BAHNO Journal club

Please find below the next group of papers for our journal club :-

  1. Technique for reliable sentinel node biopsy in squamous cell carcinomas of the floor of mouth
  • Sandro J. Stoeckli MD,
 Thomas Huebner MD,
 Gerhard F. Huber MD, MSc,



Martina A. Broglie MD

Abstract

Applicability of sentinel node biopsy (SNB) for tumors of the floor of mouth (FOM) is controversial.

Methods

Prospective evaluation of the accuracy of gamma-probe-guided superselective neck dissection of the preglandular triangle of level I for SNB in FOM squamous cell carcinoma (SCC) after preoperative lymphoscintigraphy and single photon emission CT (SPECT)/CT.

Results

In total, 22 sentinel lymph nodes were harvested in level I. Eight of 22 (36%) were seen on lymphoscintigraphy and 11 (50%) on SPECT/CT. Eleven sentinel lymph nodes (50%) were only detected intraoperatively. In unilateral tumors, 20% were contralateral, and, in midline tumors, 93% showed bilateral level I sentinel lymph nodes. The false-negative rate was 8.3%, the negative predictive value was 96.4%, and the false-omission rate was 3.6%. The ultimate neck control rate, including salvage treatment, was 100%.

Conclusion

SNB in FOM can be reliably performed using the presented surgical technique. Level I exploration, bilaterally in midline tumors, is mandatory irrespective of the visualization of sentinel lymph nodes in other levels. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1367–1372, 2016

http://onlinelibrary.wiley.com/doi/10.1002/hed.24440/full

2. Retrograde intra-arterial chemotherapy and daily concurrent proton beam therapy for recurrent oral cavity squamous cell carcinoma: Analysis of therapeutic results in 46 cases

Authors       Yuichiro Hayashi DDS

 

Abstract

The purpose of this study was to evaluate the efficacy and toxicities of proton beam therapy combined with intra-arterial infusion chemotherapy via superficial temporal and occipital arteries for recurrent oral cavity squamous cell carcinoma (SCC).

Methods

Between October 2009 and June 2013, 46 patients with recurrent oral cavity SCC were treated by proton beam therapy combined with intra-arterial infusion chemotherapy of cisplatin (CDDP) and docetaxel. Treatment consisted of proton beam therapy (28.6–74.8 GyE in 13–34 fractions) and intra-arterial infusion chemotherapy (CDDP, 30–50 mg/body/week; docetaxel, 5–25 mg/body/week).

Results

One-year and 2-year overall survival (OS) rates were 65% and 46%, respectively. One-year and 2-year local control rates were 81% and 70%, respectively.

Conclusion

These findings suggest that proton beam therapy combined with intra-arterial infusion chemotherapy could be applied effectively and safely for patients with recurrent oral cavity SCC. © 2016 Wiley Periodicals, Inc. Head Neck 38:1145–1151, 2016

http://onlinelibrary.wiley.com/doi/10.1002/hed.24421/full

 

3. Predictors of survival in parotid adenocarcinoma not otherwise specified: a National Cancer Database study of 3155 patients

Authors   Kevin Y. Zhan MD,

 

Parotid adenocarcinoma not otherwise specified (PANOS) is a common parotid cancer, but studies specifically on this subject are limited.

Methods

We conducted a retrospective review of the National Cancer Database.

Results

Ten percent of all parotid cancers were PANOS (n = 3155). Median age was 67 years. Most patients were men (62.8%) with high-grade histology (67.2%). Regional metastasis was common (35.9%), whereas occult nodal metastasis (20.2% overall) was less frequent in non-high-grade lesions (8.5% vs 31.6%; p < .001). Distant metastasis was rare (7.9%). Five-year overall survival (OS) was 47%. In multivariate analysis, age, regional metastasis, distant metastasis, high-grade, and T classification were predictors of lower survival. Patients with stage III to IV disease receiving surgery and radiotherapy had a better OS than those receiving surgery alone (51% vs 41%; p < .001).

Conclusion

PANOS is an aggressive disease with frequent regional metastasis and low survival. Numerous variables are associated with worse survival. © 2016 Wiley Periodicals, Inc. Head Neck 38:1208–1212, 2016

http://onlinelibrary.wiley.com/doi/10.1002/hed.24382/full

 

4. Comparison of the therapeutic effects of total laryngectomy and a larynx-preservation approach in patients with T4a laryngeal cancer and thyroid cartilage invasion: A multicenter retrospective review

Authors     Yoon Seok Choi MD

In T4a laryngeal cancer with thyroid cartilage invasion, no optimal frontline treatment has yet been defined in controlled trials.

Methods

We reviewed data from 89 patients with T4a laryngeal cancer featuring thyroid cartilage invasion who were treated initially with either total laryngectomy (n = 53) or a larynx-preservation strategy (n = 36).

Results

The median progression-free survival (PFS) of the total laryngectomy group had not been attained at the time of analysis and was thus significantly longer than that of the larynx-preservation group (8.7 months). The median overall survival (OS) of patients who underwent total laryngectomy was 87.2 months, significantly longer than that of the larynx-preservation group (31.3 months). The survival benefit of primary surgery compared to a larynx-preservation strategy was more striking in patients of lower N classifications.

Conclusion

Total laryngectomy may be a better therapeutic option to treat T4a laryngeal cancer featuring thyroid cartilage invasion, especially in patients exhibiting limited nodal involvement (N0/N1). © 2016 Wiley Periodicals, Inc. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1271–1277, 2016

http://onlinelibrary.wiley.com/doi/10.1002/hed.24438/full

If you come across any papers that you think would benefit your colleagues then please forward me the title; reference and a brief synopsis.

Kind regards,

Mike Fardy

President

Previous papers:

Chemoradiotherapy has become a mainstay of primary treatment in patients with squamous-cell carcinoma of the head and neck. However, there are wide variations in the management of advanced nodal disease (stage N2 or N3) in these patients because of the lack of prospective, randomized, controlled…

  • April 14, 2016Mehanna H., Wong W.-L., McConkey C.C., et al.  N Engl J Med 2016; 374:1444-1454

Mejia MB; Que JC; Dizon JM, Head & Neck [Head Neck], ISSN: 1097-0347, 2016 Jul; Vol. 38 (7), pp. 1119-28; Publisher: John Wiley And Sons; PMID: 27028991;

Background: Mucositis is a disabling effect of radiotherapy in head and neck cancers. There is no current standard on management of radiation-induced mucositis. Honey has been shown to reduce radiation-induced mucositis.

Methods: A systematic review and meta-analysis were undertaken to assess the ability of honey in reducing the severity of oral mucositis, time to mucositis, weight loss, and treatment interruptions.

Results: Eight studies were included and showed that honey was significantly better in lowering the risk for treatment interruptions, weight loss, and delaying time to mucositis, but not severity of mucositis.

Conclusion: There is current evidence that honey is beneficial for patients with head and neck cancers by decreasing treatment interruptions, weight loss, and delaying the onset of oral mucositis, but not in decreasing peak mucositis score. In light of the results, honey is a reasonable treatment for radiation-induced mucositis, but more randomized clinical trials (RCTs) should be done. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1119-1128, 2016.

© 2016 Wiley Periodicals, Inc.

Wang CC; Liu SA; Wu SH; Lin WJ; Jiang RS; Wang L, Head & Neck [Head Neck], ISSN: 1097-0347, 2016 Jun; Vol. 38 (6), pp. 913-8; Publisher: John Wiley And Sons; PMID: 26714200;

Background: Transoral robotic surgery (TORS) for early glottic cancer has been reported, but the issue of anterior commissure involvement has seldom been addressed. Therefore, the purpose of this study was to preliminarily report the treatment results of TORS in this disease entity.

Methods: Eight patients with T1 and T2 glottic carcinoma with anterior commissure involvement were selected to receive TORS. The clinical parameters, including rates of adjuvant radiotherapy (RT), survivals, as well as organ and function preservation, were retrospectively analyzed.

Results: TORS was successfully performed in all patients without temporary tracheostomy. There were no major complications and no patient received adjuvant RT to the larynx after surgery. With a mean follow-up of 40 months, all patients survived with their larynx preserved and no local recurrence, tracheostomy, or tube feeding dependence.

Conclusion: TORS is a feasible approach for selected patients with early T classification glottic carcinoma with anterior commissure involvement. The preliminary oncologic and functional outcomes are satisfactory.

© 2015 Wiley Periodicals, Inc. Head Neck 38: 913-918, 2016.

Silverman DA; Przylecki WH; Arganbright JM; Shnayder Y; Kakarala K; Nazir N; Tsue TT; Girod DA; Andrews BT, Head & Neck [Head Neck], ISSN: 1097-0347, 2016 Jun; Vol. 38 (6), pp. 820-3; Publisher: John Wiley And Sons; PMID: 25546076;

Background: The purpose of this study was to determine the benefit of 1-vein versus 2-vein outflow in microvascular free tissue transfers.

Methods: A retrospective review reflects the experience of 6 surgeons. Analysis included all patients who underwent reconstruction at a single institution between January 2004 and December 2012.

Results: Three hundred nine patients underwent a total of 317 microvascular free flap reconstructions for head and neck defects. Two hundred thirteen of 317 flaps (67.2%) used 1 venous anastomosis and 104 (32.8%) used 2 venous anastomoses. Venous congestion necessitated urgent take back in 37 of 57 patients (64.9%) requiring exploration for perioperative complications. Thirty of 37 flaps (81.1%) with venous congestion had 1 vein anastomosis, whereas 7 (18.9%) had dual vein outflow (p = .03). Overall flap success was 303 of 317 (95.6%), despite an 18.0% (57 of 317) perioperative take back rate.

Conclusion: Coapting 2 veins was shown to minimize venous congestion. © 2015 Wiley Periodicals, Inc. Head Neck 38: 820-823, 2016.

© 2015 Wiley Periodicals, Inc.

Hutcheson KA; Abualsamh AR; Sosa A; Weber RS; Beadle BM; Sturgis EM; Lewin JS, Head & Neck [Head Neck], ISSN: 1097-0347, 2016 Jun; Vol. 38 (6), pp. 886-93; Publisher: John Wiley And Sons; PMID: 26339764;

Background: Conflicting results are reported regarding the impact of neck dissection on radiation-associated dysphagia. The purpose of this study was to reexamine this question specific to oropharyngeal intensity-modulated radiotherapy (IMRT).

Methods: Three hundred forty-nine patients with oropharyngeal cancer treated with bilateral IMRT with systemic therapy (induction and/or concurrent) were reviewed. Chronic dysphagia was defined by aspiration, stricture, pneumonia, and/or gastrostomy dependence ≥12 months post-IMRT.

Results: Selective neck dissection was performed after IMRT in 75 patients (21%). Overall, 41 patients (12%) developed chronic dysphagia. Neck dissection did not increase the rate of chronic dysphagia (9% neck dissection; 12% no neck dissection; p = .464) or gastrostomy duration (p = .482). On multivariate analysis, age (odds ratio [OR] per 5-year = 1.25; 95% confidence interval [CI] = 1.04-1.51), baseline abnormal diet (OR = 2.78; 95% CI = 1.31-5.88), and IMRT dose (OR per 5-Gy = 5.11; 95% CI = 1.77-14.81) significantly predicted dysphagia.

Conclusion: In the setting of selective neck dissection for residual adenopathy after IMRT, neck dissection did not impact dysphagia.

© 2015 Wiley Periodicals, Inc. Head Neck 38: 886-893, 2016.