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Gule-Monroe MK, Calle S, Policeni B, Juliano AF, Agarwal M, Chow LQM, Dubey P, Friedman ER, Hagiwara M, Hanrahan KD, Jain V, Rath TJ, Smith RB, Subramaniam RM, Taheri MR, Yom SS, Zander D, Burns J. ACR Appropriateness Criteria® Staging and Post-Therapy Assessment of Head and Neck Cancer. J Am Coll Radiol 2023; 20:S521-S564. [PMID: 38040469 DOI: 10.1016/j.jacr.2023.08.008] [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: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Susana Calle
- Research Author, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Q M Chow
- University of Texas at Austin, Dell Medical School, Austin, Texas; American Society of Clinical Oncology
| | | | | | - Mari Hagiwara
- New York University Langone Health, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio
| | | | - Russell B Smith
- Baptist Medical Center, Jacksonville, Florida; American Academy of Otolaryngology-Head and Neck Surgery
| | - Rathan M Subramaniam
- University of Otago, Dunedin, Otepoti, New Zealand; Commission on Nuclear Medicine and Molecular Imaging
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | - Sue S Yom
- University of California, San Francisco, San Francisco, California
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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2
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Ryan WR, Xu MJ, Ochoa E, Plonowska-Hirschfeld KA, Zebolsky AL, Ha PK, Bewley AF, Mallen-St Clair J, Joshi AS, Coffey CS, Faraji F, MacDonald BV, Houlton JJ, Gobillot TA, Curry JM, Philips R, Hackman TG, Richmon JD, Holcomb AJ, Coughlin AM, Panwar A, Smith RB, Herberg ME, Fakhry C, Cognetti DM. Oncologic outcomes of human papillomavirus-associated oropharynx carcinoma treated with surgery alone: A 12-institution study of 344 patients. Cancer 2021; 127:3092-3106. [PMID: 33957701 DOI: 10.1002/cncr.33611] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The oncologic outcomes of surgery alone for patients with American Joint Committee on Cancer 7th edition (AJCC 7th) pN2a and pN2b human papillomavirus-associated oropharynx squamous cell carcinoma (HPV+OPSCC) are not clear. METHODS The authors performed a 12-institution retrospective study of 344 consecutive patients with HPV+OPSCC (AJCC 7th pT0-3 N3 M0) treated with surgery alone with 6 months or more of follow-up using univariate and multivariate analyses. RESULTS The 2-year outcomes for the entire cohort were 91% (182 of 200) disease-free survival (DFS), 100% (200 of 200) disease-specific survival (DSS), and 98% (200 of 204) overall survival (OS). The 18 recurrences within 2 years were 88.9% (16 of 18) local and/or regional recurrences and 11.1% (2 of 18) distant metastases. Recurrences were not significantly associated with smoking, pT stage, or pN stage. The 16 patients with locoregional recurrences within 2 years all underwent successful salvage treatments (median follow-up after salvage: 13.1 months), 43.8% (7 of 16) of whom underwent salvage surgery alone for a 2-year overall salvage radiation need of 4.5% (9 of 200). The 2-year outcomes for the 59 evaluable patients among the 109 AJCC 7th pT0-2 N2a-N2b patients with 1 to 3 pathologic lymph nodes (LNs) were as follows: local recurrence, 3.4% (2 of 59); regional recurrence, 8.4% (5 of 59); distant metastases, 0%; DFS, 88.1% (52 of 59); DSS, 100% (59 of 59); OS, 96.7% (59 of 61); and salvage radiation, 5.1% (3 of 59). CONCLUSIONS With careful selection, surgery alone for AJCC 7th pT0-T2N0-N2b HPV+OPSCC with zero to 3 pathologic LNs without perineural invasion, extranodal extension, or positive margins results in high DFS, DSS, OS, and salvage treatment success. Because of the short-term follow-up, these data support further investigation of treatment de-escalation in this population.
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Affiliation(s)
- William R Ryan
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Mary J Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Edgar Ochoa
- School of Medicine, University of California San Francisco, San Francisco, California
| | | | - Aaron L Zebolsky
- Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, Michigan
| | - Patrick K Ha
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Arnaud F Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California
| | | | - Arjun S Joshi
- Division of Head and Neck Oncologic Surgery, Department of Surgery, George Washington University School of Medicine, Washington, DC
| | - Charles S Coffey
- Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California
| | - Farhoud Faraji
- Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California
| | - Bridget V MacDonald
- School of Medicine, University of California San Diego, La Jolla, California
| | - Jeffrey J Houlton
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington
| | - Theodore A Gobillot
- School of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ramez Philips
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Andrew J Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts.,Head and Neck Surgical Oncology, Nebraska Methodist Health System, Omaha, Nebraska
| | - Andrew M Coughlin
- Head and Neck Surgical Oncology, Nebraska Methodist Health System, Omaha, Nebraska
| | - Aru Panwar
- Head and Neck Surgical Oncology, Nebraska Methodist Health System, Omaha, Nebraska
| | - Russell B Smith
- Section of Head and Neck Surgical Oncology, Baptist MD Anderson Cancer Physicians, Baptist Medical Center, Jacksonville, Florida
| | - Matthew E Herberg
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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3
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Smith RB, Mahnert N, Mourad J. Surgical Management for Removal of Essure Device. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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4
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Mourad J, Smith RB, Steck-Bayat KP, Reshef E. Minimally Invasive Burch Colposuspension - The Robotic Approach. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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5
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Smith RB, Steck-Bayat KP, Mourad J. Tips & Tricks: Minimally Invasive Removal of Transabdominal Cerclage. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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6
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Jorgensen JB, Smith RB, Coughlin A, Spanos WC, Lohr MM, Sperry SM, Militsakh O, Zitsch RP, Yueh B, Dooley LM, Panwar A, Galloway TLI, Pagedar NA. Impact of PET/CT on Staging and Treatment of Advanced Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2018; 160:261-266. [PMID: 30126337 PMCID: PMC8893991 DOI: 10.1177/0194599818794479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To understand the effects of positron emission tomography/computed tomography (PET/CT) evaluation on patients with previously untreated head and neck squamous cell carcinoma (HNSCC) with clinical evidence of regional lymph node involvement. STUDY DESIGN Prospective blinded study. SETTING Tertiary care cancer center. SUBJECTS AND METHODS Informed consent was obtained and data collected from 52 consecutive previously untreated patients with HNSCC and clinical evidence of cervical metastasis. All patients underwent conventional evaluation for HNSCC and whole body PET/CT. Data were evaluated by 5 independent reviewers, who performed TNM staging per the American Joint Committee on Cancer (seventh edition) manual and proposed a treatment plan prior to viewing, and after reviewing, PET/CT. Cases where at least 3 of 5 reviewers agreed were considered significant. RESULTS There were 0 patients for whom review of the PET/CT altered the T-class assessment (95% CI, 0-6.8), 12 (23.1%) for whom PET/CT altered N classification (95% CI, 12.5-34.5), and 2 (3.8%) for whom PET/CT altered the M classification (95% CI, 0.5-13.2). For 5 patients (9.6%), overall stage was altered per PET/CT review (95% CI, 3.2-21). For 3 patients (5.8%), PET/CT findings prompted reviewers to alter treatment recommendations (95% CI, 1.2-15.9). CONCLUSION When added to more conventional patient evaluation, PET/CT results in changes to the TNM categories, but overall staging and treatment were less frequently affected. Whether PET/CT should be used routinely for patients with stage III and IV HNSCC is still subjective and merits further study.
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Affiliation(s)
- Jeffery B Jorgensen
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Russell B Smith
- 2 Division of Surgical Oncology, Baptist MD Anderson Cancer Center, Jacksonville, Florida, USA
| | - Andrew Coughlin
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - William C Spanos
- 4 Department of Otolaryngology-Head and Neck Surgery, Sanford Health, Sioux Falls, South Dakota, USA
| | - Michele M Lohr
- 4 Department of Otolaryngology-Head and Neck Surgery, Sanford Health, Sioux Falls, South Dakota, USA
| | - Steven M Sperry
- 5 Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Oleg Militsakh
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robert P Zitsch
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Bevan Yueh
- 6 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura M Dooley
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Aru Panwar
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tabitha L I Galloway
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Nitin A Pagedar
- 5 Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
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7
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Rector J, Kapil S, Treude KJ, Kumm P, Glanzer JG, Byrne BM, Liu S, Smith LM, DiMaio DJ, Giannini P, Smith RB, Oakley GG. S4S8-RPA phosphorylation as an indicator of cancer progression in oral squamous cell carcinomas. Oncotarget 2018; 8:9243-9250. [PMID: 27999209 PMCID: PMC5354728 DOI: 10.18632/oncotarget.14001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 12/13/2016] [Indexed: 02/06/2023] Open
Abstract
Oral cancers are easily accessible compared to many other cancers. Nevertheless, oral cancer is often diagnosed late, resulting in a poor prognosis. Most oral cancers are squamous cell carcinomas that predominantly develop from cell hyperplasias and dysplasias. DNA damage is induced in these tissues directly or indirectly in response to oncogene-induced deregulation of cellular proliferation. Consequently, a DNA Damage response (DDR) and a cell cycle checkpoint is activated. As dysplasia transitions to cancer, proteins involved in DNA damage and checkpoint signaling are mutated or silenced decreasing cell death while increasing genomic instability and allowing continued tumor progression. Hyperphosphorylation of Replication Protein A (RPA), including phosphorylation of Ser4 and Ser8 of RPA2, is a well-known indicator of DNA damage and checkpoint activation. In this study, we utilize S4S8-RPA phosphorylation as a marker for cancer development and progression in oral squamous cell carcinomas (OSCC). S4S8-RPA phosphorylation was observed to be low in normal cells, high in dysplasias, moderate in early grade tumors, and low in late stage tumors, essentially supporting the model of the DDR as an early barrier to tumorigenesis in certain types of cancers. In contrast, overall RPA expression was not correlative to DDR activation or tumor progression. Utilizing S4S8-RPA phosphorylation to indicate competent DDR activation in the future may have clinical significance in OSCC treatment decisions, by predicting the susceptibility of cancer cells to first-line platinum-based therapies for locally advanced, metastatic and recurrent OSCC.
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Affiliation(s)
- Jeff Rector
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln NE 68583, USA
| | - Sasha Kapil
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha NE 68198, USA
| | - Kelly J Treude
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha NE 68198, USA
| | - Phyllis Kumm
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln NE 68583, USA
| | - Jason G Glanzer
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln NE 68583, USA
| | - Brendan M Byrne
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln NE 68583, USA
| | - Shengqin Liu
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln NE 68583, USA
| | - Lynette M Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha NE 68198, USA
| | - Dominick J DiMaio
- Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha NE 68198, USA
| | - Peter Giannini
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln NE 68583, USA
| | - Russell B Smith
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha NE 68198, USA
| | - Greg G Oakley
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln NE 68583, USA.,Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha NE 68198, USA
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8
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Affiliation(s)
- Russell B Smith
- Division of Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Nebraska Medicine, Omaha
| | - Robert L Ferris
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
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9
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Abstract
In this 12-week study with 29 subjects, the effect of Prokarin™ (n =22), a proprietary blend of histamine and caffeine, was compared to placebo group (n=7) for the following outcomes: 1) fatigue as measured by the Modified Fatigue Impact Scale (MFIS); 2) lower limb function as measured by timed walk test; 3) upper limb function as measured by the pegboard test; 4) cognitive function as measured by the Paced Auditory Serial Additions Test (PASAT); 5) serum caffeine level; 6) change in brain chemistry as measured by quantitative magnetic resonance spectroscopy assay of N-acetyl aspartate (NAA); and 7) safety as measured by routine blood chemistry, TSH and urinalysis. Data were acquired at baseline, 4, 8 and 12 weeks. The Prokarin™ group MFIS mean was significantly different from the mean of the placebo group at 12 weeks (df=24, t=2.08, P=<0.02), with respective means of 37.40, SD=15.18, for the Prokarin™ group and 53.2, SD=11.39 for the controls. For the secondary endpoints (PASAT, 25 foot timed walk, peg test, and magnetic resonance spectroscopy [MRS]), there were no significant differences between the Prokarin™-treated group and the placebo group. However, there were significant improvements within the Prokarin™ group for each of these measures for the pre- versus posttreatment comparison at 12 weeks. Serum caffeine data indicated that caffeine exerted no independent effect on performance. No laboratory abnormalities were seen, and the treatment was well tolerated. Conclusion: There was a modest-size statistical effect of Prokarin ™ on fatigue in multiple sclerosis (MS) compared with the placebo group. A larger trial is warranted, based on this pilot study. Multiple Sclerosis (2002) 8, 30-35
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Affiliation(s)
- G. Gillson
- Life Diagnostics, 2210 2nd Street SW-Ste G100, Calgary,
Alberta T2S 3C3, Canada
| | - TL Richards
- Department of Radiology, Box 357115, University of Washington,
Seattle, Washington 98195, USA
| | - RB Smith
- Electromedical Products International, Inc., Mineral
Wells, Texas 76067, USA
| | - JV Wright
- Tahoma Clinic, 515 W Harrison, Kent, Washington 98032,
USA
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10
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Macha MA, Rachagani S, Qazi AK, Jahan R, Gupta S, Patel A, Seshacharyulu P, Lin C, Li S, Wang S, Verma V, Kishida S, Kishida M, Nakamura N, Kibe T, Lydiatt WM, Smith RB, Ganti AK, Jones DT, Batra SK, Jain M. Afatinib radiosensitizes head and neck squamous cell carcinoma cells by targeting cancer stem cells. Oncotarget 2017; 8:20961-20973. [PMID: 28423495 PMCID: PMC5400558 DOI: 10.18632/oncotarget.15468] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/06/2017] [Indexed: 12/29/2022] Open
Abstract
The dismal prognosis of locally advanced and metastatic squamous cell carcinoma of the head and neck (HNSCC) is primarily due to the development of resistance to chemoradiation therapy (CRT). Deregulation of Epidermal Growth Factor Receptor (EGFR) signaling is involved in HNSCC pathogenesis by regulating cell survival, cancer stem cells (CSCs), and resistance to CRT. Here we investigated the radiosensitizing activity of the pan-EGFR inhibitor afatinib in HNSCC in vitro and in vivo. Our results showed strong antiproliferative effects of afatinib in HNSCC SCC1 and SCC10B cells, compared to immortalized normal oral epithelial cells MOE1a and MOE1b. Comparative analysis revealed stronger antitumor effects with afatinib than observed with erlotinib. Furthermore, afatinib enhanced in vitro radiosensitivity of SCC1 and SCC10B cells by inducing mesenchymal to epithelial transition, G1 cell cycle arrest, and the attenuating ionizing radiation (IR)-induced activation of DNA double strand break repair (DSB) ATM/ATR/CHK2/BRCA1 pathway. Our studies also revealed the effect of afatinib on tumor sphere- and colony-forming capabilities of cancer stem cells (CSCs), and decreased IR-induced CSC population in SCC1 and SCC10B cells. Furthermore, we observed that a combination of afatinib with IR significantly reduced SCC1 xenograft tumors (median weight of 168.25 ± 20.85 mg; p = 0.05) compared to afatinib (280.07 ± 20.54 mg) or IR alone (324.91 ± 28.08 mg). Immunohistochemical analysis of SCC1 tumor xenografts demonstrated downregulation of the expression of IR-induced pEGFR1, ALDH1 and upregulation of phosphorylated γH2AX by afatinib. Overall, afatinib reduces tumorigenicity and radiosensitizes HNSCC cells. It holds promise for future clinical development as a novel radiosensitizer by improving CSC eradication.
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Affiliation(s)
- Muzafar A Macha
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Satyanarayana Rachagani
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Asif Khurshid Qazi
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Rahat Jahan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Suprit Gupta
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Anery Patel
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Parthasarathy Seshacharyulu
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Sicong Li
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Shuo Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Shosei Kishida
- Department of Biochemistry and Genetics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan,
| | - Michiko Kishida
- Department of Biochemistry and Genetics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan,
| | - Norifumi Nakamura
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Toshiro Kibe
- Department of Oral and Maxillofacial Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - William M Lydiatt
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Russell B Smith
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Apar K Ganti
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA.,VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Dwight T Jones
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Buffett Cancer Center, Omaha, NE 68198, USA.,Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Maneesh Jain
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Buffett Cancer Center, Omaha, NE 68198, USA
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11
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Affiliation(s)
- R B Smith
- Reckitt & Colman Pharmaceutical Division, Dansom Lane, Kingston-upon-Hull, HU8 7 DS
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12
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Funk GF, Karnell LH, Whitehead S, Paulino A, Ricks J, Smith RB. Free Tissue Transfer versus Pedicled Flap Cost in Head and Neck Cancer. Otolaryngol Head Neck Surg 2016; 127:205-12. [PMID: 12297811 DOI: 10.1067/mhn.2002.127591] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: We sought to compare the overall 1-year management costs for patients receiving a free tissue transfer with those of patients receiving a pedicled flap reconstruction as a component of their primary head and neck cancer treatment. STUDY DESIGN AND SETTING: Case-control, cost identification analysis of 21 matched pairs of patients and multivariate analysis of variables associated with treatment costs was conducted in a tertiary referral academic institution. RESULTS: No significant difference in total 1-year charges between the pedicled and free tissue transfer groups was found. A structured measure of patient comorbidity was the only variable significantly associated with total 1-year charges. CONCLUSIONS: Total 1-year treatment costs of primary upper aerodigestive tract cancers are similar for patients reconstructed with free tissue transfer or a pedicled flap. SIGNIFICANCE: Within the context of overall 1-year management costs, the primary determinants of health care expense for these patients are comorbidity and extent of disease, not reconstructive technique.
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Affiliation(s)
- Gerry F Funk
- Department of Otolaryngology and Division of Radiation Oncology, University of Iowa College of Medicine, Iowa City, USA
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14
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Shats O, Goldner W, Feng J, Sherman A, Smith RB, Sherman S. Thyroid Cancer and Tumor Collaborative Registry (TCCR). Cancer Inform 2016; 15:73-9. [PMID: 27168721 PMCID: PMC4856228 DOI: 10.4137/cin.s32470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/08/2016] [Accepted: 03/20/2016] [Indexed: 12/14/2022] Open
Abstract
A multicenter, web-based Thyroid Cancer and Tumor Collaborative Registry (TCCR, http://tccr.unmc.edu) allows for the collection and management of various data on thyroid cancer (TC) and thyroid nodule (TN) patients. The TCCR is coupled with OpenSpecimen, an open-source biobank management system, to annotate biospecimens obtained from the TCCR subjects. The demographic, lifestyle, physical activity, dietary habits, family history, medical history, and quality of life data are provided and may be entered into the registry by subjects. Information on diagnosis, treatment, and outcome is entered by the clinical personnel. The TCCR uses advanced technical and organizational practices, such as (i) metadata-driven software architecture (design); (ii) modern standards and best practices for data sharing and interoperability (standardization); (iii) Agile methodology (project management); (iv) Software as a Service (SaaS) as a software distribution model (operation); and (v) the confederation principle as a business model (governance). This allowed us to create a secure, reliable, user-friendly, and self-sustainable system for TC and TN data collection and management that is compatible with various end-user devices and easily adaptable to a rapidly changing environment. Currently, the TCCR contains data on 2,261 subjects and data on more than 28,000 biospecimens. Data and biological samples collected by the TCCR are used in developing diagnostic, prevention, treatment, and survivorship strategies against TC.
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Affiliation(s)
- Oleg Shats
- Eppley Institute for Research in Cancer, University of Nebraska Medical Center, Omaha, NE, USA.; Progenomix, Inc., Omaha, NE, USA
| | - Whitney Goldner
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jianmin Feng
- Eppley Institute for Research in Cancer, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alexander Sherman
- Eppley Institute for Research in Cancer, University of Nebraska Medical Center, Omaha, NE, USA
| | - Russell B Smith
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.; Nebraska Methodist Hospital, Omaha, NE, USA
| | - Simon Sherman
- Eppley Institute for Research in Cancer, University of Nebraska Medical Center, Omaha, NE, USA.; Progenomix, Inc., Omaha, NE, USA
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Fontana SC, Smith RB, Nazir N, Andrews BT. Biomechanical assessment of fixation methods for segmental mandible reconstruction with fibula in the polyurethane model. Microsurgery 2016; 36:330-3. [PMID: 27059150 DOI: 10.1002/micr.30052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/15/2016] [Accepted: 03/17/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND A variety of plating techniques are employed by microsurgeons to provide rigid fixation for vascularized bone constructs of the mandible. The aim of this study was to biomechanically compare three commonly utilized plating techniques for rigid fixation of fibula bone flaps in reconstructing lateral segmental mandibular defects. MATERIALS AND METHODS Polyurethane mandibles with 3-cm segmental defects were reconstructed using polyurethane fibula models. Three fixation techniques were compared (n = 5 models per group): Group 1 used two 2.0-mm miniplates at each osteotomy site, Group 2 used a single 2.3-mm plate, and Group 3 used a single 2.7-mm plate. Biomechanical testing of maximum force and displacement at failure for each plating technique was assessed and statistical comparison performed. RESULTS The average displacement for Group 1 was 14.08 ± 1.42 mm, Group 2 was 5.79 ± 0.89 mm, and Group 3 was 6.03 ± 1.59 mm. Group 1 had significantly greater (P < 0.05) displacement when compared with Group 2 and 3. Analysis of variance demonstrated the three groups varied significantly in mean displacement (0 < 0.01). The average force before failure for Group 1 was 616.4 ± 33.83N, Group 2 was 737.8 ± 72.57N, and Group 3 was 681.0 ± 67.98N. Group 2 withstood significantly greater force than Group 1 (P < 0.05), and withstood greater force than Group 3, although the difference was not significant. Analysis of variance showed the three groups varied significantly in mean force at failure (P < 0.05). CONCLUSION Reconstruction using a single 2.3-mm plate provided the best rigid fixation for lateral segmental defects of the mandible. © 2016 Wiley Periodicals, Inc. Microsurgery 36:330-333, 2016.
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Affiliation(s)
- Stefani C Fontana
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Russell B Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Niaman Nazir
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Brian T Andrews
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS
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Agrawal A, Civantos FJ, Brumund KT, Chepeha DB, Hall NC, Carroll WR, Smith RB, Zitsch RP, Lee WT, Shnayder Y, Cognetti DM, Pitman KT, King DW, Christman LA, Lai SY. [(99m)Tc]Tilmanocept Accurately Detects Sentinel Lymph Nodes and Predicts Node Pathology Status in Patients with Oral Squamous Cell Carcinoma of the Head and Neck: Results of a Phase III Multi-institutional Trial. Ann Surg Oncol 2015; 22:3708-15. [PMID: 25670018 PMCID: PMC4565859 DOI: 10.1245/s10434-015-4382-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND [(99m)Tc]Tilmanocept, a novel CD206 receptor-targeted radiopharmaceutical, was evaluated in an open-label, phase III trial to determine the false negative rate (FNR) of sentinel lymph node biopsy (SLNB) relative to the pathologic nodal status in patients with intraoral or cutaneous head and neck squamous cell carcinoma (HNSCC) undergoing tumor resection, SLNB, and planned elective neck dissection (END). Negative predictive value (NPV), overall accuracy of SLNB, and the impact of radiopharmaceutical injection timing relative to surgery were assessed. METHODS AND FINDINGS This multicenter, non-randomized, single-arm trial (ClinicalTrials.gov identifier NCT00911326) enrolled 101 patients with T1-T4, N0, and M0 HNSCC. Patients received 50 µg [(99m)Tc]tilmanocept radiolabeled with either 0.5 mCi (same day) or 2.0 mCi (next day), followed by lymphoscintigraphy, SLNB, and END. All excised tissues were evaluated for tissue type and tumor presence. [(99m)Tc]Tilmanocept identified one or more SLNs in 81 of 83 patients (97.6 %). Of 39 patients identified with any tumor-positive nodes (SLN or non-SLN), one patient had a single tumor-positive non-SLN in whom all SLNs were tumor-negative, yielding an FNR of 2.56 %; NPV was 97.8 % and overall accuracy was 98.8 %. No significant differences were observed between same-day and next-day procedures. CONCLUSIONS Use of receptor-targeted [(99m)Tc]tilmanocept for lymphatic mapping allows for a high rate of SLN identification in patients with intraoral and cutaneous HNSCC. SLNB employing [(99m)Tc]tilmanocept accurately predicts the pathologic nodal status of intraoral HNSCC patients with low FNR, high NPV, and high overall accuracy. The use of [(99m)Tc]tilmanocept for SLNB in select patients may be appropriate and may obviate the need to perform more extensive procedures such as END.
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Affiliation(s)
- Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Francisco J Civantos
- Department of Otolaryngology, University of Miami Hospital and Clinics/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Kevin T Brumund
- Division of Head and Neck Surgery, Department of Surgery, Moores UCSD Cancer Center and Veteran Affairs San Diego Medical Center, San Diego, CA, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Nathan C Hall
- Division of Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William R Carroll
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Russell B Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert P Zitsch
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, MO, USA
| | - Walter T Lee
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
OBJECTIVE To evaluate the association between modifiable patient risk factors including tobacco use, alcohol consumption, body mass index (BMI), and thyroid cancer. STUDY DESIGN Retrospective study with chart review. SETTING Midwest university hospital. SUBJECTS AND METHODS Retrospective study comparing Midwest patients with thyroid cancer from our Thyroid Tumor and Cancer Registry with Midwest controls without a personal history of cancer. Descriptive statistics were created from patient questionnaires and chart reviews. Odds ratios (ORs) were reported for significant associations. RESULTS There were 467 patients with cancer and 255 controls. The thyroid cancer group included 404 papillary, 47 follicular, 13 medullary, and 3 anaplastic cancers. When comparing all patients with cancer with controls, smoking more than 100 lifetime cigarettes was associated with a reduced cancer risk (OR, 0.68; 95% confidence interval [CI], 0.50-0.94). Secondhand smoke exposure did not show a statistically significant relationship to thyroid cancer. Compared with never drinking, current drinking was associated with a reduced cancer risk (OR, 0.46; 95% CI, 0.29-0.73) as was consuming 1 to 2 drinks daily compared to drinking <1 drink daily (OR, 0.58; 95% CI, 0.34-0.89). There was no difference between median BMI at age 20 years, lifetime maximum BMI, or current BMI between patients with cancer and controls. CONCLUSION Our data showed no positive correlation between tobacco use, alcohol consumption, or obesity and thyroid cancer risk. Our data suggest that tobacco use and mild alcohol consumption may be associated with a slightly reduced risk of thyroid cancer. There was no association between BMI and thyroid cancer in our study population.
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Affiliation(s)
- Kyle J Stansifer
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - John F Guynan
- Department of General Surgery, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Brandon M Wachal
- University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Russell B Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Sofferman RA, Orloff LA, Smith RB, Sebelik ME, Baskin HJ, Ahuja AT. Contemporary Ultrasound of the Head and Neck. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Program Description: With the progressive improvements in imaging resolution of ultrasound, concurrent reduction in capital expenditure, and portability, this modality is ideally suited to point-of-care use by most otolaryngology practices. Primary and exported training courses through the American College of Surgeons have provided a clinical starting point. An accreditation process for head and neck ultrasound is now available through a joint project between the American Institute for Ultrasound in Medicine and the Academy. This miniseminar presents the practical application of ultrasound to general, pediatric, endocrinologic, and oncologic conditions through a panel of outstanding experts from radiology and otolaryngology. Educational Objectives: (1) Cite the principles of ultrasound and its application to conditions of the head and neck. (2) Recognize the advantages of ultrasound-guided aspiration of samples for cytology and other chemical tests. (3) Learn ultrasound techniques and eventual accreditation of skills.
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Stansifer KJ, Guynan JF, Smith RB. The Role of Modifiable Risk Factors in the Development of Thyroid Cancer. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Evaluate the role of modifiable patient risk factors including tobacco use, secondhand smoke exposure, alcohol consumption, and body mass index (BMI) in the development of thyroid cancer. Methods: Retrospective study comparing Midwest thyroid cancer patients from our multicenter Thyroid Tumor and Cancer Registry and Midwest controls without personal history of cancer. Descriptive statistics were created from detailed questionnaires, thyroid cancer type, and odds ratios were reported for significant associations. Results: There were 469 cancer patients and 425 controls. The thyroid cancer group included 406 papillary, 47 follicular, 13 medullary, and 3 anaplastic cancers. Comparing all cancer patients with controls, there was no association between smoking and thyroid cancer ( P = .18). Living or working with smokers was associated with increased cancer risk (odds ratio [OR] = 1.36, 95% confidence interval [CI] 1.04-1.77). Compared with never drinking, current drinking was associated with reduced cancer risk (OR = 0.48, 95% CI 0.31-0.75) as was consuming 1 to 2 drinks daily compared with drinking <1 drink daily (OR = 0.55, 95% CI 0.36-0.85). Consuming >2 drinks daily was not associated with cancer risk ( P = 0.26, 95% CI 0.47-1.22). There was no association between BMI and papillary cancer, except in patients older than 45 years with a BMI >30 (OR = 1.87, 95% 1.20-2.92). Conclusions: Our data suggest that secondhand smoke exposure is a risk factor for developing thyroid cancer and mild alcohol consumption is associated with reduced risk of developing thyroid cancer. BMI over 30 may be associated with thyroid cancer development for individuals over 45 years old.
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Bauer AM, Smith RB, Thorell WE. Implications of Carotid Sinus Hypersensitivity Following Preoperative Embolization of a Carotid Body Tumor. JAMA Otolaryngol Head Neck Surg 2014; 140:459-63. [DOI: 10.1001/jamaoto.2014.144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ashley M. Bauer
- Department of Otolaryngology–Head and Neck Surgery, University of Nebraska Medical Center, Omaha
| | - Russell B. Smith
- Department of Otolaryngology–Head and Neck Surgery, University of Nebraska Medical Center, Omaha
| | - William E. Thorell
- Division of Neurosurgery, Department of Surgery, University of Nebraska Medical Center, Omaha
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Smith RB, Caruana SM, Hunt JP, Shindo ML, Steward DL, Tufano RP. Clinic-Based Decision Making for Head and Neck Endocrine Disease. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813493390a34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Program Description: Patients with thyroid and parathyroid disease are commonly encountered in a head and neck surgery practice. While the evaluation and management of many patients is relatively straightforward, others are significantly more complicated. The goal of this session is to discuss complex clinical scenarios encountered in the outpatient clinic. The cost-effective use of diagnostic testing as well as the factors critical in treatment planning will be outlined. The entities reviewed will include: 1) Fine-needle aspiration (FNA) for thyroid nodules; 2) Evaluation and decision for surgery in hyperthyroidism; 3) Surveillance of patients with well differentiated thyroid cancer; 4) Evaluation and decision for surgery in hyperparathyroidism. Educational Objectives: 1) Describe the appropriate use of FNA biopsy and other diagnostic studies with a focus on patients with suspected or known Hashimoto’s thyroiditis. 2) Interpret the diagnostic evaluation and decision making for patients with functional thyroid disease with a focus on hyperthyroidism. 3) Outline the evaluation and treatment plan for patients’ hyperparathyroidism with a focus on non-localizing disease and recurrent disease.
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22
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Bikhchandani J, Wood J, Richards AT, Smith RB. No benefit in staging fluorodeoxyglucose-positron emission tomography in clinically node-negative head and neck cutaneous melanoma. Head Neck 2013; 36:1313-6. [PMID: 23956077 DOI: 10.1002/hed.23456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 05/15/2013] [Accepted: 08/12/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fluorodeoxyglucose-positron emission tomography (FDG-PET) has a high sensitivity for detecting metastasis from melanoma, but its application in early-stage melanomas is questionable. The purpose of this study was to determine if positron emission tomography (PET) is beneficial in staging of clinically node negative (cN0) head and neck melanoma. METHODS After institutional review board approval, patients with head and neck melanoma treated at 2 cancer centers (between 2000 and 2010) were identified using International Classification of Disease (ICD)-9 codes. A retrospective medical chart review of cN0 patients was performed for the treatment course and outcomes. RESULTS A total of 165 patients were treated; of these, 106 were node negative. FDG-PET was included in initial staging of 47 cN0 patients. None had true distant metastasis detected on PET. The imaging also failed to detect nodal metastasis in 2 patients who had disease on lymphatic sampling. CONCLUSION FDG-PET did not alter the initial staging or treatment in patients with cN0 head and neck melanoma. Therefore, its routine use for staging is not warranted.
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Affiliation(s)
- Jai Bikhchandani
- Department of Surgery, Creighton University Medical Center, Omaha, Nebraska
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Smith RB, Evasovich M, Girod DA, Jorgensen JB, Lydiatt WM, Pagedar NA, Spanos WC. Ultrasound for localization in primary hyperparathyroidism. Otolaryngol Head Neck Surg 2013; 149:366-71. [PMID: 23748916 DOI: 10.1177/0194599813491063] [Citation(s) in RCA: 19] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the capability of ultrasound for preoperative localization in primary hyperparathyroidism. STUDY DESIGN Prospective study. SETTING Multi-institutional Midwest Head and Neck Cancer Consortium. SUBJECTS AND METHODS Two hundred twenty patients who underwent preoperative localization and had parathyroid surgery were evaluated. The findings of preoperative localization studies were correlated with surgical findings. RESULTS Preoperative ultrasonography, sestamibi scintigraphy, or both were obtained in 77%, 93%, and 69% of the patients, respectively. Preoperative ultrasonography and sestamibi scintigraphy localized an abnormality in 71% and 79% of patients, respectively. At the time of surgery, the localization by ultrasound was accurate in 82%. The accuracy of localization was similar for sestamibi scintigraphy (85%). In patients with inaccurate ultrasound localization, the sestamibi scintigraphy correctly identified the site of disease in only 45%. In patients with a nonlocalizing ultrasound, sestamibi scintigraphy was able to localize disease in only 47%, with 2 being in the mediastinum. CONCLUSIONS Ultrasonography is an acceptable initial localization study for patients with primary hyperparathyroidism. In patients with nonlocalizing ultrasound, sestamibi scintigraphy should be obtained, but can be expected to detect an abnormality in less than 50% of patients.
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Affiliation(s)
- Russell B Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska, Omaha, Nebraska 68198, USA.
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Macha MA, Rachagani S, Pai P, Jain M, Lydiatt WM, Smith RB, Johansson SL, Lele SM, Kakar SS, Ibrahim FH, Lee JH. Abstract 4044: MUC4 knockdown induces cellular senescence in head and neck cancer cells. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-4044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The limited effectiveness of therapy for patients with advanced stage Head and Neck Squamous Cell Carcinoma (HNSCC) or recurrent disease is a reflection of an incomplete understanding of the molecular basis of HNSCC pathogenesis. Cellular senescence is an extremely stable form of cell cycle arrest that limits the proliferation of damaged cells and may act as a natural barrier to cancer progression. MUC4, a high molecular weight glycoprotein, is overexpressed in many cancers and is implicated in cell proliferation, adhesion, anti-apoptosis, cell cycle regulation, migration and invasion of various carcinomas, but nothing is known about its clinical relevance and the mechanism through which it regulates cancer progression in HNSCC. Therefore, the present study was aimed to investigate clinical relevance and a potential role of MUC4 in cellular senescence in HNSCCs.
Using immunohistochemical analysis, we observed a significant up regulation of MUC4 in 79% (68/86) of HNSCC tissue samples compared to only 10% (1/10) of benign tissues. Further, we observed high expression of MUC4 in a majority of HNSCC cell lines tested. Knockdown (KD) of MUC4 with specific shRNA in HNSCC cells markedly decreased cell proliferation. The doubling time increased from 26 h to 36 h and 34 h to 42 h in MUC4 silenced UMSCC-1 and SCC-10B cells, respectively as compared to their control counterparts. MUC4 KD in UMSCC-1 and UMSCC-10B cells resulted in accumulation of cells at the G0/G1 phase with concomitant decrease in the expression of cell cycle regulating proteins like Cyclin-E and Cyclin-D1, and decrease in BrDU incorporation. More importantly, MUC4 KD resulted in the induction of cellular senescence in both cell lines as indicated by an increase in the number of flat, enlarged and senescence-associated β-galactosidase (SA-β-Gal) positive cells. Further,
MUC4 KD resulted in the inhibition of FAK signaling, and decreased motility and invasive behavior in both UMSCC-1 and UMSCC-10B cells. Mechanistic dissection of senescent response to MUC4 silencing indicated decreased acetylated histone enrichment at Cyclin-E/Cyclin-D1 promoters, leading to their downregulation. Further, both cell lines UMSCC-1 and UMSCC-10B underwent a P16 and P21 dependent cellular senescence in response to MUC4 KD that requires inactivation of Akt and ERK signaling. In conclusions, these findings suggest a novel role of MUC4 in regulating cellular senescence and provide evidence of the functional role of MUC4 in the proliferation, motility and invasion of HNSCC cells. Therefore, downregulation of MUC4 may be a promising therapeutic approach for Head and Neck cancer treatment.
Citation Format: Muzafar A. Macha, Satyanarayana Rachagani, Priya Pai, Maneesh Jain, Williams M. Lydiatt, Russell B. Smith, Sonny L. Johansson, Subodh M. Lele, Sham S. Kakar, Farghaly H. Ibrahim, John H. Lee. MUC4 knockdown induces cellular senescence in head and neck cancer cells. [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 4044. doi:10.1158/1538-7445.AM2013-4044
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Affiliation(s)
| | | | - Priya Pai
- 1University of Nebraska Medical Center, Omaha, NE
| | - Maneesh Jain
- 1University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | | | | | - John H. Lee
- 3Sanford Cancer Research Center, Sioux Falls, SD
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Abstract
BACKGROUND Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic disease characterized by extensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs. We present a case of a 69-year-old man with maxillary sinus IgG4 sclerosing disease, with orbital invasion treated with rituximab and dexamethasone pulse therapy. Surgery was used as well to debulk the disease and to obtain tissue for diagnosis. METHODS A PubMed search using the key phrase "IgG4-related Sclerosing Disease" was performed. There were 304 different articles regarding the disease for a multitude of different organ sites. Of the 304 articles, there were 3 articles that reported this disease in the paranasal sinuses. CONCLUSIONS IgG4-related sclerosing disease is a rare entity in the head and neck. There are documented reports of steroid therapy for this disease, but the patient presented here demonstrated clinical progression of disease with steroids alone. The use of combination therapy of surgery, dexamethasone, and rituximab provided clinical improvement and stable disease determined by radiographic means.
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Affiliation(s)
- Robert H Lindau
- Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon
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Nelson RF, Dursteler B, Smith RB. Pathology quiz case 2. Tophaceous pseudogout (calcium pyrophosphate deposition disease [CPDD]) of the TMJ. ACTA ACUST UNITED AC 2012; 138:873-5. [PMID: 22986729 DOI: 10.1001/archoto.2012.1653] [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: 11/14/2022]
Affiliation(s)
- Rick F Nelson
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Smith RB, Tufano RP, Shindo ML, Caruana SM, Steward DL. Decision Making for Head and Neck Endocrine Disease in the Clinic. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812449008a37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Smith RB, Zitsch RP, Evasovich M, Pagedar NA, Girod DA, Jorgensen JB. Ultrasound for Localization in Primary Hyperparathyroidism. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451438a107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Minimally invasive surgery for primary hyperparathyroidism has gained significant popularity. Preoperative localization is required, with ultrasonography and sestamibi imaging being most commonly utilized. When both are obtained, frequently the same site is localized. It is unclear that 2 localization techniques are required in patients with hyperparathyroidism. Method: Prospectively collected data from the Midwest Head and Neck Cancer Consortium’s parathyroid protocol was retrospectively reviewed. The study included patients that had preoperative localization and subsequently underwent surgery. The localization studies were correlated to surgical findings. Results: Of the 96 patients, preoperative US, sestamibi, or both studies were obtained in 77, 88, and 71, respectively. Preoperative US and sestamibi localized an abnormality in 69% and 80%, respectively. In patients with localizing US, surgical findings were exactly as predicted in 75% and localized to the correct side in 84%. The accuracy of localization was similar for sestamibi imaging. In 8 patients with inaccurate US localization, the sestamibi detected an abnormal gland in only 50%. In patients with a nonlocalizing US, sestamibi was able to detect disease in 75%, with 2 being in the mediastinum. Conclusion: Given the lower cost of ultrasonography, it is an acceptable initial localization study for patients with primary hyperparathyroidism. In patients with nonlocalizing ultrasound, sestamibi imaging should be obtained. Frequently potential sites of disease will be identified, still allowing for a minimally invasive surgical approach.
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Gupta PK, Smith RB, Gupta H, Forse RA, Fang X, Lydiatt WM. Outcomes after thyroidectomy and parathyroidectomy. Head Neck 2011; 34:477-84. [PMID: 21638513 DOI: 10.1002/hed.21757] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 01/24/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous reports on postoperative outcomes following thyroid and parathyroid surgery are limited by relatively small sample size. We report 30-day outcomes following thyroid and parathyroid surgery and analyze factors affecting length of stay (LOS) and postoperative adverse events (AEs). METHODS The multicenter, prospective, National Surgical Quality Improvement Program (NSQIP) datasets (2007/2008) were used. Multivariable logistic regression and analysis of covariance (ANCOVA) were performed. RESULTS Patients undergoing thyroidectomy, parathyroidectomy, or both were identified (n = 13,380, 6154, 1535, respectively). Thirty-day mortality was 0.08%, 0.16%, and 0.2%, respectively; 30-day morbidity was 3.50%, 3.02%, and 4.04%, respectively. Mean LOS values were 1.1 ± 1.4, 1.1 ± 2.1, and 1.4 ± 3.1 days, respectively. Congestive heart failure, dependent functional status, dialysis dependence, and chronic corticosteroid use were significantly associated with increased LOS and postoperative AE. CONCLUSIONS Morbidity and mortality rates following thyroid and parathyroid surgery are low. These data could be used by third-party interests, and surgeons should be aware of them to ensure their outcomes are in the national norm.
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Affiliation(s)
- Prateek K Gupta
- Department of Surgery, Creighton University, Omaha, Nebraska, USA
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Abstract
Ultrasonography has an ever increasing role in the management of a wide variety of diseases affecting the head and neck. While ultrasonography is most commonly used for imaging of thyroid pathology, it also can be utilized in a host of diagnostic and therapeutic procedures. This article reviews the office-based ultrasound-guided procedures in the head and neck and discusses technical considerations for performing these interventions.
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Affiliation(s)
- Russell B Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA.
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Abstract
The diagnostic classification of small round blue cell tumors of the sinonasal area to include diverse malignancies of epithelial, hematolymphoid, neuroectodermal, and mesenchymal origin is challenging to the surgical pathologist using conventional histopathologic approaches because the cytomorphologic features are often overlapping or indistinctive. Rare or occasional clinical presentations in atypical age groups or unusual locations, as well as small biopsy samples may further complicate the differential diagnosis. Immunohistochemistry represents an extensively investigated ancillary technique that may aid in the provision of a definitive diagnosis. In recent years, certain small round blue cell tumors have been shown by cytogenetic analysis to have specific and primary chromosomal alterations, providing clinicians with a valuable tool to enhance their diagnostic armamentarium. The addition of molecular cytogenetic [fluorescence in situ hybridization (FISH), comparative genomic hybridization (CGH)] and molecular pathologic [polymerase chain reaction (PCR) and reverse transcriptase (RT)-PCR] approaches has further enhanced the sensitivity and accuracy of detecting these genetic alterations including assessment in formalin-fixed, paraffin-embedded tissues. Establishing an accurate diagnosis of a small round blue cell tumor of the sinonasal tract frequently requires adjunctive studies including immunohistochemical and molecular analyses.
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Affiliation(s)
- Julia A Bridge
- Department of Pathology, 983135 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-3135, USA.
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Smith RB. Minimally invasive radioguided parathyroidectomy performed for primary hyperparathyroidism. Otolaryngol Head Neck Surg 2010; 142:462; author reply 462-3. [PMID: 20172405 DOI: 10.1016/j.otohns.2009.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 11/13/2009] [Indexed: 11/29/2022]
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Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, Petruzelli G, Gourin CG, Wong RJ, Ferris RL, El Naggar A, Ridge JA, Paniello RC, Owzar K, McCall L, Chepeha DB, Yarbrough WG, Myers JN. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol 2010; 28:1395-400. [PMID: 20142602 DOI: 10.1200/jco.2008.20.8777] [Citation(s) in RCA: 243] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The validity of sentinel lymph node biopsy (SLNB) for T1 or T2, clinically N0, oral cancer was tested by correlation of sentinel node pathologic status with that of nodes within the completion neck dissection. METHODS This prospective, cooperative group trial involved 25 institutions over a 3-year period. One hundred forty patients with invasive oral cancers, stage T1 and T2, N0 including 95 cancers of the tongue, 26 of the floor of mouth, and 19 other oral cancers were studied. The study excluded lesions with diameter smaller than 6 mm or minimal invasion. Imaging was used to exclude nonpalpable gross nodal disease. Patients underwent injection of the lesion with (99m)Tc-sulfur colloid, nuclear imaging, narrow-exposure SLNB, and completion selective neck dissection. The major end point was the negative-predictive value (NPV) of SLNB. RESULTS In the 106 SLNBs, which were found to be pathologically and clinically node-negative by routine hematoxylin and eosin stain, 100 patients were found to have no other pathologically positive nodes, corresponding to a NPV of 94%. With additional sectioning and immunohistochemistry, NPV was improved to 96%. In the forty patients with proven cervical metastases, the true-positive rate was 90.2% and was superior for tongue tumors relative to floor of mouth. For T1 lesions, metastases were correctly identified in 100%. CONCLUSION For T1 or T2 N0 oral squamous cell carcinoma, SLNB with step sectioning and immunohistochemistry, performed by surgeons of mixed experience levels, correctly predicted a pathologically negative neck in 96% of patients (NPV, 96%).
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Yao M, Smith RB, Hoffman HT, Funk GF, Lu M, Menda Y, Graham MM, Buatti JM. Clinical Significance of Postradiotherapy [18F]-Fluorodeoxyglucose Positron Emission Tomography Imaging in Management of Head-and-Neck Cancer—A Long-Term Outcome Report. Int J Radiat Oncol Biol Phys 2009; 74:9-14. [DOI: 10.1016/j.ijrobp.2008.07.019] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 07/16/2008] [Accepted: 07/20/2008] [Indexed: 01/02/2023]
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Robey AB, Militsakh O, Smith RB. Endoscopic Coblation of Sinonasal Tumors. Laryngoscope 2009. [DOI: 10.1002/lary.21513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Andrews BT, Smith RB, Hoffman HT, Funk GF. Orocutaneous and Pharyngocutaneous Fistula Closure Using a Vacuum-Assisted Closure System. Ann Otol Rhinol Laryngol 2008; 117:298-302. [DOI: 10.1177/000348940811700410] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objectives: The vacuum-assisted closure (VAC) system is a topical negative pressure dressing that has been used extensively to manage a multitude of complicated wounds, including enterocutaneous fistula. We hypothesize that the VAC system may also facilitate the closure of orocutaneous and pharyngocutaneous fistulas. Methods: A retrospective chart review was performed. Results: Three patients were identified. Two patients developed fistulas after undergoing salvage laryngectomy, and 1 patient developed a fistula after having a hemiglossectomy defect reconstructed by a radial forearm free flap. The VAC system was successful in closing the fistula in 2 of the 3 patients. Complete fistula closure took 3 and 11 days in the 2 cases. The 1 failure of fistula closure was due to poor collapsibility of the neck tissue along the fistula tract caused by fibrosis following prior radiotherapy. Conclusions: The VAC system is a feasible treatment option for closing head and neck fistulas, especially when collapsible tissue is present at the fistula site.
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Spanos WC, Geiger J, Anderson ME, Harris GF, Bossler AD, Smith RB, Klingelhutz AJ, Lee JH. Deletion of the PDZ motif of HPV16 E6 preventing immortalization and anchorage-independent growth in human tonsil epithelial cells. Head Neck 2008; 30:139-47. [PMID: 17657785 PMCID: PMC2600880 DOI: 10.1002/hed.20673] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Human papillomavirus 16 (HPV16) has been associated with head and neck squamous cell carcinoma (HNSCC) in up to 60% of sampled specimens. METHODS To understand better the viral genes required to transform human tonsil epithelial cells (HTEC), we isolated HTEC's and transduced them with retroviral vectors containing HPV16 E6 and E7. RESULTS Immortalization and anchorage-independent growth of HTEC's only occurred with expression of E6 and E7 with resultant degradation of p53. However, cells expressing E6 lacking the PSD-95/disc-large/Zo-1 (PDZ) motif did not immortalize or grow anchorage independent. Telomerase activity and degradation of p53 were similar for wild-type and mutant E6. CONCLUSION The mechanism of oncogenic transformation by E6 in HTEC's is dependent on the PDZ binding motif. Identification of pathways affected by the interaction of E6 and PDZ domain containing proteins will further our understanding of how HPV causes HNSCC and will provide potential therapeutic targets.
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Affiliation(s)
- William C. Spanos
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa. E-mail:
| | - Jeremy Geiger
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa. E-mail:
| | - Mary E. Anderson
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa. E-mail:
| | - George F. Harris
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa. E-mail:
| | - Aaron D. Bossler
- Department of Pathology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Russell B. Smith
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa. E-mail:
| | - Aloysius J. Klingelhutz
- Department of Microbiology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - John H. Lee
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa. E-mail:
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Smith RB, Robinson RA, Hoffman HT, Graham MM. Preoperative FDG-PET imaging to assess the malignant potential of follicular neoplasms of the thyroid. Otolaryngol Head Neck Surg 2008; 138:101-6. [DOI: 10.1016/j.otohns.2007.09.008] [Citation(s) in RCA: 24] [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] [Received: 06/11/2007] [Revised: 08/29/2007] [Accepted: 09/07/2007] [Indexed: 11/28/2022]
Abstract
Objective When a fine needle aspiration biopsy of a thyroid nodule suggests follicular neoplasm, surgery is required for diagnosis. Establishing the diagnosis preoperatively would allow the patient to undergo the appropriate initial thyroidectomy. Preoper-ative [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging may be able to determine malignancy in follicular neoplasms. Study Design Prospective cases series. Subjects and Methods Twenty-three patients with a diagnosis of follicular neoplasm underwent presurgical FDG-PET at 60, 90, and 120 minutes after injection of fluorodeoxyglucose (F18). Thyroidectomy was performed with comparison of the histopathologic results with the FDG-PET results. Results There were 5 malignant conditions and 18 benign conditions identified with the standard uptake valve (SUV) ranging from 0.9 to 44.8. The follicular thyroid cancers that exhibited only capsular invasion had an average SUV of 3.1, whereas those with vascular invasion had an average SUV of 39.9. The SUV increased in 80% of the malignant cases but in only 50% of the benign cases. Conclusion Despite certain patterns being suggestive of malignancy, FDG-PET can not consistently predict the malignant potential of a follicular neoplasm.
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Affiliation(s)
- Russell B. Smith
- Department of Otolaryngology–Head and Neck Surgery, University of Nebraska, Omaha, NE, Omaha, NE
| | - Robert A. Robinson
- Department of Otolaryngology–Head and Neck Surgery, Pathology, Omaha, NE
| | - Henry T. Hoffman
- Department of Otolaryngology–Head and Neck Surgery, Omaha, NE
- Department of Otolaryngology–Head and Neck Surgery, Pathology, Omaha, NE
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Affiliation(s)
- Russell B Smith
- Department of Otolaryngology, University of Iowa, Iowa City, IA 52242, USA.
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Smith RB, Sniezek JC, Weed DT, Wax MK. Utilization of free tissue transfer in head and neck surgery. Otolaryngol Head Neck Surg 2007; 137:182-91. [PMID: 17666238 DOI: 10.1016/j.otohns.2007.04.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 03/19/2007] [Accepted: 04/18/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Free tissue transfer is frequently incorporated into the reconstructive algorithm for a multitude of defects in the head and neck. With the increasing usage of free tissue transfer we undertook to review the most current advances in the field. DATA SOURCES PubMed search of all pertinent articles as they related to oropharyngeal reconstruction, flap choice, new technologies and techniques, and outcomes. Articles were chosen based on reviewer selection. METHODS The microvascular committee met and discussed the current important topics in free tissue transfer. A priority list was created and ranked. Topics were assigned to the authors who conducted a narrative review of the literature. RESULTS Free tissue transfer has evolved to the point where a limited number of specific flaps are now utilized for most defects. Composite tissue is used to reconstruct composite defects. The coupling device and implantable Doppler are demonstrating a positive impact on flap survival and efficiency. Finally, outcomes in terms of quality of life, swallowing, and return to function have been shown to improve with the use of free tissue transfer. CONCLUSION Free tissue transfer continues to be the reconstructive modality of choice for head and neck defects.
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Affiliation(s)
- Russell B Smith
- Department of Otolaryngology--Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Buckwalter AE, Karnell LH, Smith RB, Christensen AJ, Funk GF. Patient-reported factors associated with discontinuing employment following head and neck cancer treatment. ACTA ACUST UNITED AC 2007; 133:464-70. [PMID: 17520760 DOI: 10.1001/archotol.133.5.464] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate patients' reported reasons for discontinuing employment following treatment for head and neck cancer (HNC). Discontinuing employment is a serious problem for patients with HNC and has an impact on many aspects of their lives. DESIGN Prospective, observational outcomes study. SETTING Tertiary care institution. PATIENTS A total of 666 patients with carcinomas of the head and neck who were treated from January 1, 1998, to October 31, 2004. INTERVENTIONS Patients provided information about the status of their employment at the time of diagnosis and then at 3, 6, 9, and 12 months after diagnosis. Patients who discontinued employment after treatment rated the importance of 5 factors (eating, speech, appearance, pain or discomfort, and fatigue) in that decision. MAIN OUTCOME MEASURES The 5 factors were scored on a 5-point Likert scale (5 being most important) as to their importance in the decision to discontinue work. The relationships of patient, disease, and treatment variables to employment status were evaluated. RESULTS Of the 666 patients, 239 were employed at the time of their diagnosis. After treatment, 91 (38.1%) of the 239 reported discontinuing work because of their cancer and treatment. Eighty-two (90.1%) of these 91 patients rated each of the 5 factors. Fatigue had the highest percentage (58.5%) of 4 or 5 ratings, followed by speech (51.2%), eating (45.1%), pain or discomfort (37.8%), and appearance (17.1%). Thirty-seven (40.7%) of the 91 patients who discontinued work returned to work within 1 year of treatment. CONCLUSION Identification of the factors associated with the decision to discontinue work is a first step in providing focused solutions to minimize disability.
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Affiliation(s)
- Andrea E Buckwalter
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The University of Iowa, Iowa City, IA 52242-1093, USA
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Yao M, Hoffman HT, Chang K, Funk GF, Smith RB, Tan H, Clamon GH, Dornfeld K, Buatti JM. Is planned neck dissection necessary for head and neck cancer after intensity-modulated radiotherapy? Int J Radiat Oncol Biol Phys 2007; 68:707-13. [PMID: 17379453 DOI: 10.1016/j.ijrobp.2006.12.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [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: 11/28/2006] [Revised: 12/28/2006] [Accepted: 12/28/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The objective of this study was to determine regional control of local regional advanced head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiotherapy (IMRT), along with the role and selection criteria for neck dissection after IMRT. METHODS AND MATERIALS A total of 90 patients with stage N2A or greater HNSCC were treated with definitive IMRT from December 1999 to July 2005. Three clinical target volumes were defined and were treated to 70 to 74 Gy, 60 Gy, and 54 Gy, respectively. Neck dissection was performed for selected patients after IMRT. Selection criteria evolved during this period with emphasis on post-IMRT [(18)F] fluorodeoxyglucose positron emission tomography in recent years. RESULTS Median follow-up for all patients was 29 months (range, 0.2-74 months). All living patients were followed at least 9 months after completing treatment. Thirteen patients underwent neck dissection after IMRT because of residual lymphadenopathy. Of these, 6 contained residual viable tumor. Three patients with persistent adenopathy did not undergo neck dissection: 2 refused and 1 had lung metastasis. Among the remaining 74 patients who were observed without neck dissection, there was only 1 case of regional failure. Among all 90 patients in this study, the 3-year local and regional control was 96.3% and 95.4%, respectively. CONCLUSIONS Appropriately delivered IMRT has excellent dose coverage for cervical lymph nodes. A high radiation dose can be safely delivered to the abnormal lymph nodes. There is a high complete response rate. Routine planned neck dissection for patients with N2A and higher stage after IMRT is not necessary. Post-IMRT [(18)F] fluorodeoxyglucose positron emission tomography is a useful tool in selecting patients appropriate for neck dissection.
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Affiliation(s)
- Min Yao
- Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Health Care, Iowa City, IA 52242, USA.
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Smith RB, Henstrom DK, Karnell LH, Chang KC, Goldstein DP, Funk GF. Scapula osteocutaneous free flap reconstruction of the head and neck: Impact of flap choice on surgical and medical complications. Head Neck 2007; 29:446-52. [PMID: 17163464 DOI: 10.1002/hed.20540] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The scapula osteocutaneous free flap is frequently used to reconstruct complex head and neck defects given its tissue versatility. Because of minimal atherosclerotic changes in its vascular pedicle, this flap also may be used as a second choice when other osseous flaps are not available because of vascular disease at a preferred donor site. METHODS We performed a retrospective chart review evaluating flap outcome as well as surgical and medical complications based upon the flap choice. RESULTS The flap survival rate was 97%. The surgical complication rate was similar for the 21 first-choice flaps (57.1%) and the 12 second-choice flaps (41.7%; p = .481). However, patients having second-choice flaps had a higher rate of medical complications (66.7%) than those with first-choice flaps (28.6%; p = .066). Age and the presence of comorbidities were associated with increased medical complications. All patients with comorbidities that had a second-choice flap experienced medical complications, with most being severe. CONCLUSIONS The scapula osteocutaneous free flap has a high success rate in head and neck reconstruction. Surgical complications occur frequently regardless of whether the flap is used as a first or second choice. However, medical complications are more frequent and severe in patients undergoing second-choice flaps.
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Affiliation(s)
- Russell B Smith
- Department of Otolaryngology/Head and Neck Surgery, University of Iowa, Iowa City, IA, USA.
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Yao M, Nguyen T, Buatti JM, Dornfeld KJ, Tan H, Wacha J, Bayouth JE, Clamon GH, Funk GF, Smith RB, Chang K, Hoffman HT. Changing Failure Patterns in Oropharyngeal Squamous Cell Carcinoma Treated With Intensity Modulated Radiotherapy and Implications for Future Research. Am J Clin Oncol 2006; 29:606-12. [PMID: 17148999 DOI: 10.1097/01.coc.0000242294.89536.d6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Review the University of Iowa experience with intensity modulated radiation treatment (IMRT) in oropharyngeal squamous cell carcinoma. METHODS From January 2000 to July 2004, 66 patients with oropharyngeal cancer were treated with IMRT, 62 with definitive IMRT and 4 postoperative IMRT. Three target volumes (CTV1, CTV2, and CTV3) were defined. The prescribed doses to CTV1, CTV2, and CTV3 were 70 to 74 Gy, 60 Gy, and 54 Gy, respectively, for definitive IMRT, and 60 to 66 Gy, 60 Gy, and 54 Gy, respectively, for postoperative IMRT. RESULTS Median follow-up was 27.3 months and all living patients had a follow-up of at least 11.5 months. The 3-year estimate of locoregional progression free survival was 98.8%. However, there is a high incidence of distant metastasis with a 3-year estimate of distant metastasis-free survival of 80.4%. In addition, there is a high incidence of second primary tumor. The 3-year overall survival and 3-year disease-free survival were 78.1% and 64.4%, respectively. Treatment was well tolerated with 1 death resulting from treatment toxicity. CONCLUSIONS IMRT offers an excellent locoregional control for oropharyngeal cancer patients. Failure patterns have changed with an increased portion of patients who failed distantly, either with metastasis or second primary tumor. Therefore, survival for these patients is still poor. Future research should focus on identifying patients at high risk of distant diseases and developing effective systemic treatment and prevention for distant diseases.
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Affiliation(s)
- Min Yao
- Department of Radiation Oncology, University of Iowa Health Care, Iowa City, IA, USA.
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Andrews BT, Smith RB, Chang KE, Scharpf J, Goldstein DP, Funk GF. Management of the Radial Forearm Free Flap Donor Site With the Vacuum-Assisted Closure (VAC) System. Laryngoscope 2006; 116:1918-22. [PMID: 17003705 DOI: 10.1097/01.mlg.0000235935.07261.98] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The radial forearm free flap is a popular reconstructive flap in modern head and neck surgery. Poor wound healing at the forearm donor site is common and frequently results in tendon exposure. The Vacuum-Assisted Closure (VAC) system (Kinetic Concepts Inc., San Antonio, TX) is a topical negative pressure dressing that has been shown to improve skin graft viability when used as a bolster dressing. In this study, we investigated the use of the VAC system in the management of the radial forearm free flap donor site. METHODS A retrospective chart review was performed on all subjects who underwent a radial forearm free flap reconstruction in which the VAC system was used as a bolster dressing at the donor site from January 1, 2003, through March 31, 2005. RESULTS Thirty-four consecutive subjects were included in the study. Exposed tendon did not occur in 14 (0%) subjects in which the VAC bolster was used for a minimum of 6 days. Eleven of the 20 subjects (55%) who used the VAC bolster for 5 days demonstrated small amounts of tendon exposure (<2 cm) on follow-up clinic examination. The minimum follow up for all subjects was 4 months. CONCLUSION This study demonstrates that the VAC system is a feasible alternative to conventional bolster dressing in the management of the radial forearm free flap skin-grafted donor site. Based on this study, when used for a minimum of 6 days, the VAC bolster dressing eliminated tendon exposure at the forearm donor site.
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Affiliation(s)
- Brian T Andrews
- University of Iowa College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Iowa City, Iowa, USA.
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Abstract
BACKGROUND The vacuum-assisted closure system (V.A.C.), or negative pressure dressings, has been successfully used to manage complex wounds of the torso and extremities, but its role in the head and neck region has not been frequently described. METHODS A retrospective study was performed. The V.A.C. system (Kinetic Concepts Inc., San Antonio, TX) was used at the University of Iowa Hospitals and Clinics for management of complicated head and neck wounds. RESULTS The V.A.C. system was utilized at 13 sites for 12 patients. Nine subjects had exposed calvarium (4 had failed pedicled reconstructive flaps, 3 had ablative or Moh's defects, and 2 had traumatic scalping injuries) necessitating bony coverage. Three subjects had the V.A.C. system used as a bolster dressing placed over split-thickness skin grafts (STSGs) used to reconstruct large defects of the face and skull, and 1 patient had a large soft tissue neck defect after radical surgical resection for necrotizing fascitis. One subject used the V.A.C. system for the management of 2 distinct wounds. All patients had successful healing of their wounds with the V.A.C. system without complication. All STSGs had 100% viability after 5 to 7 days of the V.A.C. system use as a bolster dressing. CONCLUSION This study demonstrates the V.A.C. system is a valuable tool in the management of complicated head and neck wounds.
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Affiliation(s)
- Brian T Andrews
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, 21200 Pomerantz Pavillion, 200 Hawkins Drive, Iowa City, Iowa 52242, USA.
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El-Deiry M, Funk GF, Nalwa S, Karnell LH, Smith RB, Buatti JM, Hoffman HT, Clamon GH, Graham SM, Trask DK, Dornfeld KJ, Yao M. Long-term Quality of Life for Surgical and Nonsurgical Treatment of Head and Neck Cancer. ACTA ACUST UNITED AC 2005; 131:879-85. [PMID: 16230590 DOI: 10.1001/archotol.131.10.879] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the long-term, health-related quality-of-life outcomes in patients with advanced head and neck cancer (HNC) treated with surgery and postoperative radiation therapy (SRT) or concurrent chemotherapy and radiation therapy (CRT). DESIGN Matched-pair study comparing patients with advanced HNC treated with SRT or CRT at least 12 months after treatment. Patients completed 2 validated surveys addressing HNC-specific outcomes and depressive symptoms and provided information on employment and tobacco and alcohol use. Results for the 2 groups were compared using paired-sample t test and chi2 analysis. SETTING University-based study. PATIENTS Patients with stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, and larynx who underwent SRT or received CRT. MAIN OUTCOME MEASURES Head and neck cancer-specific health-related quality of life from the Head and Neck Cancer Inventory and level of depressive symptoms from the Beck Depression Inventory. RESULTS The matching process resulted in 27 patients in each treatment group. The HNC-specific domain scores (with higher scores representing better outcomes) for CRT vs SRT were eating, 37.8 vs 40.8 (P = .69); speech, 65.1 vs 56.0 (P = .23); aesthetics, 80.3 vs 69.2 (P = .14); and social disruption, 69.7 vs 70.6 (P = .90). Overall health-related quality of life was 64.0 with SRT and 55.0 with CRT (P = .142). For the Beck Depression Inventory (with higher scores representing worse outcomes), patients who underwent SRT had a mean score of 9.6 compared with 11.6 for patients who received CRT (P = .42). CONCLUSION As nonsurgical means of treating HNC have become more aggressive and surgical techniques have become more focused on function preservation and rehabilitation, the overall health-related quality of life resulting from these different approaches is similar.
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Affiliation(s)
- Mark El-Deiry
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1093, USA
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Yao M, Dornfeld KJ, Buatti JM, Skwarchuk M, Tan H, Nguyen T, Wacha J, Bayouth JE, Funk GF, Smith RB, Graham SM, Chang K, Hoffman HT. Intensity-modulated radiation treatment for head-and-neck squamous cell carcinoma—the University of Iowa experience. Int J Radiat Oncol Biol Phys 2005; 63:410-21. [PMID: 16168834 DOI: 10.1016/j.ijrobp.2005.02.025] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [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: 12/17/2004] [Revised: 02/08/2005] [Accepted: 02/14/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To review the University of Iowa experience with intensity-modulated radiotherapy (IMRT) in the treatment of head-and-neck squamous cell carcinoma. METHODS AND MATERIALS From October 1999 to April 2004, 151 patients with head-and-neck squamous cell carcinoma were treated with IMRT for curative intent. One patient was lost to follow-up 2 months after treatment and therefore excluded from analysis. Of the remaining 150 patients, 99 were treated with definitive IMRT, and 51 received postoperative IMRT. Sites included were nasopharynx, 5; oropharynx, 56; larynx, 33; oral cavity, 29; hypopharynx, 8; nasal cavity/paranasal sinus, 8; and unknown primary, 11. None of the patients treated with postoperative IMRT received chemotherapy. Of 99 patients who had definitive IMRT, 68 patients received concurrent cisplatin-based chemotherapy. One patient received induction cisplatin-based chemotherapy, but no concurrent chemotherapy was given. Three clinical target volumes (CTV1, CTV2, and CTV3) were defined. The prescribed doses to CTV1, CTV2, and CTV3 in the definitive cohort were 70-74 Gy, 60 Gy, and 54 Gy, respectively. For high-risk postoperative IMRT, the prescribed doses to CTV1, CTV2, and CTV3 were 64-66 Gy, 60 Gy, and 54 Gy, respectively. For intermediate-risk postoperative IMRT, the prescribed doses to CTV1, CTV2, and CTV3 were 60 Gy, 60 Gy, and 54 Gy. RESULTS The median follow-up was 18 months (range, 2-60 months). All living patients were followed for at least 6 months. There were 11 local-regional failures: 7 local failures, 3 regional failures, and 1 failure both in the primary tumor and regional lymph node. There were 16 patients who failed distantly, either with distant metastasis or new lung primaries. The 2-year overall survival, local progression-free survival, locoregional progression-free survival, and distant disease-free survival rates were 85%, 94%, 92%, and 87%, respectively. The median time from treatment completion to local-regional recurrence was 4.7 months (range, 1.8 to 15.6 months). Only one marginal failure was noted in a patient who had extensive tonsil cancer with tumor extension into the orbit and cavernous sinus. Patients with oropharyngeal cancer did significantly better than patients with oral cavity and laryngeal cancer, with a 2-year local-regional control rate of 98%, compared with 78% for oral cavity cancer and 85% for laryngeal cancer (p = 0.005). There was no significant difference in local-regional control for patients who received postoperative radiation or definitive radiation (p = 0.339) and for patients who had chemotherapy or not (p = 0.402). Neither T stage nor N stage had a significant effect on local-regional control (p = 0.722 and 0.712, respectively). CONCLUSIONS Our results have confirmed the effectiveness of IMRT in head-and-neck cancer. It offers excellent outcomes in local-regional control and overall survival. More studies are necessary to further improve the outcomes of laryngeal cancer as well as oral cavity cancer.
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Affiliation(s)
- Min Yao
- Department of Radiation Oncology, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Smith RB. Concurrent chemoradiation as a treatment option for advanced-stage laryngeal cancers. Arch Otolaryngol Head Neck Surg 2005; 131:820. [PMID: 16172364 DOI: 10.1001/archotol.131.9.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Russell B Smith
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
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