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Howell R, Tang A, Allen J, Altaye M, Amin M, Bayan S, Belafsky P, Cervenka B, deSilva B, Dion G, Ekbom D, Friedman A, Fritz M, Giliberto JP, Guardiani E, Harmon J, Kasperbauer JL, Khosla S, Kim B, Kuhn M, Kwak P, Ma Y, Madden L, Matrka L, Mayerhoff R, Piraka C, Rosen C, Tabangin ME, Wahab SA, Wilson K, Wright SC, Young V, Yuen S, Postma GN. Killian Jamieson Diverticulum, the Great Mimicker: A Case Series and Contemporary Review. Laryngoscope 2023; 133:2110-2115. [PMID: 36453465 DOI: 10.1002/lary.30508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To assess barium esophagram (BAS) as a diagnostic marker for patients with Killian Jamieson diverticula (KJD). METHODS Prospective, multicenter cohort study of individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative. Patient demographics, comorbidities, radiographic imaging reports, laryngoscopy findings, patient-reported outcome measures (PROM), and operative reporting were abstracted from a REDCap database and summarized using means, medians, percentages, frequencies. Paired t-tests and Wilcoxon Signed Rank test were used to test pre- to post-operative differences in RSI, EAT-10, and VHI-10 scores. Diagnostic test evaluation including sensitivity, specificity, positive, and negative predictive value with 95% confidence intervals were calculated comparing BAS findings to operative report. RESULTS A total of 287 persons were enrolled; 13 (4%) patients were identified with confirmed KJD on operative reports. 100% underwent open transcervical excision. BAS has a 46.2% (95% confidence interval [CI]: 23.2, 70.9) sensitivity and 97.8% (95% CI: 95.3, 99.0) specificity in detecting a KJD and 50% (95% CI: 25.4, 74.6) positive predictive value but 97.4% (95%CI: 94.8, 98.7) negative predictive value. Preoperatively, patients reported mean (SD) RSI and EAT-10 of 19.4 (9) and 8.3 (7.5) accordingly. Postoperatively, patients reported mean (SD) RSI and EAT-10 as 5.4 (6.2) and 2.3 (3.3). Both changes in RSI and EAT-10 were statistically significant (p = 0.008, p = 0.03). CONCLUSION KJD are rare and represent <5% of hypopharyngeal diverticula undergoing surgical intervention. Open transcervical surgery significantly improves symptoms of dysphagia. BAS has high specificity but low sensitivity in detecting KJD. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2110-2115, 2023.
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Affiliation(s)
- Rebecca Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alice Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jacqui Allen
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Milan Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Semirra Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California, USA
| | - Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brad deSilva
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Greg Dion
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Dale Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mark Fritz
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - John Paul Giliberto
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Elizabeth Guardiani
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jeffrey Harmon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sid Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brandon Kim
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Maggie Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California, USA
| | - Paul Kwak
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Yue Ma
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Lyndsay Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Ross Mayerhoff
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Cyrus Piraka
- Department of Gastroenterology/Hepatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Clark Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shaun A Wahab
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Keith Wilson
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - S Carter Wright
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Vyvy Young
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Sonia Yuen
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University Health, Augusta, Georgia, USA
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Xie KZ, Bowen AJ, Richards BA, Aden A, Wiedermann J, Rutt AL, Vassallo R, Edell ES, Bayan SL, Kasperbauer JL, Ekbom DC. Proximal Scar Progression in Idiopathic Subglottic Stenosis After Wedge Excision: Does it Happen? Laryngoscope 2023; 133:875-882. [PMID: 35848772 DOI: 10.1002/lary.30292] [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: 03/23/2022] [Revised: 05/15/2022] [Accepted: 06/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the incidence of glottic stenosis in idiopathic subglottic stenosis (iSGS) patients with no prior surgical intervention to those with a history of endoscopic dilation and characterize the incidence of glottic involvement, changes in scar length, and progression of scar toward glottis following laser wedge excision (LWE). METHODS A retrospective review of iSGS patients who underwent LWE between 2002 and 2021 was performed. Patients without prior airway surgery were labeled LWE primary (LWEP) and operative findings for LWEP patients were reviewed for glottic involvement, scar length (DL ), and distance from the glottis to superior-most aspect of scar (DGS ). Rates (in mm/procedure) of DΔL , reflecting an increase in length, and D-ΔGS , reflecting proximal migration, were calculated by dividing DΔL and D-ΔGS by the number of LWE procedures. RESULTS 213 iSGS patients underwent LWE, with 132 being LWEP patients. LWEP had a lower incidence of baseline glottic involvement (n = 6, 4.5%) than LWE secondary (LWES; n = 6, 7.5%). Four new cases of glottic involvement were noted in LWEP patients following LWE, with only one being clinically significant resulting in permanently decreased vocal fold mobility. With each procedure, scar length increased by 1.0 mm and DGS decreased by 0.7 mm, reflecting a migration or decrease in DGS of 9.5% with each procedure with respect to initial DGS . Overall rates of glottic stenosis following operations were similar between LWEP and LWES cohorts, 7.6% and 7.5% respectively. CONCLUSION There appears to be a low risk of glottic involvement resulting from the LWE procedure in iSGS patients. LEVEL OF EVIDENCE 4 Laryngoscope, 133:875-882, 2023.
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Affiliation(s)
- Katherine Z Xie
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Andrew Jay Bowen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Aisha Aden
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Joshua Wiedermann
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Amy L Rutt
- Department of Otorhinolaryngology/Audiology, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Semirra L Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Karp EE, Yin LX, Xie KZ, O'Byrne TJ, Wallerius KP, Tasche KK, Van Abel KM, Kasperbauer JL, Moore EJ, Price DL. Safety outcomes and patient convenience in outpatient parotidectomy. Am J Otolaryngol 2023; 44:103806. [PMID: 36842422 DOI: 10.1016/j.amjoto.2023.103806] [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: 10/08/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Parotidectomies have historically been performed on an inpatient basis despite being well-tolerated surgeries with minimal postoperative wound care and low rates of complications at high-volume institutions. Past studies have supported the safety of outpatient surgery for parotidectomy but have been limited to superficial parotidectomy and have not addressed the patient experience surrounding the surgical intervention such as pre-operative and post-operative care and communication. PURPOSE This study assesses the impact of outpatient superficial, deep, and partial parotid surgery on various parameters including surgical safety, distance traveled for care, utilization of telehealth, and patient-initiated communication. MATERIALS AND METHODS Retrospective study from January 2020 to October 2021. Patients undergoing superficial lobe, deep lobe, and partial parotidectomies for benign and malignant pathologies were divided into inpatient and outpatient cohorts. A multivariable model examined the relationship between admission status and surgical complications, adjusted for age, sex, and tumor size. RESULTS 159 patients total, 94 outpatient and 65 inpatients. No statistical difference in rates of surgical complications with the exception of salivary leak. There was an increased rate of salivary leak reported in the inpatient group (OR 5.4, 95 % CI 1.6 to 18.0, p = 0.01). Mean patient travel distance of 354 miles one-way. Post-operatively, 76 % were evaluated via video visit. Following discharge, >55 % of patients initiated communication with the surgical team, which was not statistically different between the groups. CONCLUSIONS Outpatient parotidectomy is safe and can be more convenient, but telehealth communication must be balanced with rigorous attention to patient education.
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Affiliation(s)
- Emily E Karp
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Linda X Yin
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | | | - Thomas J O'Byrne
- Mayo Clinic Department of Quantitative Health Sciences, Rochester, MN, USA
| | | | - Kendall K Tasche
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Kathryn M Van Abel
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Jan L Kasperbauer
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Eric J Moore
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Daniel L Price
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA.
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4
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Tierney WS, Huang LC, Chen SC, Berry LD, Anderson C, Amin MR, Benninger MS, Blumin JH, Bock JM, Bryson PC, Castellanos PF, Clary MS, Cohen SM, Crawley BK, Dailey SH, Daniero JJ, de Alarcon A, Donovan DT, Edell ES, Ekbom DC, Fink DS, Franco RA, Garrett CG, Guardiani EA, Hillel AT, Hoffman HT, Hogikyan ND, Howell RJ, Johns MM, Kasperbauer JL, Khosla SM, Kinnard C, Kupfer RA, Langerman AJ, Lentz RJ, Lorenz RR, Lott DG, Makani SS, Maldonado F, Matrka L, McWhorter AJ, Merati AL, Mori M, Netterville JL, O'Dell K, Ongkasuwan J, Postma GN, Reder LS, Rohde SL, Richardson BE, Rickman OB, Rosen CA, Rohlfing M, Rutter MJ, Sandhu GS, Schindler JS, Schneider GT, Shah RN, Sikora AG, Sinard RJ, Smith ME, Smith LJ, Soliman AMS, Sveinsdóttir S, Veivers D, Verma SP, Weinberger PM, Weissbrod PA, Wootten CT, Shyr Y, Francis DO, Gelbard A. Comparative Treatment Outcomes for Idiopathic Subglottic Stenosis: 5-Year Update. Otolaryngol Head Neck Surg 2023; 168:1570-1575. [PMID: 36939627 DOI: 10.1002/ohn.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/18/2022] [Accepted: 09/10/2022] [Indexed: 01/20/2023]
Abstract
The North American Airway Collaborative (NoAAC) previously published a 3-year multi-institutional prospective cohort study showing variation in treatment effectiveness between 3 primary surgical techniques for idiopathic subglottic stenosis (iSGS). In this report, we update these findings to include 5 years of data evaluating treatment effectiveness. Patients in the NoAAC cohort were re-enrolled for 2 additional years and followed using the prespecified published protocol. Consistent with prior data, prospective observation of 487 iSGS patients for 5 years showed treatment effectiveness differed by modality. Cricotracheal resection maintained the lowest rate of recurrent operation (5%), followed by endoscopic resection with adjuvant medical therapy (30%) and endoscopic dilation (50%). These data support the initial observations and continue to provide value to providers and patients navigating longitudinal decision-making. Level of evidence: 2-prospective cohort study.
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Affiliation(s)
- William S Tierney
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Lynn D Berry
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Catherine Anderson
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Milan R Amin
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Joel H Blumin
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan M Bock
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - Paul F Castellanos
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, Mercy Health-St. Rita's Ear, Nose and Throat, Lima, Ohio, USA
| | - Seth M Cohen
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Brianna K Crawley
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Duke University, Durham, North Carolina, USA
| | - Seth H Dailey
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Donald T Donovan
- Department of Otolaryngology-Head and Neck Surgery, Baylor University, Houston, Texas, USA
| | - Eric S Edell
- Department of Pulmonology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel S Fink
- Department of Otolaryngology-Head and Neck Surgery, Mercy Health-St. Rita's Ear, Nose and Throat, Lima, Ohio, USA
| | - Ramon A Franco
- Department of Otolaryngology-Head and Neck Surgery, Harvard University, Boston, Massachusetts, USA
| | - Catherine Gaelyn Garrett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca J Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sid M Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cheryl Kinnard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexander J Langerman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Lentz
- Department of Medicine, Division of Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert R Lorenz
- Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA
| | - David G Lott
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Samir S Makani
- Scripps Health, Coastal Pulmonary Associates, Encinitas, California, USA
| | - Fabien Maldonado
- Department of Medicine, Division of Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA
| | - Andrew J McWhorter
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Albert L Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Matthew Mori
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai, New York, New York, USA
| | - James L Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor University, Houston, Texas, USA
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery, Augusta University Health, Augusta, Georgia, USA
| | - Lindsay S Reder
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brent E Richardson
- Department of Otolaryngology-Head and Neck Surgery, Bastian Voice Institute for Voice, Swallowing, and Airway Disorders, Downers Grove, Illinois, USA
| | - Otis B Rickman
- Department of Medicine, Division of Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Matthew Rohlfing
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Guri S Sandhu
- Department of Otolaryngology-Head and Neck Surgery, The London Clinic, London, England
| | - Joshua S Schindler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Glenn Todd Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor University, Houston, Texas, USA
| | - Robert J Sinard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Libby J Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Sigríður Sveinsdóttir
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital of Iceland, Reykjavik, Iceland, UK
| | - David Veivers
- Ear Nose and Throat, University of Sydney, Sydney, Australia
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Paul M Weinberger
- Department of Otolaryngology-Head and Neck Surgery, Ark-La-Tex Center for Voice, Airway & Swallowing, Shreveport, Louisiana, USA
| | - Philip A Weissbrod
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - David O Francis
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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5
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Haller TJ, Van Abel KM, Yin LX, Lohse CM, Douse D, Badaoui JN, Price DL, Kasperbauer JL, Moore EJ. Ultrasound Guided Biopsy in Patients With HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2022; 132:2396-2402. [PMID: 35275423 DOI: 10.1002/lary.30105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify the differences in sensitivity and accuracy between ultrasound-guided and palpation-guided fine needle aspirations (FNA) of suspicious lymph nodes in patients with human papillomavirus (HPV) (+) oropharyngeal squamous cell carcinoma (OPSCC). Additional objectives included identifying patient specific factors affecting biopsy accuracy and evaluating potential differences in accuracy between fine and core needle biopsies. STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS A retrospective study of diagnostic sensitivity was completed at a single tertiary care center between 1/1/2006-12/31/2016. Participants included patients who underwent pretreatment FNA biopsy with HPV(+)OPSCC confirmed pathologically following neck dissection or excisional lymph node biopsy. A true positive (TP) on FNA biopsy was defined as an FNA biopsy concerning for squamous cell carcinoma (SCC) that was confirmed on excisional biopsy or neck dissection. A false negative (FN) was defined as a negative FNA but metastatic disease identified on excisional biopsy or neck dissection. Sensitivity was calculated as TPs/(TPs + FNs). Sensitivity was compared among techniques using chi-square and Fisher exact tests. RESULTS A total of 209 FNA biopsies among 198 patients were included in the study, including 31 (15%) palpation-guided FNAs, 160 (77%) ultrasound-guided FNAs, and 18 (9%) ultrasound-guided FNA + core biopsies. Sensitivity was significantly different among palpation-guided FNA, ultrasound-guided FNA, and ultrasound-guided FNA + core biopsies (48% vs. 83% vs. 94%, respectively; P < .001) but there was no significant difference in sensitivity between ultrasound-guided FNA versus ultrasound-guided FNA + core biopsies (P = .31). CONCLUSION The use of ultrasound guidance in FNA biopsies of nodal metastases in HPV(+)OPSCC improves sensitivity compared to palpation guidance alone. Ultrasound guided biopsies are preferred in patients with suspected nodal metastasis from HPV(+)OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2396-2402, 2022.
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Affiliation(s)
- Travis J Haller
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dontre' Douse
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Joseph N Badaoui
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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6
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Zhang C, Wang S, Casal Moura M, Yi ES, Bowen AJ, Specks U, Warrington KJ, Bayan SL, Ekbom DC, Luo F, Edell ES, Kasperbauer JL, Vassallo R. RNA Sequencing of Idiopathic Subglottic Stenosis Tissues Uncovers Putative Profibrotic Mechanisms and Identifies a Prognostic Biomarker. Am J Pathol 2022; 192:1506-1530. [PMID: 35948078 DOI: 10.1016/j.ajpath.2022.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/30/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
Idiopathic subglottic stenosis (iSGS) is a localized airway disease that almost exclusively affects females. Understanding the molecular mechanisms involved may provide insights leading to therapeutic interventions. Next-generation sequencing was performed on tissue sections from patients with iSGS (n = 22), antineutrophil cytoplasmic antibody-associated vasculitis (AAV; n = 5), and matched controls (n = 9) to explore candidate genes and mechanisms of disease. Gene expression changes were validated, and selected markers were identified by immunofluorescence staining. Epithelial-mesenchymal transition (EMT) and leukocyte extravasation pathways were the biological mechanisms most relevant to iSGS pathogenesis. Alternatively activated macrophages (M2) were abundant in the subepithelium and perisubmucosal glands of the airway in iSGS and AAV. Increased expression of the mesenchymal marker S100A4 and decreased expression of the epithelial marker epithelial cell adhesion molecule (EPCAM) further supported a role for EMT, but to different extents, in iSGS and antineutrophil cytoplasmic antibody-associated subglottic stenosis. In patients with iSGS, high expression of prostate transmembrane protein, androgen induced 1 (PMEPA1), an EMT regulator, was associated with a shorter recurrence interval (25 versus 116 months: hazard ratio = 4.16; P = 0.041; 95% CI, 1.056-15.60). Thus, EMT is a key pathogenetic mechanism of subglottic stenosis in iSGS and AAV. M2 macrophages contribute to the pathogenesis of both diseases, suggesting a shared profibrotic mechanism, and PMEPA1 may be a biomarker for predicting disease recurrence in iSGS.
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Affiliation(s)
- Chujie Zhang
- Division of Pulmonary and Critical Care Medicine and Thoracic Diseases Research Unit, Mayo Clinic, Rochester, Minnesota; Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Shaohua Wang
- Division of Pulmonary and Critical Care Medicine and Thoracic Diseases Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Marta Casal Moura
- Division of Pulmonary and Critical Care Medicine and Thoracic Diseases Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Eunhee S Yi
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Andrew J Bowen
- Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine and Thoracic Diseases Research Unit, Mayo Clinic, Rochester, Minnesota
| | | | - Semirra L Bayan
- Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dale C Ekbom
- Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Fengming Luo
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine and Thoracic Diseases Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Jan L Kasperbauer
- Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine and Thoracic Diseases Research Unit, Mayo Clinic, Rochester, Minnesota.
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7
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Richards BA, Xie KZ, Bowen AJ, Aden A, Wiedermann J, Rutt AL, Vassallo R, Edell ES, Bayan SL, Kasperbauer JL, Ekbom DC. Complications following laser wedge excision for idiopathic subglottic stenosis. Am J Otolaryngol 2022; 43:103629. [PMID: 36166881 DOI: 10.1016/j.amjoto.2022.103629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Endoscopic laser wedge excision (LWE) is an effective treatment option for idiopathic subglottic stenosis (iSGS); however, data regarding complications following LWE are limited. The aim of the following analysis was to provide a review of frequency and type of complications that occur with LWE in patients with iSGS. STUDY DESIGN Retrospective review. METHODS Patients with iSGS undergoing LWE between January 2002 and September 2021 were performed. Demographic data were recorded. Complications were stratified into major and minor categories. The frequency of these complications and the respective treatment for them was analyzed. RESULTS 212 patients within the study period underwent a total of 573 LWE procedures. All but two patients were female, with a median age of 54 years at time of LWE. Of these patients, 43 (20 %) patients experienced a complication. Of these, only 7 (15 %) of the reported complications were considered major while the rest were minor in nature. Major complications included 3 cases of post-operative hemoptysis, 1 case of tracheitis, and 3 cases of reduced vocal fold hypomobility with concurrent glottic stenosis. Minor complications consisted of 2 cases of tooth fracture and 34 cases of tongue paresthesia post-operatively that was self-limited. There were no mortalities. CONCLUSION Major complications occur in <5 % of LWE procedures based off the analysis. All major complications were managed without significant long-term morbidity. Minor complications with the LWE are self-limited in nature. Our data supports the LWE as a safe treatment option for iSGS. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Bradley A Richards
- Alix School of Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Katherine Z Xie
- Alix School of Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Andrew Jay Bowen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Aisha Aden
- Alix School of Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Joshua Wiedermann
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Amy L Rutt
- Department of Otorhinolaryngology/Audiology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Semirra L Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Dale C Ekbom
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America.
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8
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Cohen-Cohen S, Scheitler KM, Choby G, Janus J, Moore EJ, Kasperbauer JL, Cloft HJ, Link M, Gompel JJV. Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma. Skull Base Surg 2022; 83:e266-e273. [DOI: 10.1055/s-0041-1725031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Abstract
Objectives Juvenile nasopharyngeal angiofibromas (JNAs) are uncommon tumors with an evolving treatment paradigm. The objective of this study was to compare our prior experience reported in 2005 with our most contemporary series to compare practice improvements and the impact of expanded endonasal procedures.
Design Retrospective review comparing a contemporary 22 patients with JNA who underwent surgical management between 2005 and 2019, compared with a historical cohort of 65 patients from the same center.
Results The most common presenting symptom was epistaxis (68%). The median maximum tumor diameter was 4.4 cm. All patients underwent preoperative embolization. An endoscopic endonasal approach (EEA) was used in 18 patients (82%), compared with 9% in the series prior to 2005. Gross total resection was achieved in all patients. The median estimated blood loss was 175 and 350 mL for EEA and open (transfacial) cases, respectively. Only two patients (9%) required a blood transfusion compared with 52% on the previous series. The median follow-up was 19 months. The overall recurrence rate was 9% in this series and 24% in the previous series. No patient required radiation therapy in follow-up compared with 3% in our historical cohort.
Conclusion There have been significant changes regarding the management of patients with JNA compared with the previous Mayo Clinic experience. The EEA has become the preferred route over the transfacial approaches to treat JNA in selected patients who do not have intracranial extension. Preoperative embolization has aided in reducing the postoperative transfusion rates.
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Affiliation(s)
- Salomon Cohen-Cohen
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Garret Choby
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeffrey Janus
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Eric J. Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jan L. Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Harry J. Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael Link
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J. Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
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9
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Routman DM, Kumar S, Chera BS, Jethwa KR, Van Abel KM, Frechette K, DeWees T, Golafshar M, Garcia JJ, Price DL, Kasperbauer JL, Patel SH, Neben-Wittich MA, Laack NL, Chintakuntlawar AV, Price KA, Liu MC, Foote RL, Moore EJ, Gupta GP, Ma DJ. Detectable Post-operative Circulating Tumor Human Papillomavirus (HPV) DNA And Association with Recurrence in Patients with HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2022; 113:530-538. [PMID: 35157995 DOI: 10.1016/j.ijrobp.2022.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 01/22/2022] [Accepted: 02/06/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To determine the rate of detectability of ctHPVDNA after surgery but before adjuvant therapy in patients with HPV-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) and to investigate whether detectable ctHPVDNA at this time point may be associated with risk of recurrence. METHODS AND MATERIALS Prospectively collected samples from patients with OPSCC were examined in a blinded fashion using a multi-analyte PCR assay. 45 samples were collected from HPV(+)OPSCC patients pre-op (prior to any treatment), and 159 samples post-op (before or at the start of adjuvant RT). Samples were identified via the radiation oncology biobank or via participation in a clinical trial. RT consisted of 60 Gy +/- cisplatin or de-escalation (30 Gy to 36 Gy in 20 b.i.d. fractions + docetaxel). 32 patients had paired samples available pre and post-op for the primary analysis. Additional exploratory analyses including associations of patient and tumor characteristics with recurrence were assessed using Cox proportional hazards models for all 159 post-op samples.. Detectability of ctHPVDNA was compared across groups utilizing logistic regression. Estimates of recurrence free survival (RFS) were made using Kaplan-Meier (KM). RESULTS In a paired analysis of 32 pre and post-op timepoints, 94% of patients had detectable ctHPVDNA pre-op and 41% post-op. RFS at 18 months was 83% (95% CI: 47-95%) for patients with detectable post-op ctHPVDNA compared to 100% for patients with undetectable post-op ctHPVDNA (p=.094).In an exploratory analysis of non-paired post-op samples, ctHPVDNA was detectable in 26% (41 of 159) of patients (median of 22 days post-op). Age (1.06, p=0.025), LVSI (OR 3.17, p=0.011) and ENE (OR=5.67, p=0.001) were associated with detectable ctHPVDNA after surgery. Detectable post-op ctHPVDNA was significantly associated with RFS (p<0.001). CONCLUSION Amongst patients with detectable pre-op ctHPVDNA, a significant proportion have detectable post-op ctHPVDNA in paired post-op samples, collected prior to the initiation of adjuvant radiation therapy. Future prospective study is warranted to investigate the association of detectable post-op ctHPVDNA with recurrence, including in comparison to established clinical and pathologic risk factors.
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Affiliation(s)
- D M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
| | - S Kumar
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - B S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - K R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - K M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - K Frechette
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - T DeWees
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix AZ, USA
| | - M Golafshar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix AZ, USA
| | - J J Garcia
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester MN, USA
| | - D L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - J L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - S H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix AZ, USA
| | | | - N L Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - K A Price
- Division of Medical Oncology, Mayo Clinic, Rochester MN, USA
| | - M C Liu
- Division of Medical Oncology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - R L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - E J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - G P Gupta
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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10
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Bowen AJ, Xie KZ, O'Byrne TJ, Bayan SL, Edell ES, Vassallo R, Ekbom DC, Kasperbauer JL. Recurrence Following Endoscopic Laser Wedge Excision and Triple Medical Therapy for Idiopathic Subglottic Stenosis. Otolaryngol Head Neck Surg 2022; 167:524-530. [PMID: 35077239 DOI: 10.1177/01945998221074684] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We present the outcomes for patients with idiopathic subglottic stenosis (iSGS) following their first carbon dioxide laser wedge excision (LWE) procedure, additionally examining the effect of compliance with adjuvant medical therapy (triple therapy) after the operation. STUDY DESIGN Retrospective chart review. SETTING Tertiary center. METHODS A retrospective review was performed on 183 patients with iSGS following their first LWE and their compliance to adjuvant medical therapy (inhaled corticosteroid, proton pump inhibitor, trimethoprim-sulfamethoxazole) following the operation, with all reviewed to December 31, 2020. The primary outcome variable was median time to recurrence (MTR). Patients were stratified by whether the LWE was their first operation (LWE primary or secondary), by compliance to triple therapy, and by compliance with trimethoprim-sulfamethoxazole. Kaplan-Meier analysis and Cox proportional hazards were used to evaluate the MTR across the stratifications. RESULTS An overall 113 patients underwent their first LWE, while 70 received the procedure after having undergone 1 to 13 procedures. The MTR between LWE primary and secondary was 4.6 and 2.9 years, respectively. Adjusted Cox proportional hazards comparing these 2 groups revealed the number of prior operations to be a confounding variable. A statistically increased MTR was demonstrated with greater degrees of medical compliance. CONCLUSION LWE conferred an MTR of 4.1 years in the iSGS cohort. The number of prior procedures preceding LWE behaved as a confounding variable. Patients who were completely or partially compliant to triple therapy appear to demonstrate increased intervals prior to recurrence.
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Affiliation(s)
- Andrew Jay Bowen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine Z Xie
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Semirra L Bayan
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Badaoui JN, Yin LX, Sauer AB, Moore EJ, Lohse CM, Price DL, Kasperbauer JL, Noel DB, Olsen KD, Van Abel KM. Transpharyngeal Approaches for Management of Oropharyngeal Squamous Cell Carcinoma: Mayo Clinic Institution Experience. Otolaryngol Head Neck Surg 2022; 167:509-516. [PMID: 35041566 DOI: 10.1177/01945998211071000] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Investigate oncologic and functional outcomes associated with transhyoid and lateral pharyngotomy (transpharyngeal) approaches in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN Retrospective review. SETTING Single institution (tertiary care center). METHODS This is a retrospective case series of patients with OPSCC undergoing transpharyngeal resection from 1990 to 2017 at Mayo Clinic. Oncologic outcomes, postoperative complications, objective swallowing data, and rates of tracheostomy and percutaneous gastrostomy tube dependence were recorded. RESULTS Of 83 patients meeting inclusion criteria, 56 (68%) were human papillomavirus positive. Overall survival rates at 5 and 10 years following surgery were 85% and 80%, respectively. Cancer-specific survival rates at these same time points were 90% and 88%. Following treatment, 35 of 49 patients (71%) had a Functional Oral Intake Scale score ≥5, indicating total oral intake of multiple consistencies; 79 of 82 (96%) were without tracheostomy or laryngectomy; and 71 of 81 (88%) were on a full oral diet. CONCLUSION Transpharyngeal approaches provide adequate functional and oncologic outcomes in the majority of patients with OPSCC. These results may have important implications for patients who are not candidates for, or are unwilling to undergo, nonoperative therapy or for those without access to radiation therapy.
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Affiliation(s)
- Joseph N Badaoui
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam B Sauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B Noel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerry D Olsen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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12
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Karp EE, Garcia JJ, Chan SA, Van Abel KM, Moore EJ, Janus JR, Kasperbauer JL, Olsen KD, Hinni ML, Price KA, Ma DJ, Foote RL, Neben Wittich MA, Price DL. The role of total parotidectomy in high-grade parotid malignancy: A multisurgeon retrospective review. Am J Otolaryngol 2022; 43:103194. [PMID: 34509079 DOI: 10.1016/j.amjoto.2021.103194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/09/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Determine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid malignancy who undergo total parotidectomy and neck dissection. MATERIALS & METHODS Retrospective review of patients undergoing total parotidectomy and neck dissection for high-grade parotid malignancy between 2005 and 2015. The presence and number of parotid lymph nodes, superficial and deep, as well as cervical lymph nodes involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified and recurrence rates reported. RESULTS 75 patients with median follow-up time of 47 months. 35 patients (46.7%) had parotid lymph node metastasis. Seven patients (9.3%) had deep lobe nodal metastasis without metastasis to the superficial lobe nodes. Nine patients (12%) had positive intra-parotid nodes without positive cervical nodes. Cervical nodal disease was identified in 49.3% patients (37/75). Local, parotid-bed recurrence rate was 5.3% (4/75). Regional lymph node recurrence rate was also 5.3% (4/75). Rate of distant metastasis was 30.6% (23/75). The overall disease free survival rate for all patients at 2 and 5 years were 71% and 60% respectively. CONCLUSION Parotid lymph node metastasis occurred at a similar rate to cervical lymph node metastasis (46.7% and 49.3%, respectively). Deep lobe parotid nodal metastasis occurred in nearly a quarter of patients and can occur without superficial parotid nodal metastasis. Rate of recurrence in the parotid bed, which may represent local or regional recurrence, was similar to regional cervical lymph node recurrence. Total parotidectomy and neck dissection should be considered high-grade parotid malignancy regardless of clinical nodal status.
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13
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Martinez-Paredes JF, Alfakir R, Kasperbauer JL, Rutt A. Zenker Diverticulum: Does Size Correlate With Preoperative Symptoms? Int Arch Otorhinolaryngol 2021; 26:e334-e338. [PMID: 35846818 PMCID: PMC9282963 DOI: 10.1055/s-0041-1730457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/14/2021] [Indexed: 10/29/2022] Open
Abstract
Abstract
Introduction Zenker diverticulum (ZD) usually affects adults after the 7th decade of life. Treatment for ZD is indicated for all symptomatic patients, but some patients prefer to defer surgical treatment until symptoms get worse and decrease their quality of life.
Objective To evaluate the association of the preoperative symptoms in ZD patients with the size of the ZD.
Methods A retrospective study design. Electronic medical records were used to identify patients diagnosed with ZD and treated over 11 years. Data collection included the chief complaints and symptoms, medical history, and findings on radiologic swallow evaluations of the patients. The diverticulum size was stratified into 3 groups: small (< 1 cm), moderate (1–3 cm), and large (> 3 cm).
Results A total of 165 patients were enrolled and stratified by diverticulum size (48 small, 67 medium, and 50 large). Dysphagia, cough, and regurgitation were the most prevalent symptoms. Dysphonia was more frequent among patients with a small pouch. Logistic regression analysis showed that dysphagia and choking were associated with large and medium diverticulum size (p < 0.05). Additionally, dysphonia was significantly associated with the presence of a small-sized ZD (p < 0.04).
Conclusion Upper gastrointestinal symptoms such as dysphagia and choking may be associated with a ZD > 1 cm and should always be evaluated. Additionally, the presence of dysphonia was found to be correlated with a ZD < 1 cm, suggesting that a prompt and appropriate fluoroscopic evaluation must be considered in those patients in whom no other clear cause of dysphonia is evident.
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Affiliation(s)
- Jhon F. Martinez-Paredes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Razan Alfakir
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Jan L. Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Amy Rutt
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
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14
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Van Gompel JJ, Atkinson JLD, Choby G, Kasperbauer JL, Stokken JK, Janus JR, O'Brien EK, Little JT, Bancos I, Davidge-Pitts CJ, Ramachandran D, Herndon JS, Erickson D, Lanier WL. Pituitary Tumor Surgery: Comparison of Endoscopic and Microscopic Techniques at a Single Center. Mayo Clin Proc 2021; 96:2043-2057. [PMID: 34120752 DOI: 10.1016/j.mayocp.2021.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/27/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand the transition from microscopic surgery (MS) to endoscopic surgery (ES) on the pituitary across the United States, we assessed a single institution practicing both procedures to discern advantages and disadvantages for each. PATIENTS AND METHODS Retrospective institutional chart review of 534 patients in a large practice over a 6-year period (January 1, 2014, to December 31, 2019) comparing a single MS neurosurgeon with a single ES neurosurgeon operating on the same days. RESULTS In this series, 14% (n=75) of patients had a prior operation, there were no carotid artery injuries, the overall risk for a postoperative infection was 0.4% (n=2), and risk for a postoperative cerebrospinal fluid leak requiring treatment was 2.0% (n=11). Mean ± SD hospital stay was 1.3±0.04 days; readmission for any reason within 30 days occurred in 3.4% (n=18) of patients. The mean volumetric resection for MS was 86.9%±1.7% and for ES was 91.7%±1.3% (P=.03). There was a higher rate of notable events (P=.015) with MS, but MS had 16% lower cost and operative times were 48 minutes shorter than for ES (83±7 vs 131±6 minutes). The ES required substantially fewer postoperative secondary treatments such as radiation therapy (P=.003). CONCLUSION Pituitary surgery is a very safe and effective procedure regardless of technique. The MS has shorter operative times and overall lower cost. The ES results in increased volumetric resection and fewer secondary treatments. Both techniques can be valuable to a large practice, and understanding these niches is important when selecting optimal approaches to pituitary surgery for a given patient.
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Affiliation(s)
- Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN.
| | | | - Garret Choby
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
| | | | | | - Jeffrey R Janus
- Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL
| | - Erin K O'Brien
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
| | | | - Irina Bancos
- Division of Endocrinology, Metabolism, Diabetes, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Caroline J Davidge-Pitts
- Division of Endocrinology, Metabolism, Diabetes, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Justine S Herndon
- Division of Endocrinology, Metabolism, Diabetes, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Dana Erickson
- Division of Endocrinology, Metabolism, Diabetes, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - William L Lanier
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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15
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McMillan RA, Van Abel KM, Yin LX, Routman DM, Ma DJ, Neben Wittich MA, Price DL, Kasperbauer JL, Price KR, Chintakuntlawar AV, Moore EJ. Second Primary Tumors in Patients Presenting With Unilateral HPV-Associated Tonsillar Squamous Cell Carcinoma. Laryngoscope 2021; 132:332-338. [PMID: 34236086 DOI: 10.1002/lary.29741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/31/2021] [Accepted: 06/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe and compare rates of metachronous and synchronous second primaries of the contralateral tonsil in patients with primary HPV(+) tonsillar squamous cell carcinoma (SCC). STUDY DESIGN Retrospective cohort study. MATERIALS AND METHODS This is a single tertiary care center retrospective case series, from 2006 to 2019, of HPV(+) tonsillar SCC patients who underwent primary surgical resection with unilateral wide-field tonsillectomy or bilateral tonsillectomy for diagnostic or therapeutic purposes. A metachronous second primary is one diagnosed >6 months after completion of surgical treatment. A synchronous second primary is one diagnosed during bilateral tonsillectomy for unilateral HPV(+) tonsillar SCC. Rates of second primary and patient characteristics were compared using chi-square tests. RESULTS About 303 patients underwent unilateral surgical resection +/- adjuvant therapy for HPV(+) tonsillar SCC. One (0.3%) developed a metachronous second primary in the contralateral tonsil 11.9 years following treatment. Fifty-seven patients with HPV(+) tonsillar SCC underwent bilateral tonsillectomy, and 37/57 (65%) had no clinical signs for contralateral disease. Of these, only 1/37 (2.7%) was incidentally found to have a synchronous second primary. Twenty patients underwent bilateral tonsillectomy due to clinical concern for contralateral disease. Of these, 3/20 (15%) were found to have a synchronous HPV(+) SCC in the contralateral tonsil. CONCLUSIONS The prevalence of metachronous second primary after appropriate treatment of HPV(+) tonsillar SCC is very low (0.3%) and so is the chance of incidentally discovering a synchronous second primary during bilateral tonsillectomy (2.7%). We do not recommend bilateral tonsillectomy as a part of the routine algorithm in the surgical management of these patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Ryan A McMillan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Katharine R Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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16
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Low CM, Gruszczynski NR, Moore EJ, Price DL, Janus JR, Kasperbauer JL, Van Abel KM, Stokken JK, Van Gompel JJ, Link MJ, Choby G. Sinonasal Osteosarcoma: Report of 14 New Cases and Systematic Review of the Literature. J Neurol Surg B Skull Base 2021; 82:e138-e147. [PMID: 34306929 PMCID: PMC8289535 DOI: 10.1055/s-0040-1701221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022] Open
Abstract
Objective The objective of this study is to describe the clinical presentation, tumor characteristics, natural history, and treatment patterns of sinonasal osteosarcoma. Methods Fourteen patients who had been treated for osteosarcoma of the nasal cavity and paranasal sinuses at a tertiary care center were reviewed. In addition, a systematic review of the literature for osteosarcoma of the sinonasal cavity was performed. Results In a systematic review, including 14 patients from the authors' institution, 53 total studies including 88 patients were assessed. Median follow-up was 18 months (interquartile range: 8-39 months). The most common presenting symptoms were facial mass or swelling (34%), and nasal obstruction (30%). The most common paranasal sinus involved by tumor was the maxillary sinus (64%), followed by the ethmoid sinuses (52%). The orbit (33%), dura (13%) and infratemporal fossa (10%) were the most common sites of local invasion. The majority of patients underwent surgery followed by adjuvant therapy (52.4%). Increasing age was associated with decreased overall survival rate (unit risk ratio [95% confidence interval (CI)] = 1.02 [1.003-1.043]; p = 0.0216) and T4 disease was associated with decreased disease-specific survival rate (hazard ratio [HR] = 2.87; p = 0.0495). The 2- and 5-year overall survival rates were 68 and 40%, respectively, while 2- and 5-year disease-specific survival rates were 71% and 44%, respectively. Conclusion Sinonasal osteosarcomas are uncommon tumors and can pose a significant therapeutic challenge. Increasing age and T4 disease are associated with worse prognosis. This disease usually warrants consultation by a multidisciplinary team and consideration of multimodality therapy.
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Affiliation(s)
- Christopher M. Low
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel L. Price
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeffrey R. Janus
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jan L. Kasperbauer
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Kathryn M. Van Abel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Janalee K. Stokken
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J. Van Gompel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Garret Choby
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
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17
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Chan SA, Van Abel KM, Lewis JE, Routman DM, Garcia JJ, Karp EE, Price DL, Janus JR, Kasperbauer JL, Moore EJ. Mucoepidermoid carcinoma of the parotid gland: Twenty-year experience in treatment and outcomes. Head Neck 2021; 43:2663-2671. [PMID: 33931913 DOI: 10.1002/hed.26735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Parotid gland mucoepidermoid carcinoma (MEC) has published five-year cancer-specific survival (CSS) rates of 77%-97%, with variance related to grade. METHODS Patients receiving primary surgery for parotid gland MEC from 1995 to 2014 at a tertiary medical center underwent clinical review, histopathologic review, and cytogenetic analysis. Survival outcomes were evaluated. RESULTS Among 58 patients, T/N/M classification was as follows: T1 in 35 patients, T2 in 14, T4a in 9, N0 in 53, N1 in 2, N2b in 3. Histologic grade was low in 27, intermediate in 17, and high in 12 patients with 98% MAML2 positivity. All patients underwent parotidectomy, and seven patients received adjuvant radiation therapy. CSS was 100% at 5 years and 94.1% at 10 and 15 years. Two patients experienced locoregional recurrence. CONCLUSIONS Treatment with adequate surgical resection and adjuvant radiation therapy for high-grade or advanced-stage tumors yields excellent survival, independent of clinical stage or pathologic grade.
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Affiliation(s)
- Stephen A Chan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jean E Lewis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily E Karp
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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18
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McMillan RA, Bowen AJ, Crum BA, Bayan SL, Kasperbauer JL, Ekbom DC. In Response to Regarding Cricopharyngeal Myotomy in IBM: Comparison of Endoscopic and Transcervical Approaches. Laryngoscope 2021; 131:E1999. [PMID: 33792935 DOI: 10.1002/lary.29544] [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: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Ryan A McMillan
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Andrew J Bowen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Brian A Crum
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Semirra L Bayan
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
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19
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May MM, Howe BM, O'Byrne TJ, Alexander AE, Morris JM, Moore EJ, Kasperbauer JL, Janus JR, Van Abel KM, Dickens HJ, Price DL. Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: Decreased nonunion and complication rates. Head Neck 2021; 43:2342-2352. [PMID: 33786910 DOI: 10.1002/hed.26688] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 10/08/2020] [Revised: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To determine whether virtual surgical planning and three-dimensional printed cutting guides (3D/VSP) improved radiographic bone union compared to conventional methods (CM) in fibula free flap (FFF) reconstruction of the mandibles. METHODS Retrospective study from the years 2000-2018 at a tertiary hospital. Osseous union was evaluated by a radiologist blinded to each patient's treatment. RESULTS Two hundred sixty patients who underwent FFF tissue transfer, 28 with VSP and 3D cutting guides. Bony union was not achieved in 46 (20%) patients who underwent CM compared to 1 (4%) of patients with VSP and guides (p = 0.036). FFF complication was significantly higher in CM with 87 patients (38%) compared to three patients (11%) in 3D/VSP (p = 0.005). Median time to bony union for patients who underwent CM was 1.4 years compared to 0.8 years in 3D/VSP. CONCLUSIONS 3D/VSP reduced the rate of radiographic nonunion and flap-related complications in FFF reconstruction for mandibular defects.
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Affiliation(s)
- Matthew M May
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Alexander
- Anatomical Modeling Lab, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathon M Morris
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Anatomical Modeling Lab, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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20
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Yin LX, Karp EE, Elias A, O'Byrne TJ, Routman DM, Price DL, Kasperbauer JL, Neben-Wittich M, Chintakuntlawar AV, Price KA, Ma DJ, Foote RL, Moore EJ, Van Abel KM. Disease Profile and Oncologic Outcomes After Delayed Diagnosis of Human Papillomavirus-Associated Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2021; 165:830-837. [PMID: 33752487 DOI: 10.1177/01945998211000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Diagnostic delay in human papillomavirus-associated oropharynx squamous cell carcinoma (HPV(+)OPSCC) is common due to nonspecific symptoms. We aim to describe the disease burden and oncologic outcomes of patients with HPV(+)OPSCC diagnosed >12 months after symptom onset. STUDY DESIGN This is a retrospective cohort study of HPV(+)OPSCC patients receiving intent-to-cure treatment (including surgery ± adjuvant therapy or primary chemoradiation). SETTING 2006-2016, tertiary care center. METHODS Tumor stage was compared between patients with and without delayed diagnosis using χ2 tests. Kaplan-Meier survival analysis with univariate and multivariable Cox regressions were used to determine the effect of diagnostic delay on oncologic outcomes. RESULTS In total, 664 patients were included. Compared to patients diagnosed <12 months from symptom onset (n = 601), those diagnosed at >12 months (n = 63) were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation (P < .01 for both). At 5 years, rates of overall survival, cancer-specific survival, progression-free survival, and distant metastases-free survival in the delayed diagnosis cohort were 80%, 90%, 80%, and 89%, respectively. A >12-month delay in diagnosis did not significantly impact overall survival (adjusted hazard ratio [aHR], 1.16; 95% CI, 0.58-2.31), cancer-specific survival (aHR, 0.83; 95% CI, 0.29-2.39), progression-free survival (aHR, 1.15; 95% CI, 0.56-2.37), or distant metastases-free survival (aHR, 1.00; 95% CI, 0.42-2.40) after adjusting for age, sex, and clinical AJCC stage (P > .05 for all). CONCLUSIONS Delayed diagnosis of HPV(+)OPSCC is associated with greater burden of disease at presentation, but oncologic outcomes remain favorable across treatment modalities. When appropriate, intent-to-cure therapy should be pursued despite diagnostic delay. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily E Karp
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna Elias
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Katharine A Price
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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21
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Lee J, Huang LC, Berry LD, Anderson C, Amin MR, Benninger MS, Blumin JH, Bock JM, Bryson PC, Castellanos PF, Chen SC, Clary MS, Cohen SM, Crawley BK, Dailey SH, Daniero JJ, de Alarcon A, Donovan DT, Edell ES, Ekbom DC, Fink DS, Franco RA, Garrett CG, Guardiani EA, Hillel AT, Hoffman HT, Hogikyan ND, Howell RJ, Hussain LK, Johns MM, Kasperbauer JL, Khosla SM, Kinnard C, Kupfer RA, Langerman AJ, Lentz RJ, Lorenz RR, Lott DG, Lowery AS, Makani SS, Maldonado F, Mannion K, Matrka L, McWhorter AJ, Merati AL, Mori M, Netterville JL, O'Dell K, Ongkasuwan J, Postma GN, Reder LS, Rohde SL, Richardson BE, Rickman OB, Rosen CA, Rutter MJ, Sandhu GS, Schindler JS, Schneider GT, Shah RN, Sikora AG, Sinard RJ, Smith ME, Smith LJ, Soliman AMS, Sveinsdóttir S, Van Daele DJ, Veivers D, Verma SP, Weinberger PM, Weissbrod PA, Wootten CT, Shyr Y, Francis DO, Gelbard A. Association of Social Determinants of Health with Time to Diagnosis and Treatment Outcomes in Idiopathic Subglottic Stenosis. Ann Otol Rhinol Laryngol 2021; 130:1116-1124. [PMID: 33629608 DOI: 10.1177/0003489421995283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine whether social determinants of health (SDH) factors are associated with time to diagnosis, treatment selection, and time to recurrent surgical intervention in idiopathic subglottic stenosis (iSGS) patients. METHODS Adult patients with diagnosed iSGS were recruited prospectively (2015-2017) via clinical providers as part of the North American Airway Collaborative (NoAAC) and via an online iSGS support community on Facebook. Patient-specific SDH factors included highest educational attainment (self-reported), median household income (matched from home zip code via U.S. Census data), and number of close friends (self-reported) as a measure of social support. Main outcomes of interest were time to disease diagnosis (years from symptom onset), treatment selection (endoscopic dilation [ED] vs cricotracheal resection [CTR] vs endoscopic resection with adjuvant medical therapy [ERMT]), and time to recurrent surgical intervention (number of days from initial surgical procedure) as a surrogate for disease recurrence. RESULTS The total 810 participants were 98.5% female, 97.2% Caucasian, and had a median age of 50 years (IQR, 43-58). The cohort had a median household income of $62 307 (IQR, $50 345-$79 773), a median of 7 close friends (IQR, 4-10), and 64.7% of patients completed college or graduate school. Education, income, and number of friends were not associated with time to diagnosis via multivariable linear regression modeling. Univariable multinominal logistic regression demonstrated an association between education and income for selecting ED versus ERMT, but no associations were noted for CTR. No associations were noted for time to recurrent surgical procedure via Kaplan Meier modeling and Cox proportional hazards regression. CONCLUSIONS Patient education, income, and social support were not associated with time to diagnosis or time to disease recurrence. This suggests additional patient, procedure, or disease-specific factors contribute to the observed variations in iSGS surgical outcomes.
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Affiliation(s)
- Jaclyn Lee
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li-Ching Huang
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Lynn D Berry
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | | | - Milan R Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joel H Blumin
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jonathan M Bock
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul F Castellanos
- Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sheau-Chiann Chen
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Seth M Cohen
- Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brianna K Crawley
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Seth H Dailey
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Donald T Donovan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Daniel S Fink
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Ramon A Franco
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - C Gaelyn Garrett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth A Guardiani
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Rebecca J Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Lena K Hussain
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sid M Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Cheryl Kinnard
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Alexander J Langerman
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Robert J Lentz
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Robert R Lorenz
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David G Lott
- Department of Otorhinolaryngology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
| | - Anne S Lowery
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samir S Makani
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, CA, USA
| | - Fabien Maldonado
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle Mannion
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA
| | - Andrew J McWhorter
- Department of Otolaryngology, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, USA
| | - Albert L Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Matthew Mori
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY USA
| | - James L Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Lindsay S Reder
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Otis B Rickman
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Guri S Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joshua S Schindler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Northwest Clinic for Voice and Swallowing, Portland, OR, USA
| | - G Todd Schneider
- Department of Otolaryngology, University of Rochester, Rochester, NY, USA
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Robert J Sinard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, The University of Utah, Salt Lake City, UT, USA
| | - Libby J Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Douglas J Van Daele
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - David Veivers
- Department of Otolaryngology-Head and Neck Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Paul M Weinberger
- Departments of Otolaryngology, Molecular and Cellular Physiology, Feist-Weiller Cancer Center, LSU Shreveport, LA, USA
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, USA
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Shyr
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - David O Francis
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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22
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McMillan RA, Bowen AJ, Bayan SL, Kasperbauer JL, Ekbom DC. Cricopharyngeal Myotomy in Inclusion Body Myositis: Comparison of Endoscopic and Transcervical Approaches. Laryngoscope 2021; 131:E2426-E2431. [PMID: 33577720 DOI: 10.1002/lary.29444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/31/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Inclusion body myositis (IBM) is a progressive inflammatory myopathy with dysphagia as a debilitating sequalae. Otolaryngologists are consulted for surgical candidacy when there are findings of cricopharyngeal dysfunction. We aim to compare transcervical cricopharyngeal myotomy (TCPM) versus endoscopic cricopharyngeal myotomy (ECPM) in the IBM population with particular focus on objective swallow study outcomes, complications, and recurrence rates. METHODS A retrospective cohort study was performed on IBM patients who underwent TCPM or ECPM (1981-2020) in the Department of Otolaryngology at a tertiary academic center with a high volume IBM referral base. Videofluoroscopic swallow studies, Eating Assessment Tool (EAT-10), Reflux Symptom Index (RSI), and Functional Outcome Swallowing Scale (FOSS) were collected at preoperative and follow-up visits. Baseline patient characteristics, intraoperative data, and postoperative course were recorded. RESULTS Forty-one patients were identified (18 TCPM; 23 ECPM). There was no significant difference in the recurrence rates, complications, hospitalization length, operative time, or return to preoperative diet between approaches. For the 12 patients (11 ECPM; 1 TCPM) that had subjective swallow data, there was a statistically significant difference in the pre and postoperative scores for EAT-10, RSI, and FOSS (P < .05). There was a statistically significant improvement in the degree of narrowing between pre and postoperative imaging for both approaches (P < .05). CONCLUSION Both TCPM and ECPM are safe approaches for the management of dysphagia in patients with IBM with objective evidence of cricopharyngeal dysfunction. Cricopharyngeal myotomy is a durable technique that has demonstrated improved subjective and objective outcomes in this patient population. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2426-E2431, 2021.
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Affiliation(s)
- Ryan A McMillan
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Andrew J Bowen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Semirra L Bayan
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
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23
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Karp EE, Yin LX, Moore EJ, Elias AJ, O'Byrne TJ, Glasgow AE, Habermann EB, Price DL, Kasperbauer JL, Van Abel KM. Barriers to Obtaining a Timely Diagnosis in Human Papillomavirus-Associated Oropharynx Cancer. Otolaryngol Head Neck Surg 2021; 165:300-308. [PMID: 33494648 DOI: 10.1177/0194599820982662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Failure to recognize symptoms of human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) at presentation can delay diagnosis and treatment. This study aims to identify patient factors and provider patterns that contribute to delayed diagnosis. STUDY DESIGN Retrospective case series. SETTING Tertiary care center. METHODS Patients with HPV(+)OPSCC receiving intent-to-cure treatment from 2006 to 2016. Clinical data, workup, and care timelines were abstracted. Univariate and multivariable linear regressions were performed to determine associations. RESULTS Of 703 included patients, 627 (89%) were male, and mean (SD) age at diagnosis was 59 (9) years. The mean (SD) delay to diagnosis was 148.8 (243.51) days, with an average delay of 63 (154.91) days from symptom onset to first presentation and 82.8 (194.25) days from first presentation to diagnosis. Most patients visited at least 2 providers (n = 546, 78%) before diagnosis and saw their primary care physician at first presentation (n = 496, 71%). The most common imaging and biopsy obtained before diagnosis was neck computed tomography (n = 391, 56%) and neck fine-needle aspiration (n = 423, 60%), respectively. On multivariable linear regression, being a homemaker, being a current smoker, seeing 3 or more providers, and getting a magnetic resonance imaging scan were associated with significant delays in diagnosis (P < .01, all). Treatment with antibiotics and a suspicion for HPV(+)OPSCC at first presentation were associated with decreased delays in diagnosis (P < .01, both). CONCLUSIONS Patient delays in seeking medical attention and provider delays in recognizing the appropriate diagnosis both contribute to delays of care in HPV(+)OPSCC. Improved patient and provider education is necessary to expedite the diagnosis of HPV(+)OPSCC.
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Affiliation(s)
- Emily E Karp
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna J Elias
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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24
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Gelbard A, Anderson C, Berry LD, Amin MR, Benninger MS, Blumin JH, Bock JM, Bryson PC, Castellanos PF, Chen SC, Clary MS, Cohen SM, Crawley BK, Dailey SH, Daniero JJ, de Alarcon A, Donovan DT, Edell ES, Ekbom DC, Fernandes-Taylor S, Fink DS, Franco RA, Garrett CG, Guardiani EA, Hillel AT, Hoffman HT, Hogikyan ND, Howell RJ, Huang LC, Hussain LK, Johns MM, Kasperbauer JL, Khosla SM, Kinnard C, Kupfer RA, Langerman AJ, Lentz RJ, Lorenz RR, Lott DG, Lowery AS, Makani SS, Maldonado F, Mannion K, Matrka L, McWhorter AJ, Merati AL, Mori MC, Netterville JL, O'Dell K, Ongkasuwan J, Postma GN, Reder LS, Rohde SL, Richardson BE, Rickman OB, Rosen CA, Rutter MJ, Sandhu GS, Schindler JS, Schneider GT, Shah RN, Sikora AG, Sinard RJ, Smith ME, Smith LJ, Soliman AMS, Sveinsdóttir S, Van Daele DJ, Veivers D, Verma SP, Weinberger PM, Weissbrod PA, Wootten CT, Shyr Y, Francis DO. Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg 2021; 146:20-29. [PMID: 31670805 PMCID: PMC6824232 DOI: 10.1001/jamaoto.2019.3022] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Question What are the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS)? Findings In this cohort study of 810 patients with iSGS who underwent 1 of the 3 most common surgical treatments, 23% of patients underwent a recurrent surgical procedure during the 3-year study period, but recurrence differed by modality (cricotracheal resection, 1%; endoscopic resection with adjuvant medical therapy, 12%; and endoscopic dilation, 28%). Among successfully treated patients, those who underwent cricotracheal resection reported the highest quality of life but the greatest perioperative risk and worst long-term voice outcomes. Meaning These results show the feasibility of integrating an engaged rare disease community with a network of surgeons to facilitate rapid and nuanced treatment comparisons; findings may help inform treatment decision-making in iSGS. Importance Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. Objective To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. Design, Setting, and Participants In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. Main Outcomes and Measures The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. Results Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score–matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. Conclusions and Relevance In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.
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Affiliation(s)
- Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Catherine Anderson
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynne D Berry
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Milan R Amin
- New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York
| | - Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joel H Blumin
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Jonathan M Bock
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul F Castellanos
- Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham
| | - Sheau-Chiann Chen
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver
| | - Seth M Cohen
- Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brianna K Crawley
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California
| | - Seth H Dailey
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Donald T Donovan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | - Daniel S Fink
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver
| | - Ramon A Franco
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - C Gaelyn Garrett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth A Guardiani
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor
| | - Rebecca J Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Li-Ching Huang
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Lena K Hussain
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles
| | - Jan L Kasperbauer
- Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Sid M Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Cheryl Kinnard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor
| | - Alexander J Langerman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert J Lentz
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert R Lorenz
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - David G Lott
- Department of Otorhinolaryngology, Mayo Clinic Scottsdale, Scottsdale, Arizona
| | - Anne S Lowery
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samir S Makani
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyle Mannion
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura Matrka
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Medical Center, Columbus
| | - Andrew J McWhorter
- Department of Otolaryngology, Louisiana State University Health Sciences Center-New Orleans, New Orleans
| | - Albert L Merati
- Department of Otolaryngology-Head & Neck Surgery, University of Washington Medical Center, Seattle
| | - Matthew C Mori
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - James L Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta
| | - Lindsay S Reder
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Otis B Rickman
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Guri S Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare National Health System Trust, London, United Kingdom
| | - Joshua S Schindler
- Department of Otolaryngology-Head & Neck Surgery, Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - G Todd Schneider
- Department of Otolaryngology, University of Rochester, Rochester, New York
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill
| | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Robert J Sinard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marshall E Smith
- Division of Otolaryngology-Head & Neck Surgery, The University of Utah, Salt Lake City
| | - Libby J Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - Douglas J Van Daele
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - David Veivers
- Department of Otolaryngology-Head and Neck Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine
| | - Paul M Weinberger
- Departments of Otolaryngology, Molecular and Cellular Physiology, Feist-Weiller Cancer Center, Louisiana State University, Shreveport
| | - Philip A Weissbrod
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California, San Diego, San Diego
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yu Shyr
- Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - David O Francis
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
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25
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Waddle MR, Ma DJ, Visscher SL, Borah BJ, May JM, Price KA, Moore EJ, Patel SH, Hinni ML, Chintakuntlawar AV, Garcia JJ, Graner DE, Neben-Wittich MA, Garces YI, Hallemeier CL, Price DL, Kasperbauer JL, Janus JR, Foote RL, Miller RC. Costs of Definitive Chemoradiation, Surgery, and Adjuvant Radiation Versus De-Escalated Adjuvant Radiation per MC1273 in HPV+ Cancer of the Oropharynx. Int J Radiat Oncol Biol Phys 2020; 110:396-402. [PMID: 33359567 DOI: 10.1016/j.ijrobp.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/12/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE De-escalated treatment for human papillomavirus (HPV)+ oropharynx squamous cell carcinoma (OPSCC) has shown promising initial results. Health-care policy is increasingly focusing on high-value care. This analysis compares the cost of care for HPV+ OPSCC treated with definitive chemoradiation (CRT), surgery and adjuvant radiation (RT), and surgery and de-escalated CRT on MC1273. METHODS AND MATERIALS MC1273 is a prospective, phase 2 study evaluating adjuvant CRT to 30 to 36 Gy plus docetaxel for HPV+ OPSCC after surgery for high-risk patients. Matched standard-of-care control groups were retrospectively identified for patients treated with definitive CRT or adjuvant RT. Standardized costs were evaluated before radiation, during treatment (during RT), and at short-term (6 month) and long-term (7-24 month) follow-up periods. RESULTS A total of 56 definitive CRT, 101 adjuvant RT, and 66 MC1273 patients were included. The CRT arm had more T3-4 disease (63% vs 17-21%) and higher N2c-N3 disease (52% vs 20-24%) vs both other groups. The total treatment costs in the CRT, adjuvant RT, and MC1273 groups were $47,763 (standard deviation [SD], $19,060], $57,845 (SD, $17,480), and $46,007 (SD, $9019), respectively, and the chemotherapy and/or RT costs were $39,936 (SD, $18,480), $26,603 (SD, $12,542), and $17,864 (SD, $3288), respectively. The per-patient, per-month, average short-term follow-up costs were $3860 (SD, $10,525), $1072 (SD, $996), and $972 (SD, $833), respectively, and the long-term costs were $978 (SD, $2294), $485 (SD, $1156), and $653 (SD, $1107), respectively. After adjustment for age, T-stage, and N-stage, treatment costs remained lower for CRT and MC1273 versus adjuvant RT ($45,450 and $47,114 vs $58,590, respectively; P < .001), whereas the total per-patient, per-month follow-up costs were lower in the MC1273 study group and adjuvant RT versus CRT ($853 and $866 vs $2030, respectively; P = .03). CONCLUSIONS MC1273 resulted in 10% and 20% reductions in global costs compared with standard-of-care adjuvant RT and definitive CRT treatments. Substantial cost savings may be an added benefit to the already noted low toxicity and maintained quality of life of treatment per MC1273.
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Affiliation(s)
- Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Sue L Visscher
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bijan J Borah
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jackson M May
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Eric J Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Michael L Hinni
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | - Joaquin J Garcia
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Daniel L Price
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | - Jeffrey R Janus
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Robert C Miller
- Division of Radiation Oncology, University of Tennessee, Knoxville, Tennessee.
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26
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Rooker SA, Van Abel KM, Yin LX, Nagelschneider AA, Price DL, Olsen KD, Janus JR, Kasperbauer JL, Moore EJ. Risk factors for subsequent recurrence after surgical treatment of recurrent pleomorphic adenoma of the parotid gland. Head Neck 2020; 43:1088-1096. [PMID: 33275822 DOI: 10.1002/hed.26570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/26/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recurrent pleomorphic adenoma (PA) can be a lifelong disease, and rates of subsequent recurrence are high. METHODS Patients between 2000 and 2015 were identified. Primary outcome was subsequent recurrence after surgical salvage. RESULTS Twenty-seven of 84 patients developed a subsequent recurrence. Risk factors for subsequent recurrence included a higher number of previous recurrences (P < .01), worse preoperative facial nerve function (P < .01), and deep parotid lesion(s) (P < .01). Interval since last surgery was protective (P < .01), specifically >10 years since last surgery (P < .01). For patients with a >10-year interval since their last surgery, the subsequent recurrence-free rate at 10 years follow-up was 80.2% vs 31.8%. CONCLUSIONS For patients presenting with a >10-year interval since their last surgery, subsequent recurrence rates are low, which may allow for as needed surveillance recommendations. For patients presenting with recurrent PA and ≤10 years since their last surgery, a closer surveillance is warranted.
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Affiliation(s)
- Steven A Rooker
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel L Price
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerry D Olsen
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Kasperbauer JL, Creppel NH, Gutierrez C, Lehrke HD, Prummer C, Yaszemski MJ, Wismayer DS, Janus JR. Mandibular Defect Reconstitution: A Contaminated Caprine Model of Bone Regeneration. J Oral Maxillofac Surg 2020; 79:1044.e1-1044.e12. [PMID: 33359103 DOI: 10.1016/j.joms.2020.11.028] [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: 08/31/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE Mandibular reconstitution with bioabsorbable scaffolds seems feasible with the application of 3-dimensional printing combined with bioactive proteins. As yet, previous studies have been limited in number of animals and have avoided a contaminated defect. We present a caprine model of mandibular defect bone regeneration with a 3-dimensionally printed bioabsorbable scaffold contaminated with oral secretions and explore the impact of bone morphogenic protein in mandibular bone reconstitution. METHODS A 3-cm, contaminated mandibular defect was generated in 18 goats and stabilized with 2 mandibular reconstruction plates. An uncoated scaffold was placed in 6 goats, and in the final 6 goats, the scaffold was coated with bone morphogenic protein-2. In 6 goats, the defect was left empty. After 12 weeks, the operative site, scaffold, and adjacent mandible were plasticized, sectioned, and evaluated histologically to assess for bone regeneration. RESULTS The specimens revealed only focal (average of 5.8% of the scaffold pores) and early bone formation in the scaffold-only group. In the scaffold + bone morphogenic protein-2 group, there was more (average of 51.4% of the pores) bone formation. In the periosteum-only group, the ratio of the bone thickness of the defect to that of the normal bone ranged from 0.16 to 0.78. No major infections occurred. CONCLUSIONS This caprine model serves as an excellent method to assess reconstructive options for contaminated mandibular deficits. Bone regeneration was documented in a 3-cm contaminated caprine mandibular defect reconstructed with a 3-dimensionally printed synthetic scaffold with or without the addition of bone morphogenic protein-2. Bone morphogenic protein-2 significantly augments bone generation in the synthetic scaffold. Residual mandibular periosteum generated bone. Future studies will focus on optimizing vascularization.
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Affiliation(s)
- Jan L Kasperbauer
- Professor, Assistant Professor, Departments of Otolaryngology and Anatomy, Mayo Clinic, Rochester, MN.
| | | | | | - Heidi D Lehrke
- Private Practitioner, Division of Anatomic Pathology, Hospital Pathology Associates, St. Paul, MN
| | | | - Michael J Yaszemski
- Professor, Biomedical Engineering and Orthopedics, Mayo Clinic, Rochester, MN
| | - Dj Schembri Wismayer
- Assistant Professor, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jeffrey R Janus
- Associate Professor of Otolaryngology, Chair Department of Otolaryngology, Mayo Clinic, Jacksonville, FL
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Rooker SA, Nagelschneider AA, Moore EJ, Yin LX, Price DL, Janus JR, Kasperbauer JL, Van Abel KM. Recurrent pleomorphic adenoma of the parotid gland: A comparison of radiographic and pathologic tumor burden. Am J Otolaryngol 2020; 41:102642. [PMID: 32682193 DOI: 10.1016/j.amjoto.2020.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare recurrent pleomorphic adenoma tumor burden as detected on magnetic resonance and computerized tomography imaging with postoperative histopathology. MATERIALS AND METHODS 44 patients were identified at a tertiary medical center between 2000 and 2015. Patients were included if they had viewable preoperative imaging and a postoperative diagnosis of recurrent pleomorphic adenoma. Primary outcomes were differences in the number and size of lesions detected on imaging and pathology. RESULTS The size in greatest dimension between pathology and imaging was not significant on aggregate MRI + CT (p = 0.78), MRI (p = 0.41), or CT (p = 0.69). There were more lesions found on pathology compared to both aggregate MRI + CT (p = 0.003) and CT alone (p = 0.014). The number of lesions between MRI and pathology failed to reach significance (p = 0.06). On univariate analysis, the interval between imaging and pathology (recurrent surgery) did not significantly affect the number of lesions detected (p = 0.18). On multivariable analysis, CT as the primary imaging modality and >1 recurrence was independently associated with greater inaccuracy with respect to number of lesions detected (p = 0.006; p = 0.008). CONCLUSION The size of the largest lesion on pathology can be accurately determined with imaging. Compared to MRI, CT scans significantly underpredict the number of lesions found on pathology. MRI should be prioritized unless contraindications exist. These findings will help guide imaging choice, preoperative planning, and patient counseling.
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Yin LX, Puccinelli CL, Van Abel K, Kasperbauer JL, Price DL, Janus JR, Ryder M, Moore EJ. Prognostic Factors in Patients with Differentiated Thyroid Cancers Metastatic to the Cervical Spine. Laryngoscope 2020; 131:E1741-E1747. [PMID: 33095932 DOI: 10.1002/lary.29174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/30/2020] [Accepted: 09/26/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The spine is the most common site of bone metastases in differentiated thyroid cancer (DTC). The role of surgery in the management of cervical spine (C-spine) metastases (CSpM) has not been adequately explored. METHODS This is a retrospective cohort study at a tertiary referral center from 2002 to 2018. Inclusion criteria were pathologic diagnosis of DTC and imaging/pathologic diagnosis of CSpM. Statistical analysis utilized t tests for continuous variables and χ2 tests for categorical variables. Survival analysis was conducted using Kaplan-Meier curves with univariate and multivariate Cox regressions. RESULTS Fifty patients with DTC and CSpM were identified. Of those, 16 underwent surgical resection of the C-spine, whereas 34 did not. The most common presenting symptom was neck pain (N = 37, 74%). Patients in the surgery group were more likely to report a subjective improvement of symptoms (P < .01) and to have local (P < .01) and systemic (P = .04) disease control. Five-year overall survival was 44.7% for the surgery group (95% confidence interval [CI]: 17.1-69.3) and 11.1% (95% CI: 2.1-28.8) for the nonsurgery group (P = .01). The strongest risk factor for improved overall survival after C-spine metastasis was local disease control at the C-spine (multivariate hazard ratio [HR] = 0.32, 95% CI: 0.12-0.85, P = .02). Surgical intervention was significantly associated with improved survival on both univariate (HR = 0. 35, 95% CI: 0.15-0.82, P = .02) and multivariate (HR = 0.37, 95% CI: 0.14-0.98, P = .04) analysis. CONCLUSION Surgical management of CSpM in differentiated thyroid cancers is associated with significantly improved local disease control and overall survival. Referral to spine surgeons should be considered after diagnosis. LEVEL OF EVIDENCE IV. Laryngoscope, 131:E1741-E1747, 2021.
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Affiliation(s)
- Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Kathryn Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jeffrey R Janus
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Mabel Ryder
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
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Yin LX, Van Abel KM, Rooker SA, Nagelschneider AA, Olsen KD, Price DL, Janus JR, Kasperbauer JL, Moore EJ. Risk factors for carcinoma ex pleomorphic adenoma in patients presenting with recurrence after resection of pleomorphic adenoma. Head Neck 2020; 43:419-427. [PMID: 33043539 DOI: 10.1002/hed.26489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In patients presenting with recurrent pleomorphic adenoma (rPA), clinical evaluation can fail to recognize carcinoma ex PA (cxPA). We aim to identify the risk factors for cxPA. METHODS This is a single institution retrospective case-control study from 2000 to 2015. CxPA was diagnosed based on surgical pathology. Demographics, clinical, and social histories were collected. RESULTS A number of 13/106 (12.3%) patients were diagnosed with cxPA, of which only 4/13 (31%) had clinical features suspicious for malignancy. Compared to benign rPA, factors associated with cxPA included age >50 (odds ratio [OR] 6.67, 95% confidence interval [CI]: 1.71-25.98, P < .01), >10 pack-years of smoking history (OR 3.36, 95% CI: 1.01-11.14, P = .04), and the largest tumor being >2 cm on pathology (OR 4.42, 95% CI: 1.14-17.10, P = .03). CONCLUSIONS In patients presenting with rPA, risk factors for malignant transformation include age >50, significant smoking history, and tumors larger than 2 cm. Clinical signs of malignancy such as rapid growth or pain are not always present.
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven A Rooker
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | | | - Kerry D Olsen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Moore EJ, Van Abel KM, Routman DM, Lohse CM, Price KAR, Neben-Wittich M, Chintakuntlawar AV, Price DL, Kasperbauer JL, Garcia JJ, Hinni ML, Patel SH, Janus JR, Foote RL, Ma DJ. Human papillomavirus oropharynx carcinoma: Aggressive de-escalation of adjuvant therapy. Head Neck 2020; 43:229-237. [PMID: 32969095 DOI: 10.1002/hed.26477] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/24/2020] [Accepted: 09/09/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Aggressive dose de-escalated adjuvant radiation therapy (RT) in patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC). METHODS Patients with HPV(+)OPSCC on a phase II clinical trial of primary surgery and neck dissection followed by dose de-escalated RT (N = 79) were compared with a cohort of patients who received standard adjuvant therapy (N = 115). Local recurrence-free, regional recurrence-free, distant metastases-free survival, and progression-free survival (PFS) were assessed. RESULTS Of 194 patients, 23 experienced progression at a median of 1.1 years following surgery (interquartile range [IQR] 0.7-2.0; range 0.3-5.4); 10 patients in the de-escalated cohort and 13 patients in the standard cohort. The 3-year PFS rate for the de-escalated cohort was 87%, and in the standard cohort was 90% (hazard ratio [HR] 1.18, 95% confidence interval (CI) [0.50-2.75]). CONCLUSION Patients with HPV(+)OPSCC who undergo surgical resection and neck dissection and meet criteria for adjuvant therapy can undergo aggressive dose de-escalation of RT without increasing risk of progression locally, regionally or at distant sites.
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Affiliation(s)
- Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Daniel L Price
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Michael L Hinni
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dan J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Ekbom DC, Bayan SL, Goates AJ, Kasperbauer JL. Endoscopic Wedge Excisions with CO2 Laser for Subglottic Stenosis. Laryngoscope 2020; 131:E1062-E1066. [PMID: 32820819 DOI: 10.1002/lary.29013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Dale C Ekbom
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Semirra L Bayan
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Andrew J Goates
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Van Abel KM, Routman DM, Moore EJ, Ma DJ, Yin LX, Fields PA, Schofield M, Bartemes KR, Chatzopoulos K, Price DL, Janus JR, Kasperbauer JL, Price KA, Chintakuntlawar AV, Neben-Wittich MA, Foote RL, Garcia JJ. T cell fraction impacts oncologic outcomes in human papillomavirus associated oropharyngeal squamous cell carcinoma. Oral Oncol 2020; 111:104894. [PMID: 32712575 DOI: 10.1016/j.oraloncology.2020.104894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND We investigated T cell clonality (TCC) and T cell fraction (TCF) in human papilloma virus associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) progressors [cases] vs. non-progressors [controls]. METHODS This nested case-control study included patients undergoing intent-to-cure surgery ± adjuvant therapy from 6/1/2007-10/3/2016. Patients experiencing local/regional/distant disease (progressors), and a consecutive sample of non-progressors were matched (2 controls: 1 case) on tumor subsite, T-stage and number of metastatic lymph nodes. We performed imunosequencing of the CDR3 regions of human TCRβ chains. RESULTS 34 progressors and 65 non-progressors were included. There was no statistically significant difference in baseline TCF (range: 0.039-1.084) and TCC (range: 0.007-0.240) (p > 0.05). Female sex was associated with higher TCF (p = 0.03), while extranodal extension (ENE) was associated with lower TCF (p = 0.01). There was a positive correlation between tumor size and clonality (R = 0.34, p < 0.01). The strongest predictor of progression-free survival (PFS) was TCF (HR 0.80, 95%CI 0.66-0.96, p = 0.02). The strongest predictors of cancer specific survival (CSS) were TCF (HR0.69, 95%CI 0.47-1.00, p < 0.05) and Adult Comorbidity Evaluation-27 (ACE-27) score (p < 0.05). Similarly, the strongest predictors of overall survival (OS) were TCF (HR 0.62, 95%CI 0.43-0.91, p = 0.01) and ACE-27 score (p = 0.03). On multivariable modeling, TCF ≥ 0.4 was independently associated with PFS (HR 0.34, 95%CI 0.14-0.85, p = 0.02) while an ACE-27 score of ≥ 2 independently predicted CSS (HR 3.85, 95%CI 1.07-13.85, p = 0.04) and OS (HR 3.51, 95%CI 1.10-11.20, p = 0.03). CONCLUSIONS In patients with HPV(+)OPSCC, TCF was higher in female patients and those without ENE, suggesting differential immune responses. Lower TCF was significantly and independently associated with disease progression. Better ACE-27 scores appear to predict improved oncologic control.
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Affiliation(s)
- Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA.
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Paul A Fields
- Adaptive Biotechnologies, Seattle, WA 98102, USA; Department of Pathology and Clinical Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Matt Schofield
- Adaptive Biotechnologies, Seattle, WA 98102, USA; Department of Pathology and Clinical Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Kathleen R Bartemes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kyriakos Chatzopoulos
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Katharine A Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Joaquin J Garcia
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Menapace DC, Ekbom DC, Larson DP, Lalich IJ, Edell ES, Kasperbauer JL. Evaluating the Association of Clinical Factors With Symptomatic Recurrence of Idiopathic Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg 2020; 145:524-529. [PMID: 31070681 DOI: 10.1001/jamaoto.2019.0707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Idiopathic subglottic stenosis (iSGS) is a progressive and potentially life-threatening condition with very few targeted treatment options. Objective To characterize the clinical factors of patients with iSGS, including body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), and evaluate their association with iSGS symptomatic recurrence. Design, Setting, and Participants This retrospective medical record review included 186 adult patients with iSGS treated at a single tertiary referral center between January 1, 1989, and December 31, 2015. All data analysis took place from January 1, 2018 to June 30, 2018. Main Outcomes and Measures The 3 BMI categories were examined for their association with iSGS recurrence. Outcome measurements included time to first symptomatic recurrence (TTFR) and recurrence-free survival (RFS). Comorbidities were recorded. Results Of the 186 patients in the study, 182 (98%) were women; mean (interquartile range) patient age, 49 (41-60) years. At iSGS diagnosis, 65 (35%) patients were underweight or normal weight; 45 (24%) were overweight; and 76 (41%) were obese (class 1, 2, or 3). Median BMI was 27.4. Ninety-one patients experienced TTFR at a median of 14 months. Compared with underweight or normal-weight patients, the hazard ratios for the associations of overweight, obese class 1, and obese class 2/3 patients with recurrence were 1.14 (95% CI, 0.65-1.99), 1.74 (95% CI, 1.04-2.93), and 1.04 (95% CI, 0.54-1.99), respectively. No differences in concomitant medical treatment regimens were found. While several comorbidities (gastroesophageal reflux disease, hypertension, hyperlipidemia, and diabetes mellitus) were associated with increasing BMI, they were not associated with iSGS symptomatic recurrence on multivariable analysis. Conclusions and Relevance Results of this retrospective review show that class 1 obesity was associated with an increased rate of iSGS symptomatic recurrence compared with underweight or normal-weight patients. This association was not seen in class 2 or class 3 obesity. Patients with class 1 obesity should be counseled about this risk to aid in the assessment and management of symptoms.
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Affiliation(s)
- Deanna C Menapace
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - David P Larson
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Ian J Lalich
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Eric S Edell
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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Van Abel KM, Yin LX, Price DL, Janus JR, Kasperbauer JL, Moore EJ. One‐year outcomes for da Vinci single port robot for transoral robotic surgery. Head Neck 2020; 42:2077-2087. [DOI: 10.1002/hed.26143] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/27/2020] [Accepted: 03/05/2020] [Indexed: 01/29/2023] Open
Affiliation(s)
- Kathryn M. Van Abel
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Linda X. Yin
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Daniel L. Price
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Jeffery R. Janus
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Jan L. Kasperbauer
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Eric J. Moore
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
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Sen I, Young WF, Kasperbauer JL, Polonis K, Harmsen WS, Colglazier JJ, DeMartino RR, Oderich GS, Kalra M, Bower TC. Tumor-specific prognosis of mutation-positive patients with head and neck paragangliomas. J Vasc Surg 2020; 71:1602-1612.e2. [PMID: 32035780 DOI: 10.1016/j.jvs.2019.08.232] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/06/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Genetic testing to identify succinate dehydrogenase (SDH) mutations in patients with head and neck paraganglioma (HNP) has been in clinical practice for more than a decade. However, the recurrence and metachronous tumor occurrence risks in surgically treated mutation-positive patients are not well studied. METHODS Clinical and procedural details of consecutive patients who underwent excision for HNP from January 1996 to October 2016 were retrospectively reviewed. End points included recurrence, metachronous tumor detection, and mortality. Germline DNA was tested to identify mutations in SDHx genes. Patients were divided into three groups on the basis of genetic testing: group I, positive; group II, negative; and group III, unknown or offered but not tested. RESULTS HNP was diagnosed in 268 patients, 214 (147 female; mean age, 47 years) included in this study. Directed genetic testing was performed in 68; mutations were detected in SDH in 47 (69%), a majority SDHD. In group I, 47 patients had 64 procedures for 81 tumors (52 carotid body tumors [CBTs]); 17 (36%) were bilateral, 7 (15%) multiple, 3 (6%) functional, and 7 (15%) malignant. Residual tumor in 10 was significant in 2, managed by radiation therapy and reoperation. Local recurrence was detected in 12 patients (25%) at a median of 8 years; 11 metachronous mediastinal and retroperitoneal paragangliomas were detected in 8 (17%) at a median of 13 years. Systemic metastases occurred in five (10%). Six patients (13%) had more than one recurrence. In group II, 21 patients had 22 procedures for 23 tumors, 17 CBTs. Two (9%) were bilateral and two (9%) malignant. Excision was complete in all with no recurrence or systemic metastasis at last follow-up. For group III, 146 patients underwent 153 procedures for 156 tumors, 95 CBTs; 7 (5%) were bilateral, 2 (1%) multiple, 8 (5%) functional, and 1 (0.6%) malignant. Local recurrence was detected in nine (6%) at a median of 9 years and metachronous HNP in three (2%) at a median of 5 years. Systemic metastases occurred in two (1%). Mortality was 4% in group I and 3% in group III, none procedure or tumor related. Group I (mutation positive) had 10-year overall, recurrence-free, and metachronous tumor-free survival rates of 93%, 69.4%, and 73%, respectively, lower than the other groups (P < .001). CONCLUSIONS Bilateral, functional, malignant, recurrent, and metachronous tumors are more common in SDH mutation-positive patients with HNP. Overall survival in patients with HNP is high. Metachronous tumors or local recurrences occur late, and long-term follow-up is necessary.
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Affiliation(s)
- Indrani Sen
- Department of Vascular Surgery, Mayo Clinic, Rochester, Minn.
| | | | | | | | - William S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | | | | | | | - Manju Kalra
- Department of Vascular Surgery, Mayo Clinic, Rochester, Minn
| | - Thomas C Bower
- Department of Vascular Surgery, Mayo Clinic, Rochester, Minn
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Ma DJ, Price KA, Moore EJ, Patel SH, Hinni ML, Garcia JJ, Graner DE, Neben-Wittich M, Garces YI, Chintakuntlawar AV, Price DL, Van Abel KM, Kasperbauer JL, Janus JR, Waddle M, Miller RC, Shiraishi S, Mutter RW, Corbin KS, Park SS, Foote RL. Reply to A.S. Garden. J Clin Oncol 2019; 37:3559-3560. [PMID: 31557088 DOI: 10.1200/jco.19.02144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daniel J Ma
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Katharine A Price
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Eric J Moore
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Samir H Patel
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Michael L Hinni
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Joaquin J Garcia
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Darlene E Graner
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Michelle Neben-Wittich
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Yolanda I Garces
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Ashish V Chintakuntlawar
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Daniel L Price
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Kathryn M Van Abel
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Jan L Kasperbauer
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Jeffrey R Janus
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Mark Waddle
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Robert C Miller
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Satomi Shiraishi
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Robert W Mutter
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Kimberly S Corbin
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Sean S Park
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Robert L Foote
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
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Chintakuntlawar AV, Yin J, Foote RL, Kasperbauer JL, Rivera M, Asmus E, Garces NI, Janus JR, Liu M, Ma DJ, Moore EJ, Morris JC, Neben-Wittich M, Price DL, Price KA, Ryder M, Van Abel KM, Hilger C, Samb E, Bible KC. A Phase 2 Study of Pembrolizumab Combined with Chemoradiotherapy as Initial Treatment for Anaplastic Thyroid Cancer. Thyroid 2019; 29:1615-1622. [PMID: 31595822 DOI: 10.1089/thy.2019.0086] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Anaplastic thyroid cancer (ATC) has poor prognosis with median overall survival (OS) of ∼6 months. We previously reported high PD-1/PDL-1 staining in ATC, raising the possibility of the productive application of the immunotherapeutic pembrolizumab. However, having found pembrolizumab to anecdotally have limited single-agent activity in ATC, we sought to alternatively define whether pembrolizumab might synergistically combine with chemoradiotherapy as initial ATC therapy. Methods: An investigator-initiated therapeutic phase 2 trial of pembrolizumab, 200 mg intravenously (IV) every 3 weeks, combined with chemoradiotherapy (docetaxel/doxorubicin, 20 mg/m2 each IV weekly plus volumetric modulated arc therapy) was initiated as frontline therapy (with or without surgery) in ATC to assess efficacy and toxicities. Six-month OS was selected as the primary endpoint using a Simon's optimal design with interim analysis (targeting accrual of 25 patients; Cohort A: prior resection, Cohort B: no resection). Based on a prior patient cohort-treated similarly, but without pembrolizumab, the design was such that, if 6-month true survival is 75%, the probability of declaring the approach worthy of further pursuit would be 91%. Results: Three patients were enrolled, two with rapidly enlarging unresectable neck masses. Early tumor responses were favorable in all three, and all three satisfactorily completed: intended radiotherapy, preceding and radiotherapy-concurrent pembrolizumab, and concurrent chemoradiotherapy. However, all three patients died <6 months following therapy initiation-one from pulmonary metastases and two from otherwise unexpected fatal pulmonary complications occurring subsequent to chemoradiotherapy completion-prompting study closure. Conclusions: Although initially tolerated and effective in terms of locoregional disease control, disappointing survival outcomes compared with historical controls raise uncertainty that the piloted approach merits further pursuit in ATC.
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Affiliation(s)
| | - Jun Yin
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology and Mayo Clinic, Rochester, Minnesota
| | - Jan L Kasperbauer
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Rivera
- Department of Laboratory and Anatomical Pathology, Mayo Clinic, Rochester, Minnesota
| | - Erik Asmus
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Nina I Garces
- Department of Radiation Oncology and Mayo Clinic, Rochester, Minnesota
| | - Jeffrey R Janus
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Minetta Liu
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology and Mayo Clinic, Rochester, Minnesota
| | - Eric J Moore
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - John C Morris
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel L Price
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mabel Ryder
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | | - Crystal Hilger
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Eleyna Samb
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Low CM, Price DL, Kasperbauer JL. Mandibular Tori Limiting Treatment of Carcinoma of the Upper Aerodigestive Tract. Clin Med Insights Case Rep 2019; 12:1179547619856599. [PMID: 31320809 PMCID: PMC6610396 DOI: 10.1177/1179547619856599] [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: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 11/15/2022]
Abstract
Background: Mandibular tori are a rare cause of difficult direct visualization of the
upper aerodigestive tract. In the setting of aerodigestive tract pathology
necessitating direct visualization, removal of mandibular tori may be
required to facilitate treatment. Methods: In the first case, large bilateral symmetric mandibular tori were removed to
facilitate access to the anterior commissure and removal of a T1 glottic
squamous cell carcinoma (SCC). In the second case, large bilateral
mandibular tori were removed to access a markedly exophytic SCC in the right
vallecula. Subsequently, the tumor was removed with robotic assistance with
excellent exposure. Results: Both patients were free of recurrence at last follow-up. Conclusion: Mandibular tori are an uncommon cause of difficult direct laryngoscopy. In
situations that require direct visualization of the anterior commissure or
base of tongue for diagnosis and management of lesions, surgical removal of
the tori may be required as in the cases presented here.
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Affiliation(s)
- Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Ma DJ, Price KA, Moore EJ, Patel SH, Hinni ML, Garcia JJ, Graner DE, Foster NR, Ginos B, Neben-Wittich M, Garces YI, Chintakuntlawar AV, Price DL, Olsen KD, Van Abel KM, Kasperbauer JL, Janus JR, Waddle M, Miller R, Shiraishi S, Foote RL. Phase II Evaluation of Aggressive Dose De-Escalation for Adjuvant Chemoradiotherapy in Human Papillomavirus-Associated Oropharynx Squamous Cell Carcinoma. J Clin Oncol 2019; 37:1909-1918. [PMID: 31163012 DOI: 10.1200/jco.19.00463] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of this study was to determine if dose de-escalation from 60 to 66 Gy to 30 to 36 Gy of adjuvant radiotherapy (RT) for selected patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma could maintain historical rates for disease control while reducing toxicity and preserving swallow function and quality of life (QOL). PATIENTS AND METHODS MC1273 was a single-arm phase II trial testing an aggressive course of RT de-escalation after surgery. Eligibility criteria included patients with p16-positive oropharyngeal squamous cell carcinoma, smoking history of 10 pack-years or less, and negative margins. Cohort A (intermediate risk) received 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks along with 15 mg/m2 docetaxel once per week. Cohort B included patients with extranodal extension who received the same treatment plus a simultaneous integrated boost to nodal levels with extranodal extension to 36 Gy in 1.8-Gy fractions twice per day. The primary end point was locoregional tumor control at 2 years. Secondary end points included 2-year progression-free survival, overall survival, toxicity, swallow function, and patient-reported QOL. RESULTS Accrual was from September 2013 to June 2016 (N = 80; cohort A, n = 37; cohort B, n = 43). Median follow-up was 36 months, with a minimum follow-up of 25 months. The 2-year locoregional tumor control rate was 96.2%, with progression-free survival of 91.1% and overall survival of 98.7%. Rates of grade 3 or worse toxicity at pre-RT and 1 and 2 years post-RT were 2.5%, 0%, and 0%. Swallowing function improved slightly between pre-RT and 12 months post-RT, with one patient requiring temporary feeding tube placement. CONCLUSION Aggressive RT de-escalation resulted in locoregional tumor control rates comparable to historical controls, low toxicity, and little decrement in swallowing function or QOL.
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Gao G, Wang J, Kasperbauer JL, Tombers NM, Teng F, Gou H, Zhao Y, Bao Z, Smith DI. Whole genome sequencing reveals complexity in both HPV sequences present and HPV integrations in HPV-positive oropharyngeal squamous cell carcinomas. BMC Cancer 2019; 19:352. [PMID: 30975103 PMCID: PMC6460540 DOI: 10.1186/s12885-019-5536-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 01/11/2019] [Accepted: 03/27/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND High risk human papillomaviruses (HPV) plays important roles in the development of cervical cancer, a number of other anogenital cancer and they are increasingly found in oropharyngeal squamous cell carcinoma (OPSCC), however there has not been comprehensive analysis about the role how these viruses play in the development of OPSCC. METHODS To characterize the physical status of HPV within OPSCC and to determine the effect this has throughout the host genome, we have performed 30-40X whole genome sequencing (WGS) on the BGI sequencing platform on 34 OPSCCs: 28 of which were HPV positive. We then examined the sequencing data to characterize the HPV copy number and HPV physical status to determine what effect they have on both HPV and human genome structural changes. RESULTS WGS determined the HPV copy number across the viral genome. HPV copy number ranged from 1 copy to as high as 150 copies in each individual OPSCC. Independent of HPV copy number, most tumors had either a small or a very large deletion in the viral genome. We discovered that these deletions were the result of either HPV integration into the human genome or HPV-HPV sequence junctions. WGS revealed that ~ 70% of these tumors had HPV integrations within the human genome and HPV integration occurred independent of HPV copy number. Individual HPV integrations were found to be highly disruptive resulting in structural variations and copy number changes at or around the integration sites. CONCLUSIONS WGS reveals that there is a great complexity in both HPV sequences present and the HPV integrations events in HPV positive OPSCCs tumors. Thus HPV may be playing different roles in the development of different OPSCCs and this further challenge the HPV-driven carcinogenesis model first proposed for cervical cancer.
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Affiliation(s)
- Ge Gao
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | | | | | | | | | | | | - David I Smith
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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Abstract
Anaplastic thyroid cancer (ATC) is a devastating and usually incurable diagnosis. Clinical and pathologic diagnosis is best assessed at a tertiary center with concentrated ATC expertise. Expeditious multidisciplinary management is recommended for optimal patient outcomes. Based on multiinstitutional and population-based studies, multimodal therapy that includes chemoradiotherapy with surgery (when feasible) is the preferred initial treatment because it is associated with incrementally improved overall survival. In ATC that carries a BRAF V600E somatic mutation, combination therapy with BRAF and MEK inhibitors has shown promise but needs further study. Immunotherapeutic agents in neoadjuvant and metastatic settings are being investigated.
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Affiliation(s)
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jan L Kasperbauer
- Division of Head and Neck Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Abstract
Hemangiopericytomas are rare tumors of vascular origin most commonly found in the extremities or retroperitoneal area. When they originate from the nasal cavity and paranasal sinuses, they tend to be less aggressive and generally do not metastasize. The term “hemangiopericytoma-like lesion” has been coined for sinonasal hemangiopericytomas that display more benign histologic and growth characteristics than do those located elsewhere. Fifteen cases of hemangiopericytoma of the nasal cavity and paranasal sinuses were reviewed over the period 1951 to 1990; included are follow-up data on cases reported earlier from this institution. The clinical course, management, and outcome was evaluated and correlated with the histologic characteristics of the tumors. The recurrence rate in our series was 13.3%; the mean follow-up was 11 years. No patients died of their disease or had evidence of metastatic disease. This clinicopathologic review suggests that sinonasal hemangiopericytomas should not be classified as “hemangiopericytoma-like” lesions; rather, they should be expected to have significant local recurrence rates with low rates of distant metastasis and mortality. Long-term follow-up is essential as there can be local recurrence after many years.
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Affiliation(s)
- Kenneth V. Hughes
- Departments of Otorhinolaryrology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
| | - Michael C. Bard
- Departments of Otorhinolaryrology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
| | - Jean E. Lewis
- Departments of Surgical Pathology, Mayo Clinic, Rochester, MN
| | - Jan L. Kasperbauer
- Departments of Otorhinolaryrology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
| | - George W. Facer
- Departments of Otorhinolaryrology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
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Gelbard A, Shyr Y, Berry L, Hillel AT, Ekbom DC, Edell ES, Kasperbauer JL, Lott DG, Donovan DT, Garrett CG, Sandhu G, Daniero JJ, Netterville JL, Schindler JS, Smith ME, Bryson PC, Lorenz RR, Francis DO. Treatment options in idiopathic subglottic stenosis: protocol for a prospective international multicentre pragmatic trial. BMJ Open 2018; 8:e022243. [PMID: 29643170 PMCID: PMC5898326 DOI: 10.1136/bmjopen-2018-022243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Idiopathic subglottic stenosis (iSGS) is an unexplained progressive obstruction of the upper airway that occurs almost exclusively in adult, Caucasian women. The disease is characterised by mucosal inflammation and localised fibrosis resulting in life-threatening blockage of the upper airway. Because of high recurrence rates, patients with iSGS will frequently require multiple procedures following their initial diagnosis. Both the disease and its therapies profoundly affect patients' ability to breathe, communicate and swallow. A variety of treatments have been advanced to manage this condition. However, comparative data on effectiveness and side effects of the unique approaches have never been systematically evaluated. This study will create an international, multi-institutional prospective cohort of patients with iSGS. It will compare three surgical approaches to determine how well the most commonly used treatments in iSGS 'work' and what quality of life (QOL) trade-offs are associated with each approach. METHODS AND ANALYSIS A prospective pragmatic trial comparing the 'Standard of Care' for iSGS at multiple international institutions. Patients with a diagnosis of iSGS without clinical or laboratory evidence of vasculitis or a history of endotracheal intubation 2 years prior to symptom onset will be included in the study. Prospective evaluation of disease recurrence requiring operative intervention, validated patient-reported outcome (PRO) measures as well as patient-generated health data (mobile peak flow recordings and daily steps taken) will be longitudinally tracked for 36 months. The primary endpoint is treatment effectiveness defined as time to recurrent operative procedure. Secondary endpoints relate to treatment side effects and include PRO measures in voice, swallowing, breathing and global QOL as well as patient-generated health data. ETHICS AND DISSEMINATION This protocol was approved by the local IRB Committee of the Vanderbilt University Medical Center in July 2015. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and directly to patient with iSGS via social media-based support groups. TRIAL REGISTRATION NUMBER NCT02481817.
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Affiliation(s)
- Alexander Gelbard
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Lynne Berry
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Alexander T Hillel
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dale C Ekbom
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric S Edell
- Department of Pulmonology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - David G Lott
- Department of Otorhinolaryngology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Donald T Donovan
- Department Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - C. Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Guri Sandhu
- Department of Otolaryngology, Imperial College Healthcare NHS, London, UK
| | - James J Daniero
- Department Otolaryngology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James L Netterville
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Josh S Schindler
- Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA
| | - Marshall E Smith
- Department of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
| | - Paul C Bryson
- Department of Otolaryngology, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Department of Otolaryngology, The Cleveland Clinic, Cleveland, Ohio, USA
| | - David O Francis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Abstract
Background Graves’ ophthalmopathy generates a volume excess for the orbital cavity, which may produce proptosis, pain, exposure keratitis, diplopia, and optic neuropathy. Endoscopic orbital decompression expands the orbital cavity into the ethmoid cavity and medial maxillary sinus. This retrospective study documents the outcomes after endoscopic orbital decompression for patients with Graves’ ophthalmopathy. Methods Data collected included demographic information, symptom resolution, complications related to the surgery, reduction in proptosis, subsequent need for eye muscle surgery, and hospital length of stay. Between July 1989 and April 2003, 62 patients were referred for endoscopic orbital decompression (often unilateral). Results Three patients refused use of their medical records for research purposes. Seventy percent were women; the average age of the study group was 49 years. Preoperatively, 63% of the patients had diplopia and optic neuropathy was noted in 27%. Two patients had a cerebrospinal fluid leak identified and managed during the decompression. No postoperative leaks occurred. Twenty-five percent of patients did not require eye muscle surgery. Forty-eight percent of the patients underwent one procedure to manage diplopia. The average reduction in proptosis was 2.5 mm. Fifty-four percent were managed as an outpatient and 27% underwent a 23-hour observation period. Conclusion This data supports the safety, efficiency, and efficacy of endoscopic orbital decompression for unilateral and bilateral Graves’ ophthalmopathy. Eye muscle surgery frequently will be required to manage diplopia after decompression. (American Journal of Rhinology 19, 603–606, 2005)
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Affiliation(s)
- Jan L. Kasperbauer
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lucinda Hinkley
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract
The endoscopic transnasal approach is an evolving technique for treating lesions in the sella turcica. Since this method was introduced at our institution 4 years ago, the majority of transsphenoidal procedures are performed with it. The records of all patients having endoscopic transnasal hypophysectomy at the Mayo Clinic during the last 4 years were reviewed retrospectively. The criteria analyzed were safety, functional and cosmetic outcome, and complications. During the 4-year period, the operative procedure was modified to improve operative exposure and safety. The results of our review showed a significant decrease in length of hospital stay, reduced operative time, reduced need for nasal packing, and elimination of a sublabial incision. The complication rate was equivalent to that reported for the traditional transseptal transsphenoidal approach. As the neurosurgeons at our institution gained experience with this approach, an increasing number of pituitary microadenomas were resected safely and successfully. In addition, because of the limited septal dissection, this approach is particularly helpful for revision operations. This approach also can be used for the full range of pituitary lesions and in conjunction with adjunctive techniques, including frontal craniotomy and -knife irradiation. Currently, the endoscopic transsphenoidal approach is the method preferred for surgically treating pituitary lesions in adults at our institution.
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Affiliation(s)
- Shawn S. Nasseri
- Departments of Otorhinolaryngology, University of South Florida, Tampa, Florida
| | - Jan L. Kasperbauer
- Departments of Otorhinolaryngology, University of South Florida, Tampa, Florida
| | - Scott E. Strome
- Departments of Otorhinolaryngology, University of South Florida, Tampa, Florida
| | - Thomas V. McCaffrey
- Department of Otorhinolaryngology, University of South Florida, Tampa, Florida
| | - John L. Atkinson
- Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, University of South Florida, Tampa, Florida
| | - Fredric B. Meyer
- Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, University of South Florida, Tampa, Florida
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Sims JR, Wieland CN, Kasperbauer JL, Moore EJ, Price DL. Head and neck desmoplastic melanoma: Utility of sentinel node biopsy. Am J Otolaryngol 2017; 38:537-541. [PMID: 28662971 DOI: 10.1016/j.amjoto.2017.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/18/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The utility of sentinel lymph node biopsy in desmoplastic melanoma has been questioned due to multiple reports of a low rate of occult nodal metastasis in this variant of melanoma. We describe a single institution experience with management of desmoplastic melanoma of the head and neck and discuss the utility of sentinel lymph node biopsy. MATERIALS AND METHODS A retrospective review was performed of 49 patients with desmoplastic melanoma of the head and neck at a tertiary care center from 1994 to 2014. RESULTS Sentinel lymph node biopsy was performed in 15 patients. Only 1 (6.7%) of these patients was found to have a positive sentinel node. Of the 46 patients without evidence of neck disease at presentation, 3 (6.5%) were found to have occult nodal disease or developed neck recurrences. When looking at the entire cohort, there were a total of 16 recurrences in 14 patients (28.6%). The majority (85.7%) of recurrences were either local or distant metastasis with only 2 (14.3%) recurrences being in regional lymph node basins. The overall rates of local, regional, and distant recurrences were 14.2%, 4.1%, and 10.2% respectively. The mixed pathologic subtype was not associated with a higher rate of nodal metastasis. CONCLUSIONS Desmoplastic melanoma has a low rate of occult nodal metastasis and a high propensity to recur locally or as a distant metastasis, regardless of regional node status. Our experience combined with the uncertain impact that sentinel node status has on survival raises the question of the utility of routine sentinel node biopsy in this specific variant of melanoma.
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Affiliation(s)
- John R Sims
- Department of Otorhinolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, United States
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Eric J Moore
- Department of Otorhinolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel L Price
- Department of Otorhinolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, MN, United States.
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Chintakuntlawar AV, Rumilla KM, Smith CY, Jenkins SM, Foote RL, Kasperbauer JL, Morris JC, Ryder M, Alsidawi S, Hilger C, Bible KC. Expression of PD-1 and PD-L1 in Anaplastic Thyroid Cancer Patients Treated With Multimodal Therapy: Results From a Retrospective Study. J Clin Endocrinol Metab 2017; 102:1943-1950. [PMID: 28324060 DOI: 10.1210/jc.2016-3756] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/01/2017] [Indexed: 02/04/2023]
Abstract
CONTEXT Anaplastic thyroid cancer (ATC) is rare and a highly fatal malignancy. The role of programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) as prognostic and/or predictive markers in ATC is unknown. OBJECTIVE Multimodal therapy offers the best chance at tumor control. The objective of this study was to detect potential associations of PD-1/PD-L1 axis variables with outcome data in ATC. DESIGN Retrospective study of a uniformly treated cohort. SETTING Single institution retrospective cohort study. PATIENTS OR OTHER PARTICIPANTS Sixteen patients who received intensity-modulated radiation therapy (15 had preceding surgery) were studied. MAIN OUTCOME MEASURE Patients treated with multimodal therapy were followed and assessed for overall survival (OS) and progression-free survival (PFS). RESULTS All samples demonstrated PD-1 expression in inflammatory cells whereas tumor cells were primarily negative. PD-L1 was expressed on ATC tumor cells in most samples and showed mainly membranous staining. High PD-1 expression (>40% staining) in inflammatory cells was associated with worse overall survival (OS; hazard ratio, 3.36; 95% confidence interval, 1.00 to 12.96; P < 0.05) and trended toward worse PFS, whereas high PD-L1 expression in tumor cells (>33% staining) trended toward worse PFS and OS. CONCLUSION PD-1/PD-L1 pathway proteins are highly expressed in ATC tumor samples and appear to represent predictive markers of PFS and OS in multimodality-treated ATC patients.
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Affiliation(s)
| | - Kandelaria M Rumilla
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905
| | - Carin Y Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905
| | - Sarah M Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota 55905
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota 55905
| | - John C Morris
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota 55905
| | - Mabel Ryder
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota 55905
| | - Samer Alsidawi
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
- Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905
| | - Crystal Hilger
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
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Deep NL, Glasgow AE, Habermann EB, Kasperbauer JL, Carlson ML. Melanoma of the external ear: A population-based study. Am J Otolaryngol 2017; 38:309-315. [PMID: 28258767 DOI: 10.1016/j.amjoto.2017.01.032] [Citation(s) in RCA: 9] [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] [Received: 01/13/2017] [Accepted: 01/31/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Primary melanoma of the external ear (PMEE) is rare and therefore well-suited for large population-based registry analysis. The objective of this study was to utilize the Surveillance, Epidemiology, and End Results (SEER) set of cancer registries to determine the incidence, treatment, and survival characteristics of PMEE. METHODS A retrospective cohort analysis of SEER data from 2004 to 2013 identified all cases of PMEE stage I-IV by AJCC 7th edition guidelines. Population-based incidence was calculated. Cancer-specific survival data by stage was assessed using Kaplan-Meier analysis and the relative effects of tumor characteristics were analyzed with Cox regression models. RESULTS A total of 5481 patients were analyzed (mean age 66.7years, 86.5% male, 93.6% non-Hispanic white). The incidence of PMEE was 1.91 per 100,000 persons-per-year. At diagnosis, 68.1% were stage I, 15.2% were stage II, 4.7% were stage III, 1.5% were stage IV, and 10.8% were unknown. The five-year overall and cancer-specific survival was 78.8% and 90.0%, and, according to AJCC stage, was 85.7% and 95.3% for stage I (n=2287), 64.6% and 81.1% for stage II (n=453), 50.8% and 57.0% for stage III (n=154), 17.2% and 20.5% for stage IV (n=34), and 71.0% and 87.1% for unknown stage (n=330), respectively. The multivariable Cox model identified tumor characteristics that were independently associated with survival. CONCLUSIONS This is the first study to characterize the epidemiology, presentation and outcome of PMEE using the SEER registries. Older age, increasing Breslow thickness, stage, presence of ulceration, positive lymph nodes and distant metastasis each independently predicted time to cancer-specific death.
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Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Amy E Glasgow
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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Menapace DC, Modest MC, Ekbom DC, Moore EJ, Edell ES, Kasperbauer JL. Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques. Otolaryngol Head Neck Surg 2017; 156:906-911. [DOI: 10.1177/0194599817691955] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives Idiopathic subglottic stenosis (iSGS) is rare, and its cause remains elusive. Treatment options include empiric medical therapy and endoscopic or open surgery. We present our results for open surgical technique. Study Design Case series with chart review (1978-2015). Setting Tertiary academic center. Subjects/Methods Thirty-three patients (32 female; median age, 51 years) met inclusion criteria and underwent cricotracheal resection with thyrotracheal anastomosis, tracheal resection with primary anastomosis, or laryngotracheoplasty with rib grafting. Continuous variables were summarized using medians and ranges while categorical features are presented using frequency counts and percentages. Results Sixteen patients (48%) underwent a single-stage approach with immediate extubation or temporary intubation following surgery (median, 1 day; range, 1-3 days). Seventeen patients (52%) underwent a double-staged approach with a median time to decannulation of 35 days (range, 13-100 days). Twenty-four (73%) patients underwent a previous intervention. Median stay in the intensive care unit was 1 day (range, 0-3 days), with a median hospital stay of 4 days (range, 2-7 days). Recurrence requiring further surgical intervention was observed in 12 patients (36%). The median time to recurrence was 8 years over an average follow-up of 9.7 years. The most common complaint following surgery was change in voice quality (fair to poor; n = 10; 30%). Conclusions Open surgery should be reserved for refractory cases of iSGS; cricotracheal resection with thyrotracheal anastomosis is the preferred open technique. Recurrence may occur after open treatment, highlighting the importance of long-term follow-up. Patients should be counseled about the potential for worsening voice quality with the open approach.
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Affiliation(s)
- Deanna C. Menapace
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Mara C. Modest
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Dale C. Ekbom
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Eric S. Edell
- Department of Pulmonology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jan L. Kasperbauer
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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