyngeal squamous cell carcinoma. Laryngoscope 2018; 129:415-421. [DOI: 10.1002/lary.27290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Vivek R. Varma
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Stephen Y. Kang
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Bhavna Kumar
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Nicole V. Brown
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Songzhu Zhao
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Guy Brock
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Ricardo L. Carrau
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Matthew O. Old
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - James W. Rocco
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - David E. Schuller
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Peter T. Dziegielewski
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Michael J. Cipolla
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute; The Ohio State University Wexner Medical Center; Columbus U.S.A
| | - Theodoros N. Teknos
- UH Cleveland Medical Center- Department of Otolaryngology, Head and Neck Surgery; Cleveland Ohio U.S.A
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Das J, Custer A, Blakaj D, Old MO, Zhao S, Bhatt AD, Kang SY, Agrawal A, Ozer E, Wobb J, Rupert R, Mitchell DL, Brock G, Verschraegen CF, Rocco JW, Bonomi MR. Incidence of ototoxicity in head and neck cancer (HNSCC) patients (pts) receiving concomitant chemo-radiation (CRT) with weekly or triweekly cisplatin (Cis). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.6046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jishu Das
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Amy Custer
- Ohio Stae University Comprehensive Cancer Center, Columbues, OH
| | | | - Matthew O. Old
- The Ohio State University - Arthur James Cancer Hospital, Columbus, OH
| | | | - Aashish D Bhatt
- Ohio Stae University Comprehensive Cancer Center, Columbus, OH
| | - Stephan Y Kang
- The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Amit Agrawal
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Enver Ozer
- The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Jessica Wobb
- Oakland University William Beaumont School of Medicine, Beaumont Cancer Institute, Royal Oak, MI
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Ur K, Demiroz S, Bengu AS, Ulucan A, Gergin OO, Kizmazoglu C, Ozer E. Serum endocan level and the severity of spinal cord injury. ACTA ACUST UNITED AC 2018; 119:298-301. [PMID: 29749245 DOI: 10.4149/bll_2018_056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether the endocan level may be related to the severity of spinal cord injury. BACKGROUND Several biomarkers were evaluated for this purpose, but endocan has never been studied before. It is correlated to endothelial dysfunction and ischemia, which are the characteristics of spinal cord injury in most cases. MATERIAL AND METHODS A total of 21 male Sprague-Dawley rats weighing 300-350 g were randomly divided into three groups. In Group I, only a laminectomy was performed; in Group II, a mild SCI was performed after laminectomy; and, in Group III, a severe SCI was performed after laminectomy. At 48 h after the injury, after neurological assessment by Tarlov method, all animals were euthanized. A 5 cc blood sample was drawn for biochemical analysis, and spinal cord tissues were removed for histopathological examination. RESULTS The difference between Groups I and III was statistically significant (p < 0.05). There was also a moderately positive correlation between the severity of SCI and the endocan level (r = 0.59, p < 0.05). CONCLUSION The endocan level may be used as an indicator to determine prognosis after SCI (Tab. 1, Fig. 2, Ref. 24). Text in PDF www.elis.sk.
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Abstract
We herein report a case of inflammatory pseudotumor of the uterus, which is a very unusual site for the lesion. To the best of our knowledge, only 2 cases of inflammatory pseudotumor of the uterus have been reported.
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Affiliation(s)
- H A Kargi
- Department of Pathology, Faculty of Medecine, Dokuz Eylül University, Izmir, Turkey
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Eskander A, Kang S, Tweel B, Sitapara J, Old M, Ozer E, Agrawal A, Carrau R, Rocco JW, Teknos TN. Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures. Otolaryngol Head Neck Surg 2018; 158:839-847. [DOI: 10.1177/0194599818757949] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Stephen Kang
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Ben Tweel
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jigar Sitapara
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Matthew Old
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Enver Ozer
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Amit Agrawal
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Ricardo Carrau
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - James W. Rocco
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Theodoros N. Teknos
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
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Eskander A, Kang SY, Ozer E, Agrawal A, Carrau R, Rocco JW, Teknos TN, Old MO. Supine positioning for the subscapular system of flaps: A pictorial essay. Head Neck 2018; 40:1068-1072. [DOI: 10.1002/hed.25051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/05/2017] [Accepted: 11/16/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Oncology; Ohio State University, James Cancer Centre and Solove Research Institute; Columbus Ohio
| | - Stephen Y. Kang
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Oncology; Ohio State University, James Cancer Centre and Solove Research Institute; Columbus Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Oncology; Ohio State University, James Cancer Centre and Solove Research Institute; Columbus Ohio
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Oncology; Ohio State University, James Cancer Centre and Solove Research Institute; Columbus Ohio
| | - Ricardo Carrau
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Oncology; Ohio State University, James Cancer Centre and Solove Research Institute; Columbus Ohio
| | - James W. Rocco
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Oncology; Ohio State University, James Cancer Centre and Solove Research Institute; Columbus Ohio
| | - Theodoros N. Teknos
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Oncology; Ohio State University, James Cancer Centre and Solove Research Institute; Columbus Ohio
| | - Matthew O. Old
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Oncology; Ohio State University, James Cancer Centre and Solove Research Institute; Columbus Ohio
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