Cumulative suppressive index as a predictor of relapse free survival and overall survival in Human Papilloma Virus‐negative oral squamous cell carcinomas with negative resection margins

xlomafota13 shared this article with you from Inoreader Cumulative suppressive index as a predictor of relapse free survival and overall survival in Human Papilloma Virus‐negative oral squamous cell carcinomas with negative resection margins Via Head & Neck Abstract Background This study aimed to analyze margin status and the impact of the immune elements on recurrence in patients with oral squamous cell carcinoma (OSCC), employing a prognostic biomarker, cumulative suppressive index (CSI), which reflects FoxP3+, PD‐L1+, and CD8+ cell spatial relationships in the tumor microenvironment. Methods Cox proportional hazards regression was used to evaluate the interactive effect of the margin by CSI discrepancy (high, 3‐4 vs low, 0‐2) on recurrence free survival (RFS) and overall survival (OS) in 119 patients with stage I to IVA OSCC. Results In cases with negative margins, multivariable analysis showed high CSI was significantly associated with worse RFS (HR = 2.59, 95% CI [1.03, 6.49], P = .04) and OS (HR = 5.49, 95% CI [1.48, 20.35], P = .01) compared to low CSI. However, high CSI was not significantly associated with recurrence in cases with positive margins. Conclusions Immune architecture analysis can augment our current histopathological risk assessment of margin status. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A prospective study of intraoperative assessment of mucosal squamous cell carcinoma margins in the head and neck

xlomafota13 shared this article with you from Inoreader A prospective study of intraoperative assessment of mucosal squamous cell carcinoma margins in the head and neck Via Head & Neck Abstract Background In head and neck cancers, tumor margin assessment has important prognostic and therapeutic implications. Frozen section control of margins is commonly employed intraoperatively. However, this is not without limitations. The aim of this study is to determine whether intraoperative slicing of the whole specimen is feasible and what impact this may have on tumor margin assessment and the requirement for postoperative radiotherapy. Methods From September 2016 to August 2018, we recruited 22 patients as a pilot study looking at both the practicalities and the clinical relevance of whole margin tumor analysis intraoperatively. Our project is a prospective single arm study with historical controls. Results Forty‐one percent of our patients required further intraoperative resection for close or involved margins. Seven of these patients who otherwise would have required adjuvant radiotherapy due to their margin status did not, after our intervention. Conclusions We found that although requiring resources, this process was feasible without unduly increasing operative times and with potential patient benefit including reduced incidence of adjuvant radiotherapy. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of treatment delay on survival of oral/oropharyngeal cancers: Results of a nationwide screening program

xlomafota13 shared this article with you from Inoreader Impact of treatment delay on survival of oral/oropharyngeal cancers: Results of a nationwide screening program Via Head & Neck Abstract Background To assess the impact of treatment delay on survival of oral/oropharyngeal cancer (OSCC). Methods We followed 5743 OSCCs between 2004 and 2009 from a population‐based screening program and ascertained death until the end of 2012. Results The hazard ratios (HRs) of mortality from OSCC were 1.46 (1.30‐1.65) and 1.18 (1.04‐1.33) in univariable and multivariable analyses, respectively, for treatment delay longer than 6 weeks compared with that shorter than 3 weeks. The corresponding figures were 1.12 (1.01‐1.24) and 1.00 (0.91‐1.11) for treatment delay between 3 and 6 weeks. Advancing age (1.01), higher stage (stage II: 1.84, stage III: 2.97, stage IV: 6.33), cancer in tongue (1.37), or hard palate (1.63) had higher HR of mortality (P < .05). However, treatment at medical center had a lower mortality (0.83, 0.75‐0.91) than local/regional hospital. Conclusions Treatment delay longer than 6 weeks for OSCCs detected via a population‐based screening program had unfavorable survival. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outpatient vs inpatient parotidectomy: Systematic review and meta‐analysis

xlomafota13 shared this article with you from Inoreader Outpatient vs inpatient parotidectomy: Systematic review and meta‐analysis Via Head & Neck Abstract The primary aim of this study was to conduct a systematic review and meta‐analysis to compare complications between outpatient vs inpatient parotidectomy. A systematic review was performed to identify patients undergoing either outpatient or inpatient partodiectomy, in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines, using PUBMED, SCOPUS, CINAHL, and the Cochrane library. Risk of bias was assessed using the Newcastle‐Ottawa Scale. Postoperative complications (hematoma, seroma/sialocele, salivary fistula formation, Frey syndrome, surgical site infection [SSI]) were compared. Our search yielded 4958 nonduplicate articles, of which 13 studies were ultimately included (11 retrospective cohort, 2 prospective cohort), encompassing a total of 1323 patients (outpatient 46.33% vs inpatient 53.67%). There was no significant difference in total complications, hematoma, seroma, salivary fistula, or SSI rates between outpatient and inpatient groups. No significant difference in total complications was found between outpatient and inpatient groups when stratified by surgical approach (partial/superficial and total parotidectomy). Our findings suggest outpatient parotidectomy may be as safe as inpatient parotidectomy in appropriately selected patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of human papillomavirus integration with better patient outcomes in oropharyngeal squamous cell carcinoma

xlomafota13 shared this article with you from Inoreader Association of human papillomavirus integration with better patient outcomes in oropharyngeal squamous cell carcinoma Via Head & Neck Abstract Background The molecular drivers of human papillomavirus‐related head and neck squamous cell carcinoma (HPV + HNSCC) are not entirely understood. This study evaluated the relationship between HPV integration, expression of E6/E7, and patient outcomes in p16+ HNSCCs. Methods HPV type was determined by HPV PCR‐MassArray, and integration was called using detection of integrated papillomavirus sequences polymerase chain reaction (PCR). We investigated whether fusion transcripts were produced by reverse transcriptase polymerase chain reaction (RT‐PCR). E6/E7 expression was assessed by quantitative RT‐PCR. We assessed if there was a relationship between integration and E6/E7 expression, clinical variables, or patient outcomes. Results Most samples demonstrated HPV integration, which sometimes resulted in a fusion transcript. HPV integration was positively correlated with age at diagnosis and E6/E7 expression. There was a significant difference in survival between patients with vs without integration. Conclusions Contrary to previous reports, HPV integration was associated with improved patient survival. Therefore, HPV integration may act as a molecular marker of good prognosis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Self‐reported medication adherence in differentiated thyroid cancer survivors: Role of illness perception and medication beliefs

xlomafota13 shared this article with you from Inoreader Self‐reported medication adherence in differentiated thyroid cancer survivors: Role of illness perception and medication beliefs Via Head & Neck Abstract Background To investigate medication adherence (MA) to Levothyroxine in differentiated thyroid cancer survivors and analyze the related factors for nonadherence. Methods The Medication Adherence Report Scale (MARS), Hospital Anxiety and Depression Scale (HAD), Brief Illness Perception Questionnaire (B‐IPQ), and Beliefs about Medicines Questionnaire (BMQ) were used to assess MA. Results Nonadherence was reported in 77 of 197 patients (39.1%). Socioeconomic status and education levels were found to be significantly related to MA. The HAD scores, all items of B‐IPQ, and BMQ were associated with MA and showed a correlation with the MARS scores. The primary predictors of MA were greater confidence in treatment modality (odds ratio [OR]: 0.48, 95% confidence interval (CI): 0.37‐0.63) and greater belief that the medication had minimal risk of harm (OR: 3.35, 95% CI: 1.50‐7.49). Conclusions Special attention should be paid to educational programs for differentiated thyroid carcinoma patients concerning the effectiveness and low risk of harm of medication in order to improve MA. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The importance of smoking status at diagnosis in human papillomavirus‐associated oropharyngeal cancer

xlomafota13 shared this article with you from Inoreader The importance of smoking status at diagnosis in human papillomavirus‐associated oropharyngeal cancer Via Head & Neck Abstract Background Smoking status at point of diagnosis is not used in defining risk groups for human papillomavirus (HPV)‐associated oropharyngeal cancer (OPC) despite its prognostic value in head and neck cancer. Methods Retrospective analysis of consecutive patients treated with chemoradiotherapy between January 2005 and July 2017 was performed with multivariable analysis to explore the impact of smoking status at diagnosis (current/former/never) on overall survival (OS), cancer‐specific survival (CSS) and progression‐free survival (PFS). Results Median follow‐up was 61 months. Four hundred and four patients were included. Current smokers had inferior OS versus never and former smokers [adjusted HR 2.37 (95% CI 1.26–4.45, p < 0.01) and 2.58 (95% CI 1.40–4.73, p < 0.01), respectively] and inferior PFS versus never smokers [adjusted HR 1.83 (95% CI 1.00–3.35, p = 0.04)]. Smoking status did not predict for CSS. Conclusion Detailed smoking behavior should be considered in refining risk groups in HPV‐associated OPC treated with radiotherapy and in future trial design eligibility and stratification. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Role of the temporoparietal fascia free flap in salvage total laryngectomy

xlomafota13 shared this article with you from Inoreader Role of the temporoparietal fascia free flap in salvage total laryngectomy Via Head & Neck Abstract The procedure for salvage total laryngectomy (STL) is burdened by a high rate of postoperative complications as a result of delayed wound healing in previously irradiated tissue. Several observational studies have investigated the role of prophylactic vascularized flaps to aid pharyngeal closure after STL and prevent the development of PCF. The use of a temporoparietal fascia free flap (TFFF) as an overlay flap for STL has been described previously in two published studies and both sets of authors agreed that the most obvious benefit of the TFFF in STL is a reduced PCF rate with low site morbidity and good functional outcomes. The aim of this video is to illustrate the use of the temporoparietal fascia flap to provide an adjunctive reinforcement layer in the reconstruction of the pharynx. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Middle turbinate mucosal flap: A low‐morbidity option in the management of skull base defects

xlomafota13 shared this article with you from Inoreader Middle turbinate mucosal flap: A low‐morbidity option in the management of skull base defects Via Head & Neck Abstract Background To describe the low morbidity of middle turbinate mucosal flap (MTMF) to repair anterior skull base defects. Methods Skull base endonasal endoscopic surgeries performed at a tertiary hospital between 2015 and 2018 were analyzed. Patients were divided into two groups according the existence or not of a significant intraoperative cerebrospinal fluid (CSF) leak. In Group 1 (n = 28), gasket seal and a pedicled endonasal flap were used to repair the defect: 13 nasoseptal flaps (NSF), 8 inferolateral wall flaps (ILF), and 7 MTMF. In Group 2 only an endonasal flap was used: 9 NSF, 4 ILF, and 18 MTMF. Surgical and recovery time were analyzed (Student's t test). Our favorite surgical technique is described. Results Fifty‐nine patients were included. Average surgical time was 27.7, 41.6, and 11.3 min for NSF, ILF, and MTMF, respectively. MTMF showed a faster recovery. Conclusion MTMF is a safe reconstructive option for anterior skull base defects. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

What is the best method for prevention of postparotidectomy Frey syndrome?

xlomafota13 shared this article with you from Inoreader What is the best method for prevention of postparotidectomy Frey syndrome? Network meta‐analysis Via Head & Neck Abstract Background Prevention of Frey syndrome (FS) after parotidectomy using an interposition barrier has long been gaining a wide popularity; however, there is no clear evidence regarding which preventive technique is more effective. The aim of this network meta‐analysis (NMA) is to answer the question: What is the best method for prevention of FS after parotidectomy? Methods A comprehensive search of the PubMed, Embase, SCOPUS, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of subjective Frey syndrome (SFS) and objective Frey syndrome (OFS). The Bayesian NMA accompanied with a random effects model and 95% credible intervals (CrIs) were calculated using GeMTC R package. Results Thirty‐four studies (n = 2987 patients) with five interventions, namely Alloderm (ADM), temporoparietal fascia (TPF), sternocleidomastoid muscle (SCM), superficial musculoaponeurotic system (SMAS), and free fat graft (FFG), were compared together and with no interposition barrier (NB). The results of NMA showed a statistically significant reduction in both SFS and OFS when ADM, TPF, SMAS, FFG, and SCM were compared with NB. No statistical differences were observed when comparing ADM, SCM, SMAS, FFG, and TPF. TPF ranked the best of all treatments (59.4%) and was associated with the least incidence of SFS; whereas ADM ranked the best of all treatments (61.1%) and was associated with the least incidence of OFS. Conclusions All interventions (TPF flap, ADM, FFG, SMAS, and SCM) were associated with a significant reduction in the incidence of FS when compared with NB. TPF and ADM showed the best outcome with the least incidence of SFS and OFS, respectively. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laryngeal soft tissue sarcoma

xlomafota13 shared this article with you from Inoreader Laryngeal soft tissue sarcoma: A systematic review and individual patient data analysis of 300 cases Via Head & Neck Abstract Background Laryngeal sarcoma is rare. We performed a systematic review and individual patient analysis to evaluate the patterns of care, prognostic factors, and role of radiotherapy in laryngeal soft tissue sarcoma. Methods A systematic search on PubMed and Google scholar was done. An individual patient data analysis was done. Results Of the 300 cases of laryngeal sarcoma, 80% underwent surgery. 44% underwent larynx preservation surgery and 25% received radiotherapy with surgery. Median progression free survival (PFS) was 48 months and overall survival (OS) of 224 months for the entire cohort. Patients with large primary, cartilage invasion, and positive margins had numerically worse PFS. Cartilage invasion and primary tumor size >3 cm were the most common risk factors for adjuvant radiation therapy. Patients receiving radiotherapy were not associated with better survival. Conclusion Laryngeal sarcoma associated with a good survival. Larynx preservation surgery is feasible in nearly half patients. Adjuvant radiotherapy may be warranted in patients poor prognostic factors. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Dental radiation dosimetric maps from intensity‐modulated radiation therapy planning for head and neck cancers

xlomafota13 shared this article with you from Inoreader Dental radiation dosimetric maps from intensity‐modulated radiation therapy planning for head and neck cancers Via Head & Neck Abstract Background The purpose of this study was to create dental radiation maps to calculate the mean dose to individual teeth, maxilla and mandible using intensity‐modulated radiation therapy (IMRT). Methods Eighteen common clinical settings were chosen. Radiation plans were extracted, and each tooth was contoured at its junction with the gingiva and labeled based on the Universal/American numbering system. Results All patients were treated with prescribed doses of 50–70 Gy in 1.66–2 Gy/fraction. Patients receiving mean doses >50 Gy to the teeth, mandible, and maxilla included those with advanced tumors of the oral cavity and gross lymphadenopathy of level 1b. Conclusion We believe this to be the first study generating dosimetric maps of estimated doses to each tooth and each third of the mandible and the maxilla for common examples of head and neck cancer faced by radiation oncologists. Adoption of these dental maps may help improve clinical workflow efficiency. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.