Oncological and functional outcomes of partial or total laryngopharyngectomy for hypopharyngeal cancer with thyroid or cricoid cartilage invasion

BACKGROUND

Patients with cartilage invasion in hypopharyngeal squamous cell carcinoma (HPSCC) would benefit from partial laryngopharyngectomy (PLP).

AIMS/OBJECTIVES

The purpose of this study was to examine the treatment outcomes of PLP for HPSCC with cartilage invasion, with a focus on the oncological safety and the function preservation.

MATERIALS AND METHODS

We performed a retrospective review of 28 patients with HPSCC with thyroid or cricoid cartilage invasion who had undergone upfront surgery and were followed for more than one year between 1993 and 2019.

RESULTS

Twelve patients treated with PLP (42.9%) and 16 patients treated with total laryngopharyngectomy (TLP) for cartilage invasion in HPSCC were identified. There was no significant difference in recurrence between the PLP group (7/12, 58.3%) and the TLP group (8/16, 50.0%) (p = .718). PLP was not associated with decreased five-year disease free survival (p = .662) or disease specific survival (p = .883) rates compared to TLP. Nine patients receiving PLP could be decannulated and retained intelligible speech (9/12, 75%). Gastrostomy tubes were placed in the PLP group (5/12, 42.9%) and TLP group (1/16, 6.2%) (p = .057).

CONCLUSIONS AND SIGNIFICANCE

PLP appears to be a feasible option for the treatment of thyroid or cricoid cartilage invasion in HPSCC.

Predictive factors of distant metastasis in surgically treated HPV-positive tonsil cancer

BACKGROUND

Human papilloma virus (HPV)-related tonsil cancer is associated with favorable outcomes.

OBJECTIVE

The purpose of this study was to define factors affecting distant metastasis in patients with surgically treated HPV-positive tonsil cancer.

METHODS

The present study enrolled 76 patients diagnosed with HPV-positive tonsil cancer who underwent primary surgery between January 2010 and December 2021.

RESULTS

Twelve (15.7%) patients experienced a distant failure with a median follow-up time of 43 months. Sites of distant metastasis included the lung (n = 10), liver (n = 1), and brain (n = 1). Upon multivariate analysis, an advanced T stage (odds ratio [OR]: 13.94, 95% confidence interval [CI]: 1.29-149.863, p = 0.003) and margin involvement (OR: 5.96, 95% CI: 1.33-26.76, p = 0.02) were independent predictors of distant metastases. The five-year disease-specific survival for the entire cohort was 85%. The multivariate analysis confirmed that distant metastasis (hazard ratio [HR]: 12.688, 95% CI: 3.424-47.016; p < 0.001) and margin involvement (HR: 6.243; 95% CI: 1.681-23.191; p = 0.006) were significant factors associated with the five-year disease-specific survival.

CONCLUSION

HPV-positive tonsil cancer patients with an advanced T stage and a positive surgical margin have a substantial risk of distant metastases. Distant metastasis and margin involvement are factors that affect their survival.

The potential cytotoxic effects of urban particle matter on olfaction

BACKGROUND

Urban particulate matter (UPM) in ambient air is implicated in a variety of human health issues worldwide, however, few studies exist on the effect of UPM on the olfactory system. This study aimed to identify the factors affecting the destruction of the olfactory system in a mouse model following UPM exposure.

METHODS

Mice were divided into: control and four UPM-exposed groups (200 µg UPM at 1 and 2 weeks, and 400 µg UPM at 1 and 2 weeks [standard reference material 1649b; average particle diameter 10.5 μm]). The olfactory neuroepithelium was harvested for histologic examination, gene ontology, quantitative real-time polymerase chain reaction, and western blotting.

RESULTS

Compared to the control group, olfactory marker protein, Olfr1507, ADCY3, and GNAL mRNA levels were lower, and S-100, CNPase, NGFRAP1, BDNF, and TACR3 mRNA levels were higher in the olfactory neuroepithelium of the UPM groups. Moderately positive correlation was present between the 1- and 2-week groups. After analyzing the 200 and 400 UPM groups separately, the strength of the association between the 200 UPM 1- and 2-week groups was moderately positive. No differences was present in the neuroepithelial inflammatory marker levels between the UPM and control groups.

CONCLUSIONS

UPM could have cytotoxic effects on the olfactory epithelium. The exposure time and particular concentration of UPM exposure could affect the degree of destruction of the olfactory neuroepithelium. The olfactory regeneration mechanism could be related to the neurotrophic factors, olfactory ensheathing cell stimulation, and trigeminal nerve support.

Prognostic impact of perineural invasion in hypopharyngeal squamous cell carcinoma

OBJECTIVES

The aim of this study was to evaluate the role of PNI in HPSCC.

METHODS

The medical records of 105 patients who underwent surgery-based treatment for HPSCC were reviewed. Clinicopathologic parameters including disease-specific survival were correlated with PNI.

RESULTS

PNI was identified in 27 of the 105 (25.7%) cases of HPSCC. Correlation analysis demonstrated that PNI in HPSCC was significantly correlated with pN classification (10.3% in N0/N1 vs 34.8% in N2/N3, p = 0.006). Patients with PNI had decreased 5-year disease-specific survival with borderline significance (p = 0.065). In a sub-set of 31 patients who did not receive post-operative radiotherapy, PNI was determined to be a significant prognostic predictor (p = 0.033). In multivariate analysis, extracapsular invasion was the only independent prognostic factor for disease-specific survival (p = 0.001).

CONCLUSION

Perineural invasion (PNI) should be considered an independent predictor for cervical lymph node involvement. PNI status in primary hypopharyngeal squamous cell carcinoma (HPSCC) specimens should be considered in decisions concerning adjuvant radiotherapy.

Natural Killer T-Cell Lymphoma of the Tongue

Lymphoma, which represents about 5.4% of all neoplasms and, more significantly, 19% to 28% of malignant neoplasms, is the most common nonepithelial malignancy of the head and neck area in Koreans. Natural killer T-cell (NK/T-cell) lymphoma is a lymphoma of putative natural killer cell lineage. NK/T-cell neoplasms are generally rare, but they are more common in people of East Asian, Mexican, or South American descent. These neoplasms are highly aggressive and show a strong association with Epstein-Barr virus. The preferential site of extranodal NK/T-cell lymphoma is the nasal cavity, and there has been no report of NK/T-cell lymphoma developing from the tongue. We encountered a rare case of NK/T-cell lymphoma of the tongue, which we report with a review of the literature.

Assessment of Apparent Vena Caval Penetration by the Greenfield Filter

Purpose:

To examine and elucidate the mechanisms for apparent “penetration” by Greenfield vena caval filters.

Methods:

Two filters were placed in the inferior venae cavae (IVC) of four immature sheep and followed with cavography for 1 year. Two animals underwent computed tomography (CT) and laparoscopic examination. At necropsy, the vena cava and adjacent structures of all four animals were examined grossly and histologically.

Results:

Based upon cavography and CT imaging, all filters appeared to penetrate the vena cava at 12 months. However, at laparoscopy, no hooks or limbs were exposed, and the pericaval tissues remained intact; each hook or limb was within the adventitia or encapsulated in scar tissue. Histology of the tissue at the hook sites revealed remodeling of the intimal surface of the IVC and thinning of the adventitia.

Conclusions:

Based upon these data, we hypothesize that the vena cava gradually adapts by medial and adventitial thinning and myointimal remodeling to the radial force exerted by a filter. This process allows increase in the filter base diameter while maintaining the integrity of the cava and protecting adjacent structures.

Chromosomal aberrations and prognosis in patients with concomitant chemoradiotherapy for resected head and neck cancer

Although concomitant chemoradiotherapy (CCRT) has recently become a mainstay of a primary treatment modality in advanced head and neck squamous cell carcinoma (HNSCC), some of the patients experience CCRT failure. If we can predict the CCRT outcomes, we can reduce unnecessary CCRT avoiding risk of CCRT‑related complication. We aimed to identify genetic alteration markers related to treatment failure in HNSCC patients who underwent radical surgery and CCRT. Genome‑wide copy number alterations (CNAs) were analyzed in 18 HNSCC patients with (n=9) or without (n=9) recurrence using oligoarray‑comparative genomic hybridization and candidate CNAs were validated by quantitative RT‑PCR. A total of 15 recurrently altered regions (RARs) were identified in the 18 HNSCC cases. Among them, two RARs were significantly associated with CCRT‑failure: copy number gained RARs of 7p11.2 harboring EGFR (P=0.029) and 18p11.32 harboring TYMS gene (P=0.029). Three RARs (7p11.2, 9p21.3 and 18p11.32) were significantly associated with poor disease‑specific survival in univariate analysis, and 7p11.2 was consistently significant in the multivariate analysis (HR 40.68, P=0.003). In conclusion, we defined novel genomic alterations associated with CCRT‑failure: 7p11.2 (EGFR) and 18p11.32 (TYMS). Our results provide useful clues for the elucidation of the molecular pathogenesis of HNSCC and to predict CCRT‑failure.

Establishment of a novel human papillomavirus-negative and radiosensitive head and neck squamous cell carcinoma cell line

BACKGROUND

The purpose of this study was to develop a CMCSCC-1 cell line for head and neck cancer research into new therapies for head and neck squamous cell carcinoma (HNSCC).

METHODS

The CMCSCC-1 cell line was isolated from a primary oral tongue tumor specimen of a female patient. Tumor cells were evaluated for biomarkers expression by Western blots, reverse transcriptase-polymerase chain reaction (RT-PCR), fluorescence activated cell sorter, and immunostaining. Cell proliferation in response to radiation was measured by the WST-8 assay.

RESULTS

The characterization analyses revealed a typical epithelial morphology; a doubling time of approximately 24 hours, high tumorigenicity in immunodeficient mice, and upregulated biomarkers. CMCSCC-1 cells were negative for human papillomavirus (HPV) infection, but more sensitive to radiation compared with those FaDu cell lines.

CONCLUSION

CMCSCC-1, a novel oral tongue SCC cell line, was established. It will help in the elucidation of the molecular pathogenesis of HPV-negative radiosensitive tumors. © 2015 Wiley Periodicals, Inc. Head Neck 38: E542-E551, 2015.

Comparison of fine-needle aspiration and core needle biopsy under ultrasonographic guidance for detecting malignancy and for the tissue-specific diagnosis of salivary gland tumors

BACKGROUND AND PURPOSE

Diagnostic test accuracy studies for ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy have shown inconclusive results due to their heterogenous study designs. Our aim was to compare the diagnostic accuracy of ultrasonography-guided fine-needle aspiration versus ultrasonography-guided core needle biopsy for detecting malignant tumors of the salivary gland and for the tissue-specific diagnosis of salivary gland tumors in a single tertiary hospital.

MATERIALS AND METHODS

This retrospective study was approved by our institutional review board and informed consent was waived. Four hundred twelve patients who underwent ultrasonography-guided fine-needle aspiration (n = 155) or ultrasonography-guided core needle biopsy (n = 257) with subsequent surgical confirmation or clinical follow-up were enrolled. We compared the diagnostic accuracy of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy regarding malignant salivary gland tumors and the correct tissue-specific diagnosis of benign and malignant tumors. We also tested the difference between these procedures according to the operator's experience and lesion characteristics.

RESULTS

The inconclusive rates of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy were 19% and 4%, respectively (P < .001). The overall accuracy of ultrasonography-guided core needle biopsy for diagnosing malignant tumors was significantly higher than that of ultrasonography-guided fine-needle aspiration (P = .024). The correct tissue-specific diagnosis rates of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy were 95% versus 97% for benign tumors (P = .648) and 67% versus 80% for malignant tumors (P = .310). Trainees showed significantly lower accuracy with ultrasonography-guided fine-needle aspiration than with ultrasonography-guided core needle biopsy for diagnosing malignant tumors (P = .021). There was no difference between the diagnostic accuracy of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy according to the internal composition of the lesions. There were no complications requiring intervention or hospitalization in our patients.

CONCLUSIONS

Ultrasonography-guided core needle biopsy is superior to ultrasonography-guided fine-needle aspiration in detecting and characterizing malignant tumors of the salivary gland and could emerge as the diagnostic method of choice for patients presenting with a salivary gland mass.

Association between the standardized uptake value and high-risk HPV in hypopharyngeal squamous cell carcinoma

CONCLUSION

Median (18)F-FDG PET/CT maximum standardized uptake values (SUV max) cut-off values of 7.9 or greater were associated with high-risk human papillomavirus (HPV) negativity in patients with hypopharyngeal squamous cell carcinoma (HPSCC). Furthermore, median (18)F-FDG PET/CT SUV max cut-off values of 7.9 or greater and high-risk HPV negativity were associated with adverse outcomes.

OBJECTIVES

We studied the association and the potential prognostic significance of (18)F-FDG PET/CT and high-risk HPV status in HPSCC.

METHODS

The medical records of 45 patients who underwent (18)F-FDG PET/CT for HPSCC before surgery were reviewed. High-risk HPV in situ hybridization was performed to detect HPV infection.

RESULTS

The median SUV max was 9.91 ± 4.91 (range 1.9-22.1) and the positive rate of high-risk HPV in situ hybridization was 11% (5 of 45). The SUV max values of negativity for the high-risk HPV subtypes (10.47 ± 4.87) and positivity (5.48 ± 2.45) were found to be significantly different (p = 0.030). The SUV max cut-off value for differentiating negativity for the high-risk HPV subtypes from positivity was 7.9, with a sensitivity of 65% and a specificity of 80%. The 5-year disease-specific survival rate (DSSR) in our cohort was 57%. Patients with an SUV max value higher than 7.9 (p = 0.005) and high-risk HPV negativity (p = 0.047) had decreased 5-year DSSR.

Swallowing function in patients with vertical hemipharyngolaryngectomy for hypopharyngeal squamous cell carcinoma

BACKGROUND

The purpose of this study was to evaluate the long-term swallowing function in patients with vertical hemipharyngolaryngectomy (VHPL) for hypopharyngeal cancer.

METHODS

A retrospective review of 30 patients followed for more than 2 years with VHPL between 1998 and 2011 was performed.

RESULTS

Five patients (16.7%) experienced gastrostomy tube placement, 4 patients (13%) had pharyngoesophageal stricture, and 13 patients (45%) had aspiration pneumonia. There was a significant difference in the fraction of gastrostomy tube placement among type II VHPL (35.7%), type I VHPL (0%), and type III VHPL (0%; p = .014). Gastrostomy tube dependence was significantly associated with flap size (larger than 70 cm(2) ; p = .043) and aspiration pneumonia (p = .009). A significant positive correlation was found between current smokers and aspiration pneumonia (p = .030).

CONCLUSION

Type II VHPL, large flap reconstruction, and aspiration pneumonia had predictable values for gastrostomy tube dependence. Smoking status correlated with aspiration pneumonia. Better counseling and vigilance concerning swallowing difficulties may be possible.

Therapeutic Decision Making of the Unilateral Vocal Cord Palsy after Thyroidectomy Using Thyroidectomy-Related Voice Questionnaire

Objectives:

Investigate the efficacy of early management of post-thyroidectomy unilateral vocal cord palsy (UVCP) and the clinical utility of the thyroidectomy-related voice questionnaire (TVQ) when planning UVCP treatment.

Methods:

The study group comprised 48 consecutive patients diagnosed with UVCP after thyroidectomy. Laryngoscopic examination and voice analysis were conducted, and the TVQ was administered pre-thyroidectomy and at 2 weeks and 1, 3, 6, and 12 months post-thyroidectomy. Twenty-five patients with aspiration symptoms and severe vocal difficulties received injection laryngoplasty, and 23 with no aspiration symptoms and relatively mild vocal difficulties underwent voice therapy. We performed a video fluoroscopic swallowing study on each patient 2 weeks after thyroidectomy and 1 month following the procedure.

Results:

The average total TVQ scores 2 weeks afterthyroidectomy were 51.92 ± 11.42 in the injection laryngoplasty group and 35.78 ± 12.99 in the voice therapy group. Both subjective and objective parameters improved significantly at 1 month after treatment and continued to improve slowly over the next 12 months ( P < .01) in both groups. TVQ scores were significantly lower in the injection laryngoplasty group than in the voice therapy group 1 month post-intervention ( P < .01). At the study end point, the greatest improvement in subjective symptoms occurred in temporary VCP patients who underwent injection laryngoplasty. The optimal TVQ score cutoff distinguishing the 2 groups was 45 (68.0% sensitivity, 78.3% specificity).

Conclusions:

Early management following timely diagnosis of post-thyroidectomy UVCP can improve symptoms within 1 month. Moreover, application of TVQ will aid clinicians to plan treatment for postoperative VCP patients.

Endoscope-assisted facelift thyroid surgery: an initial experience using a new endoscopic technique

BACKGROUND

A new approach to modifying facelift incision was recently developed for robotic thyroid surgery that seemed to be advantageous over other existing approaches. In this study, we aimed to investigate the feasibility and safety of the facelift approach not only for robotic thyroid surgery, but also for endoscope-assisted thyroid surgery.

METHODS

Endoscope-assisted facelift thyroid lobectomy was performed for 11 patients with papillary microcarcinoma.

RESULTS

All 11 operations were successfully performed endoscopically. This approach through a modified facelift incision provided safe dissection of the laryngeal nerves and exposed an adequate working space. We identified and preserved all neighboring critical structures (parathyroid gland and superior and recurrent laryngeal nerves) during surgery. The operative duration for simple thyroid lobectomy with central lymph node dissection in 11 patients was 120-180 min (average duration: 140 min). Sensory change around the earlobe occurred in three patients and was recovered within 2 months after surgery in all patients. No patient displayed laryngeal nerve palsy or a low-pitched voice.

CONCLUSIONS

The facelift approach seems to provide a shorter and more direct route to the thyroid, requiring minimal dissection, and an adequate workspace not only for robotic surgery but also for endoscopic surgery. It is worthwhile to develop and refine the surgical techniques of endoscopic facelift thyroid surgery.

The therapeutic decision making of the unilateral vocal cord palsy after thyroidectomy using thyroidectomy-related voice questionnaire (TVQ)

The objective of this study was to investigate the efficacy of early management of post-thyroidectomy unilateral vocal cord palsy (UVCP) and the clinical utility of the thyroidectomy-related voice questionnaire (TVQ) when planning UVCP treatment. The study group comprised 48 consecutive patients diagnosed with UVCP after thyroidectomy. Laryngoscopic examination and voice analysis were conducted, and the TVQ was administered pre-thyroidectomy and at 2 weeks and 1, 3, 6, and 12 months post-thyroidectomy. Twenty-five patients with aspiration symptoms and severe vocal difficulties received injection laryngoplasty, and 23 with no aspiration symptoms and relatively mild vocal difficulties underwent voice therapy. We performed a video fluoroscopic swallowing study on each patient 2 weeks after thyroidectomy and 1 month following the procedure. The average total TVQ scores 2 weeks post-thyroidectomy were 51.92 ± 11.42 in the injection laryngoplasty group and 35.78 ± 12.99 in the voice therapy group. Both subjective and objective parameters improved significantly at 1 month after treatment and continued to improve slowly over the next 12 months (p < 0.01) in both groups. TVQ scores were significantly lower in the injection laryngoplasty group than in the voice therapy group 1 month post-intervention (p < 0.01). At the study end point, the greatest improvement in subjective symptoms occurred in temporary VCP patients who underwent injection laryngoplasty. The optimal TVQ score cut-off distinguishing the two groups was 45 (68.0 % sensitivity, 78.3 % specificity). In conclusion, early management following timely diagnosis of post-thyroidectomy UVCP can improve symptoms within 1 month. Moreover, application of TVQ will aid clinicians to plan treatment for postoperative VCP patients.

The impact of depression and somatic symptoms on treatment outcomes in patients with chronic prostatitis/chronic pelvic pain syndrome: a preliminary study in a naturalistic treatment setting

AIM

The aim of this study was to evaluate the impact of depression and somatic symptoms on treatment outcomes in Korean male patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) attending a routine clinical practice.

METHODS

This was a 12-week prospective observational study (n = 80). The Korean version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) to measure the severity of CP/CPPS, the Korean version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression, the Korean version of the Patient Health Questionnaire-15 (PHQ-15) to evaluate somatisation and the Korean version of the EuroQol Questionnaire-5 Dimensions (EQ-5D), specifically the EQ-5D utility index and the EQ-5D visual analogue scale (EQ-5D VAS), to assess quality of life, were utilised and given at baseline and week 12. The primary and secondary end-points in this study were changes in the NIH-CPSI total score from baseline to week 12 according to depression and somatisation.

RESULTS

The change in NIH-CPSI total score was significantly higher in those without depression than in those with depression (p = 0.003), with a magnitude of difference of 2.8. The responder rate (a ≥ 4 point decrease in NIH-CPSI total score from baseline) was significantly higher in those without depression (42.9%) than in those with depression (17.2%, p = 0.023). However, significant differences were not observed between the two groups in the other outcome measures or in all study outcomes between subjects with or without somatisation. A logistic regression analysis revealed that the presence or absence of depression may be a principal predictor of response to treatment.

CONCLUSION

These preliminary results indicate that depression may have a negative impact on treatment outcome and is a likely predictor of response to treatment in patients with CP/CPPS. However, additional studies with adequate power and improved design are necessary to further support the present findings.

High-risk human papillomavirus and lymph node size in patients with single node metastasis of oral and oropharyngeal cancer

CONCLUSION

High-risk human papillomavirus (HPV) infection was significantly related to lymph node size in patients with single node metastasis of oral and oropharyngeal cancer.

OBJECTIVE

The purpose of this study was to examine the relationship between high-risk HPV infection and lymph node size in patients with single node metastasis of oral and oropharyngeal carcinoma.

METHODS

This study included 48 patients with oral and oropharyngeal carcinoma. Pathologic lymph node stages comprised 36 N1 and 12 N2a.

RESULTS

High-risk HPV in situ hybridization was positive in 29% of patients (14/48). Of those patients with high-risk HPV, there was a significant difference (p = 0.008) between oral (9.5%) and oropharyngeal (44.4%) cancers. Average lymph node diameter was 20.7 ± 12.6 mm (range 5-54 mm). We found a positive correlation between high-risk HPV status and lymph node size (p = 0.018). Mean lymph node diameter in high-risk HPV-positive cases was 27.3 ± 13.1 mm and 18.0 ± 11.5 mm in high-risk HPV-negative cases. Extracapsular spread (p = 0.030) and cystic nodal metastases (p = 0.019) were also significantly related to lymph node size. High-risk HPV negative status (p = 0.043), advanced tumor stage (p = 0.009), and extracapsular spread (p = 0.038) all had significant adverse effects on 5-year disease-specific survival.

Twelve-month medication persistence in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

AIMS

This study aimed to assess patients' baseline characteristics and provider factors influencing the continuation of medication for 12 months in patients who were newly diagnosed with benign prostatic hyperplasia (BPH).

METHODS

This study was conducted in patients with newly diagnosed lower urinary tract symptoms (LUTS)/BPH (age ≥ 40) who received either one or a combination of the two pharmacological classes of drugs (alpha-blockers or 5-alpha-reductase inhibitors) from January 2008 to January 2010. Patient demographics and clinical data were assessed from the electronic patient records and telephone surveys. Persistence was defined as continuation of all BPH medications prescribed at the start of the first treatment. Logistic regression analysis was used to evaluate the association between 12-month persistence and patient or provider factors.

RESULTS

Of the 789 newly diagnosed LUTS/BPH patients, 670 (84.9%) were included in the study. Twelve-month persistence for LUTS/BPH medication was 36.6%. Independent predictors of 12-month medication persistence included larger prostate volume, higher prostate specific antigen, having an adequate income and a good patient-doctor relationship. Important reasons for discontinuation were resolved symptoms (31.1%), no improvement in symptoms (23.7%) and adverse events (20.0%).

CONCLUSIONS

About two-thirds of newly diagnosed LUTS/BPH patients discontinued medications within 1 year of starting treatment. We found several potential patient and provider factors associated with persistence, which could be exploited to increase continuation of treatment in future clinical settings.

Characteristics and prognostic implications of high-risk HPV-associated hypopharyngeal cancers

Background

High-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain.

Objective

The aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC.

Methods

The study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection.

Results

The positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients.

Conclusions

High-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.

Utility of 18F-FDG PET/CT in supracricoid partial laryngectomy

CONCLUSION

(18)F-FDG PET/CT is a useful technique for the evaluation of paraglottic space invasion and lymph node metastasis in patients with supracricoid partial laryngectomy (SCPL). Primary SUVmax values (using 7.0 as a cut-off) and nodal SUVmax values (using 2.2 as a cut-off) are important for recurrence and poor prognosis.

OBJECTIVES

The purpose of this study was to evaluate the usefulness of (18)F-FDG PET/CT for paraglottic space invasion and lymph node metastasis and the prognostic significance in SCPL.

METHODS

The medical records of 42 patients who underwent (18)F-FDG PET/CT for SCPL before surgery were reviewed.

RESULTS

The median primary SUVmax was 6.63 ± 5.07 and the median nodal SUVmax was 1.25 ± 1.86. The primary SUVmax values with paraglottic space invasion (8.34 ± 5.92) and without (4.57 ± 2.74) were significantly different (p = 0.015). The (18)F-FDG PET/CT had an accuracy of 87% for the identification of cervical metastases on a level-by-level basis. A median primary SUVmax value of 7.0 and nodal SUVmax of 2.2 were associated with recurrence (p = 0.022 and p = 0.009, respectively) and 5-year disease-specific survival (p = 0.021 and p = 0.041, respectively).

Surgery with postoperative radiotherapy for pN2 head and neck squamous cell carcinoma

CONCLUSION

Factors that affected prognosis were T stage and extracapsular spread in patients that underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma.

OBJECTIVES

The purpose of this study was to examine treatment outcomes and define prognostic factors for pN2 head and neck carcinoma.

METHODS

A total of 209 patients underwent surgery with postoperative radiotherapy between 1994 and 2011. Primary tumor sites were the oropharynx (n = 70), hypopharynx (n = 48), larynx (n = 47), and oral cavity (n = 44). There were 21, 83, 60, and 45 patients with stage T1 to T4 cancers, respectively. The N stages were 20 N2a, 129 N2b, and 60 N2c.

RESULTS

The recurrence rate was 40% (83/209) over a mean observation period of 39 months. The 5-year disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) rates in our cohort were 44%, 60%, and 56%, respectively. The presence of advanced T stage or extracapsular spread had a significant adverse effect on 5-year DFS, DSS, and OS rates according to Kaplan-Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between 5-year DSS rate and advanced T stage (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.26-3.82; p = 0.005) and extracapsular spread (HR, 2.29; 95% CI, 1.24-4.21; p = 0.008).

Relationship between extracapsular spread and FDG PET/CT in oropharyngeal squamous cell carcinoma

CONCLUSION

Median maximum standardized uptake (SUVmax) cut-off values of FDG PET/CT higher than 3.85 were found to be associated with a greater risk cervical lymph node metastasis with extracapsular spread (ECS) in patients with oropharyngeal squamous cell carcinoma (OPSCC).

OBJECTIVES

The purpose of this study was to evaluate the use of FDG PET/CT for the identification of ECS and to establish its histologic correlates in OPSCC.

METHODS

The medical records of 78 patients who underwent FDG PET/CT for OPSCC before surgery were reviewed.

RESULTS

ECS was present in 42% (42/69) of dissected necks and in 51% (54/106) of dissected cervical levels. The SUVmax values of cervical lymph nodes with and without ECS were found to be significantly different (6.73 ± 3.78 vs 3.02 ± 2.24, p < 0.001). The SUVmax cut-off value for differentiating necks with ECS from those without ECS was 3.85. The presence of ECS (p = 0.036) and median SUVmax (using 3.85 as a cut-off) (p = 0.037) were found to have a significant adverse effect on 5-year disease-specific survival by univariate analysis. The multivariate analysis showed a significant association of 5-year disease-specific survival with ECS (hazard ratio (HR) = 32.3 in cervical metastasis with ECS, p = 0.012; and HR = 19.6 in cervical metastasis without ECS, p = 0.024).

Outcomes of Primary Surgery with Radiotherapy for pN2 Head and Neck Squamous Cell Carcinoma

Objectives:

Examine treatment outcomes and define factors that influence survival in patients underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma.

Methods:

Two hundred nine patients underwent primary surgery with postoperative radiotherapy between 1994 and 2011. Primary tumor sites were 70 oropharynx, 48 hypopharynx, 47 larynx, 41 oral cavity, and 3 sinonasal cavity. There were 21, 83, 60 and 45 patients with stage T1 to T4 cancers, respectively. The N stages were 20 N2a, 129 N2b, and 60 N2c.

Results:

The recurrence rate was 40% (83/209) over a mean observation period of 39 months. The 5-year disease free survival (DFS), disease specific survival (DSS), and overall survival (OS) rate in our cohort was 44%, 60%, and 56%, respectively. Patients with advanced T stage or extracapsular spread had a significant adverse effect on 5-year DFS, DSS, OS rate according to the Kaplan-Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between 5-year DSS rate and advanced T stage (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.26-3.82; P = 0.005) and extracapsular spread (HR, 2.29; 95% CI, 1.24-4.21; P = 0.008).

Conclusions:

Factors that affected prognosis were T stage and extracapsular spread in patients who underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma. An aggressive therapeutic approach may be suitable for these patients.

High Risk HPV and Lymph Node Size in Single Node Metastasis of Oral Oropharyngeal Cancer

Objectives:

Examine the relationship between high risk human papillomavirus (HPV) infection and lymph node size in patients with single node metastasis of oral and oropharyngeal carcinoma.

Methods:

The study included 48 subjects with squamous cell carcinoma,21 in the oral cavity and 27 in the oropharynx. High risk HPV in situ hybridization was performed to detect HPV infection. The pathologic N stages were 36 N1and 12 N2a.

Results:

The positive rate of high risk HPV in situ hybridization was 29% (14/48). There was a significant difference in the fraction positive high risk HPV between oral (9.5%) and oropharyngeal (44.4%) cancer ( P = 0.008). The average diameter of positive lymph node was 20.7 ± 12.6 mm (range, 5-54 mm). A significant positive correlation was found between high risk HPV status and lymph node size ( P = 0.018). The mean lymph node diameter in cases with high risk HPV positive was 27.3 ± 13.1 mm, whereas in cases with high risk HPV negative was 18.0 ± 11.5 mm. Extracapsular spread was also significantly related to the lymph node size ( P = 0.030). Patients with high risk HPV negativity ( P = 0.043), advanced T stage ( P = 0.009), or the presence of extracapsular spread ( P = 0.038) had a significant adverse effect on 5-year disease specific survival according to the Kaplan-Meier survival curves.

Conclusions:

High risk HPV infection is significantly related to lymph node size in patients with single node metastasis of oral and oropharyngeal cancer.

Recurrent Genomic Alterations of FHIT Gene with Impact on Lymphatic Metastasis in Early Oral Carcinoma

Objectives:

Determine the role of genetic factors related to the lymph node metastasis (LNM) in early oral squamous cell carcinoma (OSCC).

Methods:

Array-based comparative genomic hybridization with individual gene-level resolution using primary tumor materials from 14 early OSCC patients with (n = 7) or without (n = 7) cervical LNM. To confirm the genomic copy number alterations, immunohistochenical stain was conducted in 30 early OSCC specimens.

Results:

The number of recurrent (>25%) copy number alterations with LNM group is 34, whereas that without LNM group is 23 by array-based comparative genomic hybridization in the first cohort. We detected 10 recurrently altered regions (10 losses) associated with cervical LNM ( P < 0.05). Among them, loss of 3p14.2 for the FHIT gene was the most frequent one (5 out of 7 patients with LNM, 71.4%) and significantly associated with a worse disease specific survival ( P = 0.005). In the independent validation cohort of 30 early OSCC cases, loss of FHIT determined by an immunohistochemical analysis was associated with cervical LNM ( P = 0.032) and disease specific survival ( P = 0.045).

Conclusions:

Copy number alterations of FHIT are associated with LNM and poor prognosis, and risk stratification based on the copy-number status of this gene is useful to select the optimal treatment strategy in early OSCC patients.

Recurrent loss of the FHIT gene and its impact on lymphatic metastasis in early oral squamous cell carcinoma

CONCLUSION

Our findings show that copy number loss of FHIT is associated with lymph node metastasis (LNM) and suggest that the down-regulation of Fhit indicates poor prognosis in early oral squamous cell carcinoma (OSCC).

OBJECTIVES

The purpose of this study was to identify alterations in genetic markers related to LNM in early OSCC.

METHODS

Genome-wide copy number alterations were analyzed in 14 early OSCCs with (n = 7) or without (n = 7) cervical LNM using 180K array-comparative genomic hybridization. To explore the prognostic implications of the most significantly associated genetic alteration with cervical LNM, immunohistochemical analysis was conducted in 30 OSCCs.

RESULTS

A total of 11 recurrently altered regions (RARs) were identified in the 14 OSCC cases. Six RARs on chromosomes 3p26-3p14, 5q22, and 9p21 were found to be significantly more common in early OSCC with LNM (p < 0.05). Among these, loss of 3p14.2 (where the FHIT gene is located) was the most frequent (five of seven patients with LNM, and none of seven without LNM), and most significantly associated with cervical LNM (p = 0.005). Fhit immunohistochemical staining of 30 OSCCs showed that Fhit negativity was associated with cervical LNM (p = 0.032) and poor disease-specific survival (p = 0.045).

Standardized Uptake Value and Resection Margin Involvement Predict Outcomes in pN0 Head and Neck Cancer

Objective

The aim of this study was to evaluate the prognostic factors of patients with pathologically negative lymph node (pN0) head and neck cancer.

Study Design

Case series with chart review.

Setting

College medical center.

Subjects and Methods

The medical records of 120 patients were reviewed. Primary tumor sites included 46 larynx, 45 oral cavity, 17 oropharynx, and 12 hypopharynx.

Results

The recurrence rate was 14% (17/120) over a mean observation period of 33 months. Median 18F-fluorodeoxyglucose (FDG)–positron emission tomography (PET)/computed tomography (CT) maximal standardized uptake value (SUVmax; using 8.5 as a cutoff; P = .001), positive surgical margins ( P = .005), and pathologic T stage ( P = .012) were found to be associated with recurrence. The 5-year disease-specific survival rate (DSSR) in our cohort was 86%. Patients with an SUVmax value higher than 8.5 and positive surgical margins had significantly decreased 5-year DSSR based on Kaplan-Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between median SUVmax (using 8.5 as a cutoff; hazard ratio [HR], 6.13; 95% confidence interval [CI], 1.79-20.93; P = .004) and margin involvement (HR, 4.98; 95% CI, 1.42-17.47; P = .012).

Conclusion

A median 18F-FDG PET/CT SUVmax cutoff values of 8.5 or greater and positive surgical margins were associated with adverse outcomes in patients with pN0 head and neck cancer.

Usefulness of the anterolateral thigh flap with vascularized fascia lata for reconstruction of orbital floor and nasal surface after total maxillectomy

OBJECTIVES/HYPOTHESIS

The aim of this study was to describe a technique using the fascia lata (FL) component of the anterolateral thigh (ALT) flap to re-create the orbital floor and lateral nasal wall after total maxillectomy.

STUDY DESIGN

Retrospective analysis of medical records.

METHODS

A total of 22 patients underwent maxillary reconstruction using a composite ALT-FL flap following cancer resection. All patients underwent total maxillectomies via the Weber-Ferguson approach. The ALT flap was harvested with the deep fascia of the thigh with the aim of using it for lining of the orbital floor and lateral nasal cavity. The FL was sutured to the palatine bone inferiorly, nasal bone and zygomatic bone superiorly, and nasopharyngeal mucosa posteriorly to provide an orbital floor and make a neonasal cavity.

RESULTS

There was 100% free flap survival. Speech was normal in eight (36%) patients, near normal in 10 (46%), and intelligible in four (18%). Seventeen (77%) patients gained a good facial appearance, and five (23%) a fair appearance. Sixteen (73%) patients complained of mild nasal crust formation, and the rest (27%) developed moderate crust.

CONCLUSIONS

Microvascular reconstruction using a composite ALT-FL flap provided a reliable fascial component for orbital floor and nasal surface reconstruction of total maxillectomy defects.

Preoperative 18F-FDG PET/CT and high-risk HPV in patients with oropharyngeal squamous cell carcinoma

BACKGROUND

To evaluate the association of (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG PET/CT) and high-risk human papillomavirus (HPV) status and to establish the histologic correlates in oropharyngeal cancer (OPSCC).

METHOD

The medical records of 78 patients who underwent (18)F-FDG PET/CT for OPSCC before surgery were reviewed.

RESULTS

The positive rate of high-risk HPV in situ hybridization was 36% (28 of 78). The maximum standardized uptake values (SUVmax ) of negativity for the high-risk HPV subtypes (10.29 ± 4.30) and positivity (6.69 ± 4.17) were found to be significantly different (p = .001). The SUVmax cutoff value for differentiating negativity for the high-risk HPV subtypes from positivity was 7.10, with the sensitivity of 78% and the specificity of 68%. A median SUVmax (using 7.10 as a cutoff) (p = .041) and high-risk HPV status (p = .040) were found to be associated with 5-year disease-specific survival (DSS).

CONCLUSIONS

Median (18)F-FDG PET/CT SUVmax cutoff values 7.10 or greater are associated with a high-risk HPV negativity in OPSCC patients.

Abstract 479: ATM pathway upregulation of combination therapy with radiation and MSC-based IL-12M gene vaccine, Gx-051, in allograft animal model

PURPOSE: In spite of the powerful therapeutic effects of radiotherapy, the attempts to combined radiotherapy with others have so far kept going on to find better therapeutic protocol for patients in the head and neck cancer. Previously, we announced some part of anticancer effects of combined radiotherapy with Gx-051 named as mesenchymal stem cell (MSC) expressing modified interleukin-12 (MSCs/IL-12M). It is a novel component of human immune system to attack cancer cells by the recruitment of immune cells with a high specificity. Thus, in the present study, we have tried to reveal another therapeutic effect of combined radiation and immunotherapy, compared to the treatment with each single modality in allograft animal model.

METHODS AND MATERIALS: AT-84 cells, one of murine head and neck carcinoma cells, were injected for allograft induction on C3H/HeN mice. All the mice were randomly divided into 4 groups; control (non-treated), radiation only-treated, Gx-051 only-treated, and irradiation with Gx-051-treated. Intra-tumoral injection of Gx-051 (adopted within 24hr after irradiation) as well as 8 Gy-local irradiation was carried out, totally 4 times (twice a week for 2 weeks). To clarify the anti-tumoral effect of radiation with Gx-051 administration, we provided reasonable evidences; tumor volume, levels of IL-12 and IFN-r, and the changes in signaling pathway related-protein expression level.

RESULTS: In the present study, we could confirm that combined treatment with radiation and Gx-051 significantly enhanced the anti-tumor effect. The proliferation of cancer cell was markedly inhibited in all the treated groups compared to non-treated group (p&lt;0.05) as down-regulating of PCNA expression. Also, via mediating the expression of ATM and CDK2, the combined treatment group (radiotherapy with Gx-051) significantly enhanced the activation of ATM pathway-related proteins (p&lt;0.05). The tumor suppress gene, p53, was highly expressed and the one of typical oncogenes, Met, was suppressed in combined treatment group compared to others. In addition, expression of p38-MAPk as one of the cell stress markers was decreased in combined treatment group compared to others.

CONCLUSIONS: We determined the combined radiotherapy with Gx-051 improved the responses to HNSCC by AT-84 via the activation of ATM pathway that influenced cell proliferation, apoptosis, and regulation of tumor suppress gene and oncogene. These results gave us the partial rationale to the further study about the combined therapy of radiation with Gx-051 for the advanced treatment of human HNSCC.

This study was supported by grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare (A091205) and the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2012-0004140).

Citation Format: Jiyoung Yeo, Eun-Ji Park, Kwang-Jae Cho, Kyung Min Kim, Young-chul Sung, Jun-Ook Park, In-chul Nam, Chung-su Kim, Min-Sik Kim. ATM pathway upregulation of combination therapy with radiation and MSC-based IL-12M gene vaccine, Gx-051, in allograft animal model. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 479. doi:10.1158/1538-7445.AM2013-479

Significant invasion of the pharyngeal constrictor muscle in early squamous cell carcinoma of the tonsil: prediction of multiple regional metastasis

OBJECTIVE

To determine whether invasion of the pharyngeal constrictor muscle in early squamous cell carcinoma of the tonsil is correlated with lymph node metastasis.

DESIGN

Retrospective analysis of medical records and pathology specimens.

SETTING

Tertiary care referral center.

PATIENTS

Forty-eight patients who were diagnosed as having T2 squamous cell carcinoma of the tonsil and who underwent surgery. They were divided into 2 groups: an invasive group with invasion of the pharyngeal constrictor muscle and a noninvasive group without invasion of the pharyngeal constrictor muscle.

MAIN OUTCOME MEASURES

Comparison of regional metastasis, 5-year locoregional recurrence, and 5-year disease-specific survival between the 2 groups.

RESULTS

Invasion of the pharyngeal constrictor muscle was found in 36 patients (75%) with T2 squamous cell carcinoma of the tonsil. The rate of lymph node metastasis, the mean (SD) number of positive nodes, and the mean (SD) lymph node density were 81%, 5.47 (9.27), and 0.15 (0.22) in the invasive group, respectively, and 50%, 1.33 (1.72), and 0.04 (0.04) in the noninvasive group, respectively (P = .04, P = .02, and P = .01, respectively). Five-year locoregional recurrence was significantly correlated with invasion of the pharyngeal constrictor muscle (P = .05) and with multiple lymph node metastasis (≥5 nodes) (P = .04) in the univariate analyses. No factor was correlated with 5-year locoregional recurrence in the multivariate analysis. Five-year disease-specific survival was significantly correlated with multiple lymph node metastasis (≥5 nodes) in the univariate analyses (P = .009). Five-year disease-specific survival was not significantly correlated with any clinicopathological factor in the multivariate analysis.

CONCLUSION

Higher risk for multiple lymph node metastasis and 5-year locoregional recurrence seems to be predicted in patients with extratonsillar invasion of the pharyngeal constrictor muscle, even in early squamous cell carcinoma of the tonsil.

Abstract LB-371: Beneficial effect of combination therapy with radiation and MSC-based IL-12M gene vaccine, Gx-051, in allograft animal mode

PURPOSE: During the last decades, irradiation is one of the most well-known therapies in head and neck cancer. The combination of radiation with other treatment modalities has been researched to improve its therapeutic efficacy and reduce its side effects. Gx-051, that is mesenchymal stem cell (MSC) expressing modified interleukin-12 (MSCs/IL-12M), is recently reported as a novel component of human immune system to attack cancer cells by the recruitment of immune cells with a high specificity. We would like to evaluate the therapeutic benefits of combined radiation and immunotherapy, compared to the treatment with each single modality in allograft animal model. METHODS AND MATERIALS: AT-84 cells, one of murine head and neck carcinoma cells, were injected for allograft induction on C3H/HeN mice. All the mice were randomly divided into 4 groups; control (non-treated), radiation only-treated, Gx-051 only-treated, and irradiation with Gx-051-treated. Intra-tumoral injection of Gx-051 (adopted within 24hr after irradiation) as well as 8 Gy-local irradiation was carried out, totally 4 times (twice a week for 2 weeks). To clarify the anti-tumoral effect of radiation with Gx-051 administration, we provided reasonable evidences; tumor volume, levels of IL-12 and IFN-r, and the changes in signaling pathway related-protein expression level. RESULTS: In vivo allograft study using AT-84 cells and C3H/HeN mice showed that combined treatment with radiation and Gx-051 significantly enhanced the anti-tumor effect. The tumor volume markedly decreased in the combined treatment group compared to other groups (p&lt;0.05). Both levels of IL-12 and IFN-r were significantly higher in the combined treatment group (p&lt;0.05). The expression of Ki-67, p16, and vascular endothelial growth factor were suppressed and that of caspase-3 was enhanced in combined treatment group compared to others in immunostaining. In addition, The protein level of Ras and HIF-1α were reduced and that of cyclin B1 was increased compared to others in immunoblotting. CONCLUSIONS: Our results demonstrated the combined treatment with radiation and Gx-051 enhanced the responses to HNSCC by AT-84 via increasing cytokines’ levels (IL-12 and IFN-r) and mediating signaling pathways (apoptosis, cell cycle, and angiogenesis). Dual administration of radiation with Gx-051 showed significant anti-tumoral effects by inducing apoptosis and inhibiting angiogenesis of tumor cell and these evidences gave us the partial rationale to the further study about the combined therapy of radiation with Gx-051 for the advanced treatment of human HNSCC. This study was supported by grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare (A091205) and the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2011-0012555).

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-371. doi:1538-7445.AM2012-LB-371

Combination of voice therapy and antireflux therapy rapidly recovers voice-related symptoms in laryngopharyngeal reflux patients

OBJECTIVE

Patients with laryngopharyngeal reflux frequently experience voice-related symptoms. This study was designed to investigate the effectiveness of combined voice and medical therapy in comparison with medical therapy alone in the improvement of voice-related symptoms and parameters in patients with laryngopharyngeal reflux.

STUDY DESIGN

Concurrent nonrandomized comparative trial.

SETTING

Otolaryngology department at a university hospital.

SUBJECTS AND METHODS

In this prospective study, 100 patients diagnosed with laryngopharyngeal reflux with voice symptoms were divided into 2 groups: 50 patients were treated with medication alone, and 50 were treated with medication plus voice therapy. The following data were recorded before treatment and at 1, 2, and 3 months posttreatment: reflux symptom index (RSI), reflux finding score (RFS), voice handicap index (VHI), perceptual analysis, and acoustic analysis. The numbers of patients showing clinically significant reductions in these parameters were compared between groups using the following cutoff values: change in RSI ≥5, change in RFS ≥3, change in VHI ≥15, and change in grade, roughness, breathiness, asthenia, and strain scale (GRBAS) ≥1.

RESULTS

Significantly more patients in the study group showed a clinically significant change in RSI, VHI, and GRBAS score at the 1-, 2-, and 3-month follow-up evaluations. No clinically significant change in RFS was achieved in either group at 1 or 2 months, but a significantly greater change was achieved in the study group at 3 months.

CONCLUSIONS

Voice therapy may help to restore reversible mucosal change secondary to acidic reflux, inducing rapid resolution of symptoms and shortening of the treatment period.

Functional Impact of the Arytenoidectomy in SCPL

Objective: The arytenoid is one of the components of sphincteric function of the larynx, and arytenoid resection during supracricoid partial laryngectomy (SCPL) may negatively affect the functional results. The purpose of this study was to evaluate the functional results in patients who underwent unilateral arytenoidectomy during SCPL.

Method: Retrospectively reviewed medical records of 116 patients who received SCPL. Regarding the extended procedure of unilateral arytenoidectomy, the patients were divided into 2 groups: Nonextended group and extended group. We evaluated and compared the functional results between the 2 groups.

Results: There was a significantly higher rate of aspiration pneumonia ( P = .003*), delay of oral feeding ( P = .038*), and longer hospitalization time ( P = .008*) in the extended group. There was no significant difference in the score of “normalcy of diet,” “eating in public,” and “understandibility of speech” of PSS-HNS (Performance status scale for head and neck cancer patients) at last follow-up between the 2 groups ( P = .675, P = .645, P = 1.000).

Conclusion: Resection of the arytenoid may interrupt physiologic airway protection in the early postoperative period, so special cautions may be needed to prevent aspiration pneumonia. However, extended SCPL including arytenoidectomy allows avoidance of functional handicap and social maladjustment.

Relation between PGS Invasion and LN Metastasis in SCPL

Objective: Transglottic cancer invading PGS is characteristically known to show a high incidence of laryngeal skeleton invasion and cervical metastasis. The objective was to determine the role of paraglottic space (PGS) invasion in lymph node metastasis in patients undergoing supracricoid partial laryngectomy (SCPL).

Method: We retrospectively reviewed the clinical and pathological data of 98 patients who were diagnosed with glottis laryngeal carcinoma and underwent SCPL. We examined the relationship between PGS invasion and clinicopathological factors such as age, gender, tumor stage, vocal cord mobility, anterior commissure invasion, thyroid cartilage invasion, and subglottic extension.

Results: The PGS invasion rate was 60.2% (59/98). Significant correlations were found between PGS invasion and cervical lymph node metastasis ( P = .022). Fifteen of the 59 patients (25.4 %) with the PGS invasion had cervical lymph node metastasis, whereas only 3 of the 39 patients (7.7%) without any evidence of PGS invasion had lymph node metastasis. There was also a significant correlation of PGS invasion with T stage ( P = .008), vocal cord mobility ( P = .001), and subglottic extension ( P = .014). Patients with no evidence of PGS invasion may have a survival benefit even without statistical significance ( P = .118).

Conclusion: PGS invasion was found to be significantly related to the presence of cervical lymph node metastasis, which suggests that could be used to predict the presence of lymph node metastasis and to determine operative extent and prognosis in patients undergoing SCPL.

Toll-like receptor 4 signalling attenuates experimental allergic conjunctivitis

Allergic conjunctivitis from an allergen-driven T helper type 2 (Th2) response is characterized by conjunctival eosinophilic infiltration. Association between signalling through Toll-like receptor 4 (TLR-4) and adaptive immune responses has been observed in allergic airway disease. We examined whether administration of bacterial lipopolysaccharide (LPS), a prototypic bacterial product that activates immune cells via TLR-4, could affect the development of allergic conjunctivitis and modify the immune response to ovalbumin (OVA) allergen in an experimental allergic conjunctivitis (EAC) model. Mice were challenged with two doses of OVA via conjunctival sac after systemic challenge with OVA in alum. Several indicators for allergy were evaluated in wild-type and TLR-4(-/-) mice with or without adding of different doses of LPS into OVA in alum. Mice challenged with OVA via conjunctival sac following systemic challenge with OVA in alum had severe allergic conjunctivitis. Of interest, LPS administration markedly suppressed immunoglobulin (Ig)E-mediated and eosinophil-dependent conjunctival inflammation. In addition, mice sensitized with OVA plus LPS had less interleukin (IL)-4, IL-5 and eotaxin secretion than mice sensitized with OVA only. The suppression of allergic response by LPS administration was due to Th1 shift. In contrast, the presence of LPS during sensitization with OVA had no effect on severity of allergic conjunctivitis and Th2 responses in TLR4-4(-/-) mice. Our findings demonstrate, for the first time, that LPS suppresses Th2 responses via the TLR-4-dependent pathway in the EAC model.

Fasciocutaneous free flap reconstruction for squamous cell carcinoma of the hypopharynx

The purpose of this study was to examine functional and surgical outcomes after fasciocutaneous free flap reconstruction of the hypopharynx. A retrospective review of the records of 48 consecutive patients that underwent hypopharyngectomy and reconstruction using fasciocutaneous free flaps between 1996 and 2009 was performed. Flap donor sites included the radial forearm (n = 42), anterolateral thigh (n = 5), and lateral thigh (n = 1). There was no perioperative mortality, and the free flap survival rate was 95.8%. Five (10.4%) patients developed a postoperative pharyngocutaneous fistula. In three (6.3%) patients a stricture developed during the postoperative period. Forty-four (92%) patients were decannulated and maintained their voice. Forty-four (92%) patients were able to take oral nutrition, although 4 (8%) needed additional PEG-tube feeding. Five-year overall and disease-specific survival rates were 56 and 61%, respectively. Functional reconstruction of extensive laryngohypopharyngeal defects can be achieved using fasciocutaneous free flaps with favorable functional and surgical results.