| REVIEW ARTICLE | ||
Treatment of advanced nonsmall cell lung cancer: First line, maintenance and second line – Indian consensus statement update  | p. 1 | |
| Kumar Prabhash DOI:10.4103/sajc.sajc_227_18 The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming increasingly complex with the identification of driver mutations/rearrangements and development/availability of appropriate targeted therapies. In 2017, an expert group of medical oncologists with expertise in treating lung cancer used data from published literature and experience to arrive at practical consensus recommendations on treatment of advanced NSCLC for use by the community oncologists. This was published subsequently in the Indian Journal of Cancer with a plan to be updated annually. The present document is an update to the 2017 document. | ||
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| ORIGINAL ARTICLES: BREAST CANCER |  | |
  | Stromal expression of CD10 in breast carcinoma and its correlation with clinicopathological parameters | p. 18 |
| Ashish Nitin Dhande, Siddhi Gaurish Sinai Khandeparkar, Avinash R Joshi, Maithili Mandar Kulkarni, Nidhi Pandya, Neelam Mohanapure, Aakriti Aggarwal, Gargi Patil DOI:10.4103/sajc.sajc_56_18 Introduction: Breast cancer is the foremost cause of death in women worldwide with more than one million cases occurring annually. Aim: This study was conducted to study the stromal CD10 expression in breast carcinomas (BCa) and its correlation with various prognostic factors such as tumor size, histological grade, lymph node status, estrogen receptor (ER), progesterone receptor (PR), HER2neu, and Ki67 status. Materials and Methods: Sixty cases of BCa diagnosed between 2013 and 2015 were included in the study. Stromal expression of CD10 was studied on entire section of selected BCa blocks for all cases. A technique of manual tissue microarray was employed for the analysis of expression of immunohistochemical markers ER, PR, and HER2/Neu and Ki67 in all cases. Results were subjected to statistical analysis. Results: Stromal CD10 positivity was seen in 78.3% cases, out of which 53.3% of cases were strongly positive, and 25.0% cases were weakly positive. Positivity for ER, PR, HER2, and Ki67 was 31.7%, 33.3%, 65%, and 75%, respectively. Stromal expression of CD10 was found to be significantly associated with increasing tumor grade, lymph node status, HER2neu positivity, ER negativity, and Ki67 positivity. CD10 stromal expression was seen mainly in PR negative BCa cases; however, it was statistically insignificant. It was noted that CD10 stromal positivity increased with increasing grade. Conclusion: CD10 can be used as an independent prognostic marker and should be included in routine histopathology report. CD10 could act as a potential target for newer drug development. | ||
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| ORIGINAL ARTICLES: GI CANCER | | |
 | Practice patterns and outcomes with the use of regorafenib in metastatic colorectal cancer: Results from the Regorafenib in Metastatic colorectal cancer - An Indian exploratory analysis study | p. 22 |
| Anant Ramaswamy, Vikas Ostwal, Nikhil Pande, Atul Sharma, Shekar Patil, Ravi Thippeswamy, Nikhil Ghadyalpatil, Rakesh Roy, Harish Peshwe, Bhavesh Poladia, Deepan Rajamanickam, Bharat Rangarajan, PR Neelesh Reddy, Vimal Pandita, Ashis Mukherjee, Aniket Thoke, Abhijit Sarkar, CT Satish, H Shashidara, SD Banavali DOI:10.4103/sajc.sajc_173_18 Background: Regorafenib is considered a standard of care as third-line therapy in metastatic colorectal cancers (mCRCs). Materials and Methods: The study was based on a computerized clinical data form sent to oncologists across the country for entry of anonymized patient data. The data entry form was conceived and generated by the coordinating center's (Tata Memorial Hospital) gastrointestinal medical oncologists and disseminated through personal contacts at academic conferences as well as through E-mail to various oncologists across India. Results: A total of 19 physicians contributed data resulting in 80 patients receiving regorafenib who were available for the evaluation of practice patterns. The median age was 55 years (range: 24–75). Majority had received oxaliplatin-based (97.5%), irinotecan-based (87.5%), and targeted therapy (65%), previously. Patients were primarily started on reduced doses of regorafenib upfront (160 mg – 28.8%, 120 mg – 58.8%, and 80 mg – 12.5%). The median duration of treatment (treatment duration) with regorafenib was 3.1 months (range: 0.5–18), while the median progression free survival was 3.48 months (range: 2.6–4.3). Forty-five percent of patients required dose modifications due to toxicities, and the most common were (all grades) hand-foot syndrome (68.8%), fatigue (46.3%), mucositis (37.6%), and diarrhea (31.3%). Conclusions: Majority of physicians in this collaborative study from India used a lower dose of regorafenib at the outset in patients with mCRC. Despite a lower dose, there was a significant requirement for dose reduction. Duration of treatment with regorafenib as an efficacy end point in this study is similar to available data from other regions as it is the side effect profile. | ||
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 | Pressurized intraperitoneal aerosol chemotherapy procedure for nonresectable peritoneal carcinomatosis: First Indian study | p. 27 |
| SP Somashekhar, KR Ashwin, Rohit C Kumar, Amit Rauthan, Sushmita H Rakshit DOI:10.4103/sajc.sajc_92_18 Background: Peritoneal carcinomatosis (PC) is a common evolution of abdominal cancers and is associated with poor prognosis. A few selected patients have option of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, but majority who are not eligible for curative approach can undergo pressurized intraperitoneal aerosol chemotherapy (PIPAC). It is an emerging field of research with major therapeutic potential. It is a safe and innovative approach, which enhances the effect of chemotherapy without major toxicity. Methods: Between June 2017 and December 2017, 21 PIPAC applications in seven patients with standard chemotherapy regimen every 6 weeks at 37°C and 12 mmHg for 30 min was performed. The patients' demographics, perioperative findings, adverse events, and outcomes were prospectively recorded. Results: Twenty-one PIPAC administrations were performed in 7 patients with PC from various pathologies. The median hospital stay was 1 day. All the patients had symptomatic relief with complete resolution of ascites. There was no major perioperative complications. CTCAE Grades 1 and 2 were observed in three patients, for abdominal pain and nausea. Renal and hepatic functions were not impaired. Of the seven patients, one patient had complete histological remission; three patients had partial response, one had stable disease and one patient had no response with clinical progression. Conclusion: Our results show the feasibility and safety of PIPAC in Indian patients. The procedure has low morbidity with no mortality with the short learning curve. It can be easily adapted for Indian patients with diffuse PC as a palliative option apart from systemic chemotherapy. | ||
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 | Transarterial radioembolization with Iodine-131-Lipiodol for hepatic metastases from gastrointestinal malignancies – Experience in tertiary care oncology center in India | p. 31 |
| Vidya Bhargavi, Indusekhar Subbanna, KG Kallur, Aakash Patel, Shivakumar Swamy, Shekar Patil DOI:10.4103/sajc.sajc_205_17 Context: Unresectable colorectal hepatic metastases can be treated with radioembolization. Aims: The aim of this study is to analyze the response and survival benefits of transarterial radioembolization (TARE) with Iodine-131 (131I) Lipiodol for hepatic metastases from gastrointestinal malignancies. Settings and Design:Retrospective study of 20 patients with pathologically proven hepatic metastases from primary gastrointestinal malignancies referred for palliative therapy with TARE. Subjects and Methods: At baseline, standard laboratory and imaging data were recorded. All patients fulfilling the inclusion/exclusion criteria underwent TARE with 131I Lipiodol. Post procedure, the patients were reviewed after 1 month with follow-up positron emission tomography–computed tomography and tumor marker levels to evaluate treatment response with continued follow-up till December 2016 and overall survival calculated. Statistical Analysis Used: Data were analyzed using a statistical analysis package (Social sciences, version 15.0 for Windows; SSPS Inc.). Survival data were plotted using Kaplan–Meier survival curves. Results: At the end of follow-up period, 15 of 20 patients were alive. The mean and median survival was 38.88 ± 5.0 months (95% confidence interval [CI], 29.03–48.74 months, P = 0.17) and 49.3 ± 12.4 months (95% CI, 25.0–73.7 months, P = 0.17), respectively. 66 months survival was 75%. Response evaluation in 10 patients showed partial response in 3 (30%), stable disease in 2 (20%) and progressive disease in 5 (50%) patients. All patients with partial response showed a reduction in serum tumor marker levels. Conclusions: TARE with 131I-Lipiodol is highly effective with a significant survival benefit in refractory cases of hepatic metastases from gastrointestinal malignancies. | ||
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| ORIGINAL ARTICLE: GENITOURINARY CANCERS | | |
 | A retrospective analysis of the pattern of care and survival in patients with malignant ovarian germ cell tumors | p. 35 |
| Reshu Agarwal, Anupama Rajanbabu, Pavithran Keechilattu, Indu R Nair, DK Vijaykumar, UG Unnikrishnan DOI:10.4103/sajc.sajc_6_18 Objective: The objective of this study is to evaluate the pattern of care and survival outcome in patients with malignant ovarian germ cell tumors (MOGCTs). Materials and Methods: Between January 2004 and August 2017, 50 patients with MOGCT were identified at Amrita Institute of Medical Sciences and 48 included in analyses. Histologic subtypes were as follows: dysgerminoma 11; immature teratoma 16; yolk sac tumor 3; and mixed germ cell tumor 18. 31 (64.6% patients belonged to Stage I and 17 (35.4%) patients were advanced stage (Stage II-IV). Results: Median follow-up period was 34 months (range: 1–241 months). The 5- and 10-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 87.5% and 94.4%, respectively. DFS and OS of incomplete surgery Stage I patients 28.6% and 68.6%, respectively, were significantly lower than completely staged patients 100%. Out of 8 incomplete surgery patients, 5 recurred of which 2 died of disease within 4 and 9 months of recurrence. There was no survival difference with comprehensive surgical staging (CSS) and pediatric surgical staging (PSS) in Stage I MOGCT (DFS and OS 100%). Stage I dysgerminoma kept on active surveillance after PSS had equivalent survival of 100%. There was no survival difference in advanced stage MOGCT treated with primary debulking surgery and neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery (DFS and OS 100%). Conclusion:Incomplete surgery in Stage I MOGCT was associated with poor survival. There was no survival difference with CSS and PSS. NAC followed by surgery could be a reasonable option for patients of advanced stage MOGCT. | ||
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| ORIGINAL ARTICLE: GYNAECOLOGIC CANCERS | | |
 | Conventional radiotherapy and intensity-modulated radiotherapy in carcinoma vulva: An experience from a tertiary medical center of India | p. 41 |
| Koustav Mazumder, Arun Elangovan, Bhavana Rai, Vanita Suri, Vanita Jain, Jaswinder Kalra, Sushmita Ghoshal DOI:10.4103/sajc.sajc_66_17 Context: Vulvar cancer is one of the uncommon gynecological malignancies. Multimodality treatment with surgery, radiotherapy, and chemotherapy are required for treatment of the disease. Aims: The aim of the study was to evaluate clinical outcome in patients of carcinoma vulva, treated at our institution. Subjects and Methods: This was a retrospective-cohort study done in 50 patients with squamous cell carcinoma of the vulva, treated at our institution from January 2008 to December 2014. Data were analyzed on the basis of age, stage, type of treatment received, and treatment-related toxicity. Disease-free survival and overall survival were estimated. Statistical Analysis Used: Kaplan–Meier survival analysis and Chi-square test were used for statistical analysis. Results: Majority of the patients (52%) had presented with Stage III disease. Thirty-six of 50 patients underwent surgery: simple vulvectomy – 2, radical vulvectomy – 34, bilateral inguinal lymph node dissection was done in 32 patients, and 1 patient underwent ipsilateral-inguinal lymph node dissection. Among 40 patients who received radiotherapy and eight patients received palliative radiotherapy. Seventeen patients underwent intensity-modulated radiotherapy (IMRT) and 15 patients received conventional radiotherapy. Significantly less Grade 2 or more skin toxicity (P = 0.003) observed in patients who underwent IMRT. Among non-IMRT group, eight patients required treatment break during radiation. At a median follow-up time of 25.5 months, median overall survival was 31 months and median disease-free survival was 25 months. About 42% patients were alive and free of disease at last follow-up. Conclusions:Modified radical vulvectomy with inguinal lymph node dissection followed by radiotherapy is the mainstay of management of locally advanced carcinoma vulva. Using IMRT, we could minimize the treatment related radiation toxicity and treatment breaks. | ||
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| ORIGINAL ARTICLES: HEAD AND NECK CANCER | | |
 | Squamous cell carcinoma of upper alveolus: An experience of a tertiary care center of Northeast India | p. 44 |
| Nizara Baishya, Tashnin Rahman, Ashok Kumar Das, Chandi Ram Kalita, Jagannath Dev Sharma, Manigreeva Krishnatreya, Amal Chandra Kataki DOI:10.4103/sajc.sajc_66_18 Objective: The main objective of this study was to analyze the clinical behavior and the impact of nodal metastasis on the prognosis of upper alveolus squamous cell carcinoma (SCC). Materials and Methods: The medical records of 110 patients with SCC of the upper alveolus (International Classification of Diseases-10-C03.0) diagnosed during 2010–2015 were reviewed. Survival analysis was done using the Kaplan–Meier method and was compared using log rank-test. P < 0.05 was considered statistically significant. Results: Of the 110 patients, 59 were males and 51 were females. Forty-six (41.8%) patients presented with lymph node metastasis. Fifty-three (51.8%) patients presented in Stage IVA, thirty (27.3%) patients in Stage IVB, ten (9.1%) patients in Stage III, 12 (10.9%) patients in Stage II. The 5-year overall survival (OS) was 71.1% in Stage II, in Stage III it was 65.6%, in Stage it was IVA 56.7%, and in Stage IVB it was 19.4% (P = 0.02). The 5-year OS for node negative compared with node positive was 66.3% versus 37.3%, respectively (P = 0.019).Conclusion: Presence of lymph node metastasis is associated with lower survival rates. Adequate surgical resection with adjuvant treatment, where necessary, offers the best chance of disease control. | ||
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 | A comparative study of treatment outcome in younger and older patients with locally advanced oral cavity and oropharyngeal cancers treated by chemoradiation | p. 47 |
| Rituparna Biswas, Anirban Halder, Anshuman Ghosh, Sajal Kumar Ghosh DOI:10.4103/sajc.sajc_7_18 Background: Evidence suggests that older patients with oral cavity and oropharyngeal cancers may behave differently from their younger peers. Aim: The aim of this study is to determine if there is difference in responses, survival, and toxicities between young patients (≤40 years of age) with oral cavity and oropharyngeal cancers and older patients (>40 years of age) treated with concurrent chemoradiation. Materials and Methods: Sixty-one patients with unresectable, locally advanced oral cavity and oropharyngeal cancers received concomitant chemoradiation to a dose of 70 Gray in 35 fractions over 7 weeks with concomitant weekly cisplatin (40 mg/m2). These patients were then distributed in two arms. Arm-A patients having age ≤40 years and Arm-B patients having age >40 years, and the two arms were assessed for treatment outcome. Results: The overall response rate (complete responders + partial responders) evaluated using response evaluation criteria in solid tumors criteria version 1.1 was equivalent in both groups (80.76% in Arm-A and 74.28% in Arm-B; P = 0.93). Older patients (>40 years) experienced more acute mucositis and xerostomia (P < 0.5); although not statistically significant, more acute skin and pharynx toxicities were also observed in this group. Higher late salivary gland toxicity (P < 0.5) was also seen in older patients; however, disease-free survival and progression-free survival were found to be similar in both groups. Conclusions:Older patients with locally advanced oral cavity and oropharyngeal cancers have similar response rates and survival as compared to their younger counterparts but may experience higher treatment-related toxicities. | ||
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 | Safety and efficacy of nimotuzumab with concurrent chemoradiotherapy in unresectable locally advanced squamous cell carcinoma of head and neck: An Indian rural hospital experience | p. 52 |
| Shyamji Rawat, Hemu Tandan, Sanandan Patel, Sameer Chaudhari DOI:10.4103/sajc.sajc_76_18 Context: Nimotuzumab is the only anti-epidermal growth factor receptor monoclonal antibody which can be safely added to concurrent chemoradiotherapy (CRT) to improve efficacy in the management of unresectable, locally advanced squamous cell carcinoma of head and neck (LA-SCCHN). However, the evidence available on this is limited. Aims: We retrospectively investigated efficacy and safety of nimotuzumab when combined with chemoradiation for LA-SCCHN. Settings and Design: Hospital records of 39 patients from January 2012 to December 2016 diagnosed with locally advanced (Stage III-IVb), unresectable SCCHN, and treated with concurrent CRT with weekly nimotuzumab were reviewed retrospectively after fulfilling the inclusion/exclusion criteria. Subjects and Methods: Tumor response was calculated as per response evaluation criteria in solid tumors criteria 1.1. Association of tumor response with independent variables was assessed. Overall survival (OS) and progression-free survival (PFS) were calculated. All patients were assessed for toxicity as per common terminology criteria for adverse events Common Terminology Criteria for Adverse Events v 4.0 (U.S. Department of health and human services, National Institutes of Health, National Cancer Institute). Results:At 6 months after completion of treatment, objective response rate was 97.44% with 26 (66.67%) patients attaining Complete response (CR), 12 (30.77%) patients with Partial response (PR), and one patient (2.56%) had stable disease. Subgroup analysis did not show a significant association of tumor response with independent factors. OS at 1 and 2-year was 100% and 72.9%, while PFS at 1 and 2-year was 87% and 54.40%. The incidence of Grade I, II, III, and IV toxicity was 30%, 18.18%, 41.82%, and 10%, respectively. No grade V toxicity was observed. Common adverse events observed were mucositis (33.64%), skin reaction (24.55%), neutropenia (20.91%), vomiting (18.18%), and diarrhea (2.73%). Conclusions: Nimotuzumab is an efficacious and safe option when added to concurrent CRT in unresectable, LA-SCCHN. | ||
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| ORIGINAL ARTICLES: HEMATOLYMPHOID MALIGNANCIES | | |
 | Primary gastrointestinal diffuse large B-cell lymphoma: A prospective study from South India | p. 57 |
| Babu Suresh, Vikas Asati, KC Lakshmaiah, Govind Babu, D Lokanatha, Linu Abraham Jacob, KN Lokesh, AH Rudresh, LK Rajeev, Saldanha Smitha, Abhishek Anand, Rajesh Patidar, CS Premalata DOI:10.4103/sajc.sajc_52_18 Background: Gastrointestinal tract (GIT) is the most common extranodal site for non-Hodgkin's lymphoma (NHL) and constitutes about 10%-15% of all NHL. This was a prospective study to evaluate the epidemiological, clinicopathological characteristics, and treatment outcome of primary GIT diffuse large B-cell lymphoma (PGIL). Materials and Methods: Newly diagnosed patients of PGIL with DLBCL histology were eligible. Lugano staging system was used. All patients were treated with prephase treatment (1 mg vincristine and 100 mg prednisolone) followed by CHOP-based chemotherapy (with or without rituximab) as definitive treatment. Results: A total of 21 patients of PGIL were diagnosed. The median age was 46 years (range: 27–69 years) with male:female ratio of 2:1. Dull aching abdominal pain was the most common presenting complaint. Stomach was the most common site involved (52.4%, n = 11) followed by the colon (23.8%, n = 5). The estimated median survival in patients with Stage IV disease was significantly lower as compared to patients with localized disease (Stage I and II) (6.23 months vs. 23.4 months; P = 0.04). Patients, who did not achieve complete response (CR), had 15.5 times higher risk of death, as compared to those who achieved CR (P = 0.01). Conclusions: Stomach was the most common site for PGIL. Localized disease and CR after first-line chemotherapy were associated with better survival. A higher cost of rituximab was the prohibitive factor for cure in these patients. | ||
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 | Role of CD138, CD56, and light chain immunohistochemistry in suspected and diagnosed plasma cell myeloma: A prospective study | p. 60 |
| Jasmita Dass, Sudheer Arava, Pravas Chandra Mishra, Amit Kumar Dinda, Hara Prasad Pati DOI:10.4103/sajc.sajc_64_17 Introduction: Plasma cells (PCs) have conventionally been counted on the bone marrow aspirate, and small focal involvement may be missed even on bone marrow biopsy sections. Material and Methods: We aimed to study the role of CD138, CD56, anti-κ, and anti-λ immunohistochemistry (IHC) to separate PC myeloma from reactive plasmacytosis and to study the utility of these in cases suspected as myelomas and lacking >10% PCs on bone marrow aspirate. The study comprised 35 diagnosed myelomas, 20 reactive plasmacytosis, and 19 M-band positive suspected myelomas. CD138 IHC was performed on all cases along with CD56, anti-κ, and anti-λ IHC. PCs were counted on CD138-immunostained sections by manual count and by image analysis. In addition, CD56 expression was correlated with clinical features in diagnosed myeloma group. Results: In all cases, both manual counts and image analysis, PC counts were significantly higher on the CD138 stained sections than bone marrow aspirates. It was seen that the manual PC counts and image analysis counts were equivalent in diagnosed myeloma cases. CD56 expression was seen in ~62.85% diagnosed myeloma cases while it was negative in cases of reactive plasmacytosis. CD56 expression was significantly higher in patients with lytic lesions (78.26% vs. 21.74%). CD138, anti-κ, and anti-λ IHC also helped classify 11/19 (57.8%) cases correctly. Conclusion: The use of CD138 along with the light chain and CD56 IHC adds a high diagnostic value in myeloma patients and suspected myeloma cases. The PCs can be counted manually on the CD138-immunostained sections and correlate well with the counts obtained by image analysis. | ||
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| ORIGINAL ARTICLE: IMMUNO ONCOLOGY | | |
 | Immune checkpoint inhibitors: Real-world experience from india in advanced solid cancers that have progressed on chemotherapy | p. 65 |
| Vineet Govinda Gupta, Ranga Rao Rangaraju, Waseem Abbas, Peush Bajpai, Ruchika Khetrapal DOI:10.4103/sajc.sajc_167_18 Context: The immune checkpoint inhibitors (ICIs) nivolumab and pembrolizumab have shown dramatic efficacy with low toxicity in international studies of advanced solid cancers. No published Indian experience with ICIs exist other than isolated case reports. Aims: The aim of this study is to evaluate real-world data about the efficacy and toxicity of ICIs in advanced solid cancers among Indian patients who have progressed on one or more prior lines of chemotherapy. Materials and Methods: All patients with advanced solid cancers who received ICIs after the failure of chemotherapy at our center were retrospectively assessed. Information about efficacy and toxicity was collected and analyzed. Results: The present study included 24 patients who had received ICIs for indications including non-small cell lung, bladder, head and neck, gastrointestinal, and unknown primary cancer. Patients had received a median of two prior lines of chemotherapy (range 1–5). Grade III or higher toxicity was seen in 8% of patients. Clinical benefit at 3 months was realized in 33% of evaluable patients. Twenty-six percentages of evaluable patients achieved a response, including one patient who achieved a complete response that is ongoing at 18 months. Median progression-free survival was 3 months, and median overall survival was 8 months at a median follow-up of 10 months. Among patients who achieved clinical benefit, the majority (84%) have an ongoing response at the time of data cutoff. Conclusions: Efficacy and toxicity of ICIs in the Indian population are similar to the experience seen in large international cohorts, and Indian oncologists may feel reassured using these agents in similar settings. | ||
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| ORIGINAL ARTICLE: SARCOMAS | | |
 | Multimodality treatment of head-and-neck soft-tissue sarcomas and short-term outcomes: Analysis from sarcoma medical oncology clinic | p. 69 |
| Ilavarasi Vanidassane, Aparna Sharma, Aditi Aggarwal, Sudhakar Gunasekar, Adarsh Barwad, Ekta Dhamija, Rambha Pandey, Suryanarayana Deo, Rakesh Garg, Sameer Rastogi DOI:10.4103/sajc.sajc_229_18 Background: Head-and-neck soft-tissue sarcomas (HNSTS) are extremely rare and lack definite guidelines. Methods: We retrospectively analyzed consecutive adult patients with HNSTS who presented to our sarcoma medical oncology clinic from January 2016 to October 2017. Results: There were a total of 30 patients. Unresectable localized disease was seen in 13 (43%) patients, metastatic disease 10 (34%) patients, while resectable disease in 7 (23%) patients only. Among unresectable localized disease, 3 (25%) patients could be converted to resectable disease after neoadjuvant therapy. Median follow period was 11 months. Progression-free survival was 19 months in patients with resectable disease and 6 months in patients with the unresectable/metastatic disease. Median OS was not reached. Conclusion: Unresectable HNSTS has a poor outcome. Neoadjuvant therapy can be tried in selected cases for achieving respectability or for vital organ preservation until robust data are available. A multidisciplinary approach for local control is crucial in managing unresectable HNSTS. | ||
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| LETTERS TO THE EDITOR | | |
 | Giant solitary fibrous tumor: A rare case report | |
| Sanjay Sharma, Prriya Eshpuniyani, Kirti Bhushan, Kanishka Gautam Siddharth, Sameer Pathan DOI:10.4103/sajc.sajc_204_18 | ||
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 | Mucosal melanoma of the head-and-neck region: A single institutional clinical experience | |
| Mathumitha Ramesh, Siddhartha Nanda, Biplab Misra DOI:10.4103/sajc.sajc_326_18 | ||
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| Chronic lymphocytic leukemia with deletion 17p: An Indian scenario | ||
| Ajay Gogia, Ritu Gupta, Lalit Kumar, Atul Sharma, Lata Soni DOI:10.4103/sajc.sajc_287_18 | ||
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 | Pazopanib use preceding curative surgery in low rectal gastrointestinal stromal tumors after imatinib failure: A case report | |
| Nikhil Pande, Omshree Shetty, Mounika Boppana, Anant Ramaswamy, Avanish Saklani, Nitin Shetty, Vikas Ostwal DOI:10.4103/sajc.sajc_183_18 | ||
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Πέμπτη 17 Ιανουαρίου 2019
Cancer
Perioperative Teaching and Feedback: How are we doing in Canadian OTL-HNS programs?
Abstract
Background
Discrepancies between resident and faculty perceptions regarding optimal teaching and feedback during surgery are well known but these differences have not yet been described in Otolaryngology - Head and Neck Surgery (OTL-HNS). The objectives were thus to compare faculty and resident perceptions of perioperative teaching and feedback in OTL-HNS residency programs across Canada with the aim of highlighting potential areas for improvement.
Methods
An anonymous electronic questionnaire was distributed to residents and teaching faculty in OTL-HNS across Canada with additional paper copies distributed at four institutions. Surveys consisted of ratings on a 5-point Likert scale and open-ended questions. Responses among groups were analysed with the Wilcoxon-Mann Whitney test, while thematic analysis was used for the open-ended questions.
Results
A total of 143 teaching faculty and residents responded with statistically significant differences on 11 out of 25 variables. Namely, faculty reported higher rates of pre and intra-operative teaching compared to resident reports. Faculty also felt they gave adequate feedback on residents' strengths and technical skills contrary to what the residents thought. Both groups did agree however that pre-operative discussion is not consistently done, nor is feedback consistently given or sought.
Conclusion
Faculty and residents in OTL-HNS residency programs disagree on the frequency and optimal timing of peri-operative teaching and feedback. This difference in perception emphasizes the need for a more structured approach to feedback delivery including explicitly stating when feedback is being given, and the overall need for better communication between residents and staff.
http://bit.ly/2HeYzg5
ELS live surgery: a developing story
Abstract
Introduction
Since 2015, the European Laryngological Society (ELS) has organized on a yearly basis the European Laryngological Live Surgery Broadcast. The goal of this paper is to demonstrate the increasing worldwide audience.
Material and methods
The number of individual computers logged in, number of estimated audience, and number of countries with an active audience were calculated and compared to the numbers in 2015.
Results
In 2018, 19 live interventions were performed in three parallel sessions. The surgeons worked in 10 departments in 8 different countries. The number of individual computers logged in increased from 1000 in 2015 to 16000 in 2018. The estimated audience increased from 3000 to 32000 visitors. The number of countries with an active audience increased from 52 to 91.
Discussion
The amount of computers logged in is increasing year by year. The audience was presenting despite inconvenient broadcasting times, highlighting the educational importance. The teaching aspect remains visible on videos of this year's and previous year's interventions. They can be seen on website http://els.livesurgery.net/home.php. The organization of the European Laryngological Live Surgery Broadcast concurs to the idea that live broadcast of laryngologic surgery is feasible and attractive. Therefore, the ELS is going to continue to organize additional European Laryngological Live Surgery Broadcasts in the future.
http://bit.ly/2Hfsjtm
Topical Mitomycin-C can help as an adjunct to alkaline nasal wash and rifampicin in primary atrophic rhinitis
Publication date: Available online 16 January 2019
Source: American Journal of Otolaryngology
Author(s): Osama G. Abdel-Naby Awad, Mahmoud M. Hasan
Abstract
Purpose
Primary atrophic rhinitis (PAR) is a well-known old disease characterized by a roomy nose and extensive crustations. This study was designed to investigate the effect of topical Mitomycin-C as an adjunct to medical treatment with respect to objective and subjective improvement in patients treated with PAR.
Material and methods
This prospective randomized controlled study was conducted in a tertiary referral hospital in January 2016 and March 2018. Fifty adult patients aged 18 to 45 with PAR were randomly divided into 2 groups. Study group: treatment with Mitomycin-C dissolved in an alkaline wash plus rifampicin and control group: only treated with rifampicin and alkaline nasal wash. Subjective scores for the following symptoms: After 12 weeks of treatment, foul smell, anosmia, crusting, epistaxis, and nasal blockade, an objective score of crusting, the status of nasal mucosa, nature of the secretions and condition of nasal cavity were compared between the two groups.
Results
The degree of crustations (P < 0.0001) and the severity of epistaxis (P < 0.0001) were significantly improved in patients treated with Mitomycin-C dissolved in an alkaline wash (i.e. the study group), and the secretions returned significantly to normal (P < 0.0001). Both groups had significant improvements in both subjective and objective parameters of the assessment.
Conclusions
In patients with primary atrophic rhinitis, the use of Mitomycin-C dissolved in an alkaline nasal wash as an adjunct to oral rifampicin can produce a beneficial result than rifampicin and alkaline nasal wash alone.
http://bit.ly/2Rwt7yL
Syphilis of the oropharynx: Case series of “The Great Masquerader”
Publication date: Available online 16 January 2019
Source: American Journal of Otolaryngology
Author(s): Ameya Jategaonkar, Jaclyn Klimczak, Jay Agarwal, Arvind Badhey, William M. Portnoy, Angela Damiano, Raymond L. Chai
Abstract
Objective
Syphilis is a sexually transmitted infection with various presentations. Although, oropharyngeal manifestations are known to occur, the purpose of this study is to present the first case series in which the lesions were initially mistaken for human-papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC).
Methods
A multi-institutional retrospective review.
Results
Six cases of oropharyngeal syphilis were initially thought to be secondary to OPSCC due to presentation. Symptoms were vague and exam findings consisted of either a tonsillar or base of tongue mass, or lymphadenopathy. Biopsies were negative for OPSCC. Further workup diagnosed syphilis, with resolution of symptoms and lesions after antibiotic treatment.
Conclusions
Head and neck manifestations of syphilis have been reported in the literature. However, this is the first series reporting on oropharyngeal syphilis masquerading as HPV-related OPSCC. Ultimately, otolaryngologists must maintain a high suspicion for syphilis in order to ensure prompt diagnosis and treatment.
http://bit.ly/2CsXkUY
A randomized controlled trial to test the efficacy of trans-tympanic injections of a sodium thiosulfate gel to prevent cisplatin-induced ototoxicity in patients with head and neck cancer
Cisplatin-induced hearing loss is frequent and severe. Antioxidants such as sodium thiosulfate (STS) can neutralize the effects of cisplatin. The objective of the trial was to test the efficacy of trans-tympan...
http://bit.ly/2TT1bBG
Dizziness at a Canadian tertiary care hospital: a cost-of-illness study
In the Canadian health care system, determining overall costs associated with a particular diagnostic subgroup of patients, in this case dizzy patients, is the first step in the process of determining where co...
http://bit.ly/2Dgawhq
The effect of hypertrophied tonsils on the velopharyngeal function in children with normal palate
Publication date: Available online 16 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Mosaad Abdel-Aziz, Mahmoud El-Fouly, Ahmed Nassar, Ahmed Kamel, Ahmed Kamel
Abstract
Objective
Tonsillar hypertrophy may affect velopharyngeal closure and speech resonance. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with normal palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance.
Methods
Eighty seven children with hypertrophied tonsils and normal palate were subjected to tonsillectomy for indications other than speech problems. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech (APA) and nasometric assessment of nasalance was measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy.
Results
Thirteen patients were excluded from the study because of associated adenoid hypertrophy. The mean baseline of APA scores showed insignificant changes postoperatively. However, significant postoperative changes of nasometric parameters were detected, and the overall postoperative nasalance score was improved for nasal and oral sentences. Also, improvement of velopharyngeal closure was observed postoperatively with accession of palatal mobility and significant increase in coronal closure pattern.
Conclusion
hypertrophied tonsils may impair velopharyngeal function in children with normal palate by hindering palatal elevation. Tonsillectomy is a beneficial procedure for such patients as it can improve the velopharyngeal closure and speech resonance.
http://bit.ly/2FDplfG
Curettage adenoidectomy versus endoscopic microdebrider adenoidectomy in children: A randomized controlled trial
Publication date: Available online 16 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Sureyya Hikmet Kozcu, Erhan Demirhan, İbrahim Çukurova
Abstract
Introduction
Adenoidectomy is one of the most frequently performed surgical procedures with different techniques and technologies. Although curettage adenoidectomy (CA) has been practiced conventionally for many years, endoscopic microdebrider adenoidectomy (EMA) has emerged as an innovative surgical method. Comparing physiological effects, efficacy and safety of the endoscopic microdebrider adenoidectomy (EMA) and curettage adenoidectomy (CA) in pediatric population is aimed with this prospective, single-blind, randomized, controlled trial.
Methods
Sixty pediatric patients with type-A tympanogram according to Jerger classification in both ears before surgery were randomly assigned to receive the CA (n = 30) and the EMA (n = 30). Tympanometry evaluation for each ear was performed the day before surgery firstly and was repeated on days 1, 7 and 14 after surgery. Intraoperative time, complications during and after the operation were recorded. Postoperative pain was also evaluated for 10 days postoperatively.
Results
Tympanometric evaluation revealed significantly reduced middle ear peak pressure levels with the EMA than with the CA for each ear on day 1 after surgery and for only left ear on day 7 after surgery (P < 0.05). In addition, statistically significant reduced pain scores in postoperative first 3 days were related to the EMA (P < 0.05). There was no significant difference between the methods in terms of duration of surgery and complications.
Conclusion
According to findings from this study, the EMA procedure may be as safe and rapid as the CA. Furthermore, the EMA may be more controlled and less invasive to the surrounding tissues. Further studies are advised to support these data.
http://bit.ly/2FzVNQI
Porphyromonas gingivalis lipopolysaccharide-induced periodontitis and serum amyloid-beta peptides
Publication date: Available online 16 January 2019
Source: Archives of Oral Biology
Author(s): Yago Leira, Ramón Iglesias-Rey, Noemí Gómez-Lado, Pablo Aguiar, Francisco Campos, Francesco D'Aiuto, José Castillo, Juan Blanco, Tomás Sobrino
Abstract
Objective
The aim of this investigation was to determine the circulating levels of amyloid beta (Aβ) peptides using the Porphyromonas gingivalis (Pg) lipopolysaccharide (LPS) model to induce periodontitis.
Methods
Experimental periodontitis was induced in 6 male Sprague-Dawley rats. Alveolar bone loss was measure by micro computed tomography. Serum concentrations of Aβ1-40 and Aβ1-42 prior to periodontal induction, at 24 h, 7, 14, and 21 days the last injection of Pg-LPS.
Results
The distance between the cemento-enamel junction and the bone crest (i.e., alveolar bone loss) was significantly higher at the end of periodontal induction compared to baseline (2.92 ± 0.29 mm vs. 3.8 ± 0.28 mm, P < 0.001). Periodontitis evoked a slight acute elevation of Aβ1-40 serum levels that were maintained during the whole experiment. Aβ1-42 peptide levels peak at the end of the study. A positive strong correlation was observed between alveolar bone loss and Aβ1-40 serum levels at 7 days (r = 0.695, P = 0.012) and as well as with serum Aβ1-42 concentrations at 21 days (r = 0.968, P = 0.002).
Conclusions
Periodontitis induced Pg-LPS produced increased serum levels of Aβ peptides. Further studies are needed to confirm our results and to investigate the mechanisms by which periodontitis could be associated with an overexpression of Aβ.
http://bit.ly/2APzVNf
Tooth extraction and subsequent dental implant placement in Sprague-Dawley rats induce differential changes in anterior digastric myofibre size and myosin heavy chain isoform expression
Publication date: Available online 16 January 2019
Source: Archives of Oral Biology
Author(s): Farhan Shah, Per Stål, Jian Li, Barry J. Sessle, Limor Avivi-Arber
Abstract
Objective
to determine if tooth loss and dental implant placement in rats induce changes in the morphological and histochemical features of the Anterior Digastric muscle.
Design
Adult maleSprague-Dawley rats had their right maxillary molar teeth extracted. 'Extraction-1' and 'Extraction-2 groups were sacrificed, respectively, 4 ) or 8 weeks later, and an Implant group had an implant placement 2 weeks after the molar extraction, and rats were sacrificed 3 weeks later (n = 4/group). Naive rats (n = 3) had no treatment. Morphometric and immunohistochemical techniques quantified Anterior Digastric muscle myofibres' cross-sectional area (CSA) and myosin heavy chain (MyHC) isoform proportions. Significant ANOVAs were followed by post-hoc tests; p < 0.05 and 0.1 were considered to reflect levels of statistical significance.
Results
In naïve rats, the peripheral regions of the Anterior Digastric muscle dominated by MyHC-IIx/b isoform and there were no MyHC-I isoforms; the central regions dominated by MyHC-IIx/b and MyHC-IIa isoforms. Compared with naive rats, tooth extraction produced, 8 (but not 4) weeks later, a decreased proportion of fast-contracting fatigue-resistant MyHC-IIa isoform (p = 0.08), and increased proportion of fast and intermediate fatigue-resistance MyHC-IIa/x/b isoform (p = 0.03). Dental implant placement following tooth extraction attenuated the extraction effects but produced a decreased proportion of fast-contracting fatiguable MyHC-llx/b isoform (p = 0.03) in the peripheral region, and increased inter-animal variability in myofibre-CSAs.
Conclusions
Given the crucial role that the Anterior Digastric muscle plays in many vital oral functions (e.g., chewing, swallowing), these changes may contribute to the changes in oral sensorimotor functions that occur in humans following such treatments.
http://bit.ly/2SUOsOO
Clinical pathway for abbreviated postoperative hospital stay in free tissue transfer to the head and neck: Impact in resource utilization and surgical outcomes
Abstract
Background
Assess the impact of a clinical pathway and progressive care unit (CPW/PCU) for patients undergoing head and neck free flap reconstruction with regard to patient outcomes and resource utilization.
Methods
Retrospective chart review of 270 patients at an academic tertiary‐care center (2009‐2014). Outcomes were compared among a control, CPW/PCU transition, and CPW/PCU groups.
Results
Compared to control, the CPW/PCU group had significantly reduced medical complications (21.1%‐4.1%), intensive care unit length of stay (LOS, 5.02‐0.2 days), hospital LOS (10.5‐6.2 days), standardized total charges ($88 270‐$58 661), and hospital costs ($41 365‐$22 680). There were no observed differences in flap viability, surgical complications, reoperations, or readmissions. The CPW/PCU group achieved 100% home discharge.
Conclusions
Our proposed CPW significantly improved patient outcomes and reduced resource utilization while maintaining flap outcomes. We propose a dynamic model for resource allocation that is easily reproducible in both academic and nonacademic settings.
http://bit.ly/2TYODsH
High metastatic node number, not extranodal extension, as a node‐related prognosticator in surgically treated patients with nodal metastatic salivary gland carcinoma
Abstract
Background
The prognostic relevance of extranodal extension (ENE) for salivary gland carcinoma (SGC) remains unclear. The present study is undertaken to investigate the predictive significance of pathological nodal parameters in surgically treated patients with nodal metastatic SGC.
Methods
This multicenter cohort included 114 patients with pathologically proven node‐positive SGC between 2000 and 2014. Possible correlations of clinicopathological parameters and outcomes were examined.
Results
The median follow‐up was 69 months (range, 11‐173 months). The multivariate analysis identified metastatic node number (1‐2 vs 3‐6; 1‐2 vs ≥7) as an independent predictor for regional control (P = 0.005; P = 0.02), locoregional control (P = 0.008; P = 0.04), distant metastasis‐free survival (P = 0.17; P = 0.006), disease‐free survival (P = 0.05; P = 0.002), and overall survival (P = 0.18; P = 0.009), whereas ENE was not associated with survival outcomes.
Conclusions
Metastatic node number, not ENE, is an independent node‐related prognosticator for SGC. Integration of ENE into the American Joint Committee on Cancer 8th edition staging criteria may not improve prognostic performance.
http://bit.ly/2Dg0htC
Not CD68 but stabilin‐1 expression is associated with the risk of recurrence in patients with oral cavity squamous cell carcinoma
Abstract
Background
This study's aim was to identify CD68 and stabilin‐1 expressions and their prognostic implications in patients with oral cavity cancer (OCC).
Methods
Stabilin‐1 and CD68 immunochemical staining was conducted in samples from patients with OCC who underwent curative surgery in our institute. We retrospectively analyzed patients' clinical information. We investigated the relationship between CD68 and stabilin‐1 expression levels and their effect on prognostic factors and survival.
Results
Fifty‐four patients' data were analyzed. CD68 and stabilin‐1 expressions were positively correlated (P = .008). CD68 and stabilin‐1 expressions were not correlated with other prognostic factors (eg, T classification or lymph node metastasis). Stabilin‐1 expression and tumor recurrence risk were positively correlated (P = .015). CD68 expression was neither associated with recurrence‐free nor OCC‐specific survival.
Conclusion
CD68 and stabilin‐1 expressions in OCC were positively correlated. Stabilin‐1 expression was significantly associated with OCC recurrence risk, but the prognostic value of CD68 was not confirmed.
http://bit.ly/2DfnIDn
Impact of varying anatomic sites on advanced stage and survival of oral cancer: A 9‐year prospective cohort of 27 717 cases
Abstract
Background
To elucidate the impact of varying anatomic sites on advanced stage of and death from oral cancer.
Methods
A total of 27 717 oral cancers mainly from a population‐based visual inspection program in Taiwan from 2004 to 2009 was followed until the end of 2012.
Results
Using lip cancer as reference, the odds ratios (95% confidence interval [CI]) of advanced stage of cancer were 2.20 (1.92‐2.51) for tongue, 2.60 (2.28‐2.97) for buccal, 2.68 (2.20‐3.28) for floor of mouth, 2.96 (2.52‐3.47) for hard palate, 6.04 (5.17‐7.05) for gingiva, and 10.83 (9.20‐12.74) for oropharynx. The estimated hazard ratios (95% CI) for oral cancer death increased from 1.48 (1.31‐1.67) in buccal, 1.61 (1.43‐1.82) in tongue, 1.68 (1.41‐1.99) in floor of mouth, 1.79 (1.57‐2.05) in gingiva, 1.97 (1.71‐2.26) in hard palate, and 2.15 (1.89‐2.45) in oropharynx.
Conclusion
Different anatomic sites had variations in advanced stage of and death from oral cancer and need vigilant surveillance.
http://bit.ly/2TUQ9f4
Effects of APE1 Asp148Glu polymorphisms on OPMD malignant transformation, and on susceptibility to and overall survival of oral cancer in Taiwan
Abstract
Background
The associations between malignant transformation of oral potentially malignant disorders (OPMDs), oral cancer development and prognosis, and apurinic/apyrimidinic endonuclease 1 (APE1) functional polymorphisms are unclear.
Methods
Patients with OPMDs, patients with oral cancer, and healthy controls from the community were recruited to determine the effects of APE1 polymorphisms on malignant transformation, overall survival, and genetic susceptibility, respectively.
Results
The APE1 Asp148Glu polymorphisms significantly correlated with a high hazard ratio for OPMD malignant transformation (adjusted hazard ratio [AHR] = 2.29; 95% confidence interval [CI] = 1.44‐3.74) and low overall survival in oral cancer patients (AHR = 1.71, 95% CI = 1.11‐2.56) according to follow‐up and survival analysis. However, APE1 polymorphisms did not significantly correlate with development of oral cancer in the case‐control study and logistic regression analysis.
Conclusions
These results indicate that APE1 Asp148Glu polymorphisms may have indirect roles in increasing the OPMD malignant transformation rate and in decreasing overall survival in oral cancer patients.
http://bit.ly/2TUPVoe
The combined use of EFS, GPX2, and SPRR1A expression could distinguish favorable from poor clinical outcome among epithelial‐like head and neck carcinoma subtypes
Abstract
Background
We aimed at identifying molecular markers predictive of clinical outcome in patients with head and neck cancer based on the expression profile of cells showing epithelial‐like (EL) or mesenchymal‐like (ML) phenotypes.
Materials and methods
We analyzed the association between EL and ML cells and migration, drug resistance, or tumor growth. The differential gene expression profile between cell types was used to build a model to stratify patients according to survival.
Results
EL cells were sensitive to cisplatin and cetuximab, showed low migration, and generated squamous differentiated tumors in mouse. A differential 93‐gene expression signature between ML and EL cells was used to build a three‐gene (EFS, GPX2, and SPRR1A) survival model by analyzing the RNA‐seq data of the TCGA‐HNSC project. Its prognostic value was confirmed in two independent cohorts.
Conclusion
EFS, GPX2, and SPRR1A are prognostic markers able to distinguish clinical outcome among subtypes sharing an EL phenotype.
http://bit.ly/2Dh5DoB
Durable intracranial and extracranial response to nivolumab with appearance of secondary resistance in a heavily pretreated patient with head and neck cancer
Abstract
Background
Recently, nivolumab was approved in the second‐line setting of squamous cell cancer of the head and neck (SCCHN). The benefits of PD‐(L)1 inhibitors in PD‐L1(−) tumors are unclear, and no reports exist on the activity of these agents in brain metastases from SCCHN. Little is known regarding the mechanisms underlying acquired resistance to PD‐(L)1 inhibition.
Methods
A patient with PD‐L1(−) metastatic SCCHN progressing to cetuximab‐based chemotherapy received third‐line nivolumab. T cell infiltration and mRNA expression of immune‐related genes were compared in prenivolumab and postnivolumab biopsies from a progressing tumor lesion.
Results
An exceptional local and systemic response was achieved, including complete devitalization of brain metastases that lasted for more than a year. Increased T cell infiltration and upregulation of genes related to T cell exhaustion and resistance to PD‐1 inhibition were found.
Conclusion
Durable responses to PD‐(L)1 inhibitors may be observed in biomarker‐negative SCCHN. Mechanisms of resistance should be studied.
http://bit.ly/2TUPRF0
Survival of patients with head and neck cancer with metachronous multiple primary tumors is surprisingly favorable
Abstract
Background
The objectives of this study are to determine the incidence and survival rate of patients with head and neck squamous cell carcinoma (HNSCC) with multiple primary tumors (MPT) in the HN‐region, lung, or esophagus.
Methods
Patient and tumor specific data of 1372 patients with HNSCC were collected from both the national cancer registry and patient records to ensure high‐quality double‐checked data.
Results
The total incidence of MPTs in the HN‐region, lung, and esophagus in patients with HNSCC was 11% (149/1372). Patients with lung MPTs and esophageal MPTs had a significant worse 5‐year survival than patients with HN‐MPTs (29%, 14%, and 67%, respectively, P < 0.001). The 5‐year survival rate for synchronous HN MPTs was only 25%, whereas it was surprisingly high for patients with metachronous HN MPT (85%, P < 0.001).
Conclusions
One of 10 patients with HNSCC develop MPTs in the HN‐region, lung, or esophagus. The 5‐year survival of patients with metachronous HN MPTs was surprisingly favorable.
http://bit.ly/2DhHAWn
Prognostic factors in recurrent or metastatic squamous cell carcinoma of the head and neck
Abstract
Background
In clinical trials of recurrent and metastatic head and neck carcinoma, Argiris et al have identified prognostic factors for overall survival (OS) and progression‐free survival (PFS), weight loss, Eastern Cooperative Oncology Group performance status (ECOG‐PS), tumor primary site, tumor differentiation, prior radiotherapy, deriving a two‐group prognostic classification. This study evaluates Argiris's classification in "field‐practice" patients.
Methods
The main analysis included 327 cases; a secondary analysis excluded 31 patients with oropharyngeal carcinoma (OPC) p16‐positive and/or human papilloma virus (HPV)‐positive. OS and PFS curves were estimated with the Kaplan‐Meier method; multivariable Cox analyses were also performed.
Results
In the full series, OS was significantly different in patients with 0‐2 and ≥3 adverse features (median, 14 vs 10 months; P = .03). PFS was statistically different in the two groups (median, 7 vs 5 months; P = .02). At a multivariable analysis investigating additional prognostic features, site of relapse and disease‐free interval were significant predictors of OS and PFS.
Conclusion
The Argiris's model was confirmed in a "field‐practice" population. Moreover, we found additional putative prognostic factors.
http://bit.ly/2TVFcdo
Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival: Analysis of the National Cancer Database
Abstract
Background
Adult head and neck (H&N) sarcomas are a rare malignancy with limited data delineating the role of postoperative radiotherapy (PORT), particularly for a positive surgical margin. There are no randomized trials supporting the use of PORT, therefore treatment trends vary between institutions. A positive margin predicts recurrence and poor survival outcomes. This study uses the National Cancer Database (NCDB) to investigate whether PORT improves overall survival (OS) in adult H&N sarcomas with a positive margin and how utilization has changed.
Methods
Patients (n = 1142) in the NCDB from 2004‐2013 with adult H&N sarcomas who underwent resection and had a positive margin.
Results
Factors significantly associated with increased utilization of PORT were: having insurance, salivary gland primary site, high‐risk histology, poor differentiation, and a macroscopic positive margin. Treatment with PORT was associated with improved 5‐year OS for all patients with a positive margin (57% vs 48%; P = .002), both microscopic (57% vs 49%; P = .010) and macroscopic (57% vs 41%; P = .036). Improved OS was significant after controlling for other known covariates on multivariate analysis (HR: 0.76; [0.64‐0.90]; P = .002). Treatment at a community‐based facility was an independent predictor for reduced OS (HR: 1.37; [1.15‐1.64]; P < .001). The percentage utilization (53%) of PORT for these patients did not change significantly over time.
Conclusion
PORT provides a significant survival benefit for adult H&N sarcoma patients with either a microscopic or macroscopic positive margin; however, PORT is underutilized. Treatment at academic/research cancer programs was associated with increased utilization of PORT and improved survival outcomes.
http://bit.ly/2DfQLXm
African head and neck fellowships: A model for a sustainable impact on head and neck cancer care in developing countries
Abstract
Background
There is an extreme shortage of head and neck surgeons in Africa. Fourteen head and neck surgeons have completed fellowships in Cape Town and Cameroon. This study determines whether such Africa‐based fellowships are a good model for developing countries by making a sustainable impact on head and neck cancer care.
Methods
An observational study was conducted by emailing questionnaires to past fellows.
Results
All fellows had returned to teaching hospitals in their counties. Seven established new multidisciplinary cancer teams. Head and neck operations had increased by >335%, as had complexity of the surgery. There was effective transfer of surgical skills to trainees. All considered head and neck fellowships to be the best model to grow head and neck care.
Conclusion
Head and neck fellowships in developing countries are effective models for establishing training programs and for increasing provision of specialized surgical services in a sustainable fashion.
http://bit.ly/2TSUX4P
Radiation dose to the masseter and medial pterygoid muscle in relation to trismus after chemoradiotherapy for advanced head and neck cancer
Abstract
Background
We studied the relationship between trismus (maximum interincisor opening [MIO] ≤35 mm) and the dose to the ipsilateral masseter muscle (iMM) and ipsilateral medial pterygoid muscle (iMPM).
Methods
Pretreatment and post‐treatment measurement of MIO at 13 weeks revealed 17% of trismus cases in 83 patients treated with chemoradiation and intensity‐modulated radiation therapy. Logistic regression models were fitted with dose parameters of the iMM and iMPM and baseline MIO (bMIO). A risk classification tree was generated to obtain optimal cut‐off values and risk groups.
Results
Dose levels of iMM and iMPM were highly correlated due to proximity. Both iMPM and iMM dose parameters were predictive for trismus, especially mean dose and intermediate dose volume parameters. Adding bMIO, significantly improved Normal Tissue Complication Probability (NTCP) models. Optimal cutoffs were 58 Gy (mean dose iMPM), 22 Gy (mean dose iMM) and 46 mm (bMIO).
Conclusions
Both iMPM and iMM doses, as well as bMIO, are clinically relevant parameters for trismus prediction.
http://bit.ly/2DeuI37
Τετάρτη 16 Ιανουαρίου 2019
Voice outcome after unilateral ELS type III or bilateral type II resections for T1‐T2 glottic carcinoma: Results after 1 year
Abstract
Background
Voice outcome was assessed in patients with extended T1 and limited T2 glottic carcinoma, treated with a unilateral type III or a bilateral type II resection according to the European Laryngological Society (ELS) classification.
Methods
Objective evaluation (acoustic and aerodynamic parameters), perceptual evaluation (GRBAS), and patients' self‐assessment (voice handicap index [VHI]) were performed before and 1 year after treatment. Results were evaluated according to ELS resection type and the involvement of the anterior commissure.
Results
The majority of voice parameters in all resection subgroups showed an improvement of the mean score 1 year postoperatively. Grade of dysphonia varied between 1.15 and 1.66 postoperatively and VHI score varied from 23.3 to 24.5.
Conclusion
Voice outcome after ELS unilateral type III or a bilateral type II resection for extended T1 and limited T2 glottic carcinoma is good with mild to very moderate perceptive dysphonia and low self‐reported voice impairment.
http://bit.ly/2QU2kXF
Significant racial differences in the incidence and behavior of the follicular variant of papillary thyroid carcinoma
Abstract
Background
Increased detection of papillary thyroid cancer (PTC) has led to overtreatment of the largely indolent follicular variant (fvPTC). To guide management of non‐aggressive lesions, we investigated whether race predicts PTC variant and tumor behavior.
Methods
Analysis of 258 973 patients from the National Cancer Database diagnosed with PTC in 2004‐2014. Clinical and tumor information was compared by race. Multivariate logistic regression was used to predict fvPTC, extrathyroidal extension (ETE), and lymph node metastasis (LNM) of fvPTC.
Results
Blacks had the highest fvPTC rate (40% vs white 30%, Hispanic 26%, Asian 25%, P < .001). Blacks had higher odds of fvPTC (aOR = 1.33, 95% CI: 1.28‐1.37) and lower odds of ETE than whites (aOR = 0.90, 95% CI: 0.82‐0.99) (P < .001). Hispanics and Asians had lower odds of fvPTC (aOR = 0.89, 95% CI: 0.86‐0.92 and aOR = 0.81, 95% CI: 0.79‐0.84) and higher odds of LNM and ETE than whites (P < .001).
Conclusions
Racial disparities in fvPTC incidence and behavior should be considered to optimize diagnosis and treatment planning.
http://bit.ly/2VXaItc
Transoral robotic excision of laryngocele: Surgical considerations
Abstract
Background
Transoral robotic surgery (TORS) has emerged as a novel, safe, and feasible procedure for the resection of malignant supraglottic laryngeal cancers. The purpose of this study was to demonstrate the surgical technique with extension of the use of TORS to excise a laryngeal cyst.
Results
Laryngeal cyst resection, along with its tract, was accomplished with preservation of both false and true vocal cords. There was no perioperative or early postoperative complications. The patient was extubated immediately after surgery. Oral diet was initiated within 24 hours. No tracheostomy was required. A video demonstration of the surgical technique is included on Head & Neck's website.
Conclusion
TORS is a safe and feasible procedure for excision of selected laryngeal cysts.
http://bit.ly/2QTMVqo
January is Thyroid Awareness Month
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The post January is Thyroid Awareness Month appeared first on American Thyroid Association.
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A Comment on a Controversial Interpretation of an Apparent Thyroid Phenotype in the Paintings of Henri Matisse
Thyroid, Ahead of Print.
http://bit.ly/2FwTtdp
Impact of Mutation Density and Heterogeneity on Papillary Thyroid Cancer Clinical Features and Remission Probability
Thyroid, Ahead of Print.
http://bit.ly/2FHNYIh
Τhe minimum fascia–tumor distance (MFTD) criterion is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.
The Diagnostic Performance of Ultrasonography and Computed Tomography in Differentiating Superficial from Deep Lobe Parotid Tumors
Ping‐Chia Cheng Chih‐Ming Chang Chun‐Chieh Huang Wu‐Chia Lo Tsung‐Wei Huang Po‐Wen Cheng Li‐Jen Liao
First published: 12 January 2019 https://doi.org/10.1111/coa.13289
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/coa.13289
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Abstract
Objectives
To validate and compare ultrasound (US) versus computed tomography (CT) criteria in the localization of superficial/deep lobe tumors of the parotid gland.
Design and Setting
This was a retrospective study of diagnostic tests performed from January 2008 to June 2017.
Participants
We included adult patients who were referred for a neck ultrasonography examination due to parotid tumors, and who subsequently underwent parotid surgery.
Main outcome measures
We assessed the location of parotid tumors, comparing the minimum fascia–tumor distance (MFTD) criterion on an US with eight CT criteria. We analyzed receiver operating characteristic (ROC) curves of the MFTD for malignant, benign, and all parotid tumors, and compared the accuracy, sensitivity, and specificity of the optimal MFTD with those of CT anatomical criteria.
Results
A total of 166 parotid tumors were included. The mean (SD) MFTD in superficial lobe tumors was significantly shorter than that of deep lobe tumors (1.2 [0.7] vs 2.8 [1.9] mm, effect size: 1.84; 95% CI, 1.27 to 2.41). The areas under the ROC curve were 0.63 for malignant tumors and 0.88 for benign tumors. The optimal MFTD cut point was 2.4 mm for the 154 benign parotid tumors and the accuracy, sensitivity, and specificity were 90%, 80% and 91%, respectively. For the 136 benign parotid tumors that underwent CT examination, three criteria had an accuracy of over 90% (FNline, tMasseter and Conn's arc), but the sensitivities were all below 50%.
Conclusions
MFTD is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.
Contemporary treatment patterns and outcomes of salivary gland carcinoma: a National Cancer Database review
Abstract
Purpose
Salivary gland carcinomas (SGC) are rare malignancies and data regarding treatment outcomes stratified by histologic subtype are currently limited. This study aims to examine current, national treatment patterns and overall survival (OS) of patients with the major histologic subtypes of salivary gland carcinoma.
Subjects and methods
A review was performed of the National Cancer Database (NCDB) of patients with confirmed diagnoses of mucoepidermoid carcinoma, acinic cell carcinoma, adenoid cystic carcinoma, adenocarcinoma, or carcinoma ex pleomorphic receiving curative treatment between 2004 and 2014. Univariate and multivariate regression modeling were performed to identify risk factors significantly associated with overall survival (OS). Adjusted survival analyses stratified by treatment and staging were performed with the primary outcome of overall survival (OS) and were further stratified based on histologic subtype.
Results
The final analysis included 7342 patients [3547 men (48.3%) and 3795 women (51.7%); mean age 58.3 years (range 18–90 years)]. Mucoepidermoid carcinoma was the most common histology encountered [n = 2669 (36.4%)]. Unadjusted and adjusted analysis demonstrated improved survival with surgery and radiation therapy (RT) for adenoid cystic (HR = 0.69; p = 0.029), adenocarcinoma (HR = 0.61; p < 0.001), high-grade mucoepidermoid carcinoma (HR = 0.70; p = 0.026), and carcinoma ex pleomorphic (HR = 0.64; p = 0.028), while surgery with chemoradiation therapy (CRT) was associated with worse OS regardless of histologic subtype. The impact of advanced stage on survival varied amongst the histologic subtypes but portended the worst prognosis for patients with adenocarcinoma and carcinoma ex pleomorphic.
Conclusions
The results of this NCDB review demonstrate unique treatment patterns and survival outcomes for SGC based on major histologic subtype.
http://bit.ly/2AQ3s9C
Dizziness at a Canadian tertiary care hospital: a cost-of-illness study
Abstract
Background
In the Canadian health care system, determining overall costs associated with a particular diagnostic subgroup of patients, in this case dizzy patients, is the first step in the process of determining where costs could be saved without compromising patient care. This study is the first Canadian study that evaluates these costs at a tertiary care hospital and will allow for the extrapolation of cost data for other similar academic health science centers, regional health initiatives, and provincial healthcare planning structures.
Methods
We conducted a retrospective cohort study of patients of any age presenting to The Ottawa Hospital (TOH), a tertiary care hospital, between January 1st, 2009 and December 31st, 2014 with a main diagnosis of dizziness or dizziness-related disease.
De-identified patient information was acquired through TOH Data Warehouse and included a patient's sex, age, arrival and departure dates, Elixhauser co-morbidity score, location of presentation (emergency department or admitted inpatient) presenting complaint, final diagnosis code, any procedure codes linked to their care, and the direct and indirect hospital costs linked with any admission.
We derived the mean hospital costs and 95% confidence interval for each diagnosis. We obtained the number of patients who were diagnosed with dizziness within Ontario in year 2015–16 from Canadian Institute for Health Information (CIHI). A simple frequency multiplication was performed to estimate the total cost burden for Ontario based on the cost estimate for the same year obtained from TOH. Cost data were presented in 2017 Canadian dollars.
Results
The average total hospital cost per patient with dizziness for the entire cohort is $450 (SD = $1334), with ED only patients costing $359 (SD = $214). The total estimated hospital cost burden of dizziness in Ontario is $31,202,000 (95% CI $29,559,000 – 32,844,000).
Conclusions
The estimated annual costs of emergency department ambulatory and inpatient dizziness in Ontario was calculated to be approximately 31 million dollars per year. This is the first step in identifying potential areas for cost savings to aid local and provincial policy-makers in allocation of health care spending.
http://bit.ly/2SWl2jp
A randomized controlled trial to test the efficacy of trans-tympanic injections of a sodium thiosulfate gel to prevent cisplatin-induced ototoxicity in patients with head and neck cancer
Abstract
Background
Cisplatin-induced hearing loss is frequent and severe. Antioxidants such as sodium thiosulfate (STS) can neutralize the effects of cisplatin. The objective of the trial was to test the efficacy of trans-tympanic injections of a STS gel to prevent cisplatin-induced ototoxicity.
Methods
Eligible participants were newly diagnosed patients with stage III or IV squamous cell carcinoma of the mouth, oropharynx, hypopharynx, or larynx and scheduled to be treated by concurrent chemoradiation (CCR). Patients with asymmetric hearing were not eligible. The planed treatment included cisplatin 100 mg/m2 at days 1, 22 and 43. A baseline pre-treatment complete audiometric evaluation (pure tone at frequencies ranging from 0.5 to 14 kHz, bone conduction at 0.5–4 kHz and DPOAEs) was performed. Adverse effects were noted according to CTCAE.
On the day before the beginning of CCR, eligible and consenting patients were randomized to receive a trans-tympanic injection of the gel either in the left ear or in the right ear. A final post-treatment complete audiometric evaluation was scheduled to be performed 1 month after the end of CCR by audiologists kept blind to the ear assignment.
For the main outcome, the permanent threshold shift (PTS) in decibel (dB) was calculated as the difference between the final and baseline measures at all pure tone frequencies at 0.5–14 kHz for each patient and for each ear. The main outcome was assessed blindly in a mixed linear model with the PTS as the dependent variable and intervention, frequency, their interaction and radiation dose to the cochlea as independent variables.
Results
Between January 2015 and April 2016, 13 patients were randomized. The trial was stopped in June 2016 for poor accrual. The average loss of hearing over all frequencies was 1.3 dB less for treated ears compared to control ears. Although not statistically (p = 0.61) nor clinically significant, the difference was in favor of the treated ears for all frequencies between 3 and 10 kHz.
Conclusions
Our trial suggests that STS deposited on the round window was safe for the middle and inner ears. More work is needed to improve the efficacy of trans-tympanic injections of cisplatin antidotes.
Trial registration
ClinicalTrials.gov, NTC02281006, Registered 3 November 2014.
http://bit.ly/2AOiBrU
Torus mandibularis affects the severity and position‐dependent sleep apnea in non‐obese patients
Abstract
Objective
Various anatomical structures of upper airway and physical differences are known to be risk factors for obstructive sleep apnea (OSA). Torus mandibularis is a structure that can appear on the inside of the mandible. Therefore, it is possible for tori to influence airway volume by occupying the space for tongue, and cause sleep apnea. The purpose of this study is to investigate the effect of torus mandibularis on the severity of OSA as one of the craniofacial risk factors.
Design
Retrospective case‐control study.
Setting
University‐based tertiary medical center.
Participants
Adult patients over 19‐years‐old who visited out‐patient clinics with complaints of sleep‐disordered breathing symptoms between January 2010 and December 2017 were investigated.
Main outcome measures
The presence of torus mandibularis in oral cavity was confirmed by physical examination or CT image. We analyzed demographic findings including age, sex, medical history, previous operation history, physical findings of upper airway, and result of polysomnography. To evaluate the effect of torus mandibularis on OSA, polysomnography data of the two groups according to presence or absence of torus mandibularis were compared and analyzed.
Results
232 OSA patients with BMI less than 25 were divided into two groups, according to either the presence or absence of torus mandibularis. We analyzed 138 patients of control group and 94 of torus mandibularis group. AHI was 18.8 ± 14.9 in control group and 25.1 ± 18.4 in torus mandibularis group (p=0.006). RDI was 23.1 ± 14.7 in control group and 27.9 ± 18.4 in torus mandibularis group (p=0.035). Supine AHI showed 26.6 ± 20.3 in control group and 32.5 ± 22.6 in torus mandibularis group (p=0.039). Patients with torus mandibularis had a trend of increase in proportion according to the severity of sleep apnea, such as AHI (p=0.007) or RDI (p=0.034).
Conclusions
We newly found that the presence of torus mandibularis affects not only severity of OSA and also position dependent OSA. These results support the necessity of torus mandibularis evaluation in OSA patients, and further study is also required to investigate its consequence in the surgical outcome.
This article is protected by copyright. All rights reserved.
http://bit.ly/2MghDcs
Our Experience with a Novel CSF Leak Repair Material in 14 Patients Following Anterior Skull Base Surgery
Abstract
Hemopatch (HE) advanced hemostatic pad composed of collagen and a synthetic, protein‐reactive monomer which polymerises on contact with protein containing body fluids such as blood and CSF to seal tissues.
HE is readily available which shortens the operating time, and may be manipulated intra‐nasally to reconstruct defects of the anterior skull base.
Reconstruction using HE reduces the morbidity compared with traditional facia lata graft harvesting techniques.
Length of stay and operative times might be decreased due to lower morbidity from donor site complications.
This article is protected by copyright. All rights reserved.
http://bit.ly/2stVL4j
Burden of treatment: Reported outcomes in a head and neck cancer survivorship clinic
Objective
With the intensification and utilization of multimodal treatment, acute toxicities have increased; however, the frequency of treatment sequelae in long‐term head and neck cancer (HNC) survivors are poorly described. The purpose of this analysis was to determine the prevalence and predictors of patient‐reported late and long‐term treatment‐related sequelae in HNC survivors.
Methods
We performed a cross‐sectional analysis of patient‐reported outcomes from 228 survivors attending a multidisciplinary HNC survivorship clinic. The primary outcomes comprised quality of life (QOL), symptoms of anxiety and depression, and swallowing dysfunction.
Results
Male gender, tumor sites in the oropharynx and larynx, longer time since treatment, and treatment with surgery alone were associated with higher physical QOL (P < .05). Male gender, longer time since treatment, and treatment with surgery alone were associated with higher social‐emotional QOL (P < .05). A reduction in anxiety symptoms and a higher QOL were related to longer time since treatment; however, a reduction in swallowing dysfunction symptoms was only related to longer time since treatment until approximately 6 years. After 6 years, survivors reported worse swallowing dysfunction (P < .05). One hundred thirty‐two survivors (56%) reported at least three treatment‐related effects that impacted their daily life. Finally, advanced stage disease at diagnosis (stage III–IV) was also associated with severe swallowing dysfunction (P = .004).
Conclusion
These data indicate the remarkable prevalence of treatment‐related effects in HNC survivors. These results highlight the need for de‐intensification of therapies, where appropriate, and for a better understanding of pathophysiology and new approaches to mitigating treatment effects.
Level of Evidence
4. Laryngoscope, 2019
http://bit.ly/2AKmmP5
Vergleich von piezoelektrisch assistierter und konventioneller Osteotomie bei der Rhinoplastik
Zusammenfassung
Hintergrund
Bei der Rhinoplasik werden postoperative periorbitale Ödeme und Ekchymosen v. a. durch die konventionelle nasale Osteotomie mit Hammer und Meißel verursacht. Möglicherweise führt die Piezochirurgie zu einem verbesserten frühpostoperativen Verlauf durch Schonung des Weichgewebes. Ziel dieser Arbeit war eine systematische Übersicht über Methoden und Ergebnisse von Studien zum Vergleich einer konventionellen mit einer piezoelektrischen Osteotomie.
Methoden
Es erfolgte eine systematische Literaturrecherche in den elektronischen Datenbanken PubMed/MEDLINE und Google Scholar. Bei der primären Selektion wurden alle Studien über den Vergleich konventioneller und piezoelektrischer Osteotomie hinsichtlich postoperativer periorbitaler Ödeme und/oder Ekchymosen erfasst. Die sekundäre Selektion umfasste nur Publikationen mit einer Kontrollgruppe.
Ergebnisse
Die primäre Selektion ergab 15 thematisch relevante Publikationen mit deutlicher Zunahme an jährlichen Veröffentlichungen zwischen 2007 und 2017. Es wurden 6 Studien mit Kontrollgruppen sekundär selektiert, die qualitativ und methodisch sehr heterogen waren. Die Ergebnisse von 5 der 6 Studien wiesen auf einen deutlichen Vorteil der Piezotechnik im Vergleich zur konventionellen Osteotomie hin. Nur in einer Studie wurde kein signifikanter Unterschied bezüglich des untersuchten Ergebnisses festgestellt.
Schlussfolgerung
Nach piezoelektrischer Osteotomie fand sich eine geringere Neigung zu postoperativer Ödembildung und Ekchymose als bei konventioneller Osteotomietechnik. Derzeit sollten die Ergebnisse als Trend interpretiert werden. Eine abschließende Empfehlung zur Überlegenheit einer Methode kann erst bei Vorliegen von mehr Studien mit größeren Patientenzahlen erfolgen.
http://bit.ly/2FCH5b5
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Abstract Objectives To investigate factors related to reasoning skills in 434 school children aged 5–9 years. Methods The Leiter Interna...
