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Background: Squamous cell carcinoma of the nasal vestibule (SCCNV) is a rare disease, distinctly different in presentation, treatment, and outcome from squamous cell carcinoma (SCC) of the nasal cavity and paranasal sinuses. However, these are often not analyzed separately. Methods: The Netherlands Cancer Registry (NCR) and pathology reports from the Dutch Nationwide Pathology Databank (PALGA) were used to identify all newly diagnosed SCCNV cases in the Netherlands between 2008 and 2021. Results: A total of 763 patients were included. The yearly incidence rate displayed a significant downward trend with an annual percentage change (APC) of −3.9%. The 5‐year overall survival (OS) and disease‐free survival were 69.0% and 77.2%, respectively. The 5‐year relative survival was 77.9% and improved slightly over the inclusion period. OS for patients who were staged cT3 appeared to be worse than those staged cT4a, calling the applicability of the TNM‐classification into question. Conclusion: SCC of the nasal vestibule is rare, with declining incidence rates. Introducing a specific topography code for SCCNV is recommended to enhance registration accuracy. The TNM classification seems poorly applicable to SCCNV, suggesting the need to explore alternative staging methods. [ABSTRACT FROM AUTHOR]

Objective: To investigate utilization of mental healthcare among head and neck cancer (HNC) patients from diagnosis to 2 years after treatment, in relation to psychological symptoms, mental disorders, need for mental healthcare, and sociodemographic, clinical and personal factors. Methods: Netherlands Quality of life and Biomedical Cohort study data as measured before treatment, at 3 and 6 months, and at 1 and 2 years after treatment was used (n = 610). Data on mental healthcare utilization (iMCQ), psychological symptoms (Hospital Anxiety and Depression Scale, Cancer Worry Scale), mental disorders (CIDI interview), need for mental healthcare (Supportive Care Needs Survey Short‐Form 34, either as continuous outcome indicating the level of need or dichotomized into unmet need (yes/no)) and several sociodemographic, clinical and personal factors were collected. Factors associated with mental healthcare utilization were investigated using generalized estimating equations (p < 0.05). Results: Of all HNC patients, 5%–9% used mental healthcare per timepoint. This was 4%–14% in patients with mild‐severe psychological symptoms, 4%–17% in patients with severe psychological symptoms, 15%–35% in patients with a mental disorder and 5%–16% in patients with an unmet need for mental healthcare. Among all patients, higher symptoms of anxiety, a higher need for mental healthcare, lower age, higher disease stage, lower self‐efficacy and higher social support seeking were significantly associated with mental healthcare utilization. Conclusion: Mental health care utilization among HNC patients is limited, and is related to psychological symptoms, need for mental healthcare, and sociodemographic, clinical and personal factors. [ABSTRACT FROM AUTHOR]

Objective: Currently, there is no up‐to‐date guideline for the treatment of buccal mucosal squamous cell carcinoma (BMSCC) in the Netherlands. A questionnaire was used to investigate the opinions of Dutch head and neck surgeons on BMSCC of the cheek treatment. Methods: A questionnaire was sent to all 91 head and neck surgeons in the Netherlands. Their opinions on surgical tumor‐free margins, through‐and‐through defects, and indications for local adjuvant therapy were questioned. Results: The response rate was 51%. To prevent a through‐and‐through defect, 67% of the surgeons would accept a deep clinical (macroscopic) margin of ≤5 mm. The less adverse histological characteristics a tumor has, the less consensus there is amongst the surgeons for local adjuvant treatment in case of close margins. Conclusion: There is no consensus amongst Dutch head and neck surgeons about the optimal treatment for BMSCC of the cheek. There are different opinions on acceptable resection margins, indications for a through‐and‐through defect, and indications for adjuvant treatment. BMSCC of the cheek treatment should be more uniform and less surgeon dependent. Level of evidence: N/A [ABSTRACT FROM AUTHOR]

Background: The adequate surgical margin for local control of buccal mucosa squamous cell carcinoma (BMSCC) is under debate. This study investigates surgical margins and other factors associated with local recurrence free survival (LRFS) in a large cohort of BMSCC patients. Methods: Multiple factors were evaluated retrospectively in 97 patients with BMSCC. Cox‐regression and Kaplan–Meier curves were used for analysis. Results: The local recurrence rate was 23%. The tumor‐free margin was <5.0 mm in 89% of the patients and the deep margin was significantly more often inadequate. Multivariate analysis associated pT3‐classification, former smokers, tumor‐free margin status, and postoperative (chemo)radiation (PO(ch)RT) with local recurrence. Re‐resections did not improve LRFS in patients with <5.0 mm tumor‐free margins. Conclusions: Adequate tumor‐free margins are pivotal for LRFS of BMSCC. PO(ch)RT, not re‐resection, can improve LRFS in patients with <5.0 mm tumor‐free margins. [ABSTRACT FROM AUTHOR]

Background: Image‐guided surgery could help obtain clear (≥5.0 mm) resection margins. This feasibility study investigated ultrasound‐guided resection accuracy of buccal mucosa squamous cell carcinoma (BMSCC). Methods: MRI and ultrasound measurements of tumor thickness were compared to histology in 13 BMSCC‐patients. Ultrasound measured margins (at five locations) on the specimen were compared to the corresponding histological margins. Results: Accuracy of in‐ and ex‐vivo ultrasound (mean deviation from histology: 1.6 mm) for measuring tumor thickness was comparable to MRI (mean deviation from histology: 2.6 mm). The sensitivity to detect clear margins using ex‐vivo ultrasound was low (48%). If an ex‐vivo ultrasound cutoff of ≥7.5 mm would be used, the sensitivity would increase to 86%. Conclusions: Ultrasound‐guided resection of BMSCC's is feasible. In‐ and ex‐vivo ultrasound measure tumor thickness in BMSCC accurately. We recommend ≥7.5 mm resection margins on ex‐vivo ultrasound to obtain histological clear margins. Additional research is required to establish the effect of 7.5 mm ultrasound cutoff. [ABSTRACT FROM AUTHOR]

We measured the tumor thickness on histology to make a reliable comparison to the in vivo US and ex vivo US tumor thickness measurements. A complete initial resection without the need for reresection is preferred since reresections come with relocation problems.[[4]] The surgeon can immediately adjust the resection plane if the intraoral US measures an inadequate margin. In those cases, it is possible to immediately adjust the resection plane with intraoral US or adjust it by a reresection after ex vivo US. [Extracted from the article]

The aim of this meta‐analysis was to determine the diagnostic test accuracy of sentinel lymph node biopsy (SLNB) in patients with oropharyngeal, laryngeal, and hypopharyngeal squamous cell carcinoma (SCC). For this purpose, MEDLINE, EMBASE, and Web of Science were searched from inception to March 8, 2022. Included were studies evaluating diagnostic test accuracy of SLNB to identify cervical lymph node metastases with elective neck dissection or follow‐up as reference. A bivariate generalized linear mixed model approach was used for the meta‐analysis. Nineteen studies were eligible, evaluating 377 cases in total. The pooled estimates of sensitivity and negative predictive value were 0.93 (95% CI: 0.86–0.96) and 0.97 (95% CI: 0.94–0.98), respectively. The excellent accuracy of SLNB justifies a place in the diagnostic workup of patients with larynx and pharynx SCC. Randomized trials are required to demonstrate oncologic safety and benefits on treatment related morbidity and quality of life when omitting elective neck treatment based on SLNB. [ABSTRACT FROM AUTHOR]

Background: Skeletal muscle mass (SMM) and chronic inflammation are associated with postoperative complications and survival. Methods: Patients with head and neck cancer (HNC) undergoing microvascular free flap reconstruction were included. SMM and neutrophil‐to‐lymphocyte ratio (NLR) were measured and their association with treatment outcomes analyzed. Results: Five hundred and fifty‐four patients were included. Predictors for complications were elevated NLR in all flaps (OR 1.5), low SMM in radial forearm flap (OR 2.0), and elevated NLR combined with low SMM in fibula flap surgery (OR 4.3). Patients with solely elevated NLR were at risk for flap‐related complications (OR 3.0), severe complications (OR 2.2), and when combined with low SMM for increased length of hospital stays (LOS) (+3.9 days). In early‐stage HNC, low SMM (HR 2.3), and combined elevated NLR with low SMM (HR 2.6) were prognostics for decreased overall survival. Conclusions: SMM and NLR are predictive for poor outcomes in patients with HNC undergoing microvascular reconstruction. [ABSTRACT FROM AUTHOR]

Background: Research in esophageal surgery showed that computed tomography (CT) assessed arterial calcification (AC) is associated with postoperative complications. We investigated the association between AC and pharyngocutaneous fistula (PCF) formation after laryngectomy. Methods: This was a retrospective cohort study of patients undergoing laryngectomy. AC was scored at 10 different anatomical locations on CT imaging, blinded for PCF occurrence. Association with PCF was investigated using logistic regression. Results: The 224 patients were included; 62 (27.7%) developed a PCF. Moderate to severe AC was widespread in patients undergoing TL; 7.1% of patients had at most mild AC, of whom 1 experienced a PCF (p = 0.05). A higher cumulative calcification score was associated with PCF in univariable (OR 1.11, p = 0.04) and multivariable analysis (OR 1.14, p = 0.05). Conclusion: AC is widespread in patients undergoing laryngectomy and its burden is associated with PCF. Extensive AC on preoperative imaging may be considered a risk factor for PCF. [ABSTRACT FROM AUTHOR]

Background: Low skeletal muscle mass (SMM) is an adverse prognostic factor for chemotherapy dose‐limiting toxicity (CDLT). In patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing chemoradiotherapy (CRT), low SMM is a predictor for CDLT. We aimed to validate these findings. Methods: Consecutive LA‐HNSCC patients treated with primary CRT with high‐dose cisplatin were retrospectively included. SMM was measured on pre‐treatment CT‐imaging. A cumulative cisplatin dose below 200 mg/m2 was defined as CDLT. Results: One hundred and fifty three patients were included; 37 (24.2%) experienced CDLT, and 84 had low SMM (54.9%). Patients with low SMM experienced more CDLT than patients with normal SMM (35.7% vs. 10.1%, p < 0.01). Low SMM (OR 3.99 [95% CI 1.56–10.23], p = 0.01) and an eGFR of 60–70 ml/min (OR 5.40 [95% CI 1.57–18.65], p < 0.01) were predictors for CDLT. Conclusion: Pre‐treatment low SMM is associated with CDLT in LA‐HNSCC patients treated with primary CRT. Routine SMM assessment may allow for CDLT risk assessment and treatment optimization. [ABSTRACT FROM AUTHOR]

Keywords: [99mTc]Tc-tilmanocept; Lymph Node; Lymphoscintigraphy; metastasis; oral cancer; sentinel lymph node biopsy EN [99mTc]Tc-tilmanocept Lymph Node Lymphoscintigraphy metastasis oral cancer sentinel lymph node biopsy 1383 1388 6 10/14/21 20211101 NES 211101 KEY POINTS This study compares sentinel lymph node identification using [ SP 99m sp Tc]Tc-tilmanocept to [ SP 99m sp Tc]Tc-nanocolloid in early-stage oral cancer patients. Diagnostic accuracy of [99mTc]Tc-tilmanocept compared to [99mTc]Tc-nanocolloid for sentinel lymph node identification in early-stage oral cancer The prospective cohort has been described in the prequel study in detail.4 Patients underwent lymphoscintigraphy including SPECT-CT for both [ SP 99m sp Tc]Tc-tilmanocept and [ SP 99m sp Tc]Tc-nanocolloid. Besides, owing to relatively low activity residing in SLNs for [ SP 99m sp Tc]Tc-tilmanocept, intraoperative SLN localisation was challenging in some patients when using [ SP 99m sp Tc]Tc-tilmanocept for SLNB. [Extracted from the article]

In clinically node‐negative patients with early oral cavity cancer, [18F]fludeoxyglucose (FDG) positron emission tomography–computed tomography (PET‐CT) should be compared with sentinel node biopsy. Cost effectiveness is one of the important aspects for implementation of FDG/PET‐CT in clinical practice for this patient population. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate a clinical prediction model (CPM) for survival in hypopharynx cancer, thereby aiming to improve individualized estimations of survival.Methods: Retrospective cohort study of hypopharynx cancer patients. We randomly split the cohort into a derivation and validation dataset. The model was fitted on the derivation dataset and validated on the validation dataset. We used a Cox's proportional hazard model and least absolute shrinkage and selection operator (LASSO) selection. Performance (discrimination and calibration) of the CPM was tested.Results: The final model consisted of gender, subsite, TNM classification, Adult Comorbidity Evaluation-27 score (ACE27), body mass index (BMI), hemoglobin, albumin, and leukocyte count. Of these, TNM classification, ACE27, BMI, hemoglobin, and albumin had independent significant associations with survival. The C Statistic was 0.62 after validation. The model could significantly identify clinical risk groups.Conclusions: ACE27, BMI, hemoglobin, and albumin are independent predictors of overall survival. The identification of high-risk patients can be used in the counseling process and tailoring of treatment strategy or follow-up.Level Of Evidence: 4 Laryngoscope, 130:2166-2172, 2020. [ABSTRACT FROM AUTHOR]

The sensitivity of the ex-vivo US at 5.0 mm tumor-free margin was 48%, which means that in 48% of <5.0 mm histological margins, the ultrasound measured <5.0 mm." On page 652 in section 3.2 Tumor-free margins, "Of the 29 < 5.0 mm tumor-free margins on histology, only 15 (52%) were correctly identified as <5.0 mm by the ex-vivo US." should have read "Of the 29 < 5.0 mm tumor-free margins on histology, only 14 (48%) were correctly identified as <5.0 mm by the ex-vivo US." The sensitivity of the ex-vivo US at 5.0 mm tumor-free margin was 48%, which means that the histological tumor-free margin was >=5.0 mm in 48% of the ultrasound measurements that were >=5.0 mm." should have read "The area under the curve was 0.70 (95%CI: 0.56-0.84, p = 0.007) for <5.0 mm histological tumor-free margin, which was fair. [Extracted from the article]

The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nasopharyngeal carcinoma (NPC) treatment is mainly based on clinical staging. We hypothesize that better understanding of the molecular heterogeneity of NPC can aid in better treatment decisions. Therefore, the purpose of this study was to present our exploration of cancer gene copy‐number alterations (CNAs) of Epstein‐Barr virus (EBV)‐positive and EBV‐negative NPC. Methods: Multiplex ligation‐dependent probe amplification was applied to detect CNAs of 36 cancer genes (n = 103). Correlation between CNAs, clinicopathological features, and survival were examined. Results: The CNAs occurred significantly more in EBV‐negative NPC, with PIK3CA and MCCC1 (P < .001) gain/amplification occurring more frequently. Gain/amplification of cyclin‐L1 (CCNL1) and PTK2 (P < .001) predict worse disease‐free survival (DFS) in EBV‐positive NPC. Conclusion: The EBV‐positive and EBV‐negative NPC show some similarities in cancer gene CNAs suggesting a common pathogenic route but also important differences possibly indicating divergence in oncogenesis. Copy number gain/amplification of CCNL1 and PTK2 are possibly good predictors of survival in EBV‐positive NPC. [ABSTRACT FROM AUTHOR]

Abstract: Background: Sacrifice and reconstruction of the carotid artery in cases of head and neck carcinoma with invasion of the common or internal carotid artery is debated. Methods: We conducted a systematic search of electronic databases and provide a review and meta‐analysis. Results: Of the 72 articles identified, 24 met the inclusion criteria resulting in the inclusion of 357 patients. The overall perioperative 30‐day mortality was 3.6% (13/357). Permanent cerebrovascular complications occurred in 3.6% (13/357). Carotid blowout episodes were encountered in 1.4% (5/357). The meta‐regression analysis showed a significant difference in 1‐year overall survival between reports published from 1981‐1999 (37.0%) and 2001‐2016 (65.4%; P = .02). Conclusion: This review provides evidence that sacrifice with extracranial reconstruction of common or internal carotid artery in selected patients with head and neck carcinoma may improve survival with acceptable complication rates. However, all of the published literature is retrospective involving selected series and, therefore, precludes determining the absolute effectiveness of the surgery. [ABSTRACT FROM AUTHOR]

Abstract: Background: Lymph node ratio (LNR) is increasingly reported as a potential prognostic tool. The purpose of this review was to analyze the available literature on the prognostic significance of LNR in head and neck squamous cell carcinoma (HNSCC). Methods: A PubMed internet search was performed and articles meeting selection criteria were reviewed. Results: Twenty‐eight studies were identified in the literature dealing with the prognostic value of LNR. The published results are variable with a range of cutoff values of LNR associated with prognosis (overall survival [OS] and/or disease‐specific survival [DSS]) between 0.02 and 0.20, with an average of 0.09. Conclusion: The LNR is reported to be of value in assessing prognosis in the patients with HNSCC. Although it is easy to calculate and could be considered in the staging of these patients, the currently available evidence in the literature does not yet provide a solid base for implementation. [ABSTRACT FROM AUTHOR]

Background Intraoperative analysis of lymph nodes during a sentinel lymph node biopsy (SLNB) procedure could result in one-step surgery for early oral squamous cell carcinoma (OSCC) with an occult nodal metastasis. One-step nucleic acid amplification rapidly detects cytokeratin 19 ( CK19) RNA with high accuracy. Sensitivity and specificity of CK19 expression in OSCC was evaluated. Methods Immunohistochemical CK19 expression was done in 207 patients with OSCC with 65 cases of paired nodal metastases. Results CK19 was expressed in 65% of all OSCC and even less in early OSCC (56%), with poor correlation between primary tumor and (occult) nodal metastasis. Furthermore, ectopic glandular tissue in close proximity of lymph nodes showed strong CK19 expression. Conclusion CK19 lacks both sensitivity and specificity as a biomarker for nodal metastasis in OSCC, which questions the suitability for CK19-based one-step nucleic acid amplification in SLNB procedures. Therefore, future studies should focus on other biomarkers, because the concept of fast intraoperative diagnostics during SLNB remains attractive. [ABSTRACT FROM AUTHOR]

Background There is an ongoing debate about the value of (neo-)adjuvant chemotherapy in high- and intermediate-grade osteosarcoma of the head and neck. Methods All records of patients older than 16 years diagnosed with osteosarcoma of the head and neck in the Netherlands between 1993 and 2013 were reviewed. Results We identified a total of 77 patients with an osteosarcoma of the head and neck; the 5-year overall survival (OS) was 55%. In 50 patients with surgically resected high- or intermediate-grade osteosarcoma of the head and neck younger than 75 years, univariate and multivariable analysis, adjusting for age and resection margins, showed that patients who had not received chemotherapy had a significantly higher risk of local recurrence (hazard ratio [HR] = 3.78 and 3.66, respectively). Conclusion In patients younger than 75 years of age with surgically resected high- and intermediate-grade osteosarcoma of the head and neck, treatment with (neo-)adjuvant chemotherapy resulted in a significantly smaller risk of local recurrence. Therefore, we suggest (neo-)adjuvant chemotherapy in patients amenable to chemotherapy. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck 39: 140-146, 2017 [ABSTRACT FROM AUTHOR]

Background Donor site morbidity of pectoralis major pedicled flap (PMPF) is scarcely studied. Methods A cross-sectional study on patients who underwent reconstructive surgery with a PMPF at least 6 months before was performed. Patients with a similar type neck dissection on both sides and PMPF on one side ( n = 9) were assigned to group 1; patients with neck dissection and PMPF ( n = 26) were assigned to group 2; and neck dissection only ( n = 47) were assigned to group 3. All 3 groups filled out a shoulder disability questionnaire and underwent shoulder function tests. Pain of the shoulder was rated on a visual analog scale (VAS). Patients were also asked if they had experienced stiffness of the shoulder during the previous week. Range of motion (ROM) of the shoulder was examined by one single examiner using an inclinometer, in accord with a standardized protocol. Radical neck dissection (RND), modified radical neck dissection (MRND), and selective neck dissection (SND) sides were separately analyzed. Results In group 2, shoulder morbidity was experienced more often ( p = .065) than in group 3, particularly at the sides where an SND was performed ( p = .010). Significant differences in prevalence of shoulder stiffness between PMPF and neck dissection sides and neck dissection only sides were found in the RND ( p = .001) and MRND ( p = .004) groups, but not in the SND group. A lower ROM of abduction ( p = .026) was found in group 2 as compared to group 3. Conclusion Patients frequently have additional shoulder morbidity after PMPF harvest, particularly after SND. PMPF harvest adds to impairment of abduction. © 2016 Wiley Periodicals, Inc. Head Neck 38:1221-1228, 2016 [ABSTRACT FROM AUTHOR]

Background Different clinical high-risk factors for the development of distant metastases have been identified but not tested in the same cohort of patients with head and neck squamous cell carcinoma (HNSCC). Methods In 145 patients with previously identified clinical high risk factors, the presence of extranodal spread (ENS) and matted node on pretreatment CT ( n = 96) and/or MRI ( n = 111) were determined. Results Of 145 patients, ENS was detected in 87 patients (60.0%) and matted nodes in 53 patients (36.6%). Kaplan-Meier curves for presence or absence of ENS (on CT and/or MRI) and matted nodes (on CT) differ significantly. In a Cox regression analysis, only ENS was a significant risk factor (hazard ratio [HR] = 3.3; 95% confidence interval [CI] = 2.0-5.5; p < .001). Conclusion In patients with high-risk HNSCC with clinically (palpably or radiologically) ENS and matted nodes, both determined radiologically, are high risk factors for development of distant metastases. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1452-E1458, 2016 [ABSTRACT FROM AUTHOR]

Background Patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC) have a better survival than with HPV-negative oropharyngeal SCC. An 18F-fluorodeoxyglucose positron emission tomography-CT (18F-FDG-PET-CT) may also provide prognostic information. We evaluated glycolytic characteristics in HPV-negative and HPV-positive oropharyngeal SCC. Methods Forty-four patients underwent pretreatment 18F-FDG-PET-CT. Standardized uptake values (SUVs) and metabolic active tumor volumes (MATVs) were determined for primary tumors. HPV status was determined with p16 immunostaining, followed by high-risk HPV DNA detection on the positive cases. Results Twenty-seven patients were HPV-positive (61.4%). Median MATV was 2.8 mL (range = 1.6-5.1 mL) for HPV-positive and 6.0 mL (range = 4.4-18.7 mL) for HPV-negative tumors ( p < .001). SUV values are volume dependent (partial volume effect), therefore, MATV was included as covariate in multivariate analysis. In this multivariate analysis, the maximum SUV in HPV-positive tumors was 3.9 units lower than in HPV-negative tumors ( p = .01). Conclusion The 18F-FDG-PET-CT parameters are lower in HPV-positive than in HPV-negative patients. Low pretreatment SUV values in HPV-positive oropharyngeal SCC may be at least partly explained by HPV-induced tumor changes. © 2015 Wiley Periodicals, Inc. Head Neck 38: 529-535, 2016 [ABSTRACT FROM AUTHOR]

Primary mucosal melanomas (PMMs) of the head and neck are uncommon malignancies that arise mainly in the nasal cavity and paranasal sinuses, followed by the oral cavity. The mainstay of treatment is radical surgical resection followed by adjuvant radiotherapy in selected patients with high-risk features. Multimodality therapy has not been well studied and is not standardized. Adjuvant radiotherapy seems to improve locoregional control but does not improve overall survival (OS). Elective neck dissection is advocated in patients with oral PMM. Systemic therapy should be considered only for patients with metastatic or unresectable locoregional disease. Despite improvements in the field of surgery, radiotherapy, and systemic therapy, patients with PMM still face a very unfavorable prognosis (5-year disease-free survival [DFS] <20%) with high rates of locoregional recurrence and distant metastasis. The present review aims to summarize the current state of knowledge on the molecular biology, pathological diagnosis, and management of this disease. [ABSTRACT FROM AUTHOR]

Regional metastasis is a prominent feature of head and neck squamous cell carcinoma (HNSCC) and is an important prognostic factor. The currently available imaging techniques for assessment of the neck have limitations in accuracy; thus, elective neck dissection has remained the usual choice of management of the clinically N0 neck (cN0) for tumors with significant (≥20%) incidence of occult regional metastasis. As a consequence, the majority of patients without regional metastasis will undergo unnecessary treatment. The purpose of this review was to discuss new developments in techniques that potentially improve the accuracy of the assessment of the neck in patients with HNSCC. Although imaging has improved in the last decades, a limitation common to all imaging techniques is a lack of sensitivity for small tumor deposits. Therefore, complementary to improvements in imaging techniques, developments in more invasive diagnostic procedures, such as sentinel node biopsy (SNB) will add to the accuracy of diagnostic algorithms for the staging of the neck. [ABSTRACT FROM AUTHOR]

Background Sentinel node biopsy (SNB) in head and neck cancer is recently introduced as the staging technique of oral squamous cell carcinoma. We report the results of SNB in patients diagnosed with a T1-T2 oral squamous cell carcinoma and clinically negative (N0) neck in a single center. Methods A retrospective analysis of 90 previously untreated patients who underwent SNB between 2007 and 2012 was performed. The SNB procedure consisted of preoperatively performed lymphoscintigraphy, intraoperative detection using blue dye, and gamma probe guidance and histopathologic examination including step-serial sectioning (SSS) and immunohistochemical (IHC) staining. A positive SNB was followed by neck dissection, whereas regular follow-up with ultrasound-guided fine-needle aspiration cytology (FNAC) was done in case of a negative SNB. Results The lymphoscintigraphic identification rate was 98% (88 of 90 patients) and the surgical detection rate was 99% (87 of 88 patients). The upstaging rate was 30%. Sensitivity of SNB was 93% and the negative predictive value was 97%. The median follow-up was 18 months (range, 2-62 months). Overall survival (OS) and disease-free survival (DFS) for SNB negative were 100% and 84% and for SNB positive patients 73% and 88%, respectively. Conclusion SNB is a reliable diagnostic staging technique for the clinically negative neck in patients with early-stage (T1-T2, cN0) oral squamous cell carcinoma. © 2014 Wiley Periodicals, Inc. Head Neck, 2014 © 2014 Wiley Periodicals, Inc. Head Neck 37: 573-578, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs and quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularized tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis. Data Sources: English language literature from 2004 to 2013. Review Methods: We searched the English language literature for articles published on the subject from 2004 to 2013. Results: Adequate data was available to identify pooled incidence rates from seven articles. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by one-third. Conclusion: This pooled analysis suggests that there is a clear advantage in using vascularized tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair. [ABSTRACT FROM AUTHOR]

Background The role of sentinel node biopsy in head and neck cancer is currently being explored. Patients with positive sentinel nodes were investigated to establish if additional metastases were present in the neck, their distribution, and their impact on outcome. Methods In all, 109 patients ( n = 109) from 15 European centers, with cT1/2,N0 tumors, and a positive sentinel lymph node were identified. Kaplan-Meier and univariate and multivariate logistic regression analysis were used to identify variables that predicted for additional positive nodes and their position within the neck. Results A total of 122 neck dissections were performed in 109 patients. Additional positive nodes were found in 34.4% of cases (42/122: 18 same, 21 adjacent, and 3 nonadjacent neck level). Additional nodes, especially if outside the sentinel node basin, had an impact on outcome. Conclusions The results are preliminary but suggest that both the number and the position of positive sentinel nodes may identify different prognostic groups that may allow further tailoring of management plans. © 2012 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Background Parotidectomy is a common procedure and Frey's syndrome (gustatory sweating) is a common side effect. The current literature was assessed concerning the effectiveness of the sternocleidomastoid muscle (SCM) flap to prevent Frey's syndrome after parotidectomy. Methods A bibliography search was conducted for studies published between 1966 and 2010 and included randomized controlled trials (RCTs) or cohort studies with patients undergoing parotidectomy with facial nerve preservation. The outcome measures of particular interest were the incidence of Frey's syndrome and cosmetic impairment. Results In all, 12 studies were selected (1 meta-analysis of all interventions to prevent Frey's syndrome, 2 RCTs, and 9 cohort studies). The trials were too heterogeneous to perform a meta-analysis on the effect of the SCM flap. The results reported by the authors of each study suggest an objective decrease in Frey's syndrome when the SCM flap was used, but there was no difference in the patients' subjective reporting of symptoms. However, this conclusion is prone to the biases inherent in these studies, and thus overall it is impossible to make any recommendation. Conclusion Current reported evidence is inconclusive as to the use of SCM muscle flap as an intervention to prevent Frey's syndrome following parotid surgery. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Retropharyngeal lymph node (RPLN) metastasis of primary head and neck cancer often receives less consideration than lymph node metastasis in the neck. With improvements in imaging techniques and reports of surgical pathology, there is an improved understanding of the risk and subsequently the need for treatment of RPLNs. The rates of RPLN metastasis from carcinomas of the nasopharynx, oropharynx, hypopharynx, postcricoid region, maxillary sinus, and cervical esophagus are sufficiently high to warrant routine treatment, either electively or therapeutically, of this region. Through improved diagnostic techniques and heightened awareness of RPLN metastasis, patients at risk of having these metastases can be treated more effectively. © 2010 Wiley Periodicals, Inc. Head Neck, 2010 [ABSTRACT FROM AUTHOR]

Background. Sinonasal cancer is a relatively uncommon entity encountered by head and neck oncologists, rhinologists, and skull base surgeons. Recent innovations in surgical and nonsurgical therapeutic modalities raise the question of whether there has been any measurable improvement for treatment outcomes. Methods. A retrospective review of data from recent studies that focus on surgery, radiation, and chemotherapy, or combinations thereof, was conducted. Results. Surgery continues to be the preferred treatment and provides the best results, albeit with an inherent bias based on patient selection. For advanced disease (T4 lesions), the survival rate remains only modest. Complications of treatment, including both surgical and radiation therapy, have been reduced. Conclusions. There is a need to improve the efficacy of treatment for this disease. Recommendations for the future direction of therapeutic investigations are outlined. © 2010 Wiley Periodicals, Inc. Head Neck, 2010 [ABSTRACT FROM AUTHOR]

In laryngeal, hypopharyngeal, and cervical esophageal carcinomas, the paratracheal lymph nodes (PTLN) may be at risk for lymph node metastasis. The presence of PTLN metastasis is an important prognostic factor for the development of mediastinal and distant metastases, stomal recurrence, and disease-free and overall survival. Studies on PTLN metastasis are scarce. In most studies, PTLN dissection has not been routinely performed, and selection criteria for PTLN dissection are usually not well defined. Therefore, in most reported studies, selection bias is present and results are difficult to compare. The reported prevalence of PTLN metastases varies according to the site and stage of the primary tumor: subglottic cancer, transglottic cancer, and glottic cancer with subglottic extension have a higher risk of PTLN metastases. Diagnostic imaging is not sufficiently reliable to detect occult PTLN metastases and avoid unnecessary PTLN dissections. PTLN dissection is associated with limited morbidity, but damage to major vessels may occur, and because of exposure of these vessels PTLN may increase the morbidity of fistulae that can occur after total laryngectomy. The dissection may produce hypocalcemia, if performed bilaterally. Nevertheless, the limited morbidity and high rate of metastasis in specific laryngeal, hypopharyngeal, and cervical esophageal carcinomas argue in favor of routine elective PTLN treatment for these tumors. Large prospective studies are needed to identify the patients at risk with primary tumors in more detail. Moreover, improved diagnostic imaging is needed to detect (occult) PTLN metastases more reliably. Based on future studies, clinical guidelines have to be developed to avoid undertreatment and overtreatment. © 2010 Wiley Periodicals, Inc. Head Neck, 2011 [ABSTRACT FROM AUTHOR]

We report here a review of the literature intended to clarify the nomenclature and boundaries of the nodes in the 'central compartment' of the neck, the frequency with which tumors from the different laryngeal sites metastasize to these nodes, and the indications for central compartment node dissection in the treatment of cancers of the larynx. From this review, we conclude that, until consensus is reached about grouping of the lymph nodes in this area, it is best to refer to these nodes by their anatomic location, ie, prelaryngeal, pretracheal, or paratracheal lymph nodes. It is also advisable to describe dissection of these nodes as selective neck dissection (SND) with an annotation about the specific lymph node groups removed. Metastases in prelaryngeal and paratracheal lymph nodes in patients with squamous cell carcinoma of the larynx are associated with increased tumor recurrence, more frequent metastases in lymph nodes of the lateral compartment of the neck, and decreased survival. If untreated, they may lead to the development of peristomal recurrence. Therefore, elective treatment of level VI nodes is recommended in patients with squamous cell carcinomas of the subglottic region, advanced glottis carcinomas with subglottic extension, and in certain advanced carcinomas of the supraglottic region. © 2010 Wiley Periodicals, Inc. Head Neck, 2011 [ABSTRACT FROM AUTHOR]

The author reflects on the proposal for a rational nomenclature of neck dissections. He mentions that it is important to have precise classification for different types of neck dissection for research and clinical purposes. He adds that techniques in neck dissection have evolved, however, this was applied less globally. He notes that the lack of international acceptance needs an international nomenclature for cervical nodal groups and neck dissections.

Objectives/Hypothesis: To assess the impact of patient reported voice outcome on quality of life and emotional functioning in patients treated for recurrent respiratory papillomatosis (RRP). Study Design: Cross-sectional. Methods: All adult patients treated for RRP between 1984 and 2008 were asked to participate. Outcome measures were obtained from questionnaires including VHI (Voice Handicap Index), HADS (Hospital Anxiety and Depression Scale), 36-Item Short Form Health Survey (SF-36), and Utrechtse Coping List. Results: Out of 45 included patients, 34 (22 males,12 females) participated (76%). Mean age was 52 years (range, 25-85 years). RRP was located only in the larynx in 90% of the cases. Adult onset RRP was diagnosed in 29 cases, juvenile onset RRP in 5. Median number of surgical procedures was five (range, 1-17). In this study cohort, 68% scored above the VHI cutoff point, and 18% had an increased risk for depression or anxiety disorders (HADS). VHI scores were related to age, time between consecutive surgeries, time since last surgery, and passive coping. They were not related to gender, onset of RRP, or location. VHI scores were related to the SF-36 subscales social functioning ( r = −0.43) and mental health ( r = −0.43). Conclusions: Patients with RRP often report voice problems in daily life, and this is related to (a passive) coping style, social functioning, and mental health. Psychosocial intervention targeting an adaptive coping style may be beneficial in selected cases. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Background The objective of this study was to evaluate the effectiveness and safety of our careful observational strategy and neck dissections and the accuracy of ultrasound-guided fine-needle aspiration cytology, and to determine the prognostic factors for outcome and regional control after primary chemoradiation. Diagnostic evaluation of the regional status after concurrent chemoradiation for advanced head and neck cancer remains difficult, and the indications for a salvage neck dissection and its extent are not clearly defined. Methods In a series of 540 patients, there was suspicion of regional residual or recurrent disease after chemoradiation in 61 patients who underwent 68 salvage neck dissections and 68 patients who were considered unresectable. For the patients with salvage neck dissection, the accuracy of ultrasound-guided fine-needle aspiration cytology was determined. Disease control in the neck, disease-specific and overall survival, and parameters that may have prognostic value for the outcome were evaluated. Results Neck dissection specimens contained viable tumor in 26 (43%) patients. Of these, 13 had selective neck dissections and 13 modified radical neck dissections. Ultrasound-guided fine-needle aspiration cytology had a sensitivity of 80% and specificity of 42%. Nine patients developed a regional recurrence after salvage neck dissection (5 located in contralateral neck). Five-year regional control and overall survival rates were 79% and 36%, respectively. Significant prognostic factors for overall survival were surgical margins and “residual versus recurrent disease” in multivariate analysis. Conclusion Considering the good regional control rate and the high rate of unnecessary neck dissections with a theoretical planned neck dissection strategy, we conclude that a careful observational strategy is worthwhile and safe. For the evaluation of radiation treatment response, ultrasound-guided fine-needle aspiration cytology has a low specificity. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [ABSTRACT FROM AUTHOR]

Background. Treatment of head and neck mucosal melanoma remains a challenge. Surgery has traditionally been the main therapeutic approach. The role of postoperative radiotherapy has never been clearly established. Methods. The experience with a group of 42 patients (16 males, 26 females) with a primary head and neck mucosal melanoma is reported. Results. Eleven of 19 patients (57.9%) receiving surgery alone developed a regional lymphatic metastasis. For patients receiving postoperative radiotherapy (19 patients), regional metastatic spread occurred in 4 patients (21%). Percentages of local failure were 57.9% (11/19) and 26.3% (5/19) for patients treated with surgery alone and for those treated with surgery and radiotherapy, respectively. Distant metastases occurred in 10 of 19 patients (52.6%) receiving surgery alone and in 9 of 19 patients (47.3%) receiving both therapies. Conclusions. The present evaluation confirms a poor prognosis for patients with head and neck mucosal melanoma, independent of the treatment modality. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [ABSTRACT FROM AUTHOR]

Background Diagnosing recurrent laryngeal tumor after radiotherapy is challenging. The most reliable method is direct laryngoscopy under general anesthesia. However, many futile laryngoscopies are performed in disease-free patients. Imaging tests selecting patients for this invasive procedure would be useful. The aim of this systematic review was summarizing the available evidence and determining the diagnostic accuracy of CT, MRI, thallium-201 (201Tl) scintigraphy, and F-18-fluorodeoxyglucose positron emission tomography (18FDG-PET). Methods A systematic review was performed according to the guidelines of the Cochrane Collaboration. Two reviewers scored the articles according to A-, B-, and C-items. Statistical meta-analysis was performed producing summary pooled estimates of sensitivity and specificity. Results There were 8 eligible studies on 18FDG-PET. The validity of the 18FDG-PET studies was reasonable; the pooled estimates (95% CI) for sensitivity and specificity were 89% and 74%. Conclusion The diagnostic accuracy of 18FDG-PET is promising and warrants a randomized trial comparing a strategy based on conventional diagnostic work-up to one based on 18FDG-PET. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [ABSTRACT FROM AUTHOR]

Almost all patients who undergo parotidectomy will to some extent develop Frey syndrome (auriculotemporal syndrome or gustatory sweating) after surgery, because of aberrant regeneration of cut parasympathetic fibers between otic ganglion and subcutaneous vessels. However, only the minority of these patients needs treatment. The syndrome consists of gustatory sweating, flushing, and warming over the preauricular and temporal areas. Thick skin flap and partial superficial parotidectomy are the most important techniques to minimize the risk of developing symptomatic Frey syndrome. Intracutaneous injection of botulinum toxin A is an effective, long-lasting, and well-tolerated treatment of Frey syndrome. If recurrence occurs, the treatment can be repeated. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to analyze swallowing outcome in advanced oral/oropharyngeal cancer patients treated with microvascular reconstructive surgery and adjuvant radiotherapy. Methods. Eighty patients were included. Patient, tumor, and treatment factors were assessed. Postoperative videofluoroscopic swallowing studies (VFSS) and scintigraphy tests were performed at 6 (n = 54 vs 44) and 12 (n = 32 vs 37) months. Swallowing parameters such as the oropharyngeal swallow efficiency and the Penetration/Aspiration Scale were analyzed. Results. Impaired swallowing status was found at 6 months, which remained stationary at 12 months. Comorbid condition, larger tumors (T3-T4 vs T2), and resections of the base of tongue and soft palate combined (vs defects of other dynamic structures) were associated with most profound swallowing problems (p < .05). Conclusions. Swallowing difficulties are relatively frequent and can to a large extent be predicted. With the knowledge of this study, better counseling and vigilance as to swallowing difficulties may be possible. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [ABSTRACT FROM AUTHOR]

Background. Thoracic duct cysts of the cervical portion are rare benign lesions for which surgery is the treatment of choice. Methods. We present 2 cases of a thoracic duct cyst of the cervical portion. One patient was treated by surgery and the other patient by ethanol sclerotherapy. Results. After establishing diagnosis by radiologic assessment and chemical and cytological fine-needle aspirate of the cystic masses, both patients were treated successfully. Conclusion. Ethanol sclerotherapy provides an alternative therapy for thoracic duct cyst when evaluation establishes a high likelihood of clinical diagnosis. © 2006 Wiley Periodicals, Inc. Head Neck, 2007 [ABSTRACT FROM AUTHOR]

Background. The purpose of this retrospective study was to determine the long-term effects of radiotherapy on hearing function in patients who underwent parotidectomy and postoperative radiotherapy for unilateral tumors of the parotid gland. Methods. An extensive set of tests was used to measure hearing loss. The mean dose on middle ear, cochlea, and Eustachian tube was estimated with a CT-planning system. Results. A hearing loss of ≥ 15 dB in 3 frequencies was found in 32% of the 52 patients included in the study. Patients with an asymmetrical hearing loss received a higher mean dose on the hearing structures (p < .002). The threshold dose for clinically relevant hearing loss was found at 50 Gy on the cochlea and Eustachian tube. Conclusions. Radiation-induced hearing loss is a common complication. A mean dose of > 50 Gy on the cochlea should be avoided. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The detection of distant metastases during screening influences the choice of treatment in patients with head and neck squamous cell carcinoma. A previous study in the authors' institution showed that chest computed tomography (CT) scan was the most important screening technique. Different clinical risk factors in patients with head and neck squamous cell carcinoma for the development of distant metastases were identified. Study Design: Retrospective cohort study. Methods: To evaluate the authors' diagnostic strategy, the accuracy of screening for distant metastases with chest CT in 109 consecutive patients with head and neck squamous cell carcinoma with risk factors between 1997 and 2000 was retrospectively analyzed. Results: Preoperative screening with CT revealed 20 patients (18%) with lung metastases and 1 liver metastasis. Despite negative screening with chest CT, 9 (11%) patients developed distant metastases within 12 months during follow-up. Sensitivity of the chest CT was 73%; the specificity was 80%. Conclusion: Although chest CT frequently detects distant metastases, there seems to be a need for a more sensitive and whole-body screening technique. [ABSTRACT FROM AUTHOR]

Background. The aim of the study was to analyze speech outcome for patients with advanced oral/oropharyngeal cancer treated with reconstructive surgery and adjuvant radiotherapy. Methods. Speech tests (communicative suitability, intelligibility, articulation, nasality, and consonant errors) were performed in a control group and in patients before treatment (n = 76), and 6 months (n = 51) and 12 months (n = 42) after treatment. Results. Speech tests were significantly worse for patients before and after treatment compared with the controls. Speech did not improve between 6 and 12 months. After treatment, patients with T3–4 tumors showed a significantly worse score for communicative suitability, intelligibility, and articulation than patients with T2 tumors. No significant differences were found for subsites after treatment, although patients with mobile tongue tumors showed the best results. Conclusion. Speech difficulties are significant, and with the knowledge of this study better counseling and vigilance as to speech difficulties may be possible in patients undergoing treatment for oral/oropharyngeal cancer. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX–XXX, 2005 [ABSTRACT FROM AUTHOR]

Objectives The detection of distant metastases at initial evaluation may alter the selection of therapy in patients with head and neck squamous cell carcinoma (HNSCC). In this study the value of screening for distant metastases is evaluated. Study Design Retrospective analysis. Methods The results of screening for distant metastases were retrospectively analyzed in 101 consecutive HNSCC patients with high-risk factors who were scheduled for major surgery. All patients had computed tomography (CT) scan of the thorax, bone scintigraphy, examination of the liver by ultrasound and/or CT scan, and blood tests. Results Distant metastases were found in 17% of the patients. Patients with four or more clinical lymph node metastases or low jugular lymph node metastases had the highest incidence of distant metastases (33%). CT scan of the thorax detected in 12 patients, lung metastases; in 4, mediastinal lymph node metastases; and in 2, primary lung tumors. Bone scintigraphy detected in four patients bone metastases; in all four patients lung or mediastinal lymph node metastases were also found. Ultrasound and/or CT scan of the liver revealed one patient with metastases. Blood tests did not show any significant difference between patients with or without bone or liver metastases. Conclusions Screening in patients with three or more lymph node metastases, bilateral lymph node metastases, lymph nodes of 6 cm or larger, low jugular lymph node metastases, locoregional tumor recurrence, and second primary tumors revealed distant metastases in 10% or more. CT scan of the thorax is currently the single most important diagnostic technique for screening of distant metastases. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A rational approach to pulmonary screening in newly diagnosed head and neck cancer," by K. S. Loh, D. H. Brown and others in the 2005 issue.

Background: The objective of this study is to obtain insight into distress in spouses and patients treated for head and neck cancer., Methods: Forty-one patient-spouse pairs completed the Hospital Anxiety and Depression Scale (HADS). Inclusion criteria included curative treatment for head and neck cancer. Exclusion criteria were visiting the clinic without a spouse, bad news at the routine follow-up examination, diseases causing cognitive dysfunction, and poor understanding of the Dutch language. Next to the HADS, the assessment protocol included age, gender, health status, coping strategy, time since cancer treatment, tumor stage and site, treatment modality, functional and social impairment, and caregiving burden., Results: A clinical level of distress was noted in 20% of the spouses and in 27% of the patients. Distress in spouses was related to the presence of a feeding tube in patients, a passive coping style, less vitality, and a disrupted daily life schedule resulting from caregiving. Distress in patients was related to the presence of a feeding tube, speech and swallowing problems, less social contacts, a passive style of coping, and nonexpression of emotions., Conclusion: Distress is often present in spouses and patients treated for head and neck cancer. Routine screening for psychologic distress is recommended.